BC Sessional Papers

Ministry of Health ANNUAL REPORT 1978 British Columbia. Legislative Assembly 1979

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 PROVINCE OF BRITISH COLUMBIA
Ministry of Health
ANNUAL REPORT
1978
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1979
  Hon. Robert H. McClelland.
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 1978.
R. H. MCCLELLAND
Minister of Health
Office of the Minister of Health,
Victoria, B.C., March 27,1979.
 Ministry of Health, Victoria, B.C., March 27, 1979
The Honourable R. H. McClelland,
Minister of Health, Victoria, B.C.
Sir: I have the honour to submit the Annual Report of the Ministry of Health
for 1978.
CHAPIN KEY
Deputy Minister of Health
 MINISTRY OF HEALTH
The Honourable R. H. McClelland, Minister of Health
J. W. Mainguy,1 Deputy Minister of Health
C. Key,2 Deputy Minister of Health
PLANNING AND SUPPORT SERVICES
J. Bainbridge
Assistant Deputy Minister
F. G. Tucker
Consultant in Mental Health
W. Dietiker
Director of Data Processing
W. F. Locker
Director of Personnel
M. L. Chazottes
Director of Health Promotion and Information
J. S. Bland
Consultant in Geriatrics
COMMUNITY HEALTH PROGRAMS
K. I. G. Benson
Assistant Deputy Minister, Public Health Programs and Provincial Health Officer
J. H. Doughty
Director of Administration
W. D. Burrowes
Director, Division of Vital Statistics
W. Bailey
Director, Division of Environmental Engineering
L. M. Crane
Director, Division of Public Health Nursing
A. A. Larsen
Director, Division of Epidemiology
F. McCombie3
Director, Division of Dental Health Services
A. Gray
Acting    Director,    Division    of    Dental
Health Services
H. J. Price
Comptroller
R. G. Scott
Director,  Division of Public Health  Inspection
P. Wolczuk
Director, Division of Community Nutrition
G. D. Zink
Director, Division of Speech and Hearing
Special Health Services
J. H. Smith
Director, Bureau of Special Health Services
W. J. Bowmer
Director, Division of Laboratories
C. E. Bradbury
Director, Division of Aid to Handicapped
H. K. Kennedy
Director, Division of Venereal Disease
Control
i On pre-retirement leave effective October 31, 1978.
- Appointment effective November 1, 1978.
" Retired effective September 30, 1978.
L. D. Kornder
Director, Division of Occupational Health
F. D. Mackenzie
Director, Division of Tuberculosis Control
 MEDICAL AND HOSPITAL PROGRAMS
Hospital Programs
J. G. Glenwright
Assistant Deputy Minister
P. M. Breel
H. R. McGann
Senior Director
C. F. Ballam
Senior Medical Consultant
A. C. Laugharne
Director, Hospital Consultation and Inspection Division
R. H. Goodacre
Director, Research Division
Director, Hospital Finance Division                     "• " Fisher
Director, Hospital Construction and Plan-
J. D.Herbert                                                              ning Division
Director, Administrative Services Division
Medical Services
D. H. Weir
Chairman
R. B. H. Ralfs
A. W. Brown
Director, Salaried and Sessional Programs               Director, Plan Administration
D. M. Bolton
R. A. Munro
Senior Medical Consultant
Director of Financial Services
Commissions, Etc.
H. F. Hoskin
J. Duffy
Chairman, Alcohol and Drug Commission              Executive Director, Forensic Psychiatric
of British Columbia                                                    Services Commission
D. H. Weir
I. Manning
Chairman, Emergency Health Services                     Director of Government Health Insti-
Commission                                                                 tutions
P. Ransford
J. Bainbridge
Executive Director, Emergency Health                      Chairman, Provincial Adult Care Facili-
Services Commission                                                      ties Licensing Board
F. G. Tucker
M.Dahl
Chairman, Forensic Psychiatric
Commission
■ Services                 Chairman, Provincial Child Care Facilities Licensing Board
Mental Health Programs
A. Porteous
Assistant Deputy Minister
M. M. Lonergan4
D. Fernandez
Consultant in Nursing
Planning and Research Officer
Mrs. F. Ireland
R. S. McInnes
Co-ordinator, Boarding-home Program                     Co-ordinator of Mental Health Centres
J. B. Farry
A. G. Devries
Consultant in Social Work
Consultant in Phychology
E. Luke 5
Consultant in Psychiatry
78.
6
* Resigned effective February 28, 19
5 Appointed effective June 1, 1978.
 British Columbia Youth Development Centre
P. H. Adilman, Director, Residential and Day Unit
D. C. Shalman, Director, Psychological Education Clinic
Greater Vancouver Mental Health Services
J. Seager, Executive Director
Burnaby Mental Health Services
W. C. Holt, Director
Integrated Services for Child and Family Development (Victoria)
J. Ricks, Director
 MINISTRY OF HEALTH  (as from December 1, 1978)
ORGANIZATION CHART
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1
 MINISTRY OF HEALTH  (as from December 1, 1978)
  TABLE OF CONTENTS
Page
Year in Review      15
Demographic Features  22
Planning and Support Services  23
Program Development Group    23
Personnel  24
Health Promotion and Information    25
Data Processing  — 27
Community Care Facilities Licensing Board  28
Long-term Care Program  29
Public Health Programs  31
Introduction  31
Public Health Programs Highlights   32
Communicable and Reportable Disease  32
Health and Our Environment  37
Specialized Community Health Programs  44
Community Public Health Nursing Services    49
Home Care Programs   52
Dental Health Services    55
Nutrition Services  58
Vital Statistics    60
Aid to Handicapped  63
Laboratory Services  64
Action B.C  70
Council of Practical Nurses  71
Voluntary Health Agencies    71
Tables—
1—Reported Communicable Diseases, British Columbia,1974-78  72
2—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, 1966, and 1971-78  72
3—Selected Activities of Provincial Public Health Nurses, September 1,
1977, to August 31, 1978  73
4—Community Psysiotherapy New Patients/Visits, 1978  74
5—Physiotherapy Patients by Type of Care, 1978  74
6—Types of Community and Preventive Services  Carried  Out by
Physiotherapy Service, 1978  74
7—Selected Activities of Provincial Public Health Inspection, 1974-
78  .... 75
8—Registrations, Certificates, and Other Documents Processed by Division of Vital Statistics, 1977 and 1978  76
9—Case Load of Division for Aid to Handicapped, 1978  76
10—Tests Performed by Division of Laboratories, 1977 and 1978  78
11—Licensing of Practical Nurses   79
12—Hearing-impaired Cases by Degree and Type of Impairment, Division of Speech and Hearing, 1978    79
11
 Pace
13—Number of Cases Referred for Hearing Assessment, by Source, Division of Speech and Hearing, 1978  79
14—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1978   80
15—Number of Community Care Facilities and Capacities, by Permit
Status for the Three Categories of Facility, 1975-78  80
Mental Health Programs
Introduction  81
Mental Health Programs Highlights  82
Community Mental Health Centres  82
Greater Vancouver Mental Health Service  89
Burnaby Mental Health Services  90
Integrated Services for Child and Family Development, Victoria  92
British Columbia Youth Development Centre, The Maples  92
Boarding-home Program  94
Consultants    96
Tables—
16—Patient Movement Data, Mental Health Facilities, 1978 .... 100
17—Patient Movement Trends, Mental Health Facilities, 1975-78  102
Hospital Programs
Introduction  103
Hospital Programs Highlights   104
Hospital Insurance Act  104
Hospital Act    105
British Columbia Regional Hospital Districts Act  106
British Columbia Regional Hospital Districts Financing Authority Act.::_ 107
Hospital Rate Board and Methods of Payment to Hospitals._   108
Hospital Consultation and Inspection Division    108
Research Division  111
Hospital Finance Division    ... 111
Hospital Construction and Planning Division  114
Medical Consultation Division  120
Administrative Services Division  121
Approved Hospitals  123
Statistical Data  126
Tables—
18—Patients Separated and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization) 127
19—Total Patient-days and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals Only (Excluding Federal, Private, Extended-care, and Out-of-Province Hospitalization) 127
20—Patients Separated, Total Patient-days and Average Length of Stay,
According to Type and Location of Hospital for Hospital Programs
Patients Only, and Days of Care per 1,000 of Covered Population 128
21—Summary of the Number of Hospital Programs In-patients and Outpatients, 1973-78  128
12
 22—Summary of Hospital Programs Out-patient Treatments, by Category, 1973-78  -	
23—Patients Separated, Total Days' Stay, and Average Length of Stay
in British Columbia Public Hospitals for Hospital Programs Patients
Only, Grouped According to Bed Capacity, 1978 (Excluding
Extended-care Hospitals)	
Page
129
129
24—Percentage Distribution of Patients Separated and Patient-days for
Hospital Programs Patients Only, in British Columbia Public Hospitals, Grouped According to Bed Capacity, 1978 (Excluding
Extended-care Hospitals)  „. 129
Charts—
I—Percentage Distribution of Days of Care by Major Diagnostic
Groups, Hospital Programs, 1977  131
II—Percentage Age Distribution of Male and Female Hospital Cases
and Days of Care, Hospital Programs, 1977  132
III—Percentage Distribution of Hospital Cases, by Type of Clinical Service, Hospital Programs, 1977  133
IV—Percentage Distribution of Hospital Days, by Type of Clinical Service, Hospital Programs, 1977  134
V—Average Length of Stay of Cases in Hospitals in British Columbia,
by Major Diagnostic Groups, Hospital Programs, 1977 (Excluding
Newborns) ■_  135
Medical Services Commission
Introduction  137
Medical Services Commission Highlights  138
Benefits Under the Plan  138
Services Excluded Under the Plan  140
Premium Rates and Assistance  141
Laboratory Approval  141
Professional Review Committees     141
Salaried and Sessional  142
Statistical Tables...   142
Tables—
25—Registration and Persons Covered, by Premium Subsidy Level, at
March 31,1978  143
26—Persons Covered, by Age-group, at March 31, 1978  143
27—Coverage, by Family Size, at March 31, 1978  144
28—Distribution  of  Fee-for-service  Payments  for  Medical  Services
(Shareable )  145
29—Distribution of Medical Fee-for-service Payments and Services, by
Type of Service  146
30—Average Fee-for-service Payments, by Type of Practice    147
31—Distribution of Fee-for-service Payments for Insured Services, Non-
shareable Additional Benefits  147
32—Average Fee-for-service Payments, by Type of Practice, Nonshare-
able Additional Benefits    148
33—Summary of Expenditures, 1969/70 to 1977/78  148
13
 Page
Charts—
VI—Coverage, by Age-group, at March 31, 1978  143
VII—-Coverage, by Family Size, at March 31, 1978  144
Government Health Institutions  149
Emergency Health Services Commission    154
Forensic Psychiatric Services Commission  157
Alcohol and Drug Commission    158
MINISTRY OF HEALTH EXPENDITURES, 1977/78
Financial Tables and Chart
Tables—
34—Expenditure, by Principal Categories, in the Ministry of Health for
the Fiscal Year 1977/78  164
35—Detailed Expenditure, by Principal Categories, in the Ministry of
Health for the Fiscal Year 1977/78  165
36—Statement of Financial Position as at March 31, 1978, of The Medical Services Plan of British Columbia  168
37—Statement of Operations and Working Capital Deficiency for the
Year Ended March 31, 1978, of The Medical Services Plan of
British Columbia   169
Chart—
VIII—Expenditure, by Principal Categories, in the Ministry of Health
for the Fiscal Year 1977/78      164
14
 THE YEAR IN  REVIEW
—C. KEY, Deputy Minister
On November 1, 1978, Jim Mainguy, Deputy Minister of Health, retired after
38 years in the Public Service. Mr. Mainguy gave exemplary service to the Province in a number of capacities, starting in the Vital Statistics Division in 1941 and,
finally, serving four years as Deputy Minister. Throughout these years Mr. Mainguy
was active in Provincial and Federal affairs.
Mr. Mainguy leaves the Public Service with the same vigour and youthfulness
that accompanied his first employment. He is respected by all who know of him
and his retirement is well earned, although the Ministry will miss him greatly.
A significant event for the Ministry of Health took place toward the end of
1978. In October, members of senior management in the Ministry met to consider
and develop a purpose for the Ministry as long-range objectives, which could be
used as a guide for operations over a prolonged period.
These senior members of the Ministry applied their administrative professional
knowledge and experience to set down objectives and guidelines for the provision
of an equitable health delivery system in the Province.
The purpose and long-range objectives will be valuable in an administrative
sense for advising on the development of public policy, as well as managing the
co-ordination of diverse functional activities within Ministry staff. Out of the
stated purpose the objectives were developed and are as follows:
A. Purpose:
To provide leadership and direction in the promotion and safeguarding of an
optimum state of health, for all residents of the Province, with due regard to
financial limitations, by ensuring the provision of services through the efficient
use of available resources and by stimulating personal, family, and community
responsibility and involvement.
B. Objectives:
1. To promote programs of a preventive nature as well as other alternatives
in order to contain rising costs of health care.
2. To foster a responsive organization of the Ministry of Health which facilitates effective communication, co-operation, and co-ordination and achieves
a planning and evaluation capability supported by an integrated health
information system.
3. To provide an effective delivery system throughout the Province which
provides equitable access to preventive and treatment programs.
4. To implement a Province-wide public education program dealing with their
(a) financial responsibility and utilization of services,
(b) lifestyle and attitudes,
(c) personal, family, and community involvement.
5. To identify and reduce environmental hazards to health in co-operation
with other ministries and agencies.
Out of these objectives grew the following organization, with an overt
emphasis on Health Promotion as well as Planning and Development to aid the
newly co-ordinated functions of Professional and Institutional Services (Hospital
Programs, the Medical Services Commission and the Emergency Health Services
Commission) and Community Health Services (Public Health Services, Mental
Health, and Long-term Care).
15
 16 MINISTRY OF HEALTH REPORT,  1978
The reorganization involved new senior appointments, some reallocation of
duties, and a change in reporting patterns for several sections of the Ministry. While
not all appointments to the new positions had been finalized by the fiscal year-end,
the following senior positions had been created: Senior Assistant Deputy Minister,
Professional and Institutional Services; Senior Assistant Deputy Minister, Community Health Services; Executive Director, Planning and Development; Executive
Director, Health Promotion and Information. Other senior positions remained
much as in the past except where responsibilities were realigned as mentioned below.
The reorganization brought together sections of the Ministry which provide
service of a similar nature, with the aim of improving delivery of services by a
common understanding of work function between similar sections of the Ministry
of Health, and providing a greater flexibility of funding between these similar types
of operation.
Under the reorganization, Direct Care Community Services will be responsible
for the following operations within the Ministry: Long-term Care, Home Care,
Health Agency funding, Mental Health, and Government Institutions.
Preventive and Special Community Services encompass Public Health Nursing,
Dental Services, Vision Services, Public Health Inspection, Speech and Hearing
Services, and those functions previously a part of the Bureau of Special Services,
including the Provincial Laboratory.
Support Services comprise the centralized functions of Personnel, Building
Services, Accounting, Budgeting, and Management Services.
Planning and Development will cover, when firmly established, Planning,
Development, Evaluation and Research, Professional Consultants, Vital Statistics,
Education Liaison, and Rehabilitation Services.
As part of the realignment of health promotion activities within the Ministry,
the following operations come under Health Promotion: Information Services, the
Audiovisual Production Centre, Health Education, Nutrition Services, Occupational
Health, and Action B.C.
Heroin Treatment Program
The staff of the Alcohol and Drug Commission spent much time in the past
year preparing for British Columbia's heroin treatment program, which was scheduled to begin on January 1, 1979, with phase one becoming responsible for those
heroin users under treatment, and providing withdrawal services to users who
volunteer for treatment.
Phase two was due to commence on April 1, 1979, to cover both voluntary
patients and those heroin users who have been referred by the courts.
Phase three was due to come into effect in July or August 1979 to cover police
referrals. Those users who are known to the police will then be referred to the
program for assessment and treatment.
New treatment centres are planned to open in Kelowna, Prince George,
Nanaimo, Victoria, Campbell River, Surrey, Chilliwack, and New Westminster, as
well as four community clinics in Vancouver. The Provincial co-ordinating centre
for the program will also be located in Vancouver.
During the first quarter of 1979, the treatment centre at Brannan Lake near
Nanaimo will be prepared for operation. The first patients are expected to begin
treatment there in April.
The program is expected to be a key factor in helping to overcome the massive
problem of heroin dependency, and was prompted by the fact that 60 per cent of
Canada's heroin-user population is located in British Columbia.
 YEAR IN REVIEW 17
Long-term Care
The Long-term Care Program, introduced January 1, 1978, has proved to be
very successful. As of October 31, over 40,000 applications had been processed
by the 22 health units in the Province. Of these, over 39,000 were considered
eligible. Projected calculations would indicate that approximately 43,000 residents
would have been considered eligible by the year-end.
At the end of October, 17,618 individuals were under care in Long-term Care
facilities, including public and extended-care hospitals, and 11,714 were receiving
care services in their homes from 77 homemaker agencies. Review care teams were
established to investigate complaints alleging unfair billing being charged to patients
by a few private operators. It was considered in the best interest of the operators
and the general public for a team to visit all persons receiving care and review all
allegations.
Mental Health Services
There were over 9,000 therapy sessions per month provided at the Province's
31 mental health centres. In addition, an average of over 7,000 hours of service
per month was provided to community agencies and groups. Services provided
were client consultation and education. During the year services were extended to
rural regions through the opening of suboffices in Salmon Arm, Osoyoos, Fernie,
Merritt, and Campbell River. Other suboffices are soon to be opened in Castlegar,
Dawson Creek, Port Hardy, Quesnel, Burns Lake, and the Queen Charlottes.
Admissions to the Greater Vancouver Mental Health Service were over 2,000 cases
during the year, and the year-end case load was over 2,700 cases.
A project was set up to assess the delivery of mental health services in British
Columbia headed by Dr. John Cumming. The purpose of the project is to study
the many facets of mental health care in the Province and to make recommendations
which will improve the co-ordination and delivery of these services. Dr. Cumming
has previously served as Consultant and Program Analyst in The University of
British Columbia.   The study is expected to take a full year to complete.
Hospital Services
Gross operating expenses for public general, rehabilitation, and extended-care
hospitals for 1978 amounted to approximately $617 million. This amounts to
approximately one-half of the total Ministry budget; the maintenance of British
Columbia's hospital system being the largest single item in the Provincial budget.
The present method of funding hospitals was developed 30 years ago and the
equitable allocation of funds to these institutions has been increasingly more difficult.
While it has been modified over time, it does not adequately reflect today's
hospital system with its emphasis on ambulatory' and day-care programs, care provided by special categories of hospitals and health agencies, as well as the rapid
advance in technology.
The British Columbia Health Association and the Health Ministry are jointly
making a major analysis of the British Columbia hospital's funding system. Known
as the Hospital Funding Project, it involves officials of the Ministry, BCHA, and
individual hospitals, in a review of the procedures of budgeting and standards used
to meet day-to-day operating costs.
The aim of the project is to assure a funding system that allocates funds
equitably for optimum patient care in this Province. The analysis is particularly
timely because of the impact of changes that have recently occurred in Federal-
Provincial funding arrangements for hospital care.   The project is managed by a
 18 MINISTRY OF HEALTH REPORT,  1978
joint steering committee composed of representatives of the Ministry and BCHA.
It already has established terms of reference and has engaged the consulting firm
of Ernst and Ernst of Vancouver, which has available to it a wide range of expertise
in the systems related to hospital funding.
During the year a whole-body computerized axial tomography (CAT) scanner
was approved for the Vancouver General Hospital; the Royal Jubilee Hospital,
Victoria; and the A. Maxwell Evans Clinic, Vancouver. The cost of each scanner,
including installation, is approximately $1 million. A head scanner was approved
for the Prince George Regional Hospital and one is presently in use at the Vancouver General.
Four regional hospitals—Prince George, Kamloops, New Westminster, and
Victoria—have been designated special care centres (Level II) for at-risk babies.
The intention of the program is to upgrade this Province's perinatal services.
Special skills and equipment will be concentrated in these few, easy-to-reach centres
because staff of all disciplines cannot maintain the necessary expertise to deal with
these seriously ill babies unless they have frequent exposure to a relatively large
volume of problem cases.
Special care nurseries in Victoria will be available at both Royal Jubilee and
Victoria General until the latter's facilities are relocated on Helmcken Road, in the
early 1980's.
In 1978, 18 major hospital projects were completed, involving an estimated
$90.25 million. This construction program included the following extended care
hospitals: Langley (75 beds), Mission (50 beds), Oliver (75 beds), and Glengarry
in Victoria (150 beds). In addition, a new 27-bed general hospital was completed
at Sparwood, and a major expansion and renovation program was completed at
Burnaby General Hospital, Fort Nelson, Royal Columbian (New Westminster),
and St. Vincent's in Vancouver. Fire protection upgrading programs were carried
out at Shaughnessy, Sunny Hill, and Vernon Jubilee.
Approval was authorized by the Provincial Government and the Capital
Regional Hospital District to allocate $44 million to replace the existing Victoria
General Hospital on a 34-acre site located at the intersection of Helmcken and the
Trans-Canada Highway, in Victoria's western community. The proposed 469-bed
acute-care facility will include pediatric and obstetrical services. The present institution will remain in the downtown Victoria area and will have an important role
as a health facility when its physical facilities have been appropriately renovated.
Funds totalling $4 million were allocated for the redevelopment of the Prince
George Regional Hospital to enable it to fulfil its role as a regional centre.
At the year-end there were 5,621 extended-care beds in the Province and
about 680 additional extended-care beds under construction or in planning stages.
In all, 390,150 eligible adult and child patients were discharged from hospitals
in 1978, an increase of 3,278 or 0.85 per cent more than in 1977; 95.6 per cent of
all patients discharged were covered by Hospital Programs.
A new screening program for newborn infants was added to existing programs
in 1978. Newborns will be screened for hypothyroidism, which is a congenital
dysfunction of the thyroid gland. Cost of the new program is estimated at $180,000
a year and it is expected that two to four new cases will be detected annually and
prevented from becoming cretinous. Because of the importance of this type of
program as a preventive measure, a permanent Advisory Committee concerned
with screening programs for inborn errors of metabolism had been formed.
 YEAR IN REVIEW
19
Vancouver General Hospital
A major incident arose during the past year which bears mention because of its
impact in the news media and its effect on the Province's largest hospital. The
issues, in the main, revolved around the adequacy of nursing care within the hospital
and the adequacy of nursing input into the decision-making levels. Management's
attempts to resolve these issues resulted in further unrest which precipitated public
concern in regard to the quality of care provided. As a consequence, the Minister,
on August 11, appointed Peter Bazowski as public administrator of the hospital to
attempt to resolve the conflict which had arisen. As a consequence of Mr. Baz-
owski's recommendations, the Minister, on November 10, appointed Mrs. Marie
Taylor as Chairman and reconstituted an Interim Board of Trustees.
The Minister listed these major guidelines which he expected the interim
board to follow.
• The establishment of a vice-president of nursing.
• The establishment of a professional advisory committee from members of
the hospital staff.
• Review of the contract between VGH and UBC to ensure that the relationship between these institutions is still appropriate.
• A redesign of the hospital's corporate structure in line with the interim
appointments.
The Minister assumed the role of public administrator so that the full resources
of the Ministry would be available to the new advisory board.
The Minister also announced at the same time that the hospital would be
allowed to create 60 additional full-time nursing positions immediately.
As the year drew to a close the Vancouver General Hospital appeared to be
returning to its normal activities with the co-operation of all of its staff.
Medical Services Commission
During the year the Commission continued to respond in an appropriate
manner to residents of the Province, with emphasis on prompt payment of physicians and attempting to improve relations with the public and health professions.
Changes in the level of taxable income applicable for eligibility for Premium
Assistance eliminated the 50-per-cent assistance category and significantly increased
the number of subscribers eligible for the 90-per-cent Premium Assistance.
The Ministry spent an additional $5 million during the year to subsidize the
medicare premiums for the several thousand low-income citizens of British Columbia helped by this new income ceiling for subsidized premium eligibility.
The Provincial Government now pays 90 per cent of the premium of families
where neither husband nor wife had a taxable income of up to $1,680 during 1977.
Previously, a 90-per-cent subsidy was available only to those who had no taxable
income, and a 50-per-cent subsidy was provided to persons whose taxable income
did not exceed $1,000.
At the present time, about 25 per cent of the 2.5 million enrolled medicare
beneficiaries in British Columbia have their premiums subsidized by the Ministry of
Health.
The total expenditure for insured benefits under the Medical Services Plan
rose 11.2 per cent to $334,086,613 in 1977/78 from $300,467,866 in 1976/77.
The increased costs to the Medical Services Plan were the result of upward
revisions to the fee schedule, increased utilization of benefits, changes in the
practitioner/population ratio, and increased population.
 20 MINISTRY OF HEALTH REPORT,  1978
Public Health Services
During the year organ donor information pamphlets and consent cards were
distributed through all public health units and the major motor licence offices, with
a view to increasing the donation of urgently required tissues and organs to persons
who would benefit medically from such a program. People over the age of 19,
who are in good health, can qualify to be donors. The signed donor card is to be
carried by the potential donor at all times and a coloured decal is affixed to the top
right corner of his or her driver's licence, to alert the police, ambulance crew, and
hospital staff to look for a signed donor card.
This program has been showing positive results as noted by the fact that there
were 25 kidney transplants at the Vancouver General Hospital in 1978, compared
with 17 during 1977 and 14 in 1976.
The marked increase in reported salmonella food infections and the steady
rise in the number of persons with recurrent malaria is continuing to be of concern.
A major outbreak of poliomyelitis in the Upper Fraser Valley during the
summer months was prevented by prompt action by the staff of the Public Health
Unit in developing a widespread immunization program in the community. The
outstanding co-operation of the local press and radio kept the public informed and
helped make the immunization program effective while at the same time preventing
undue public concern.
More than twice as many cases of streptococcal throat infections were reported
in 1978 as in 1977 though there did not appear to have been a corresponding rise
in the incidence of rheumatic fever.
In order to deal with the increasing problem of food-borne illness, the
Division of Public Health Inspection was involved in the work of developing a
comprehensive educational program along with regulations setting forth basic
standards for food safety. Various regulations under the Health Act were being
rewritten related to this problem.
An extensive program of nutrition services to clients of the Long-term Care
Administration was initiated under the direction of the Nutrition Division. Two
full-time and 10 part-time nutritionists were added to the staff. Four full-time
community nutritionists were employed in the Northern Interior Health Unit, North
Okanagan Health Unit, East Kootenay Health Unit, and Upper Fraser Valley
Health Unit.
B.C. Health Care Research Foundation
During the year a scientific advisory committee was appointed to the British
Columbia Research Foundation to review applications for grants and awards, and
to advise the Ministry in regard to research policy. The foundation is a nonprofit
society, set up to administer funds designated for health care research, the primary
source of which will be the Western Express Lottery. The 10-member advisory
committee is made up of a cross-section of professionals in the health sciences, as
well as members of the general public, under the chairmanship of Dr. Kenneth
Evelyn of Vancouver.
Research grants and research scholar awards will have been funded in the first
year with $1.5 million from the lottery.
Although some basic research is supported, emphasis is placed on clinical or
applied research, and on demonstration projects directed to the solution of priority
health delivery problems in British Columbia.
 YEAR IN REVIEW 21
Interagency Committee on the Audiology and Speech Pathology
Training Program
An Interagency Committee, composed of representatives of UBC and the
Ministry of Health, was established early in the year to examine both the job requirements of the Division of Speech and Hearing, Ministry of Health, and the
curriculum of UBC's training program in Audiology and Speech Sciences.
The work of the committee was to clear up differences between these two
programs, one of service and one of education, and one of the recommendations
which the Minister has endorsed is that funding be made available to allow two
senior students from UBC to acquire clinical experience within the speech and
hearing program. This will be a pilot project which, if successful, could be
broadened in the future and open some Government facilities to UBC to assist in
providing a part of the graduates practised training.
Vision Care Task Force
During the year the report of the Vision Care Task Force was released. The
task force had been established by the Minister on April 1, 1976, under the chairmanship of John E. Liersch, to examine the cost and operation of the present vision
care system in British Columbia and to make recommendation about the future of
eye care in the Province. The task force included representatives from the British
Columbia Optometric Association; the Department of Ophthalmology, UBC; the
College of Physicians and Surgeons of B.C.; the British Columbia Medical Association; the Dispensing Opticians Association of B.C.; the Ministry of Health, and
the Ministry of Education. The recommendations are being studied by the Ministry
staff.
Medical Manpower Advisory Committee
A Medical Advisory Committee was established in 1978 to make recommendations on the distribution of physicians as well as to advise on some related cost
containment issues in the Province. The Lower Mainland and Greater Victoria
are well supplied with physicians by almost every measurement. However, in other
parts of the Province, there are great deficiencies, particularly in specialist services.
The chairman of the committee is Wesley D. Black (a former Minister of Health
and Provincial Secretary who was a founder of the medical care insurance program
that exists in the Province today). The vice-chairman is Phyllis Whittome of
Duncan, a registered nurse on the board of the Cowichan and District Hospital, and
a former president of the B.C. Health Association.
The committee includes representatives from the B.C. College of Physicians
and Surgeons, the B.C. Medical Association, the Ministry of Health, and the Health
Education Advisory Council, an organization from the Ministry of Education that
reviews education programs for health professionals. The committee's first assignment was to study the implications of the fact that in 1976, British Columbia had a
ratio of one physician for every 569 people in the Province, which already exceeds
the Canadian target of one for every 665, in 1981. British Columbia also exceeds
national standards for numbers in almost all medical specialties. There is evidence
that a population that has a surplus of physicians may also be over-serviced. In
British Columbia the per capita cost of medical care was $102.10 in 1976/77,
compared with national average of $83.55. While such figures are dramatic, one
must view this area of health service with caution, thus the need to include cost
containment in the terms of reference of the Medical Manpower Advisory Committee.
 22 MINISTRY OF HEALTH REPORT,  1978
In addition to studying the numbers in the physician work force, the committee also will be concerned with redistribution. The Government must be concerned that the citizens of certain areas of the Province, who have a right to expect
a certain equality of access to medical care, might not be receiving the types of
physician services to which they are entitled.
DEMOGRAPHIC FEATURES
The population of British Columbia in 1978 was estimated as 2,530,000. This
was an increase of 36,000 over the previous year's figure and represents a doubling
of the Province's population in the 15 years since 1953.
The birthrate for this Province this year was 14.7 per 1,000 population, slightly
above the 40-year record low figure of 14.4 recorded two years ago. Last year's
rate was slightly higher at 14.9. The proportion of all births represented by illegitimate births reached a record high of 13.8 per cent in 1969, and after a period of
decline to a low of 11.4 per cent in 1972, has been increasing steadily in recent
years.   In 1978 the proportion returned to the 1969 high figure of 13.8.
The marriage rate this year was 8.5 per 1,000 population. This is below the
rate of 8.6 recorded in 1977. The 1976 rate was also 8.6. Rates in the first half
of the 1970's were above 9.
The deathrate was 7.5 per 1,000 population in 1978, the same record low rate
as for 1977 and 1976.
Among the specific causes of death, heart disease continues to exact the largest
toll of life. In 1978 there were 249 deaths per 100,000 population from heart
disease, somewhat of an increase over the 1977 figure of 245 and the 1976 figure
of 248 but well below the figure recorded 10 years ago which was above the 300
mark.
Mortality from malignant neoplasms continues to increase and whereas in
1978 there were more than twice as many deaths from heart disease as from cancer,
in 1978 the excess of heart disease deaths was only 54 per cent. The deathrate per
100,000 population from malignancies was 162 in 1978, slightly below the 1977
figure but well above the rates of the early 1970's.
Cerebrovascular disease mortality continues to decline and the rate was down
to 73 in 1978, the lowest rate recorded in recent years and 25 per cent below the
figure 10 years ago.
Accidental deaths continued at the markedly lower level which has been
maintained in the last few years, the rate being 63. While this was slightly above
the 1975 and 1976 figures it was well below the 1974 rate of 83. Among the
various specific causes of accidental deaths, motor-vehicle fatalities made up 39
per cent, somewhat below the figure of 44 per cent for 1977. Falls accounted for
18 per cent of accidental deaths. This was below the 1977 proportion of 19 per
cent and the same patterns prevailed for drownings which caused only 8 per cent
of accidental deaths in 1978 compared to 9 per cent in 1977. There was a somewhat larger decline in poisoning deaths as a proportion of all accidental deaths
which made up 7 per cent in 1978 and 9 per cent in 1977.
The rate of suicides per 100,000 population in 1978 was 17, slightly below
the 1977 figure of 18.
Infant mortality again declined this year, reaching a record low of 12 deaths
per 1,000 live births compared to 13 in 1977. The decline was most evident among
infants under one day of age and from one month to one year.
 PLANNING AND SUPPORT SERVICES */|
PROGRAM DEVELOPMENT GROUP
The Program Development Group provides support services to the Ministry
in the following areas: implementation and development of new programs, special
projects, and general planning services. Responsibilities assigned to the group
meet one or more of the following criteria:
(1) A new program or project that crosses interdivisional lines in the
Ministry.
(2) A program of sufficient size that a division of the Ministry requires
additional manpower/consultative services.
(3) The Executive staff of the Ministry have designated a specific project
as a priority within the Ministry.
During the year the Program Development Group continued its over-all administrative and development responsibilities for the four Community Human
Resources and Health Centres (Queen Charlotte Islands, Granisle, Houston, and
James Bay, Victoria).
23
Throughout the year these specialist functions, including Personnel, Data
Processing, Management Engineering, Health Promotion and Information, as well \^
as Policy and Program Development, were co-ordinated to assist the established ^^
programs and to develop new policies and programs. ^^
During the year the Assistant Deputy Minister was responsible for the develop- g^
ment of the Long-term Care Program. At the year-end reorganization, this respon- ^B
sibility was transferred to the Assistant Deputy Minister of Direct Care Community UJ
Services. Kft
The Ministry's relations with the B.C. Buildings Corporation, and B.C. Systems Corporation, as well as with Treasury Board and the staff of the Government |hh
Employee Relations Bureau, were co-ordinated within this group, which was also 4^0
involved in the continuing development of the Long-term Care Program. ™JJ
With the reorganization at the end of the year, the Assistant Deputy Minister II
was given expanded responsibilities for Support Services, but Planning and Development are to be the responsibility of an Executive Director reporting directly to the
a
Deputy Minister. £b
MANAGEMENT ENGINEERING SERVICES 3
This division consists of the management consultants and analysts who service VJ
the needs of the Ministry and its client organizations. During the past year undertakings have included a study of pharmacy services for Government institutions; ^j
studies of materials management systems for hospitals; the evaluation and develop- ^_
ment of staffing methodologies for hospital nursing and dietetic departments; the ^Sa
development of operating-room and bed-scheduling systems; and involvement with ^4
outside consultants in a study of the means of funding health care services. ^^
Management Services provided by the division includes the management of
those services provided for the support of the Ministry's headquarters operations, tj
such as printing, space planning, and building services. JljL
Space occupancy consultation involves the co-ordination of the Ministry's jjf>£
requirements in respect to accommodations, the representation of these requirements ■■■■
to the B.C. Buildings Corporation, and liaison with the corporation on all matters ^^
affecting space occupied by the Ministry.
z
<
 24 MINISTRY OF HEALTH REPORT, 1978
In addition, the group was involved in the following major projects or areas,
during 1978:
(a) Long-term Care Program—the involvement during the early part of
1978 was extensive but at the year-end the group only maintained a
limited involvement through certain committees and special projects.
(b) Interprovincial and Federal-Provincial committees—the group was
involved in co-ordinating background material for senior staff prior
to these meetings, and on disseminating information after such
meetings to appropriate Ministry staff.
(c) Mental Health Project—the group worked with Dr. John Cumming
and his staff on the implementation of certain recommendations
resulting from the mental health study.
(d) Role of hospitals—under the direction of the Hospital Programs
Planning Group, work was started on examining the methodologies
that might be used to determine the role of an acute hospital.
(e) The Program Development Group also assisted in co-ordinating the
development of over-all long-term Ministerial objectives, and numerous other projects.
PERSONNEL
During the year a merit system for management staff was introduced. The
program was recommended by consultants from Hay and Associates, and personnel
aided the Assistant Deputy Minister in the lengthy committee work necessary for
the evaluation of all excluded Ministry positions. The maintenance of this new
program has become a major task of the personnel organization. The introduction
of the merit pay plan to the management ranks of the Provincial service, has
resulted in a job evaluation and salary plan as modern as any in Canada.
The previously divided central personnel organization was finally consolidated
into a new single location on the fourth floor of the Richard Blanshard Building.
This physical change was made coincidental with the development of personnel
specialist areas in Labour Relations, Classification Organization and Establishment,
Recruitment and Selection and Training and Development.
The personnel staff are prepared for delegation from central agencies in both
classification and recruitment responsibilities, and negotiations have been taking
place to finalize necessary guidelines.
A personnel officer was added to the Alcohol and Drug Commission staff to
give direct assistance in the newly developing Narcotic Treatment Program. This
brings to 18 the number of personnel officers serving the Ministry staff of over 6,500.
Personnel services are required to be of two distinct types, in order to provide
the needed services to every area of this very complex and diversified Ministry.
The central personnel headquarters staff serves directly all community and mental
health centres as well as other branches without personnel staff of their own.
Functional guidance and co-ordination is also given to the Government hospitals
and commissions employing their own personnel officers. The latter include River-
view, Valleyview, and Pearson Hospital, and the Medical Services Commission, the
Emergency Health Services Commission, and the Alcohol and Drug Commission.
The Director of Personnel continued to serve on the Personnel Advisory Committee to the Government Employee Relations Bureau, allowing Ministry input
into central agency policy-making.
 PLANNING AND SUPPORT SERVICES 25
Major personnel functions include the negotiating of fee-schedules for fee-for-
service and sessional members of the British Columbia Medical Association, as well
as with dentists and other health care groups such as physiotherapists, optometrists,
and chiropractors. These activities are now of a year-round nature.
The important field of pre-retirement counselling has been enlarged this year
to include Government-wide planning seminars, and health personnel staff are
engaged in an advisory role with the Public Service Commission.
HEALTH PROMOTION AND INFORMATION
INFORMATION SERVICES SECTION
When the Division of Health Information was organized in 1976 to serve the
entire Ministry the responsibilities of the Information Services Section were defined
as follows: to produce speeches; press releases; television and film scripts; texts for
leaflets, brochures and handbooks; to assist in the preparation and editing of instructional manuals; to develop copy for displays and posters; and to prepare other
printed material as may be required by the Ministry.
The acceptance and success of this amalgamation of the Ministry's information
services is evidenced in the increasing demands made on the section's three writers.
An example of the growing work load is the fact that in 1977 approximately 35
speeches were written for the Minister and senior staff, and in 1978 this volume had
increased to 81, including speeches, prepared remarks for official openings, and
Government greetings at special functions.
There was also a substantial increase in the number of press releases that were
issued. These totalled 64 in 1977 and increased to 87 in 1978. This average of
just over one press release per week falls within the guidelines set by the division,
as there is a tendency to lose credibility with the media when an unnecessarily large
number of press statements are issued.
The staff also prepared feature articles during the year for use in professional
journals and newspapers. Subject-matter included nutrition, heart disease, fitness,
and lifestyles.
Assistance was also given in publishing the "Nutrition Buyline", sent to all
newspapers monthly; and in the preparation of an inservice community health
nursing newsletter.
The section also provided assistance with the production of audio visual programs, including a series of 13 programs of the "Senior Chef", two slide-tape
presentations for the Medical Services Plan, the nutrition film "Think About It",
a slide-tape program on recreation and fitness, and radio spots dealing with nutrition. At the year-end staff were involved in preliminary planning for a proposed
film dealing with the Speaker's Office in the Legislature, a training series on the
home dialysis program, and a slide-tape presentation for children entitled, "Our
Poison Jungle".
Pamphlets developed during the year included "British Columbia's Emergency
Health Services"; "Enjoying Your Retirement"; a pamphlet outlining the career
opportunities of speech pathologists and audiologists, and a third printing of the
pamphlet "Cigarettes and Your Health". Several others were prepared with the
section's assistance. Brochures under production in December described the Heimlich procedure in helping victims of choking; one dealing with hearing problems in
infants, and a pamphlet on colour vision problems in childhood.
 26 MINISTRY OF HEALTH REPORT,  1978
A summer student provided considerable assistance in the preparation of the
script for a 45-minute inservice orientation videotape.
The section initiated a Certificate of Appreciation, to be awarded to long-
service hospital volunteers. The idea was endorsed by the executive of the B.C.
Association of Hospital Auxiliaries and the first presentations were made in
December.
Routine responsibilities included the handling of general inquiries, drafting
correspondence for the Minister's signature, and maintaining the news clipping file.
The section was also responsible for chairing the Annual Report Advisory Committee, which co-ordinated and edited the Ministry's annual report.
AUDIOVISUAL SECTION
With the changing role of the division as a whole, the Audiovisual Section has
been involved with its share of development. During the past year this section was
heavily engaged in supplying and servicing audiovisual equipment to all field staff.
In previous years the service was mainly confined to public health programs but all
sections of the Ministry now receive service.
The equipment loan service, which has been in existence for many years, was
dramatically expanded during the last 12 months. A substantial amount of equipment is located at Ministry headquarters and is available for loan to disciplines
within the Greater Victoria area. A backup service is provided to all field offices.
This includes periodic checks of existing equipment to determine the degree of use
and the need for replacement.
The section has been actively participating in planning for the new Government video production centre to be located in the Ministry's headquarters in the
Richard Blanshard Building, 1515 Blanshard Street. A major requisition for new
equipment for the centre was approved by Treasury Board and by the end of the
year two-thirds of the equipment was located in temporary quarters in the Blanshard
Building.
Approval for the establishment of a video production centre in the Blanshard
Building was received in late fall and plans were immediately started for necessary
construction in the basement. Plans were ready, bids were invited in December
and the anticipated completion date is May 1979.
During the past year the film library was officially transferred to the Division
of Health Promotion and Information. Formerly under public health programs,
the library was transferred to the division because it was felt that it could better
serve the Ministry as an integral part of Health Information. The transfer necessitated relocating the library in the Richard Blanshard Building and it will operate
under the general direction of the Ministry's central library.
With the relocation came an expanded role for the film library. This is
reflected in its new title of Audiovisual Library. In addition to providing a free
loan service for 16-mm films, the Audiovisual Library now provides a loan service
for video-taped programs as well as small format materials (e.g., audio tapes,
slides, etc.) and audiovisual equipment.
Although the Audiovisual Library is still in the process of developing these
additional services, it is hoped that by spring of 1979 a comprehensive audiovisual
service will be fully established.
A new departure for the division was the establishment of a display service.
This necessitated planning and production of display material for use by disciplines
 PLANNING AND SUPPORT SERVICES 27
within the Ministry at special functions such as conventions, meetings, community
projects, and public "open houses" of Ministry facilities.
This service underwent very rapid development between spring and fall and
the major task undertaken was the production of a special display on air ambulance
service for the Abbotsford Air Show. Other disciplines provided with service
included Speech and Hearing, Nutrition, Environmental Engineering, Public Health
Inspection, Dental Services and Nursing.
The photographic section of the division was occupied with the production of
slide-presentations for various disciplines, special slide-tape presentations for senior
staff, and for copywork on request of Ministry staff both in head office and in the
field.
A major production in the video field was 13 programs in a new "Senior Chef"
series. The televising of these programs commenced in the Lower Mainland in
November and will continue throughout the Province early in 1979.
The production of leaflets, pamphlets, booklets, and posters has increased
dramatically during the year and reached the point in the fall where the appointment
of a full-time staff artist was approved.
A number of students were employed during the summer months on various
production tasks within the audiovisual section.
DATA PROCESSING
MANAGEMENT INFORMATION SYSTEMS
The Division of Data Processing was renamed the Division of Information
Systems to more accurately reflect its status now that the data processing functions
are carried out by the B.C. Systems Corporation. The realignment of functions
occasioned by the creation of the systems corporation has also led to a reformulation of the division's objectives.
The primary objective of the division is to assist senior management of the
Ministry in defining, developing, and implementing management information systems
which will provide greatly improved capabilities for fiscal control, program evaluation, policy analysis and long-range planning. In addition, the division will provide
consultation as to the best alternatives by which the Ministry's informational needs
may be met using either manual or advanced electronic data processing technology.
Significant events during the year:
• The transfer of the subscriber inquiry system of the Medical Services Commission from the IBM computer to the Honeywell computer was completed.
• Work progressed as scheduled on the implementation of a completely redesigned Medical Services Plan computer system.
• A computerized cash flow monitoring system for hospital construction
projects was undertaken.
• Developmental work was continued on a data processing system for speech
and hearing services.
• A basic information/payment system was developed and implemented for
the Long-term Care Program.
• Work continued on the development of a basic management information and
billing system for the Emergency Health Services Commission.
• Consultative assistance continued to be provided to Hospital Programs,
which provided funds to 12 major hospitals in the Province for the provision
 28
MINISTRY OF HEALTH REPORT,  1978
of a computer system to improve the efficiency of their administrative
operations. By the year-end, computer systems had been installed in 11 of
the hospitals and a number of the subsystems were operational.
COMMUNITY CARE FACILITIES LICENSING BOARD
Provincial Child Care Facilities Licensing Board—1978 was again a very
active one for the Provincial Child Care Facilities Licensing Board and staff. There
was an 8.24 per cent over-all increase in capacity in licensed child care facilities for
the first six months of 1978 (see Table I).
There has been a continual growth for applications for licences in Family Day
Care and Out of School Care programs.
On September 24, the new Child Care Regulations were approved and gazetted.
At the year's end amendments to the Summer Camp Regulations were also
currently being processed. There was an increase of 0.9 per cent in camp capacities
over the first six months of 1978 (see Table I).
Provincial Adult Care Facilities Licensing Board—1978 was an extremely busy
year for the Provincial Adult Care Facilities Licensing Board. The launching of
the new Long-term Care Program on January 1 greatly increased the work of the
board and staff. The Adult Care Board was chosen as the vehicle for bringing the
program into reality.
There was an increase of 981 beds in the first six months of 1978, or an increase
of 6.04 per cent over 1977 (see Table I).
The Licensing and Long-term Care staff were working together with the assistance of a Long-term Care investigation team in following up complaints of the
Long-term Care Program.
Current legislation was being reviewed so as to cover all aspects of Licensing,
Long-term Care, and Home Support Services.
Table I
Adult Care Facilities
Year
Interim Permit
Licences
Surrendered
Final Count
Facility
Capacity
Facility
Capacity
Facility
Capacity
Facility
Capacity
1975	
1976        	
59
53
51
58
1,792
1,291
1,734
1,805
453
449
465
481
14,534
15,085
15,008
15,407
130
78
30
1,928
1,281
511
382
424
486
539
14,398
15,095
1977	
1978 (first six months).
16,231
17,212
The 981 capacity in
crease over first six months is 6.04 per cent.
Child Care Facilitii
IS
1975 -	
1976           	
155      |      2,229
192      |      2,694
235      |      3,063
291      !      3,675
1
909      |    16,786
929      |    16,869
1,005      j    17,866
1,028      |    18,370
267
308
75
30
4,130
4,034
900
364
797
813
1,165
1,289
14,885
15,529
1977    	
1978 (first six months).
20,029
The 1,652 capacity
increase over first six months is 8.24 per cent
Camps
1975	
1976            _
59
54
58
59
5,395
4,814
4,905
4,970
75
83
82
82
5,942
6,868
6,979
6,969
16
6
1
819
129
50
	
118
131
139
141
10,518
11,553
1977 _
1978 (first six months).
11,834
11,939
The 105 capacity increase over first six months is 0.9 per cent.
 PLANNING AND SUPPORT SERVICES 29
THE LONG-TERM CARE PROGRAM
PREAMBLE
The Long-term Care Program became effective January 1, 1978. As of
October 31, 1978, 41,986 applications had been processed by the 22 health units
in the Province. Of these, 39,880 eligible applicants have been placed within the
program, suggesting that by year-end 43,000 residents of British Columbia will have
received benefits of this comprehensive service. At the end of October, 17,618
persons were under care in Long-term Care facilities, including public and extended-
care hospitals, and 11,714 persons were receiving care services in their homes from
77 homemaker agencies. A total of 29,332 persons was under care at the end of
October.
The Long-term Care Program is a positive approach to the needs of that segment of the population who cannot live without help, because of health-related
problems which do not warrant 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.
ORGANIZATION
The Ministries of Health and Human Resources have joint responsibilities for
the Long-term Care Program: the former for the administration and functional
control of the total program; the latter for the social services necessary to ensure
that those in need may receive the required services as expediently as is humanly
possible without loss of dignity.
The Provincial Adult Care Facilities Licensing Board (PACFLB) is the
organizational body responsible to the Minister of Health for the total co-ordination
of the Long-term Care Program. This responsibility includes: formulation of policy;
formulation of procedures and the establishing of guidelines for the program; the
hearing and adjudicating of appeals in respect to the program; the interpretation of
policy and its application; the licensing 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; liaison with the other programs
within the Health Ministry to ensure the interaction of the programs that may have
desirable input to the Long-term Care Program; and, in particular, liaison with the
22 health units of the Province, for the local administration and inspections of the
community care facilities participating in the Long-term Care Program. The senior
public servant responsible to the Provincial Adult Care Facilities Licensing Board
for the functional direction of the Long-term Care Program is the Executive Director, Long-term Care Program.
The organizational units responsible for the function of the program at the
community or local levels are the public health units. These units are responsible
to the Provincial Adult Care Facilities Licensing Board (PACFLB) for this aspect
of their activity. To assist these health units, a Long-term Care Administrator is
based in each health unit. This person is a member of the health unit establishment,
and is responsible, through the director of the unit (Medical Health Officer), to the
Executive Director of the Long-term Care Program for the implementation and
direction of the Long-term Care Program in the community served.
 30 MINISTRY OF HEALTH REPORT,  1978
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 application for benefits of the program (these teams have as a core a
public health nurse, a social 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 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, and must be a Canadian citizen or a landed
immigrant who has resided continuously in British Columbia for a period of not
less than 12 months in order to be eligible for personal or intermediate care, or
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 a personal care facility.
• Residential Care in an intermediate 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) are required to pay a universal charge of $6.50 per day, while beneficiaries
in home support care may be required to pay a user charge for this service in
accordance with a graduated scale.
The success of the program has been due, not only to those given the responsibility of function, but also to the many community care facilities, hospitals, and
homemaker agencies who have elected to participate in the program. To date,
529 of the 556 community care facilities in the Province have elected to participate
in the program. Translated to beds, this means that 15,082 of the existing 17,584
beds in community care facilities in the Province are available to the beneficiaries
of the program. Percentage-wise, 95.1 per cent of all facilities in the Province
have opted-in to the Long-term Care Program since January 1, 1978, bringing with
them 85.8 per cent of all the community care beds in the Province. A total of
7,531 of these participating beds are in privately owned facilities (proprietary);
6,100 in nonprofit facilities; and 1,451 in mental health facilities.
As of October 31, 77 homemaker agencies were participating in the program
and providing for the care of 11,714 clients.
 Public Health Programs
Public health legislation in British Columbia dates back to 1869
when statutory authorization was given for a Provincial Board of
Health. However, active administration of public health services
in the Province by the Board did not get under way until the last
decade of the 19th century. By 1946 the services had developed
to the point where full departmental rank was warranted and in that
year the Department of Health and Welfare was established.
Public Health Programs is now one of the two major administrative subdivisions of Community Health Programs (the other
being Mental Health Programs) and is charged with providing a
wide range of preventive, treatment, and environmental control
services and with promoting positive health. These services are
made available to the public through certain centralized facilities
and a network of 17 local health units covering the non-metropolitan areas of the Province. Greater Vancouver and the Capital
Regional District have their own health organizations, which are
not under the jurisdiction of the Provincial Health Department,
but which receive certain consultative and specialized services
together with financial assistance from the Provincial Government.
These two administrations collaborate very closely with the Provincial Health Department in disease prevention and control, and in
program implementation.
Statutory support for the operation of Public Health Programs
comes mainly via the Health Act, and pursuant regulations, and the
Public Schools Act. These statutes confer powers on the Minister
of Health, the local Medical Health Officer, and the local board of
health for dealing with matters of public health. The local board
of health may be either a municipal council (covering municipal
areas which may also draw up additional public health by-laws),
or a union of municipalities and school districts, to administer
relevant sections of the Health Act or pursuant regulations in areas
outside municipalities.
A review of the activities of Public Health Programs is presented on the following pages:
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31
 32 MINISTRY OF HEALTH REPORT,  1978
PUBLIC HEALTH  PROGRAMS HIGHLIGHTS
• A widespread outbreak of poliomyelitis in the Upper Fraser Valley was prevented
by prompt action in setting up and carrying through a community mass immunization program. Co-operation on the part of the local press and radio helped in
publicising the program and prevented undue public concern.
• More than twice as many cases of streptococcal throat infections were reported
in 1978 as in 1977, though there did not appear to have been a corresponding
rise in the incidence of rheumatic fever.
• The marked increase in reported salmonella food infections and the steady rise
in the number of persons with recurrent malaria continued to be of concern.
• The immigrant population continued to be the source of many tuberculosis cases
and over 50 per cent of the new cases in the Province in 1978 arose from this
source.
• The Organ Donor Program of the Ministry was given an extremely favourable
reception by many organizations and individuals. The program showed positive
results and there were 25 kidney transplants at the Vancouver General Hospital
in 1978, compared with 17 in 1977 and 14 in 1976.
• An extensive program of nutrition services to clients of the Long-term Care
Administration was initiated under the direction of the Nutrition Division. Two
full-time and 10 part-time nutritionists were added to the staff. Four full-time
community nutritionists were employed in Northern Interior Health Unit, East
Kootenay Health Unit, and Upper Fraser Valley Health Unit.
• The largest dental extern program ever provided served 38 rural and isolated
communities in British Columbia. For the first time there were no shortages of
dentists in British Columbia. Almost 50 per cent of the population was covered
by dental insurance.
• In order to deal with the increasing problem of food-borne illness, the Division of
Public Health Inspection was involved in the work of developing a comprehensive
educational program along with regulations setting forth basic standards for food
safety.
COMMUNICABLE AND REPORTABLE DISEASE
Although the one case of imported paralytic poliomyelitis that occurred in the
Fraser Valley this year was headlined for several weeks, the tremendous increase
in the number of reported salmonella food infections along with the steady rise in
the number of persons with recurrent malaria is of a more real concern because
unlike poliomyelitis there is no ready answer to these latter two problems.
Every province has groups of people who, for one reason or another, refuse
to accept the protection offered by immunization. One such group of well over a
thousand people lives in the Upper Fraser Valley. This summer an unimmunized
visitor from Holland brought Type 1 poliovirus with him and infected a similarly
unimmunized relative in the Fraser Valley.
This was recognized as a potentially explosive situation because of the large
number of unimmunized Dutch people in the community and it was at once decided
to institute a community-wide immunization program with oral vaccine.   The out-
 PUBLIC HEALTH PROGRAMS 33
standing co-operation of the local press and radio made it possible in a two-week
period to notify and immunize over 17,000 people of all ages whose protection
was not up to date. As a result, only one additional mild case of paralytic poliomyelitis occurred, again in an unimmunized person.
Very similar small outbreaks occurred in both Alberta and Ontario and in
each case the affected persons were unimmunized and there was no spread to any
immunized person. These are the first reported cases of poliomyelitis in the
Province since 1964. This incident is another reminder that the world is far from
free of poliomyelitis and that the only effective shield against this disease is an
aggressive immunization program.
Less apparent, but perhaps of equal importance, is the dramatic increase in the
number of cases of salmonella food poisoning this year. Last year 307 cases were
reported, this year 908 laboratory-proven cases occurred. Three outbreaks, one
resulting in over 100 cases, were traced to poor food-handling practices. The
disturbing thing, however, was the number of small incidents or individual cases
that could not be linked to any known source of infection. Public Health Inspectors
will be spending more time promoting good food-handling practices and supervising places where food is prepared and served than they have for some years and
the Ministry's educational programs on good food-handling practices will be
stepped up.
The steady increase in the number of cases of malaria reported in this Province
is a reflection of the growing incidence of this disease in many parts of the world.
This year 300 cases were diagnosed, an increase of 10 per cent over 1977. There
is little that can be done to prevent recurrent malarial attacks among visitors but
in most cases there is no good reason for British Columbia residents travelling
abroad to become infected since preventive medication is readily available. The
Ministry is developing a public education campaign in an attempt to assure that
residents travelling to parts of the world where malaria is endemic realize the
importance of starting prophylactic medication before leaving on their trip.
There were 1,297 cases of streptococcal throat infections reported this year
which is more than double the number in 1977. This increase has so far not resulted
in a significant rise in the incidence of rheumatic fever, although characteristically
rheumatic fever has been one of the principal complications of streptococcal infections. There are now very effective antibiotics available to treat streptococcal infection and this may be a factor in controlling the complications.
Seventeen cases of diphtheria were reported in 1978. This is more than double
the number reported the previous year, but far below the peak in 1974 when 69
cases occurred. Effective antibiotics have reduced the threat of death from this
disease where treatment can be started early enough, but the only real defence lies
in an aggressive program of childhood immunization.
Last year an older variant of the influenza virus reappeared in North America
(A/USSR) after an absence of some years. This led to some concern that influenza
could become widespread in the winter of 1978 among those age groups not previously exposed. The Ministry therefore decided to continue its program of offering
influenza vaccine to all persons felt to be at risk if they contracted influenza, namely,
all persons over 65 years of age and persons of any age with chronic chest, heart,
kidney, or metabolic conditions. The vaccine was offered at public health clinics
throughout the fall and winter and was made available to physicians in private
practice for their own patients. Particular efforts were made to make certain that
all residents of long-term care facilities had an opportunity to receive this vaccine.
 34 MINISTRY OF HEALTH REPORT,  1978
RHEUMATIC FEVER PROPHYLAXIS PROGRAM
There were 800 young people on the Provincial Rheumatic Fever Prophylaxis
Program at the end of the year. This program is currently being reviewed by an
Advisory Committee, chaired by Dr. Maurice Young, Professor, Department of
Paediatrics, Faculty of Medicine, UBC, and it is expected that the committee will
shortly recommend a number of major policy changes which will come into effect
next year. Rheumatic fever no longer occurs with the same severity, or frequency,
as it did 20 years ago when this program was first started and it is doubtful whether
the lifelong prophylaxis medication originally advocated for everyone who has ever
had an attach of rheumatic fever is still necessary.
POISON CONTROL PROGRAM
The B.C. Poison Control Program has increased the service provided by the
Provincial referral centre based in Vancouver, which is now fully operative from
8 a.m. to 8 p.m. week-days and "on call" at all other times through a paging system.
The program provides consultative service to physicians and hospitals respecting
the management and treatment of difficult poison cases.
This year the College of Pharmacists of British Columbia and the Poison
Control Program jointly sponsored two poison prevention projects, one in which
the public was offered the opportunity of returning outdated, or unwanted, drugs
to any pharmacy for safe disposal and a second in which parents were offered the
opportunity to buy a unit dose of Ipecac at a much reduced price for home use.
On the recommendation of a physician, Ipecac can be used to induce rapid vomiting
in children who have swallowed a poisonous substance.
ORGAN DONOR PROGRAM
The Ministry's Organ Donor Program got off to a good start during the year
despite unexpected difficulties and delays in obtaining supplies and the equipment
needed to automate the mailing procedure.
The very favourable reception given to the concept by many organizations and
individuals exceeded expectations and it is planned to take advantage of this goodwill to expand the program as soon as a supply of better quality donor decals can
be obtained.
Donor decals and consent cards will be sent out by the Motor-vehicle Branch
with every new and renewal driver's licence. They will also be available at all
Public Health and Motor-vehicle Branch offices and through the Kidney Foundation, the Eye Bank, and the Ear Bank headquarters.
TUBERCULOSIS CONTROL
Preliminary data indicate that the number of new active cases of tuberculosis
in British Columbia may show a slight increase in 1978, reversing the slow but
steady decline of the past few years. The immigrant population continues to be
the source of many cases and over 50 per cent of all new cases in the Province arose
in individuals who were born outside Canada. Immigrants from high incidence
areas will continue to be a source of new cases for many years to come.
Two small epidemics on Indian reservations also contributed to the increase.
While the actual number of cases in each situation was not great, they did represent
10 per cent of the involved population. This is a sharp reminder that there is no
room for complacency, but rather that tuberculosis is still present and ready to
strike under certain conditions.
 PUBLIC HEALTH PROGRAMS
35
Mass screening of the general population has been discontinued for some time
but, in certain high incidence areas, such as Vancouver's Skid Row, annual surveys
are still conducted and are productive. However, the major weapons against
tuberculosis today are ensuring the active case receives good and adequate treatment,
that the contacts are thoroughly investigated and, if indicated, given prophylaxis,
and that certain well-known groups who are at high risk of reactivating a previous
infection are followed to detect any new disease as early as possible.
With only 44 tuberculosis beds for the entire Province, local health institutions
are being encouraged to treat tuberculosis patients when indicated. As the effectiveness of the new drugs is better appreciated, the reluctance of some institutions
to handle tuberculosis is gradually diminishing. The great majority of cases are
treated on an ambulatory basis and every effort made to disrupt the patient's normal
routine as little as possible, consistent with good treatment and limitation of the
spread of the disease.
It is anticipated the tuberculosis beds will be moved from Pearson Hospital to
Willow Chest Centre in the not-too-distant future. Having these patients in close
proximity to the diagnostic and other facilities available at Vancouver General
Hospital will be a decided advantage.
VENEREAL DISEASE CONTROL
It has become apparent ovef the past few years that sexually transmissible
infections (venereal diseases) are no longer limited to certain "core" at-risk groups,
but are pervasive throughout the community at large. To control and reduce the
incidence of these infections a new approach has been developed by this division.
This consists largely of an enhancement of effort in three specific areas which
experience indicates will most likely be productive.
The term now used to denote these infections is sexually transmissible diseases,
or STD. This term is a more accurate depiction of why the diseases are considered
as a group, and, being relatively new, is somewhat more value-free in contrast to
the term "VD". Furthermore, most people regard VD as either syphilis or gonorrhoea, while we now know of at least 15 different infections which are all primarily
transmitted during intimate physical contact. The most common of these in British
Columbia are nongonococcal urethritis (NGU), gonorrhoea, moniliasis, herpes
simplex virus, trichamonas, syphilis, chlamydia, and two parasitic infestations:
pubic lice and scabies.
The new approach implemented this year, while not neglecting the totality of
STD, has focused primarily on gonorrhoea, which—despite an 8-per-cent reduction
in reported incidence—is still the single, most widespread STD in British Columbia.
Syphilis remains under control in British Columbia with 1978 rates holding constant
to the rates for recent years.
There are three components to the new control approach which, if they are
carefully co-ordinated, could lead to a substantial reduction in gonorrhoea rates
within two or three years and perhaps to an end to the epidemic.
Public Awareness
This is, to date, the most fully developed aspect of the campaign. Its intent
is to approach the subject of STD from a new perspective, one in which these
diseases are no longer regarded with impunity or merely as manifestations of sexual
indiscretion. Some of the public awareness activities undertaken over the past year
have included four months of radio advertising, a two-month busboard campaign
in the Greater Vancouver area, the production of three new pamphlets and six
 36 MINISTRY OF HEALTH REPORT,  1978
posters, and appearances on radio and television talk-shows. In addition, the
VD Information Line continues to be publicized, and in the first 12 months of
operation received over 50,000 calls from all areas of the Province. The Information Line gives a three-minute recorded message on symptoms, prevention, and
treatment of six common STD's, with special emphasis on gonorrhoea. Finally, a
summer project involving three students was undertaken to develop materials
relating both to the public awareness campaign, and to the two other components
of the new control program.
The benefits of the radio advertising and general publicity have already become
apparant: there has been a sizeable increase in clinic attendance over the past year,
with more people coming in for preventive STD check-ups. This may be one
reason why gonorrhoea rates are beginning to decline more steeply, i.e., with more
preventive screening and/or prompt examination, the "reservoir" of asymptomatic
infections is slowly being reduced. It is also worth mentioning that one series of
our radio ads received an honourable mention in a national competition sponsored
by the Radio Bureau of Canada, with one ad edging out over 800 other entries to
win first prize for copywriting.
Community Health Nurse Participation
To ensure that local community needs are met with respect to screening, diagnosis, and treatment of STD, and education on the subject to local schools and
groups, there has been an increase in the nursing time devoted to STD and clinics
are located in the following communities: Victoria, New Westminster, Kamloops,
Dawson Creek, Prince George, Prince Rupert, Quesnel, Williams Lake, Vernon,
Kelowna, and Penticton. The responsibilities of these nurses include liaising with
private physicians so that, if a doctor were to treat an individual for VD, she or he
could utilize the nurse's services with regard to interviewing, contact tracing, and
the diagnosis and treatment of named contacts.
A nurse-educator has also been hired to work out of Vancouver. Her duties
will be to assist in upgrading the knowledge and skills of the other community health
nurses in the Province on all aspects of STD (particularly clinical aspects), and to
aid in the special training programs, on venereology this division operates for community health nurses working in VD clinics in other Provincial communities.
Finally the centre of the VD Control Program is located in Vancouver, and
continues to serve the Lower Mainland. As a result, with the exception of the
southeast region of the Province and certain remote locations, specially trained
staff are now in place to implement the new control program.
Physician Awareness Program
The single most important reason why gonorrhoea rates continue to be epidemic
in British Columbia and in North America as a whole, is the absence of thorough
contact-tracing and of treatment of infected contacts. In British Columbia the
control program is currently estimated to be no more than 20 to 30 per cent
effective, with a reported gonorrhoea rate of approximately 360 per 100,000 population. The true rate is further estimated to be in excess of 1,000 per 100,000. In
Great Britain, where the control program is almost 100 per cent effective, gonorrhoea rates are just over 100 per 100,000.
The weakest link in the present control program continues to be the unwillingness of the private physician to report confirmed cases of gonorrhoea to this division.
While the Vancouver Clinic physician remains active in promotional and edu-
 PUBLIC HEALTH PROGRAMS 37
cational seminars with the UBC Faculty of Medicine and local medical associations,
a joint physician awareness program has been undertaken by this division and the
Infectious Diseases Committee of the British Columbia Medical Association. The
purpose of this program, which includes articles in the B.C. Medical Journal and
special mailings to private physicians, is to illustrate the pivotal role played by the
physician in the control of gonorrhoea. It is hoped that, in combination with the
public awareness campaign, a concerted effort to explain the logic of the new control program will win the co-operation of physicians, as it is only through their
assistance that the epidemic can be eliminated.
While the bulk of this division's energies has been directed at the control of
gonorrhoea, research and education into the other STD's has not been ignored.
A program has been started in co-operation with the SEARCH* clinic, which is
funded by this division, to provide syphilis and gonorrhoea screening tests for the
unattached gay male population who frequent Vancouver's steambaths. This group
has a disproportionately higher incidence of syphilis, and can be regarded as one
of the few special "at-risk" groups that still exist.
Dr. William Bowie has been appointed as consultant to the division in a joint
program with the UBC Faculty of Medicine. Dr. Bowie is currently running
research programs on the diagnosis and treatment of nongonococcal urethritis,
concentrating especially on chlamydia (a known cause of cervicitis in women and
a probable cause of urethritis in men). These background studies are vitally
important, given that there has been a sharp increase over the past year in people
attending VD clinics with a herpes virus infection (American figures indicate that
herpes is second in incidence to gonorrhoea).
In general, the past year has been one in which adequate staff, resources, and
planning were co-ordinated to implement a new control program (coupled with a
new STD "ethic") which has a realistic prospect of actually ending the gonorrhoea
epidemic in this Province.
HEALTH AND OUR ENVIRONMENT
ENVIRONMENTAL ENGINEERING
For the purpose of administering the program of the Division of Environmental Engineering, the Province is divided into nine areas consisting of groups of
two to four health units geographically grouped, where possible, and served by one
centrally located Regional Engineer. Most of the Regional Engineers are located
in the field where they are readily accessible to Medical Health Officers and others.
The staff carries out the technical functions of the division assigned under the
Health Act and offers technical and consultative support to Medical Health Officers,
Government agencies, municipalities, and individuals on matters relating to the
design, operation, and maintenance of water supplies, swimming-pools, sewage
works, and solid waste programs. They also have a major role in the training of
water and wastewater personnel.
Description of Functions and Major Achievements
The primary purpose of the division is to ensure that all new waterworks
construction in the Province meets the minimum standards of design outlined in
their publication Waterworks Systems Guidelines, particularly as they relate to the
* Society for Education Action Research and Counselling on Homosexuality.
 38 MINISTRY OF HEALTH REPORT,  1978
protection of public health. A diligent effort was made again this year to obtain
pertinent data concerning the physical aspects of the water delivery systems and
the potential health hazards associated with these systems. It is essential that the
water sources and all works involved in getting drinking-water safely delivered to
consumers' taps are regularly reviewed by staff who have special training in this
field of public health.
The division also fulfilled its educational role in co-ordinating the annual
water and sewage operators short course at UBC and shared this responsibility at
Prince George where a special operators' school was held.
The engineers participated in swimming-pool operator training courses at
several centres throughout the Province. These courses met the needs of more than
200 operators of both public and commercial swimming-pools.
Of equal importance was the day-to-day contact engineers had with waterworks operators, health unit personnel, and the general public in a consultative or
advisory capacity. It is at this stage that much can be done in preventive health
measures.
Waterworks—The division reviews, for approval, plans and specifications for
all new waterworks proposals, including those for municipalities, regional districts,
improvement districts, utilities, and commercial systems. Following a study of
practices used throughout the Province concerning waterworks disinfection, the
division issued a policy on this matter to improve the sanitary control of newly
constructed waterworks. Several water purveyors improved their water supplies
with the addition of chlorine. Included among these were the municipalities of
Armstrong and Port Clements and the Eagle Cliff Water Improvement District.
Discussions have continued with other ministries which also have an interest
in the beneficial use of water resources. Attempts are being made to provide a
uniform Governmental approach to the approvals of all waterworks systems in the
Province. There is much to be done in planning and providing suitable management
of small waterworks systems. It has been encouraging to see some regional districts
take on the responsibility for water supply as specified areas within their regions.
Consolidation of several small waterworks systems into larger and better managed
units would solve many of the problems which are beginning to appear.
Sewage works—The division reviews, for approval, plans for public sewage
works where the flows are less than 5,000 gallons per day with ultimate disposal to
the ground.
Swimming-pools—The division reviews, for approval, plans and specifications
for all swimming-pools except private backyard pools, to ensure that physical,
sanitary, and safety standards for all public pools are met. A 20-minute instructional movie film made with the help of the division was well received throughout
the Province.
Sanitation—The division offered technical support to the Division of Public
Health Inspection, primarily in connection with private sewage disposal systems
and package sewage-treatment plants. Engineers contributed to the Ministerial
Standards for the design of alternative methods of sewage disposal and compiled a
list of approved prefabricated septic tanks and pipe materials acceptable for use in
disposal fields. A guideline was prepared in this connection to assist manufacturers
of package treatment plants. Only plants having received prior approval can be
incorporated into any sewage disposal system under Ministry jurisdiction.
Pollution control permits—The division, on behalf of the Minister, receives
copies of Pollution Control Applications from the Pollution Control Branch. Comments are obtained from the local health authorities by the engineers who formulate
 PUBLIC HEALTH PROGRAMS
39
an assessment of each application. The Regional Engineer in Vernon was a
member of the Keremeos Task Group, which investigated alternative methods of
sewage treatment and recommended a suitable method to the Village of Keremeos.
Participation in Related Activities
In addition to their normal duties during the year, the Environmental Engineering staff offered direct assistance to other Government agencies, municipalities,
regional districts, and other specialized groups. Staff membership and affiliations
with these groups encompass a wide range of local, national, and international
agencies.
Short Courses and Conferences
Members of the division attended a number of short courses and conferences
as part of an ongoing program of professional training and continuing education.
Statistical Information
In the area of water supply, the division processed 804 certificates of approval
for various improvements projects among the 973 known water systems in the
Province. This compares to 688, 639, 710, and 771 certificates issued for the years
1974 through 1977 respectively.
There were only two certificates issued for sewerage systems, since small collections systems are usually not economically practical.
During the year, the division processed 74 certificates for swimming-pool
approvals. This compares to 115, 81, 83, and 85 for the years 1974 through 1977
respectively.
PUBLIC HEALTH INSPECTION
Public Health Inspectors continue to play an important role in the industrial
development of the Province. As members of the community health services, they
provide advice and guidance to prevent or minimize adverse social and environmental conditions in respect to new towns and industrial sites. The Director of
the Division of Public Health Inspection, representing the Deputy Minister of Health
on the Technical Land Use Committee, acts as a co-ordinator in seeking the opinions
of local health officials regarding large developments such as the Northern B.C.
Pipeline.
Food Safety
One of the greatest hazards to safe food is microbiological contamination and
it is considered that food-borne illness accounts for more absenteeism from work
than any other disease, except the common cold. The incidence of salmonella has
more than tripled from last year, being 908 cases this year, compared to a total of
307 cases for 1977, and a five-year average of 460. Bacillary dysentery was also
higher with 105 reported cases for 1978, as compared with 101 for 1977.
Much has been said about the need to establish microbiological standards to
determine the safety and quality of foods by placing a limit on the number of
organisms that may be permitted in foods. The focus of attention in this Ministry,
however, is on the development of a comprehensive educational program and
regulations that set basic standards for handling and storage of food. Senior
officials of the Ministry of Health have been meeting with other agencies involved
with food safety to bring about a co-ordinated approach to the problem.
 40 ministry of health report, 1978
Revision of Regulations
One of the prime responsibilities of the Division of Public Health Inspection
has been the rewriting of regulations under the Health Act. Priority has been given
to the development of a Sewage and Waste Disposal Regulation and to the writing
of a Tourist Campground Regulation. Other regulations, including Food Premises,
Industrial Camps, Swimming-pool and Summer Camps are presently being reviewed.
Training Programs
The Ministry of Health, in co-operation with the British Columbia Branch of
the Canadian Institute of Public Health Inspectors, sponsored a four day In-Service
Training Seminar at the British Columbia Institute of Technology for 65 Public
Health Inspectors in February.
Several Chief Public Health Inspectors have been given the opportunity to
attend the Public Service Staff Management courses offered through the Public
Service Commission.
A Chief Public Health Inspectors' Educational Seminar was held in Vancouver,
November 20 to 23, inclusive, for 28 Chief Public Health Inspectors employed in
Provincial and Municipal Health Departments.
Because of the importance attached to on-site sewage disposal, three of the
consultants from this division attended conferences on Individual On-site Wastewater Systems.
The Ministry of Health provided field training for 32 student Public Health
Inspectors from the British Columbia Institute of Technology.
Land Use
The Senior Consultant with this division has been working with a committee
to develop guidelines or Ministerial Standards for Alternate Methods for on-site
sewage disposal. Although the number of sewage permits issued this year is down
from the previous year, as shown in Table 7 much of the unsewered land now
available for residential development is unsuitable for a conventional system and the
inspection staff requires considerable knowledge of soil capabilities to be in a
position to approve an acceptable alternate method or site specific design.
DIVISION OF OCCUPATIONAL HEALTH
The Division of Occupational Health offers a multidisciplinary service to all
Provincial Government and some Crown corporation employees. It also acts in
an advisory capacity to both Government and non-Government organizations. Services are provided through offices located in the Greater Vancouver, Victoria, and
Kamloops areas. Travelling clinics are utilized for other areas of the Province.
Emphasis is placed on prevention of both occupational and nonoccupational injury
and disease through the provision of a safe, healthy work environment, placement
of individuals in work compatible with their physical and mental abilities, and
through the encouragement of personal health maintenance. Every effort is also
made to ensure optimal treatment and rehabilitation for health problems. Areas
of expertise within the division include medical, nursing, radiation protection,
alcoholism rehabilitation, and employee physical fitness.
Employee health assessments again increased with medical and nursing personnel seeing approximately 30 per cent more individuals this year than last.
Division personnel assumed a major role this year in the assessment of employees
utilizing the recently introduced Short-term Illness and Injury Plan and the Long-
 A member of the Environmental Engineering Division inspects the installation of a
water-main to ensure that the pipe assembly meets public health standards.
!
am
-■■■■■wee
Health inspections are required for all public swimming-pools, in order to maintain
proper standards of chlorination, safety, and maintenance.
 The proper preparation of food is included in the public health inspection of all restaurants,
hospitals, institutions, and long-term care facilities.
A Public Health Inspector checks the temperature in the walk-in refrigerator of a hospital.
 PUBLIC HEALTH PROGRAMS
43
term Disability Plan. As was expected, these plans have greatly increased the
necessity for medical and vocational evaluation, and for eventual placement through
the Screening Committee.
A gradual expansion of pre-employment evaluations continued for those individuals beginning work in relatively high-risk areas. This year the service was
extended to Ministry of Attorney-General Sheriff Services and selected Liquor
Distribution Branch employees. Occupational Health Services were also made
available in the new Provincial Government Robson Square complex with the
opening of a new facility in that location.
Expanded Workers' Compensation Board Industrial Hygiene Regulations
became effective in early 1978. The existing Hearing Conservation Program for
noise-exposed Government employees was as a consequence greatly expanded
throughout the Province, with the assistance of the Division of Speech and Hearing.
Regular liaison with the Accident Prevention Division of the Public Service Commission and individual ministry safety officers resulted in more effective sharing of
information and co-ordination of occupational health and safety activities. A joint
effort is under way to initiate a toxic chemicals control program, as well as to define
other hazardous work environments. Prevention of musculoskeletal injuries remains
an area of mutual concern.
Development of a modern information system continued to be a high priority
endeavour. Computer storage of illness and injury data, with safeguards to ensure
their confidentiality became feasible this year. It is hoped this information can be
linked with that currently recorded for purposes of the short- and long-term illness
plans to provide the type of information necessary for effective decision making
within the division.
Medical personnel continue to participate on Government and other committees concerned with numerous environmental hazards of public health concern,
health promotion, and advanced medical treatment procedures.
The Radiation Protection Service is responsible for monitoring sources of
ionizing radiation within the Province. The past year saw extensive involvement
in the evaluation of potential uranium mine sites. Efforts were co-ordinated through
the Uranium Mining Steering Committee of the Ministry of Energy, Mines and
Petroleum Resources. Environmental studies have been established for sites under
consideration, including measurement of background radiation levels.
A radon gas survey was carried out in the Castlegar and Trail areas in a joint
effort with the Radiation Protection Bureau, Department of National Health and
Welfare. This program measured the level of radon daughters and radon gas in
270 homes between Trail and Castlegar. The results of this survey are presently
being collated. A program was also established in collaboration with the local
health units for the testing of potable water samples for radium content. In all
cases, the levels were found to be exceedingly small and far lower than the current
proposed drinking-water standard.
Completion of the initial phase of a mammography quality assurance program,
carried out in co-operation with the U.S. Bureau of Radiological Health, showed
that equipment utilized in British Columbia was considerably safer than that found
in the pilot study performed in the U.S. The Radiation Protection Service also
continued a program of dental X-ray unit and microwave oven emission monitoring.   Several incidents of accidental radiation overexposure were again investigated.
 44 MINISTRY OF HEALTH REPORT,  1978
The activities of the Radiation Protection Service for the past year are summarized as follows:
1978 1977
Radiation surveys  (X-ray, radioisotopes, and microwaves) 	
Consultations and visits	
Talks and lectures	
Radioisotope leak tests
Analysed water samples
Air samples 	
,020
1,261
520
305
40
27
260
350
250
183
50
52
Employee Development Services function as a diagnostic and motivational
counselling program within the Division of Occupational Health. Two staff members provided counselling and social services to Government employees with work
difficulties resulting from alcoholism, chemical dependency, marital, legal, financial,
and other similar problems. Approximately 150 new employees were referred to
this service last year with referral to appropriate community treatment resources
or to the Alcohol and Drug System of Care. At present over 300 such employees
are being actively supported through a lengthy period of rehabilitation.
Employees in difficulty on the job, especially those with alcohol or chemical
dependency problems, are a serious management problem involving considerable
expense, many extra hours of supervision and much frustration. It is estimated
that alcoholics alone cost management between 25 per cent to 50 per cent of their
salaries. The rehabilitation of such employees not only stops such expense, frustration, and concern but also salvages employees' lives and families. The program
has been consistently returning about 70 per cent of such employees to satisfactory
job performance. It is estimated that these efforts over the past year have again
resulted in a.dollar return to the Government of approximately $500,000.
The Employee Fitness Program enjoyed another busy and productive year.
Services provided included exercise classes, physical activity and nutritional counselling, fitness assessments, and numerous recreational opportunities. A new program, consisting of a series of workshops and educational seminars on health topics,
was introduced to various employee groups. Positive lifestyle change in the area
of exercise and nutrition continued to be a major priority for the Employee Fitness
Program.  This in fact was accomplished for many over the past year.
Facilities continue to be limited to the Victoria area. Numerous requests were
received over the past year from employee groups throughout the Province for help
in initiating their own programs. Arrangements for this have been made and will
begin in several Government institutions with the introduction of exercise programs
for the prevention of musculoskeletal injuries.
SPECIALIZED COMMUNITY HEALTH PROGRAMS
MEDICAL SUPPLY SERVICE
The headquarters of the Kidney Dialysis Service has been established at 1159
West Broadway in Vancouver. This includes the administrative headquarters, the
technician laboratory, and the "Willow Dialysis unit."
The "Willow Dialysis unit" is known as a limited care unit in which there is
limited technical help and it is necessary for the patients to assist in their own treatment. This concept of an ambulatory treatment centre allows the patient freedom
to regulate his own dialysis which many patients prefer to do.   A technician has
 A patient receives assistance prior to going on kidney dialysis.
A patient relaxes while undergoing dialysis in the old Willow Unit in Vancouver.
A new unit was opened December 12, 1978.
 46 MINISTRY OF HEALTH REPORT,  1978
been employed to operate the equipment and two nurses have been employed to
initiate the operation of the unit. When fully staffed, the unit will be able to accommodate up to 40 patients.
The number of patients on home hemodialysis has decreased from 80 to 71.
This change has occurred because patients have been transferred to other forms of
treatment and the additional task of training patients for limited care units has
restricted the number of patients that can be put through the home training centres.
The number of patients receiving peritoneal dialysis has increased from 23 to
35. The large increase that occurred last year was due to the introduction of
cyclers to assist these patients, but use of peritoneal dialysis has decreased so that
there are now only 12 patients using this procedure. The new method that has been
adopted is called Continuous Ambulatory Peritoneal Dialysis or CAPD. This is
a simple procedure in which the patient places 2 litres of solution through a tube
into the abdominal cavity. This solution is drained and then replaced four times
a day. This continuous form of dialysis allows an almost average diet and relative
freedom of movement with the result that the patients feel well. Most patients on
this procedure can be trained within a week so that it is possible to return them to
their home with a minimum of equipment, no need for an assistant, and an almost
independent lifestyle. It has been difficult, however, to develop a technique to
ensure that the patient will remain free of infection and until this problem is overcome the method will be limited to those patients who can adequately manage this
procedure.
A nurse has been employed to make routine visits to the patients on home
dialysis to ensure that their technique remains good and that the patients remain
under medical care, and to resolve other problems that may be encountered. This
is in addition to the regular visits of the technicians to ensure that the equipment
remains in good operating condition and occasional visits from the hospital social
worker and dietitian as required.
It was necessary to introduce dietary supplements for children on dialysis to
ensure that they receive enough calories for proper growth. These supplements are
free of protein, sodium, and potassium. This was further extended to adult patients
who developed special problems such as weight loss. The number of patients
receiving dietary supplements has increased from 41 to 107.
The first summer camp for children on dialysis and children of patients on
dialysis was held this year at Vernon. Sponsored by the Kidney Foundation, this
service provided a proportioning unit and the dialysis supplies for the camp. A
mobile home was provided to the Kidney Foundation by the Canadian Legion.
The Kidney Dialysis Service provided the supplies for patients who were able to
take a holiday by this method.
The service has made an effort to assist the transplant program by employing
a physician to co-ordinate the activities throughout the Province. Collecting centres
and improved methods of transporting cadaver kidneys are being organized and
co-ordination with other Provincial centres is being developed. This has led to an
increase in the number of transplants from 18 to 28 in the past year. The transplant
committee considers that approximately 40 transplants a year will meet the need in
this Province.
Miscellaneous Services
The B.C. Hemophilia Society has been provided with a Provincial 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,
 PUBLIC HEALTH PROGRAMS
47
which is the standard form in haemophilia. The 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
five patients being totally fed intravenously. Advances have been made in the production of oral supplements and products are now available such as Vivonex, Flexi-
cal, Ensure, and Nutramigen. There are now five patients being maintained on
these oral supplements.
SPEECH THERAPY
Ministry of Health Speech Pathology services provides comprehensive treatment programs for individuals with communication disorders, aimed at preventing
further consequences of the speech and language problems. These services are
provided to clients in all age categories throughout the Province from local Health
Unit Speech and Hearing Clinics and through school board programs. Continued
services were given to school populations this year, resulting from a co-operative
agreement previously reached with the Ministry of Education, Science and Technology. The Program for Communication Disorders was extended on a contract
for service agreement to seven school districts within five local health unit geographic areas. Several additional school districts have applied to participate in
our school program.
All program services were provided to communicatively handicapped populations within a framework of standardized guidelines. These policies have resulted
in increased effectiveness and consistency of client services throughout the Province.
Twenty-one speech pathologists provided services from 17 local health unit clinics
and additionally, 17 speech pathologists delivered speech and language services
through the school program.
On the average, clients were referred for speech and language services at a
rate of 280 clients per month. Following individual assessments, 76 per cent of
these clients were recommended for treatment programs. Each month an average
of 760 communicatively handicapped individuals received weekly/bi-weekly treatment from the Division of Speech and Hearing. Eight per cent of all treatment cases
were dismissed each month. Seventy-two per cent of staff time was devoted to
direct client treatment and 38,080 individual therapy sessions were conducted last
year. This is a significant increase in direct remediation of communication disorders.
Local staff are utilizing advanced techniques and procedures in a variety of
program areas which have improved the quality and effectiveness of service to
speech and language handicapped individuals throughout British Columbia. Fifty
per cent of all treated cases were reported to have achieved their therapy goals upon
dismissal.
HEARING CONSERVATION PROGRAM
The Division of Speech and Hearing delivers a comprehensive, cost-efficient
community hearing conservation program across the Province which serves an
increasing number of British Columbia residents each year.
Audiology clinics in 17 community health centres provide complete hearing
services, including diagnostic testing and hearing-aid fittings, to an age-group ranging
from newborns to 100 plus years. The success of these programs is based on the
high level of local community and medical input achieved through the use of medical
advisory committees in each hearing clinic locality.    In addition programs are
 48 MINISTRY OF HEALTH REPORT,  1978
closely co-ordinated with other community facilities and services such as hospitals,
school boards, other public health personnel, and local offices of other Provincial
ministries.
The cost efficiency of the division's Hearing Conservation Program is the
direct result of standardization of all critical parameters.
Although the hearing aid program is perhaps the best-known hearing program,
the prevention of hearing loss before it occurs and the earliest possible detection of
unavoidable hearing loss are the primary objectives of the hearing program. Efforts
toward these aims are provided through
(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.
During 1978 the demand for speech and hearing services from across the
Province has resulted in the establishment of 17 audiology clinics serving 83 per
cent of Provincial health unit programs.
In addition, the division is, through contractual arrangement, providing these
services to two independent boards of health.
VISION SERVICES
The main purpose of Vision Services is to provide a program which will enable
children to have optimal visual function.
The pre-school years are critical ones in the development of a child's eyes.
Strabismus (a term used to describe eyes that are not straight) occurs in approximately 4.5 per cent of children. Most of these cases can be recognized before 3
years of age when there is still a good chance of successful treatment. Early
detection and treatment of eye problems gives a child a chance to develop some
degree of normal binocular function prior to entering school. As many pre-school-
aged children as possible are being screened.
A film titled "Vision Testing for Three and Four Year Old Children" was
produced by this Ministry. The film explains how to carry out vision screening on
pre-schoolers and the procedures demonstrated are (a) visual acuity (using the
Stycar Chart) and (b) stereopsis.
During the year, consultative services were provided by the Provincial Orth-
optist to 12 main health unit offices and 15 branch offices. Visits to the field
included workshops and sessions involving public health nurses, registered nurses,
health unit aides, volunteers and summer students.
The orthoptist also spent two weeks in the Baffin Zone, Northwest Territories,
working with Federal Health and Welfare nurses. The procedures used in the Vision
Screening Program in British Columbia were discussed and demonstrated, and it
was felt that these simple screening methods could be useful in various Arctic
settlements.
The follow-up results of a kindergarten vision screening survey in 1976/77
(involving nearly 23,000 children) have now been evaluated. The study showed
that
(1) most eligible children do receive vision screening as outlined in the Policy
Manual;
(2) only one half of those who were rechecked failed the second test;
 PUBLIC HEALTH PROGRAMS
49
(3) the proportion of students for whom results of follow-up were known by
the start of the following school-year was relatively low, even after special
follow-up;
(4) in all, 1,294 children (5.6 per cent) had vision defects and of these, 520
(40.2 per cent) were previously known conditions.
A more recent evaluation of vision screening in kindergarten took place in
Central Vancouver Island Health Unit. Muscle balance testing was added to the
vision and stereopsis tests, and the outcome of this study will soon be available.
Since the publication of the Vision Care Task Force Report and Recommendations, various interested organizations including consumer groups have made
suggestions and given input, and their suggestions are now being studied.
COMMUNITY PUBLIC HEALTH NURSING SERVICES
Community health nursing is a field of nursing practice through which health
care services are made available to all people within a community and not just to
special age-groups or to those with specific diseases or conditions. The emphasis
is on health promotion and disease prevention, wellness rather than illness, and on
family and community health.
Constant review and readjustment in health services is necessitated by the
social changes that are continually taking place in our communities, the growing
sophistication of consumers regarding their health and the demands of the public
for a reduction of health hazards in the environment. In addition, the rising cost
of illness care and the effects of poor lifestyle habits accentuate the need for change
in planning and delivery of community health services.
All too frequently, health information on an individual basis is not enough to
effect the behavioural changes necessary to attain a healthy lifestyle. For this
reason, community health nurses have been giving special attention to alternative
approaches such as special clinics, work with groups and use of the mass media.
Community health nursing in British Columbia offers comprehensive spectrum
of services for the community. The two components of the services are: home care
given mainly by registered nurses, and the preventive program provided by the
public health nurses. The two groups of nurses are referred to collectively as community health nurses. They are assisted in the delivery of their services by a number
of health care aides, orderlies, and volunteer workers.
FAMILY HEALTH
Perinatal
The perinatal program has continued to reflect the increasing importance of
lifestyle for expectant and new parents. In all health units the topics of nutrition,
smoking, alcohol, fitness, and coping with stress are being integrated into the
continuum of perinatal teaching provided in first trimester (early bird), third
trimester, and postnatal classes and home visits.
Most health units also offer special instruction and discussion for groups such
as adopting parents, single mothers, parents planning for caesarian delivery, etc.
Based on statistics from Table 3 "Selected Activities of Provincial Public
Health Nurses, September 1, 1977, to August 31, 1978," it has been calculated that
42 per cent of all mothers who gave birth during the 1977/78 year attended prenatal
classes as did 28 per cent of all fathers.
 50 MINISTRY OF HEALTH REPORT,  1978
With the assistance of two summer students who were public health nurses,
work has continued on developing an over-all plan for the perinatal program,
including
• objectives for first trimester, third trimester, and the postnatal period;
• a questionnaire to assist parent and public health nurse to determine teaching and counselling needs for each client during each of the above time
periods;
• a record system which will facilitate continuity of service for each patient
as well as ongoing evaluation of the program.
Infants and Pre-school
Recognizing that the years from birth to school entrance can be of the utmost
importance in determining an individual's health and future lifestyle, public health
nurses have continued to give high priority to families with infants and pre-school
children. This emphasis is reflected by the following statistics:
• Over 35,800 visits were made to new mothers visited within six weeks of
giving birth.
• Each infant received on the average approximately three home visits in the
first year of life.
• 68 per cent of all infants were brought to Child Health Conferences.
• More emphasis has been placed on health assessments as shown by the
20-per-cent increase in infant and pre-school assessments done.
• An increase of 6 per cent in the number of visits to pre-school children
including those with special needs has been achieved.
• Attendance at groups on parenting of pre-school children increased by
26 per cent.
Public health nurses have continued their involvement with licensing of community care facilities for children as well as providing consultation to the staff on
factors related to good child health care.
School
During the school-year two special projects were carried out for the purpose
of providing an over-all review of public health nursing services to school populations as carried out in local health units by Public Health Programs staff.
The first project was a prospective time analysis survey of a random sample
of 30 public health nurses. The study identified the types of service being provided
by the nurse to school-age children and the time involved in each activity. These
activities are listed below showing the percentage of the nurses' time in school-
related-services used for a particular activity. Times are an average of the 30 nurses
studied.
• Vision and hearing screening including referrals and follow-up—23 per
cent.
• Health education and counselling. This includes health counselling to
individuals on a wide variety of health topics and addressing the individual
student's need. This also includes group health teaching and providing
information and resource material to teachers—16 per cent.
 PUBLIC HEALTH PROGRAMS 51
• Services related to mental health and family problems, including individual
counselling, liaison with other resources and home visits—14 per cent.
• Planning, recording, and reports—13 per cent.
• Immunization—10 per cent.
• Episodic care including first aid—4 per cent.
• Communicable disease related service—less than 4 per cent.
• Chronic disease related services—less than 3 per cent.
• A variety of other reasons for counselling, home visits, and liaison services
together accounted for another 13 per cent of the nurse's time in school
services.
The second project was a joint undertaking with other divisions in Public
Health Programs and Mental Health Programs. In this project the total spectrum
of health services in schools was reviewed. Related activities were described,
staffing requirements and service costs were estimated. This was done for three
levels of service identified as "minimal," "adequate," and "preferred." Using the
time analysis survey described above, it was possible to list in some detail activities
presently being carried out by nurses in school health services and then to list
additional services, which if added would provide an "adequate" or "preferred"
public health nursing service in schools.
Some highlights of the public health nursing service provided during the
1977/78 school-year are listed below:
• 16 per cent of total public health nursing time was spent in school-related
services to serve an average case load of 1,200 students per nurse.
• 120,110 vision screening services were done by nurses, which was an
increase of 16,059 over the previous year.
• 49,745 hearing screenings were done by nurses, which was an increase of
8,833 over the previous year.
• Communicable disease and other screening services totalled 42,641, a
decrease of 2,940 from the previous year.
• 23,900 student/nurse conferences occurred.
• 70,174 conferences between teacher or principal and nurse were held.
• 28,151 home or office visits were made concerning school-age children.
ADULT, GERIATRIC, AND OTHER COMMUNITY SERVICES
The services provided to clients beyond school-leaving age and to those with
special health problems are adapted to meet community needs and demands for
services.   In the past year
• the ongoing services such as geriatric, family planning, and immunization
clinics have been maintained with increased attendance at the latter;
• visits for the purpose of licensing and monitoring community care facilities
continue to be given special attention;
• prevention of mental health problems was the primary reason for over
4,550 visits, and concepts relative to the promotion of good physical and
 52 MINISTRY OF HEALTH REPORT, 1978
mental health initiated 38,172 visits.    Over 3,300 visits were made to
patients with a diagnosed mental illness;
• counselling, referral, and follow-up visits to the elderly and to families with
complex problems received concentrated effort.
Public health nurses work with many community groups, agencies, and professionals attending a total of 11,955 meetings related to the planning and delivery
of preventive and promotional health services during the year.
COMMUNICABLE DISEASE CONTROL
Public health nurses are in an ideal situation not only to carry out immunization procedures, but also to disseminate community disease control information
available from other divisions within Public Health Programs. The nurse has
access to and acceptance in homes, schools, and other community settings when
she can emphasize the importance of protecting infants and young children early
in life against preventable communicable disease such as diphtheria, whooping-
cough, tetanus, poliomyelitis, rubella, and measles.
• Over 416,000 immunizations were given in 1978, an increase of approximately 9,700 in the number given in 1977.
• The importance of protection against rubella for all women of childbearing
years continued to be stressed.
• Tuberculosis, although no longer a major health problem, still required
over 5,500 public health nursing visits.
• Visits in relation to diagnosed cases of infectious hepatitis increased by 33
per cent over the previous year.
• The British Columbia immunization schedule was revised to conform to
the National Immunization Committee recommendations which reflect
current research findings.
HOME CARE PROGRAMS
The Home Care Program is administered through the health units and all
patients are admitted to the program on referral by their attending physician(s).
The Home Care Program consists of two categories, the hospital replacement
and non-hospital replacement.
(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 free of charge. The services are
co-ordinated and paid for by the Home Care Program. Approximately 20 per cent 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.
(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
 PUBLIC HEALTH PROGRAMS 53
the Province and provides nursing care and a limited amount of
physiotherapy at no charge to the patient. The patient is responsible for payment of other services such as homemaker, medication,
or equipment that may be required.
The Home Care statistics were computerized May 1, 1977. Data processed
for the period May 1, 1977, to March 31, 1978, revealed
• in the hospital replacement category, 56 per cent of the 14,466 patients
admitted were in the 20-64 age-group;
• in the non-hospital replacement category 66 per cent of the 26,453 patients
admitted were over 65 years of age;
• the three-month period following the implementation of the Long-term
Care Program on January 1, 1978, showed a steady increase in the number
of patients 65 years of age and over admitted for Home Care. This is probably an indication of the effect that the new Long-term Care Program will
have on the Home Care Program.
COMMUNITY PHYSIOTHERAPY SERVICES
During the year, 21 full-time and six part-time physiotherapists provided direct
treatment, consultative, and preventive medicine services to patients, families,
physicians, public health staff, hospitals, Government ministries, and the general
public through 12 health units representing 18 office locations. These services were
provided to three major program areas, namely, Home Care, Long-term Care, and
Public Health Programs.
The demand for physiotherapy services from physicians and the public generally has continued to increase to the point where it outstrips available resources.
Most health units in the Province are utilizing their community physiotherapists to
maximum benefit and a statistical survey indicates that the concept of community
physiotherapy and rehabilitation generally is being accepted by the referring
physicians. This is most obvious in the hospital replacement program where
referrals have increased by at least 10 per cent. Any patient requiring physiotherapy who is able to get to a local hospital out-patient department is required to
do so and the success of this policy has been reflected in a reduction of the non-
hospital replacement program referrals.
An analysis of the 1978 case load statistics by age shows the following distribution: under 1, 8 per cent; 1 to 5, 12 per cent; 6 to 18, 21 per cent; 19 to 64, 24 per
cent; and 65 and over, 35 per cent.
Previous annual statistics showed that the over 65-year-old population constituted the largest group being served by community physiotherapists. However,
in 1978, the 6 to 18 and 19 to 64-year-old groups have risen by nearly 25 per cent
each, whereas even with the addition of the Long-term Care Program, the 65 and
over age-group referrals have only shown a 2-per-cent increase. It is also interesting to note that the provision of services to patients less than 1 year old has
increased by over 37 per cent in the last 12 months probably as a result of the
continued interest of community physiotherapists in paediatric care and a willingness
to be involved in the continuing education programs available in pediatric care.
Services are being provided in
(1) Preventative 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 exist-
 54 MINISTRY OF HEALTH REPORT,  1978
ing problems, or recurrence of a treated problem. Additionally, the
therapist is also involved in services, the primary function of which
is prevention, 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 usually 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.
(a) acute care—this is 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. Thus, the community physiotherapists are involved in the treatment of a high percentage of both
acute medical and surgical patients. Therapists have been involved
in a variety of medical areas, including acute and chronic respiratory
diseases, orthopaedics, prosthetics, soft tissue injuries, post-surgical
care, and manipulations, etc.; coronary care, theracic 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. These programs usually involve either periodic treatment or supervision by
the physiotherapist over many years and may include continuous
assessment, special training programs, specialized procedures, and
the provision and constant re-evaluation of aids and devices necessary for independence.
(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 multidisciplinary approach has been taken.
Physiotherapists therefore 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 in features needed in public
buildings and facilities to avoid architectural barriers to the disabled.
 PUBLIC HEALTH PROGRAMS
55
The establishment of new services and the evaluation of present services will
be the major focus for 1979 in Community Physiotherapy Programs. From the
beginning of 1979 a new system of statistical reporting will be implemented so that
by the end of the year information will be available on the use of the community
physiotherapists within each local area.
DENTAL HEALTH SERVICES
The past year was the most productive ever for the Division of Dental Health
Services with school districts continuing to ask for the expansion of dental programs.
However, the available staff is still only about half of that which would be required
to provide effective dental health programs in all school districts served by Provincial health units. Therefore, the policy of carrying out effective programs in
selected school districts, or parts of them, rather than attempting to provide partial,
less effective, programs in larger geographic areas, has been maintained. The staff
is comprised of six dental officers, 13 dental hygienists, and 26 dental assistants.
Through the co-operation of the College of Dental Surgeons and The University of
British Columbia, a public health training module is being established to train
certified dental assistants. This will enable dental assistants to relieve the hygienists
of some of their routine duties, and allow expansion of effective programs. Public
health training for hygienists is being considered because new duties are being
developed for them, such as responsibility for long-term care patients.
THREE-YEAR-OLD BIRTHDAY CARD PROGRAM
This program operated in 53 of the 66 school districts served by Provincial
health units. Close to 10,000 children were started down the road to dental health
through the free examination and parental counselling that this program provides.
A participation rate of 67 per cent of eligible children throughout the Province was
achieved, an increase of 11 per cent from last year. This demonstrates the continuing positive change in society's behaviour in respect to early and regular dental
care for children. An intensive follow-up procedure has stimulated this increased
participation, particularly in the Boundary Health Unit.
SCHOOL DENTAL PROGRAM
Provincial dental hygienists and dental assistants provided oral hygiene instruction, education, and motivation to almost 80,000 elementary school children, an
increase of 8,000 from last year. Of the total, 64,000 used the self-applied fluoride
paste and rinse provided on a twice-yearly basis. In addition, 48,000 children were
inspected by dentists or hygienists, an increase of 10,000 from last year. Almost
15,000 telephone follow-ups were made to parents whose children were in need of
dental care.   This follow-up program will be expanded in the coming year.
School dental health programs also operated in the Capital Regional District
and Greater Vancouver. In the Capital Regional District, an additional 24,000
pupils were involved. Of these, 90.5 per cent were judged to be under regular
dental care, with dental diseases under control. In Greater Vancouver, in addition
to the school preventive program, some treatment services were provided for about
1,400 children 4 to 8 years of age.
A dramatic improvement in the dental health levels of school-age children is
being reported by most public health dentists. Not only do these estimates suggest
that the great majority of children are receiving dental care, but that the number of
 Health Minister Bob McClelland attended a school "brush-in" where children are
taught proper techniques on how to "keep their teeth for a lifetime."
 PUBLIC HEALTH PROGRAMS
57
teeth lost by extraction is greatly reduced. The majority of public health dentists
estimate that only 10 to 20 per cent of children are not having their dental diseases
controlled and they are now the target population. The accuracy of these estimates
will be checked by the proposed 1980 Provincial Dental Health Survey. Many
factors are at work to improve dental health. Most children are attending schools
with a dental public health program, where home care skills, prevention, and
attendance at the family dentist are taught and promoted. More dentists are available. Positive nutrition advice is published everywhere. Dental insurance plans
continue to grow and now cover half of our population. Children now in school
realize that retaining their own teeth for a lifetime is an attainable concept.
DENTAL EXTERN PROGRAM
The largest extern program to date was conducted during the year by 12
dentists and 21 hygienists and assistants on a fee-for-service basis, at 90 per cent
of the dental fee schedule. They utilized our six mobile vans, one trailer, and
three packaged sets of portable equipment. The permanent dental facility at Prince
Rupert was modified to accommodate two separate dental offices, allowing for the
provision of more dental service to that dentist-short city. The externs visited 38
communities which were in need of dental service and provided complete dental
care for 7,114 people. This is almost 2,000 more people than were completed last
year.   Many more persons received emergency care and partial treatment.
Two Dodge Maxivans were obtained to transport the packaged equipment
which has been modernized.
PROFESSIONAL RELATIONSHIPS
A close-working relationship has been maintained with the College of Dental
Surgeons whose members continue to demonstrate an enthusiastic co-operation with
the 3-year-old birthday card program, the school program, and the cytology program for oral cancer diagnosis. This latter program continues to function in cooperation with the Cancer Control Agency of British Columbia.
The Division of Dental Health Services has worked with the College of Dental
Surgeons on a report to the Minister on possible alternate methods of making a
dental care plan available to all the dentally uninsured citizens of British Columbia.
Among those with difficulties in purchasing dental treatment are some old-age
pensioners, and men, women, and children with low family incomes. The report
is in its final stages.
DENTAL EDUCATION
This division has worked closely with the Faculty of Dentistry, The University
of British Columbia, in developing a dental department at the new UBC Hospital
for acute and extended care patients. It is intended that this new facility will
dramatically improve the training and capability of the dental graduates of UBC
to provide the highest standard of care for the elderly, the handicapped, the chronically ill, and those under institutional care. The Ministry has continued to support
the Faculty of Dentistry in the provision of a Summer Dental Clinic at UBC. This
past summer, under the direction and supervision of the faculty, senior dental
students and dental hygiene students provided full dental care for 1,100 children.
Many of these children were pre-selected by public health dentists as being in need
of care which they would not have received except for this program.
The training leading to certification of dental assistants at various community
colleges throughout the Province has been very successful. Dental hygienists
remain in short supply.
 58 MINISTRY OF HEALTH REPORT,  1978
The division has continued to support the actions of the Dental Technicians'
Board throughout the year. The board has continued to improve its performance
and capability in regulating and training dental mechanics and dental technicians.
OTHER ACTIVITIES
During the year, a week of in-service training was held in Vancouver for all
the staff of the division. The positive effect of this training is reflected in the growing enthusiasm, high standard of performance, and the dedication of individuals
within the service.
The Dental Division is developing programs to assist in the care of the Long-
term Care patient. A preliminary screening of more than 3,000 such patients has
indicated that many of these patients are in a state of dental neglect. Pathways by
which this situation can be corrected are being found. This includes the Dental
Division being instrumental in securing treatment, and in training nursing home
staff, the homemakers service, family and friends in the oral hygiene practices these
patients need. The same problems exist in many extended-care hospitals, in which
the Dental Division hopes to become active also.
Plans for the Provincial Dental Health Survey to be carried out in 1980 are
well under way. Some pre-testing has been done and the final preparations are
almost complete. This survey will employ the most advanced method known for
obtaining representative dental health information.
Recent data suggests that the dentist to population ratio for British Columbia
is now around 1:1,600. This is by far the best in Canada, and British Columbia
no longer has a shortage of dentists. There are a few communities in the Province
which could use the full time service of a resident dentist, but these are rapidly
disappearing.
NUTRITION SERVICES
In 1978 the Nutrition Division had two primary objectives: (a) to make nutrition services available throughout the Province, and (b) to make nutrition information accessible to those at high risk of nutritional problems.
Considerable progress was made toward the first of these objectives with the
addition of four full-time nutritionist positions to the field staff. The goal of
Province-wide coverage was not attained with six public health units having no
community nutritionists on staff (Upper Island, Skeena, Peace River, West Kootenay, Selkirk, and Coast Garibaldi).
Three high-risk groups were the focal points for nutrition information in this
year: maternal and infant, adults aged 20-39, and seniors.
If gross nutritional deficiencies occur in the prenatal and early neonatal period,
the damage caused is often irreparable. Therefore, pregnant women and mothers
of new infants were selected as a major target group for nutritional information.
The division prepared two publications for parents: "Eating for a Baby" and
"Nutrition: Day One to Year One". Three slide series on infant nutrition were
developed. Informational papers on "Fetal Alcohol Syndrome" and "The Nutritional Implications of Poly Chlorinated Biphenyls (PCB's)" were prepared for
health professionals.
Two demonstration projects were undertaken to evaluate alternative educational methods. The first involved intensive counselling for high-risk mothers.
This was a short-term repetition of a previous project but once again demon-
 PUBLIC HEALTH PROGRAMS 59
strated with a small group of very high-risk mothers that infant birth weights can
be affected by one-to-one counselling programs.
An additional project explored the use of distance learning for nutrition education. In co-operation with the cablevision station in Nanaimo, The University
of British Columbia, and the Central Vancouver Island Health Unit, the nutritional
component of prenatal classes was broadcast publicly and evaluated. The evaluation
showed that viewers readily learned concepts from the television broadcast but that
more extensive publicity was required to expand the viewing audience.
The second priority in the nutritionally high-risk group was young adults, aged
20-39 years. The national nutrition survey showed that, within this age-group,
twice as many young men in British Columbia have elevated blood cholesterol
levels than in the nation as a whole. Also, more British Columbians are overweight
than over-all Canadians. More than 65 per cent of the adults over age 40 are
overweight or obese. The need for preventive programs designed to encourage
maintenance of body weight and protective food habits to prevent heart disease
was apparent. Planning for promotional work was initiated to include radio spots,
press features, a school kit, "Coming Out of the Dark about Nutrition," a film
entitled "Think About It," a coupon offer, and three publications "Good Nutrition
Guards Your Heart," "Fight Fat," and the "Fat Fighters Handbook." Several
novelty items including calendars and decals were also produced. The materials
were distributed to health unit nutritionists for use throughout the Province in
October and November. Two small evaluation projects, of the film and the coupon
offer, were begun. Results are expected early next year. Initial feedback indicated that the materials were well received by teachers and nurses due to the
quality of both presentation and content.
The third priority in the high-risk groups were senior adults. This was the
only group with clinical signs of malnutrition in British Columbia. The innovative
television series designed for seniors entitled "The Senior Chef" was repeated with
13 new half-hour programs completed. The recipe book was revised and expanded.
The new series was scheduled for broadcast throughout British Columbia. The last
series was broadcast in the Yukon, Saskatchewan, and Manitoba. Some revenue
was generated through national sales of the cookbooks.
In addition, an extensive program of nutrition services to clients of the Long-
term Care Administration was initiated under the direction of the Nutrition Division. Two full-time and 10 part-time nutritionists were added to the staff to provide
for the inspection of food service to residents of Long-term Care facilities, to
provide in-service education to homemakers and home care staff, and to provide
nutritional counselling to Long-term Care clients as necessary. This program of
service was initiated in November. Among the first priorities for service will be
the investigation of complaints regarding food service in Long-term Care institutions at the request of the Medical Health Officers and the Long-term Care
Administrators.
Thus, much progress has been made toward the achievement of the second
divisional goal, that of making nutrition information available to the identified high-
risk groups.
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 on Diet and Cardiovascular Disease and
for a conference in Nanaimo on physical fitness and nutrition; revising the British
Columbia Diet Manual in co-operation with the British Columbia Dietetics Association; producing the "Directory of Community Nutrition Services '78"; develop-
 60 MINISTRY OF HEALTH REPORT, 1978
ing the British Columbia Food Cost Plan which outlines the actual cost of feeding
a family to a standard of nutritional quality; conducting in-service workshops for
community health nurses and dental hygienists; and producing a weekly column
entitled "Nutrition Buyline" which is distributed to 1,400 outlets throughout British
Columbia. The latter will be discontinued in the New Year due to staffing
constraints.
Of the other projects undertaken in the division this year, several were directed
toward young children, including the development of guidelines for acceptable
accessory foods served in the schools, a survey of the quality of food served in a
small sample of day care centres, and the production of a pamphlet on nutrition for
pre-school children entitled "Food for Little Folks."
However, nutritional services to the schools and young children remain in
deficit. Reports of nutritional habits suggests that it would be appropriate to focus
additional resources on nutrition programs for children in the next year.
VITAL STATISTICS
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.
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; also for administering the issuance of marriage
licences in accordance with the prescribed requirements of the Marriage Act, and
for the solemnization of marriages by civil contract throughout 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 Registry of Wills Notices maintained under the Wills Act provides for a
testator voluntarily to file with this division a notice indicating the existence of a
will and where it is deposited. The Act provides for this information to be released
after decease of the testator, upon application to the Director in the prescribed form.
REGISTRATION SERVICES
The total number of registrations accepted under the specified Acts was somewhat lower than in 1977. There was a slight increase in the number of each of the
major forms of registration, births, deaths, and marriages.
There was a further substantial increase in the number of applications processed
under the Change of Name Act.
The number of registrations of vital events, and the number of certificates and
other documents issued therefrom under the Acts administered by the division, for
the years 1977 and 1978, are shown in Table 8.
BIOSTATISTICAL SERVICES
Two research offices, one in Victoria and the Health Surveillance Registry in
Vancouver, have a combined staff of 22 persons. These two offices are supported
by a 14-member data processing office in Victoria. Together, under the supervision
of the Co-ordinator of Research and Registration Services, this group provides a
 PUBLIC HEALTH PROGRAMS 61
wide range of statistical information as well as extensive collaborative and independent research. Recipients of these services include the Division of Vital Statistics itself, sectors of the Public Health and Special Health Services within the
Ministry, other sectors of the Provincial and Federal Governments, universities and
hospitals, and members of the general public.
In 1978 the division's dependence upon a centralized computer service for
data processing, provided by British Columbia Systems Corporation, increased when
outdated unit-record equipment was finally set aside at the end of 1977. Considerable difficulty has been encountered in relation to this developmental change to
centralized computer services. Large portions of the eight research officers' time
have been occupied in supporting systems analysts and programmers and in mastering methods of assessing computerized information from a service which is. not yet
fully operational. Nevertheless, it can be stated that the division now possesses the
capacity to deal with larger segments of vital data and to process some of these
data more efficiently.
The Health Surveillance Registry office in Vancouver has added 12,000 cases
to the registry file, bringing the total cases at year-end to approximately 120,000.
The registry encompasses congenital anomalies, genetic defects, and chronic handicapping conditions. Annual reports for 1976 and 1977 were published during the
year. Five research papers utilizing registry data were also published. The staff
has collaborated in a study of trends in maternal age-specific incidence rates of
Down Syndrome with the Department of Medical Genetics, The University of British
Columbia, and participated with the same department in a workshop on the faetal
effects of alcohol. It is continuing to co-operate with the Department of Medical
Genetics in the development of a rapid and responsive monitoring system for congenital anomalies in British Columbia. Initial steps were taken to convert the
medical codes of the entire existing registry files from the Eighth Revision to the
Ninth Revision of the International Classification of Diseases. This task will require
the assistance of computer programmers, a professional consultant, and extra clerical
staff. The need for such a recoding task occurs only once in each decade, since by
international agreement the classification is revised every 10 years.
The Cancer Registry, also maintained by the Vancouver research office, has
benefited from the development of a computerized system for recording data. This
register records newly diagnosed neoplasms from pathology reports submitted by
regional hospital laboratories as well as from reports received from the Cancer
Control Agency of B.C. and from private physicians. Information about neoplasms
ascertained at death is obtained from the division's own registration system. The
registry collaborates with the Western Canada Registry Cancer Association, made
up of the representatives of Cancer Registries in the four western provinces. A
close-working relationship with the Cancer Control Agency of B.C. continued during
the year.
Two research officers of the division continued to serve as members of the
Continuing Advisory Subcommittee on Perinatal Care. They were actively involved
in the development of a new perinatal form for hospitals and physicians and gave
particular attention to improving the quality of statistical data which is available in
relation to perinatal events. Studies which are presently under way are concerned
with cerebral spastic infantile paralysis and the causative factors surrounding
potentially viable stillbirths who have died during labour.
The Tuberculosis Control Division received service in the preparation of an
annual report, annual indexes, and monthly file maintenance of records relating to
that disease in this Province. There are now nearly 90,000 records on this master
file.   Collaboration was given in a study of tuberculosis deaths among immigrants
 62 MINISTRY OF HEALTH REPORT, 1978
to Canada residing in this Province. Another subject of special study at the present
time is Contacts to New Active Cases of TB.
Registries of infectious diseases, i.e., diphtheria, hepatitis, salmonella infections, streptococcal infections, and meningitis, were maintained. Special registries
of all newly reported cases of malaria and Asiatic parasitic disease were also
maintained.
The Division of Venereal Disease Control received monthly statistical reports
compiled on its behalf by the Division of Vital Statistics.
The G. F. Strong Rehabilitation Centre was again provided with annual tabulations and listings of their patient records.
New forms were developed for a survey undertaken by the Aid to Handicapped Division in order to determine the need for vocational rehabilitation services
among the injured and disabled in the Vancouver districts of Riley Park and
Kitsilano.
Monthly statistics were prepared for the Home Care Program. Both monthly
and annual statistics were prepared for the Director of Public Health Nursing.
Following the Chilliwack polio outbreak, this program was adjusted to enable the
use of both Salk and Sabine vaccines throughout the Province to be monitored
separately.
Quarterly statistical summaries of the activities of public health inspectors
were supplied to the Division of Public Health Inspection. A sewage-disposal complaint reporting system was maintained for participating health units.
Data from the Rheumatic Fever Prophylaxis program was provided to the
Division of Epidemiology. Analysis of Poison Control Reports was provided for
the Drug and Poison Information Centre.
A water-quality study was designed to determine the potability of Kootenay-
Columbia River water during periods of low precipitation. A study of coliform
bacteria in 1,100 samples, taken from 29 sampling sites along the river system from
Nelson to Trail over a period of one year, was embarked upon. This division
undertook responsibility for co-ordinating the activities of the West Kootenay
Health Unit with those of the Division of Laboratories in this project. A further
study, relating to the quality of Christina Lake water, was commenced. In this case
bacteriological, nutrient, biological, and chemical characteristics of the water are
to be studied as well as plant growth and sediment deposits.
The division co-operated in yet another study in the West Kootenay area,
related to the risk to young children of environmental lead. Samples of urban dust
and dirt were obtained from Trail, Nelson, and Vancouver. The highest lead concentrations were found to occur in downtown Vancouver at high traffic density
locations.
A report on the mouth rinse study undertaken for the Division of Dental
Health Services in the Port Alberni area was published in the Canadian Journal of
Public Health. It demonstrated that the rinse could help prevent caries and could
lead to a very significant saving in that regard.
A form was designed for reporting driver-related medical conditions to the
Motor-vehicle Branch. The form was pre-tested with the help of 20 family physicians, and plans were made to refine and improve it over a one-year period.
Four health program evaluation studies were in progress at the end of the
year. A post-cardiac fitness program, already of three years' duration, is assessing,
on the basis of more than 25 parameters, the effectiveness of the prescribed fitness
activities. Important will be whether the program reduces heart attacks and leads
to improvements in health or confidence. An antismoking information program for
 PUBLIC HEALTH PROGRAMS
63
young children has resulted in a positive preliminary report which will shortly be
concluded. A feasibility study is under way relative to respiratory conditions such
as asthma, bronchitis, emphysema, and lung cancer, to assess the effectiveness of
the services of a respiratory nurse who provides home supervision for patients
suffering from these conditions. It is hoped that this service might reduce hospital
days and physician visits, and retard the progress of the respiratory disability. All
of these studies are being carried out in collaboration with the South Okanagan
Health Unit. A further program evaluation study is commencing in Victoria with
regard to the use of acupuncture in the treatment of chronic pain.
Use of the Ninth Revision of the International Classification of Diseases for
morbidity and mortality coding will be instituted in 1979 and considerable attention
has been given to preparations for the changeover.
Vital Statistics data, as well as notifications concerning congenital anomalies,
inheritable diseases, and notifiable diseases, have continued to be supplied to
Statistics Canada in pursuit of long-standing Federal-Provincial arrangements for
exchange of services.
The division has continued to share responsibility for the data processing
requirements of Mental Health.
The research office in Victoria has responded to numerous individual inquiries
for vital and population data.
AID TO HANDICAPPED
The Division for Aid to Handicapped, through a community-based program,
assists mentally and physically disabled persons toward economic independence.
This assistance is in the form of vocational counselling; provision of technical aids
such as hearing aids, wheelchairs, orthotics, etc.; vocational or academic training;
and help with job placement.
A number of developments took place in 1978 that had significance for the
division's programs. Late in the year the Federal Government cancelled its plan
to provide block funds to the provinces as its share of financing for a wide range of
social services. This cancellation meant that as heretofor, Aid to Handicapped
would continue to operate under the cost-sharing guidelines of the Vocational Rehabilitation of Disabled Persons Act and Agreement.
Several staff changes took place during the year. It is notable that service in
the Skeena and Northern Interior Regions was resumed as new staff were placed in
those two areas.
Decentralization was carried out during the year. Each regional office was
given a budget for providing services to clients. This move has made the program
more responsive to regional needs.
Sixteen students were employed during the summer in the Working In Government program on three projects:
(1) A survey of the health, education, and work needs of two selected
areas in Vancouver City was carried out.
(2) Two students surveyed the needs of the developmentally disabled
youth (between the ages of 15 and 22) in the Vancouver area.
(Other regions such as the Central/Upper Vancouver Island are also
studying this problem.)
(3) One student studied the management information systems of the
division.
 64 MINISTRY OF HEALTH REPORT,  1978
The findings of these projects have provided information that will allow the division
to better carry out its mandate in helping in the rehabilitation of disabled persons.
A special rehabilitation committee for the visually impaired client was established early in the year in Vancouver. Aid to Handicapped consultants can refer
visually impaired persons from anywhere in the Province to this committee comprised of knowledgeable professionals with expertise in "blindness."
Notable developments in the regional offices include:
(1) An active program of pre-interviewing clients was instituted in the
Vancouver area resulting in greater communication between the
division and other agencies. This system led to better and more
efficient help to those clients accepted for service.
(2) In the Kootenays a Regional Advisory Planning Committee was set
up under the Kootenay Society for the Handicapped. This committee will plan a schedule of service development for the mentally
handicapped population of the East and West Kootenays. The Aid
to Handicapped consultant in the area will sit on this committee.
(3) On a trial basis, our staff became more actively involved in the
placement in employment of job-ready clients in the Victoria area.
Our placement activities augment those provided for clients who
qualify for Canada Employment and PREP services.
LABORATORY SERVICES
The British Columbia Provincial Health Laboratories, with 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. Tests are available to registered physicians, hospitals, and
health-related agencies at all levels of government; specimens are shipped by
courier from all parts of the Province.
Between 1977 and 1978 the work load of the Division of Laboratories
increased by 6 per cent. In Table 10 the numbers of tests performed at the main
laboratory and at the branch laboratories in Nelson and Victoria during 1978
are compared with the corresponding figures for 1977. Increases in work performed occurred in the Virology Service (19 per cent), examinations for intestinal
parasites (14 per cent), enteric bacteriology (11 per cent), and miscellaneous bacteriology (8 per cent).   No appreciable decreases occurred.
During 1978, tests for the diagnosis of infection with Corynebacterium diphtheria, Neisseria gonorrhoea, and Herpes hominis, types 1 and 2, by immunoflu-
orescent techniques were among the new procedures to be performed at the
Provincial Health Laboratories.
BACTERIOLOGY
Corynebacterium Diphtheria
The number of cases and carriers increased from 72 in 1977 to 165 in 1978.
An obese, 45-year-old man died of laryngeal diphtheria two days after admission
to hospital. The dramatic increase of laboratory-proved diphtheritic infection con-
 PUBLIC HEALTH PROGRAMS 65
tinues. During the 12-year period, 1956 to 1967, only 16 infections were confirmed (range—none in five of these years to seven in 1957). Yet the incidence
rose to 1,182 infections in the 11-year period 1968 to 1978 (range—19 in 1969
to 355 in 1974). More adequate immunization of the people with diphtheria
toxoid is therefore needed.
Hemophilus Influenza and H. Parainfluenza
Haemophilus infections were diagnosed in close to 50 patients in 1977 and
1978. Most of these organisms were recovered from sputum; other sources
included eye, ear, and genital tract.
Neisseria Gonorrhoea
In 1978, 4,200 cultures yielded N. gonorrhoea?, 5 per cent more than in 1977.
By contrast, 4,800 genital smears showed gonococci microscopically, a substantial
16 per cent fewer than in 1977. 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 168 in 1977 and 173 in
1978. Of the 173 cultures, 150 were recovered from sputum specimens and 23
from other sources, such as blood, cerebrospinal fluid, and genito-urinary tract.
The serogroups of 68 isolates were A (1), B (17), C (7), X (3), Y (9), Z (3),
29E (12), and 135 (16).
Opportunistic Pathogens
Opportunistic infections are often caused by micro-organisms formerly considered nonpathogenic. Such infections are common in immuno-suppressed
patients. While some 2,200 opportunistic pathogens were identified in 1977, more
than 2,500 were recovered in 1978, an increase of more than 10 per cent. The three
most often recovered were Acinetobacter calcoaceticus, Escherichia coli, and
Acinetobacter Iwoffi.
Anarobic Bacteria
Of 224 anaerobic strains identified, the three most common were Clostridium
perfringens, Bacteroides fragilis, and Peptococcus asaccharolyticus.
Enteric Bacteria
The number of specimens submitted for culture for Salmonella, Shigella, and
enteropathogenic Escherichia coli (EEC) increased by 10 per cent. First isolations
from 1,427 persons included Salmonella (1,003), Shigella (167), and EEC (257).
The common human Salmonella types were Salmonella typhimurium and S. typhi-
murium var. copenhagan (710), S. heidelberg (43), S. newport (42), S. enteritidis
(30), S. typhi (19), S. infantis (17), S. saint paul (15), S. san diego (14) and
S. javiana (13). Types isolated for the first time in British Columbia were S. brunei,
S. hartford, S. michigan, and S. nigeria. Nineteen cases of typhoid fever were
confirmed bacteriologically. Salmonella? were identified from 92 nonhuman
sources: animals such as bovines, hogs, felines, dogs, horses, and mink; birds such
as chickens and turkeys; reptiles such as snake, alligator-snapping turtle, and tegu
lizard; foods or fertilizers such as shrimp, summer sausage, and fish meal; and
environmental swabs. Of 20 types identified, most common were S. typhimurium
(37), S. nienstedten (12), and S. senftenberg (12).
3
 66 MINISTRY OF HEALTH REPORT,  1978
The 167 Shigella strains included Sh. sonnei (96), Sh. flexneri (59), Sh. boydii
(7), and Sh. dysenteric (5). The most common enteropathogenic E. coli were
026:K60 (45), 0128:K67 (44), 018:K77 (41), 0111 :K58 (30), 0126:K71
(23), and0125:K70 (18).
Food Poisoning
During the investigation of 233 incidents of suspected food poisoning in 1978
(compared with 165 in 1977), 426 specimens were cultured. Food poisoning
organisms were isolated in 27 incidents: Bacillus cereus (11); Staphylococcus
aureus (10); Salmonella (A) (S. typhimurium (2), S. thompson and S. enteritidis);
Yersinia enterocolitica; and one double contamination with Staphylococcus aureus
and Bacillus cereus.
One incident of scombroid-like fish poisoning occurred on the coast of British
Columbia; five persons fell ill after eating cooked mahi-mahi or dolphin fish. In a
food poisoning incident on Vancouver Island, several people became sick after
eating pecan rolls; the Federal Food Laboratory found that an unopened package
of pecan rolls from the same batch contained rancid hydrogenated coconut oil, the
putative cause of gastroenteritis in this incident.
The Food Poisoning Section reported 73 incidents of food-borne disease in
1973 and 116 in 1974. Health Protection Branch, Ottawa, collected and collated
such information from all parts of Canada and published "Food-borne Disease in
Canada—Annual Summary 1973" in 1976 and "Food-borne and Water-borne
Disease in Canada—Annual Summary 1974" in 1978.
Mycobacterium Tuberculosis
The number of specimens cultured for Mycobacterium tuberculosis decreased
from 32,962 in 1977 to 32,856 in 1978, but the number of microscopic examinations increased from 29,964 in 1977 to 30,291 in 1978. In 1977 and 1978 nearly
1,000 requests were received for antimicrobial drug susceptibility tests. Each strain
was tested with four antimicrobials—streptomycin (SM), isoniazid (INH), rifampin
(RM), and ethambutol (EMB).
Bacterial Serology
Requests for screening tests for syphilis increased from 180,564 in 1977 to
181,148 in 1978. The demand for microhaemagglutination-TVepowemtf pallidum
(MHA-TP) tests increased 9 per cent from 5,646 in 1977 to 6,000 in 1978.
During 1978, exudates from 293 patients were examined by darkfield microscopy and by the Direct Fluorescent Antibody-Treponema pallidum (DFA-TP)
technique.   In 39 patients (13 per cent) the examinations were positive.
Serological tests for the diagnosis and control of febrile illnesses remained
constant at 11,000 in 1977 and in 1978.
Sera were referred to reference laboratories for titration of bacterial antibodies.
The 3 8 reactive sera included: Neisseria gonorrhoea? (16), Bordetella pertussis (15),
and Yersinia (7).
PARASITOLOGY AND TROPICAL AND PARASITIC DISEASE
REFERENCE SERVICE
The Health Laboratories provide 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.
Exotic drugs, not available commercially in Canada, were supplied for the
treatment of several patients with parasitic diseases, such as schistosomiasis,
amcebiasis, filariasis, and clonorchiasis.
 PUBLIC HEALTH PROGRAMS
67
The number of specimens submitted for examination for parasites increased
by 15 per cent from 31,424 in 1977 to 35,820 in 1978. Parasites were found in
5,300 specimens—18 per cent of those examined.
Intestinal Parasites
The numbers of faecal specimens showing protozoan parasites in 1978 were:
Usually considered pathogenic—Giardia lamblia (1,353) and Entamoeba
histolytica (241);
Generally considered nonpathogenic—Entamoeba coli (1,520), Endoli-
max nana (948), Iodamceba butschlii (178), and Chilomastix mes-
nili (82); and
Pathogenicity uncertain—Entamoeba hartmanni (297), unidentified Entamoeba cysts (49), and damaged cysts (73).
The numbers of faecal specimens showing helminthic eggs in 1978 were Tri-
churis trichiura (777), hookworms  (665), Clonorchis sinensis (335), Ascaris
lumbricoides  (250), Hymenolepis nana  (107),  Enterobius vermicularis  (89),
Trichostrongylus spp. (20), Schistosoma mansoni (20), Diphyllobothrium latum
(5), Schistosoma haematobium (4), Fasciolopsis buski (3), Dicroccelium dendriti-
cum (2), and Ascaris spp. Hookworm larvae (97) and larvae resembling Strongy-
loides stercoralis (90) and Anasakis were also seen.
The following mature helminths were identified: Ascaris lumbricoides (33),
proglottids of Taenia saginata (7), Strongyloides stercoralis (4), Enterobius vermicularis (2), Diphyllobothrium latum and Ascarid.
The number of anal swabs examined for Enterobius vermicularis (pinworm)
was 1,072, fewer than the 1,168 examined in 1977. Twenty-nine ectoparasites
were identified: fly and insect larvae (16), fleas (3), Pediculus humanus (3),
Phthirus pubis (3), nits (2), and ticks (Dermacentor andersoni and Ixodes pacifi-
cus). Of interest was the identification of eggs of Dicroccelium dendriticum in
human faeces, probably a spurious infection. This fluke is normally a parasite of
sheep, deer, and other herbivorous mammals.
Blood Parasites
The number of blood films examined for malaria parasites increased by 34
per cent from 701 in 1977 to 939 in 1978. The number of patients investigated
increased 25 per cent from 400 in 1977 to 500 in 1978.
Serology of Parasites
Antibodies to parasitic helminths and protozoans were demonstrated at the
Institute of Parasitology (or other reference laboratories) in 85 serum specimens:
Helminthic parasites—Toxocara spp. (31), Filaria (16), Trichinella (4), Echino-
coccus (A), Schistosoma (3); Protozoan parasites—Toxoplasma (20), Entamoeba
histolytica (3), and Trypanosoma.
The Indirect Haemagglutination (IHA) and Indirect Fluorescent Antibody
(IFA) tests for Toxoplasma increased by about 20 per cent from 800 in 1977 to
nearly 1,000 in 1978.
MYCOLOGY
Dermatophytes
The number of skin, nail, and hair specimens yielding dermatophytes decreased
by 17 per cent from 509 in 1977 to 425 in 1978. The dermatophytes most frequently isolated were Trichophyton rubrum, Trichophyton mentagrophytes, and
Microsporum canis (which cause "ringworm" and athlete's foot).
 68 MINISTRY OF HEALTH REPORT,  1978
Systemic Fungi
Coccidioides immitis was isolated from one lung biopsy; Histoplasma cap-
sulatum from another lung biopsy; and Aspergillus fumigatus from one lung autopsy.
Fungal Serology
Fungus antibodies were demonstrated at reference laboratories in 29 serum
specimens: Histoplasma (22), Coccidioides (6), and Cryptococcus.
Environmental Microbiology of Water
The number of water samples examined by the coliform test declined from
48,146 in 1977 to 47,494 in 1978. Of these samples, 4,096 were also examined
by the completed coliform test, 3 per cent fewer than in 1977. The faecal coliform
test was done on 11,200, almost the same as in 1977.
Samples from bathing beaches numbered 3,300 in 1977 compared with 3,000
in 1978. The Standard Plate Count was done on 3,300 samples. The number of
water samples submitted by the public for the coliform test was almost 650, as in
1977.
VIROLOGY SERVICE
The 695 viral and other agents isolated or identified serologically were: herpes
simplex (263), influenza (211), rubella (66), enteroviruses (40), adenoviruses
(26), mumps (26), rotavirus (15), mycoplasma (10), varicella-zoster (9),
measles (7), parainfluenza (6), psittacosis (3), and respiratory syncytial (3).
Polioviruses
Wild poliovirus type 1 was isolated from nine patients, all residing in the
Fraser Valley of British Columbia. Two presented with paralysis, one with viral
meningitis, while the remainder were asymptomatic excreters. All were members
of a religious sect which does not condone vaccination. Laboratory tests proved
that the virus was brought into Canada by a visitor from Holland, a member of the
same sect. An epidemic of poliomyelitis among sect members in Holland took place
during the summer of 1978.
Influenza Virus
Influenza was epidemic in British Columbia during the winter months.
Although widespread throughout the Province, the symptoms were generally mild,
consisting usually of fever, nausea and vomiting, cough and generalized aches and
pains. The virus responsible for the winter outbreak was the influenza A/Texas
strain.
During the summer months, a group of Australian soldiers arrived at Canadian
Forces Base Esquimalt with symptoms of influenza, which was subsequently shown
by the laboratory to be due to Influenza B. Spread to the surrounding community
did not occur.
Rubella
There was a mild outbreak of German measles (rubella) in British Columbia
during the spring, when 66 laboratory-proven cases were identified, in sharp
contrast to the 800 laboratory-proven cases during the epidemic of 1974/75.
 PUBLIC HEALTH PROGRAMS
69
EVENTS IN 1978
Main Laboratory
Dr. W. A. Black, an outstanding laboratory physician, was appointed Medical
Microbiologist in the Provincial Health Laboratories in June 1978. Dr. Black is
known for his achievements in improving the proficiency of medical microbiology
laboratories and his expertise will be of great benefit to the Ministry of Health.
Miss J. McDiarmid, for many years Senior Scientist in the Provincial Health
Laboratories, retired after a long and satisfying career commencing in 1935 and
extending until 1978 with several years of service in the Canadian Army during
World War II. She was supervisor of several bacteriology sections and finally
responsible for the important Training and Development Section.
Branch Laboratories
For many years, Mrs. C. A. Johnston, Senior Bacteriologist at Royal Jubilee
Hospital, supervised the Victoria Branch Laboratory under the direction of Dr. K.
R. Thornton, the hospital's director of laboratory medicine. Mrs. Johnston retired
in 1977 and E. Potter, trained at the Westminster Hospital, London, England, was
appointed Senior Bacteriologist to the hospital.
A second laboratory technician was appointed at the Nelson Branch Laboratory to assist Mrs. A. Malone, technologist-in-charge.
Visits
On the request of Medical Health Officers, one or two of the three medical
microbiologists continued to visit hospitals and their laboratories in six health
units during 1978. These visits permitted discussions with physicians, laboratory
staff, and health unit staff on the role and services of the Health Laboratories as
part of the Bureau of Special Health Services in the diagnosis and control of communicable diseases.
ACKNOWLEDGMENTS
The services, biological reagents, expertise, and advice provided by reference
laboratories in Canada and elsewhere are gratefully acknowledged. These reference
laboratories included:
(1) Laboratory Centre for Disease Control (Ottawa) and its reference
laboratories:
botulism (Ottawa); staphylococcal enterotoxin typing (Ottawa);
arboviruses (Toronto); yersiniosis (Toronto); leptospirosis
(Montreal); parasitic diseases (Montreal).
(2) Other Canadian Laboratories:
Ontario Provincial Laboratories (Toronto); Ontario Agricultural
College, University of Guelph; Environment Canada (Vancouver);
City Analyst (Vancouver); The University of British Columbia
(Vancouver).
(3) Foreign Laboratories:
Center for Disease Control (Atlanta, Georgia); National Jewish
Hospital (Denver, Colorado); Royal Informary (Edinburgh, Scotland).
 70 MINISTRY OF HEALTH REPORT,  1978
ACTION  B.C.
For Action B.C., 1978 was a year of continuing progress within the general
objectives of the organization—to make British Columbians more aware of the
positive choices available toward a healthier lifestyle. Emphasis is on the responsibility of the individual for his or her own health, and on Action B.C.'s role in
suggesting alternatives, and providing motivation toward this goal.
Over the past five years Action B.C. has been involved in varying ways in
22 school districts, ranging from assessing the fitness of every child in the district,
to testing a single class. Due to the very heavy work-load which mass testing
imposed on the small Action B.C. staff, the emphasis changed to in-service training
for teachers, parents and volunteers, to be able to carry out the testing at their own
convenience. This system appears to be very practical as it leaves the expertise
within the community to be used whenever necessary. The teachers themselves
have frequently taken advantage of the testing/counselling program for themselves.
The two-year teenage smoking cessation project, "Butt-Out", completed its
first year. The research phase to be conducted during 1979 is designed to produce
a final program, to be made available in 1980.
The industrial sector continued to be a high priority, with requests for the
fitness assessment program being filled on a regular basis. This on-site procedure
includes a Health Hazard Lifestyle appraisal, Action B.C. 3-day nutrition analysis,
a cardio-respiratory test, flexibility tests, and skinfold measurements. The small
staff made tremendous strides in producing a quality program to fill the growing
needs.
Conferences played a major role in Action B.C.'s activities. This varied from
total conference co-ordination, or provision of meal services, to delegate fitness
assessments, or displays and presentations. These events provide an excellent way
to introduce the varied programs to a widespread audience.
Work in the community continued to take place in malls, fitness festivals, and
at special events. This allows a wide spectrum of the population to be involved in
Action B.C. activities. The three vans supplied by the Vancouver Kiwanis have
helped greatly in enabling the staff to reach all corners of the Province. At Recreation Commissions intensive in-service training has been given to instructors, to
enable them to deliver testing and counselling on an on-going basis.
The largest public events of the year were the Vancouver Sea Festival, and the
Pacific National Exhibition. In these two events over 20,000 people were tested,
counselled, or had their nutrition analysed. Both these events will continue in the
next year with some changes to make them even more attractive to the public.
The nutrition analyses function of the Action B.C. computer provoked
Province-wide interest. It can now deal with from 1- to 7-day input, which
can be used as either motivation or an in-depth study of diet. This analysis has
been used extensively in schools and industry and next year it is proposed to have
the perinatal analysis included in the computer.
The close relationship between Action B.C. and the Ministry of Health has
proved beneficial, both in the development of mutually complementary programs,
and in their delivery. Even greater co-operation is planned for next year, especially
in the areas of nutrition, and programs directed toward the "Year of the Child".
 PUBLIC HEALTH PROGRAMS
71
COUNCIL OF PRACTICAL NURSES
The number of applications received to date is 15,369. In 1978, licences were
issued to 322 British Columbia graduates and 209 trained outside British Columbia,
for a total of 531.
This is the 14th year of operation of the British Columbia Council of Practical
Nurses under the mandate of the Practical Nurses Act.
The Council is continuing to use the Canadian Nurses' Association Testing
Service examinations for licensing purposes and three examination sittings were held
in March, June, and October of 1978. Examinations written in British Columbia
in 1978 produced the following results:
March June October
National mean  518.49 499.45 512.13
British Columbia mean  549.24 551.66 573.55
British Columbia colleges offering courses in Practical Nursing are: Vancouver
Community College, Vocational Division; Malaspina College, Nanaimo; Camosun
College, Victoria; College of New Caledonia, Prince George; Selkirk College,
Nelson; Okanagan College, Kelowna; and Douglas College*, Surrey.
VOLUNTARY HEALTH AGENCIES
The Ministry of Health continued to give financial support to a wide range of
voluntary health agencies. The majority of these agencies provide service to persons
suffering from chronic debilitating conditions who have special needs beyond the
scope of health services routinely available, and to certain disadvantaged socioeconomic groups in the population. Over $3 million in grants was awarded to these
agencies for the 1978/79 fiscal year.
* The first year of the two-year nursing program at Douglas College prepares  students to write British
Columbia licensing examinations for practical nurses.
 72
MINISTRY OF HEALTH REPORT,  1978
Table 1—Reported Communicable Diseases, British Columbia, 1974—78
(Rate per 100,000 population)
1974
1975
1976
1977
1978
Disease
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Amcp.hiasis
Brucellosis	
Diarrhoea  of  the newborn
(F.   rnli)
2
52
69
91
302
7
~2
1,381
11
43
12
66
T42
573
203
789
6
0.1
2.2
2.9
3.8
12.6
0.3
0.1
57.7
0.5
1.8
0.5
2.8
14.3
23.9
8.5
32.9
0.3
1
1
49
22
97
456
33
962
10
1
33
16
49
476
1,149
184
739
8
0.1
0.1
2.0
0.9
3.9
18.6
1.3
39.2
0.4
0.1
1.3
0.7
2.0
19.4
46.8
7.5
30.1
0.3
1
52
11
93
321
3
745
12
47
11
77
69
181
120
698
2
7
0.1
2.1
0.5
3.8
13.2
0.1
30.7
0.5
1.9
0.5
3.2
2.8
7.4
4.9
28.7
0.1
0.3
1
2
57
7
70
307
1
884
15
40
14
45
1
78
310
101
539
1
9
0.1
0.1
2.3
0.3
2.8
12.3
0.1
35.4
0.6
1.6
0.6
1.8
0.1
3.1
12.4
4.0
21.6
0.1
0.4
15
35
17
58
908
3
1
794
12
43
15
104
1
90
129
105
1,297
16
0.6
1.4
Diphtheria	
Dysentery, type unspecified-
Food infection—
0.7
2.3
35.9
Unspecified	
Food intoxication—
Staphylococcal	
0.1
0.1
Hepatitis—
31.4
0.5
Meningitis-
1.7
Viral	
0.6
Pprtnssis
PoUomyelitis	
Rubella	
4.1
0.1
3.6
5.1
Shigellosis	
Streptococcal  throat  infection and scarlet fever.	
Tetanus	
Typhoid   and   paratyphoid
4.2
51.3
0.6
Totals
3,951
165.0
4,286 |
174.4
2,450
100.8
2,482
99.4
3,643
144.0
Table 2—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946,1951,1956, 1961,1966, and 1971-78
Year
Infectious Syphilis
Gonorrhoea
Number
Ratei
Number
Ratei
194/;
834
36
11
64
71
73
98
101
146
174
106
70
121
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
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
460.4
1951..    .
286.4
1956                        	
1961	
244.9
225.3
1966
290.8
1971
325.7
1972
353.4
1971
388.9
1974
390.8
1975
402.5
1976	
1977	
1978                                    ...            	
394.4
393.0
355.9
1 Rate per 100,000 population.
 PUBLIC HEALTH PROGRAMS
73
Table 3—Selected Activities of Provincial Public Health Nurses,
September 1,1977, to August 31,19781
Family and child health—
Expectant parent classes-
Mothers 	
Fathers 	
-series enrolment—
Total class attendance	
Prenatals—number of home visits	
Postnatals and new infants—number of home visits	
Infants—
Number of first visits to Child Health Conferences ..
Total number of visits to Child Health Conferences
Number of home visits	
Pre-school—
Number of visits to Child Health Conferences	
Number of home visits	
Special assessments—infant and pre-school	
School—
Screening tests	
Follow up 	
Conferences with students
Conferences with staff	
Home visits	
11,050
7,398
56,488
4,098
35,834
17,996
59,844
45,405
69,217
28,910
27,011
216,096
22,039
23,900
70,174
28,151
Special group classes (parenting, child growth, and development,
etc.)—
Number of adults enrolled in series	
Total class attendance	
5,187
10,163
B. Adult, geriatric, and other community services (excluding Home Care
Program)—
Adult (ages 19-64 years)—number of home visits  98,252
Adult (ages 65 and over)—number of home visits  31,504
Geriatric clinic attendance  269
Family planning clinic attendance  841
Community care facilities—number of visits  5,877
Mental retardation—number of home visits  1,377
Mental illness—number of home visits  3,315
Mental health (preventive counselling)—number of home visits  4,558
Family problems—number of home visits  7,979
Health promotion—number of home visits  38,172
Episodic care (periodic)—number of home visits  10,163
C. Disease control—
Immunizations—number given  416,247
Tests (tuberculosis, diphtheria, and other)   25,541
Venereal disease—number of visits  6,908
Tuberculosis—number of visits  5,584
Infectious hepatitis—number of visits  2,239
i Statistics provided are for activities of Provincial public health nurses and New Westminster, but do not
include activities of public health nurses employed in Greater Vancouver and Capital Regional District areas.
 74 MINISTRY OF HEALTH REPORT,  1978
Table 3—Selected Activities of Provincial Public Health Nurses, September 1,
1977, to August 31,1978—Continued
Other communicable diseases—number of visits       4,662
Chronic disease—number of home visits     13,664
Assessment and treatment—number of home visits     17,094
D. Total-
Home visits by public health nurses  126,282
Professional services by telephone  254,601
Community liaison meetings      11,955
Table 4—Community Physiotherapy New Patients/Visits, 1978
Category Number
New hospital replacement program—
Patients       663
Visits   2,412
New nonhospital replacement program—
Patients   1,152
Visits   8,347
Total new patients  1,815
Table 5—Physiotherapy Patients by Type of Case, 1978
Type of Case Number
Assessment  2,086
Medical   2,173
Surgical  -  1,771
Orthopaedic   5,728
Neurological   3,709
Respiratory  2,359
Cardiac    220
Plastic/Burns   214
Postnatal   225
Psychiatry   87
Consultation  1,176
Total   19,748
Table 6—Types of Community and Preventive Services Carried Out
by Physiotherapy Service, 1978
Type of Service Number
Patient group work  3,045
Lecture/Class   741
In-service conferences   1,680
Out-service conferences   345
Hospital liaison  513
Consultation  750
School programs   975
Agency visits  412
Liaison   645
Other  357
Total   9,463
 PUBLIC HEALTH PROGRAMS 75
Table 7—Selected Activities of Provincial Public Health Inspection, 1974-78
Type of Inspection or Activity
1974
1975
1976
1977
1978
Inspection—
Food premises—
Eating and drinking places	
Food stores  _ 	
Other  	
Factories	
Industrial camps	
Community carei-
Schools	
Summer camps.
Housing..
Mobile home park.
Campsites	
Other housing.
Hairdressing places-
Farms — 	
Parks and beaches_
Water and waste investigation-
Swimming-pools—
Inspection..
Samples (pools and beaches).
Surveys (sanitary and other)	
Waste disposal.
Public water supplies—
Inspection	
Samples.
Private water supplies—
Inspection  	
Samples.
Pollution and survey samples..
Private sewage disposal-
Municipal outfalls and plants-
Other sewage control 	
Land use investigation—
Subdivisions   	
Site inspections-
Nuisance investigation—
Sewage-
Garbage and refuse-
Other (pest, etc.)	
Disease investigation _.
Educational activities-
Meetings  	
,051
,553
,512
561
305
,139
,013
300
,672
,199
,344
600
370
400
352
26,
,094
,153
430
890
,496
370
.665
.717
563
251
430
686
140
.786
,361
,107
,776
541
,479
,330
11,107
2,392
2,045
343
317
3,013
544
266
1,653
2,015
1,249
666
396
367
388
2,613
1,791
445
720
1,915
6,663
2,953
3,179
722
24,367
384
1,518
5,259
14,208
3,350
1,769
2,763
813
1,284
3,226
10,525
2,366
1,972
156
348
2,464
587
312
1,308
1,355
1,138
474
396
309
300
2,126
1,626
425
616
1,861
7,790
3,221
3,273
512
26,608
320
4,726
6,255
13,749
3,370
1,373
2,345
609
1,255
2,819
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
16,272
4,358
2,908
167
385
3,289
1,232
316
1,729
586
1,190
749
809
317
670
3,438
3,256
597
657
2,789
11,636
3,731
3,782
1,932
31,990
275
6,659
7,576
12,545
3,895
2,263
3,950
1,040
1,604
3,362
Note—Activities of the Capital Regional District Community Health Services Inspectors are included for
1977 and 1978 only.
l Includes boarding-homes, youth hostels, day care centres, hospitals, and other institutions.
 76 MINISTRY OF HEALTH REPORT, 1978
Table 8—Registrations, Certificates, and Other Documents Processed by
Division of Vital Statistics, 1977 and 1978
Registrations accepted under Vital Statistics Act—
Birth registrations 	
Death registrations	
Marriage registrations 	
Stillbirth registrations	
Adoption orders 	
Divorce orders	
Delayed registrations of birth	
Registration of wills notices accepted under Wills Act     46,611
1977
1978
37,138
37,176
18,746
19,017
21,018
21,166
330
317
1,991
l,610i
9,976
8,400!
293
296
46,611
46,217
Total registrations accepted  136,103        134,199
Legitimations of birth effected under Vital Statistics Act  279 250
Alterations of given names effected under Vital Statistics
Act   283 322
Change of name applications granted under Change of
Name Act  3,046 3,600»
Materials issued by the Central Office—
Birth certificates  95,243 92,198
Death certificates   9,806 9,821
Marriage certificates  10,888 10,582
Baptismal certificates  21 20
Change of name certificates  3,131 3,089
Divorce certificates  331 307
Photographic copies  12,607 13,621
Wills notice certification  12,334 12,733
Total items issued   144,421 142,371
Nonrevenue searches for Government ministries by the
Central Office     14,905 12,649
Total revenue $593,243      $615,021
i Preliminary.
Table 9—Case Load for Aid to Handicapped, January 1 to December 31,1978
Cases currently under assessment or receiving services, January 1, 1978  1,164
New cases referred to Aid to Handicapped Committees in Vancouver Metropolitan Region (nine committees)  .  402
New cases referred to Aid to Handicapped Committees outside
Vancouver Metropolitan Region (39 committees)   742
Cases reopened (all regions)  :  263
Total new referrals considered for services, January 1, 1978, to December
31, 1978 (includes reopened)  1,407
Total cases provided with service in 1978 ,  2,571
 PUBLIC HEALTH PROGRAMS 77
Analysis of Closed Cases, January 1 to December 31,1978
Employed—
Employment placement made—
Canada Manpower   31
Aid to Handicapped  11
Self    177
Other  67
Total   286
Services completed—
Referred to other service  143
Competitive employment not feasible  122
Vocational rehabilitation not feasible  186
Increased independence    .19
Maintained employment       8
Self-care        3
Sheltered employment       9
Other     22
Total   512
Services not completed—
Declined services   162
Unable to locate client  99
Left Province   21
Other  42
Total   324
Other-
Consultation only     46
Deceased      14
Total      60
Total cases closed in 1978  1,182
Cases remaining in assessment or receiving services  1,389
Grand total  2,571
 78 MINISTRY OF HEALTH REPORT, 1978
Table 10—Tests Performed by Division of Laboratories, 1977 and 1978
Item
1977
Main      Nelson    Victoria
1978
Main      Nelson    Victoria
Bacteriology Service
Enteric Section—
Cultures—
Salmonella/Shigella..
Enteropathogenic E. coli..
Food poisoning	
Sensitivity tests-
Miscellaneous Section—
Cultures—
C. diphtheria 	
Haemolytic Staph./Strep.
Miscellaneous	
Fungus..
IV. gonorrhoea;.
Smears—N. gonorrhoea;	
Immunofluorescence—N. gonorrhoea;..
Animal virulence—  	
Anaerobes  	
Tuberculosis Section—
Cultures—M. tuberculosis..
Smears—M. tuberculosis	
Sensitivity test.
Atypical mycobacteria..
Animal inoculation.	
Parasites—
Faeces  	
Pinworm swabs..
Malaria blood film	
Water Microbiology Section—
Presumptive/Confirmed coliform test-
Completed coliform test	
Faecal coliform test   _	
Faecal streptococcal test-
Standard plate count..
Other tests (algae, shellfish)..
Serology Section—
Syphilis—
Screening _. _.
Confirmatory. 	
ASTO    	
Widal, brucella, heterophile-antibody..
Immunofluorescence   -
Toxoplasmosis    _. _	
Virology Service
Virus Isolation—-
Tissue culture..
Rubella	
Embryonated egg...
Mouse	
Serological Identification—
Haemagglutination inhibition-
Rubella	
Other viruses 	
Complement fixation-
Neutralization	
Electron microscopy	
Fluorescent microscopy-
Totals^ 	
12,933
3,536
271
1,879
4,444
28,077
3,957
25,192
100,127
5,802
146
30,834
28,066
974
312
597
26,225
1,150
701
39,366
3,480
9,716
3,249
1
180,564
5,646
6,977
4,082
8,378
806
5,016
158
414
134
54,368
7,825
11,468
8,167
420
137
33
413
37
302
1,030
18
2,807
405
5,374
1,063
30
2,416
159
7
8,212
688
2,128
1,898
2
3,330
5,973
325
1,305
618
1,027
625,458 |      5,182 [    34,555
14,681
3,348
419
1,265
4,029
6,095
35,253
3,954
25,150
101,571
7,756
350
338
30,464
27,960
986
323
574
30,166
1,040
939
39,723
3,248
10,891
3,332
181,148
5,995
6,983
4,031
9,959
964
5,477
174
1,191
72
63,971
9,210
17,529
5,338
1,307
795
125
43
367
318
347
1,543
32
3,413
513
667,999 |      6,701
6,488
840
7
1,838
428
56
8j52
450
2,392
2,331
3,643
4,358
335
295
4
726
968
33,311
Combined totals	
665,195
708,011
 PUBLIC HEALTH PROGRAMS
79
Table 11—Licensing of Practical Nurses
(Disposition of applications received since inception of program in 1965 to December
Received 	
Approved—
On the basis of formal training .
On the basis of experience only-
Full licence 	
9,488
Partial licence
396
876
1,272
Rejected 	
Deferred pending further training, etc. 	
Deferred pending receipt of further information from applicants
Awaiting assessment at December 8, 1978	
5, 1978)
15,369
10,760
2,027
2,015
515
52
Number of licences issued to December 8, 1978	
Number of practical nurses holding currently valid licences at December 8,
1978  	
15,369
9,968
6,814
Table 12—Hearing-impaired Cases, by Degree and Type of Impairment,
Division of Speech and Hearing, 1978
Type of Impairment
Degree of Impairment
Total of
Mild
Moderate
Severe
Profound
Each Type
Conducive	
1,662
2,015
331
427
2,397
462
1,243
313
533
194
2,089
6,188
1,300
4,008
3,286
1,556
727
9,577
Number of hearing impaired
Number of normals assessed „
Number assessed 	
9,577
2,816
12,393
Table 13—Number of Cases Referred for Hearing Assessment, by Source,
Division of Speech and Hearing, 1978
Referral Source
Item
Physician
Public Health
Nurse
Otheri
Total
1
10 032           I            150?
859
12,393
i High-risk hearing register, public health clinics, etc.
 80
MINISTRY OF HEALTH REPORT,  1978
Table 14—Number of Cases Referred for Hearing Assessment, by Type of
Evaluation, Division of Speech and Hearing, 1978
Type of Evaluation
Item
Initial
Assessment
Reassessment
Hearing-aid Evaluation
and Rehabilitative
Audiology
Other
Total
Number of cases	
4,120            |           2,629
1
5,225
419
12,393
Table 15—Number of Community Care Facilities and Capacities, by Permit
Status for the Three Categories of Facility, 1975—78
A. ADULT CARE FACILITIES
Year
Interim Permit
Licences
Surrendered
Final Count
Facility
Capacity
Facility
Capacity
Facility
Capacity
Facility
Capacity
1975     	
59
53
51
58
1,792
1,291
1,734
1,805
453
449
465
14,534
15,085
15,008
130
78
30
1,928
1,281
511
382
424
486
539
14,398
1976     	
15,095
1977	
16,231
1978	
481
15,407
17,212
B. CHILD CARE FACILITIES
1975	
1976	
1977	
1978	
155
192
235
291
2,229
2,694
3,063
3,675
909
929
1,005
1,028
16,786
16,869
17,866
18,370
267
308
75
30
4,130
4,034
900
364
797
813
1,165
1,289
14,885
15,529
20,029
21,681
C. CAMPS
1975_
1976_
1977..
1978-
59
54
58
59
5,395
4,814
4,905
4,970
75
5,942
16
819
118
83
6,868
6
129
131
82
6,979
1
50
139
82
6,969
	
141
10,518
11,553
11,834
11,939
 </>
o
a
Mental Health Programs
On October 12, 1872, just 14 months after British Columbia's
entry into Confederation, Mental Health Programs had its beginnings when the Royal Hospital in Victoria was designated as the
Provincial Asylum. The management of the institution was placed
under the jurisdiction of Mental Health Services in the Provincial
Secretary's Department, where it remained until 1959, at which
time it was transferred to the Department of Health and Welfare
and became known as the Mental Health Branch.
With the change in name to Mental Health Programs in 1975,
as part of the reorganization of the Ministry of Health, the branch
transferred the operation of the various mental health institutions
to the Division of Government Health Institutions, and became
solely responsible for the development of mental health servipes at
the community level.
A review of the year's operations of the various community
services throughout the Province appears on the following pages:
<
ui
X
81
 82 MINISTRY OF HEALTH REPORT, 1978
MENTAL HEALTH  PROGRAMS HIGHLIGHTS
• There were over 9,000 therapy sessions per month provided at the Province's
31 mental health centres. In addition, an average of over 7,000 hours of service
per month was provided to community agencies and groups. Services provided
were client and program consultation and education.
• Services were extended to rural regions through the opening of suboffices in
Salmon Arm, Osoyoos, Fernie, Merritt, and Campbell River. Other suboffices
are soon to be opened in Castlegar, Dawson Creek, Port Hardy, Quesnel, Burns
Lake, and the Queen Charlottes.
• The in-house continuing education program staged over 80 workshops in communities across the Province. These workshops were well attended by other
agency staff as well as mental health centre staff.
• Admissions to the Greater Vancouver Mental Health Service were over 2,000
cases, and year-end case load was over 2,700 cases.
COMMUNITY MENTAL HEALTH CENTRES
Mental health centres have been established in 30 British Columbia communities, and currently services are being expanded into 10 additional ones with
one- or two-person offices. The function of each centre is to develop, in cooperation 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, Squamish, Surrey, Terrace, Trail, Vernon, Victoria, Whalley, and Williams
Lake. Additional services are being expanded to cover Dawson Creek, Merritt,
Osoyoos, Port Hardy, Queen Charlottes, Quesnel, Salmon Arm, Smithers, Spar-
wood, and Vanderhoof.
In 1978, in addition to the geographic expansion, staff of a number of centres
was expanded to provide mental health services to the new Long-term Care Program, through the addition of 18 long-term care social workers working closely with
the existing mental health centre staff, other Long-term Care staff, and other
community agencies.
A centre is staffed by a team of experts in mental health and may include a
psychiatrist, a psychologist, psychiatric social workers, mental health nurses, and
other professional personnel.
The majority of the centres provide the following services in varying proportions:
• Direct treatment services for adults and children.
• Consultative services to physicians, health, welfare, educational, and correctional agencies.
• Educational programs, both professional and nonprofessional.
• Special programs such as the supervision of the long-term patient, preventive
programs, boarding-home care, special group homes, etc.
 MENTAL HEALTH PROGRAMS 83
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
The Vancouver Island Region was served by mental health teams from Courtenay, Duncan, Nanaimo, Port Alberni, Powell River, Saanich, and Victoria. North
of the Malahat teams serve all ages, but in the Capital Region children's services
are provided by Integrated Services for Child and Family Development and adult
services by the Victoria and Saanich Mental Health Centres. During the year the
number of cases carried by the teams in the Vancouver Island Region was 2,220.
The number of new cases officially opened in the region was 1,379. In addition
to these, there were probably an equal number of individuals seen briefly but not
opened as cases.
Direct patient treatment was the major service provided, with additional time
spent in consultation to agencies and other caregivers and in community education.
Areas away from centre headquarters continued to be serviced by travelling clinics.
At the Courtenay Centre the demand for direct services increased dramatically,
the major sources of referrals being the family doctor and self-referrals. Clients
were seeking early intervention for individual, marital, or family problems. Recreational opportunities have greatly expanded to boarding-home residents with the
aid of summer and exchange students. Several community mental health courses
are given. Biofeedback techniques, using equipment donated by service clubs,
have enhanced therapy and been well received in the professional and lay community. At the year-end mental health services were being extended in the Campbell River area, with two new positions focusing on the area.
The Duncan Centre continued to offer a range of services, including counselling, child management, family therapy, behaviour therapy, and group programs.
Individual therapy is augmented with biofeedback equipment donated by local
service clubs. Consultation is provided to the school district, the local workshop
for the retarded, the Indian Band and the hospital psychiatric unit. The centre is
involved in several local liaison team meetings, which involve schools, Public
Health, Human Resources, and other agency personnel. The centre was instrumental in the inception of a volunteer bureau, and continues to work closely with
it. A small day program was started during the year for chronically mentally ill
persons in the community and in boarding-homes.
At the Nanaimo Centre programs continued with direct individual, marital, and
family therapy. Referrals were received from almost every community agency, with
the largest grouping coming from physicians, the school system, and self-referrals.
Difficulties varied from a minor relationship problem to severe mental disorders.
Consultation and liaison with other agencies was given, as well as efforts at public
mental health education. During the year several staff vacancies were filled, enabling the centre to increase its services.
 84
MINISTRY OF HEALTH REPORT, 1978
The Port Alberni Centre out-patient load continued to be heavy. The psychiatrist provided services to the court and the RCMP at least once every two
weeks, including court appearances out of the area. A number of groups were
offered for patients, including two for adolescent girls, one of older women with
chronic problems, and several children's groups, augmented during the summer
with 10 students. The centre was involved in planning for an in-patient psychiatric
unit and a day care program. The centre is active in a variety of community
organizations, and has received biofeedback equipment, recreational equipment,
and waiting-room furnishings from local service groups.
The Powell River Centre reported an increase in the demand for direct services,
especially from the psychiatrist, who initiated a travelling clinic to Texada Island.
The centre is involved with several key community co-ordinating agencies, and
was instrumental in forming a Parents in Crisis chapter. Professional education
was offered to public health nurses and the general hospital, and a series of mental
health workshops to the community were offered.
At the Saanich Centre the direct case load continued to be heavy, with a
high proportion of marital and crisis counselling. A study indicated that there
was a high proportion of men and women aged 20 to 40 in Saanich hospitalized
with major nonpsychotic disorders. At the year end the centre was attempting to
set up neighbourhood support groups for this population. A number of students
and volunteers from the University of Victoria School of Nursing provided service
through the centre, including a support group for former Eric Martin Institute
patients, services to native people, and suicide attempt follow-up. A summer
student conducted major research in the latter area. The centre was also concerned
with finding high-risk families, and was active in community efforts for services
to the elderly and handicapped.
The Victoria Centre focused on direct treatment as its major service, with
increasing emphasis on chronic care and a beginning service in the psychogeriatric
field. In addition to individual treatment, a number of group services were offered
by the centre. The centre's art therapy service receives referrals from a wide
variety of sources and serves as a major training centre for art therapists, both
professional and volunteer. This centre maintains close liaison with the Eric
Martin Institute, the Ministry of Human Resources, and a variety of community
services.
LOWER MAINLAND REGION
The Lower Mainland Region comprises the catchment areas of 10 mental
health centres, including Chilliwack, Abbotsford, Langley, Surrey, Port Coquitlam,
New Westminster, Maple Ridge, Squamish, and Sechelt. A suboffice, located in
Mission, and the opening of the North Delta suboffice in November, reflects an
emphasis on the delivery of mental health services to people within their own
community. Supportive services are provided by teams located in the respective
mental health centres.
During 1978 a total of 3,474 patients was treated by mental health teams
within the region. A total of 1,743 patients initiated contact with the centres during
the past year.
Statistical trends indicate that relative to other parts of the Province, the Lower
Mainland devotes a very large proportion of time to activities related to direct client
services. During the past year there has been an increased emphasis on service
evaluation, with a number of centres implementing procedures to examine their
efficacy as viewed by their referral sources.
 MENTAL HEALTH PROGRAMS 85
A total of seven Long-term Care social work positions was added to the
region to improve services to clients receiving benefits from the Long-term Care
Program.
The Port Coquitlam Mental Health Centre increased its emphasis on the
delivery of group programs, permitting a greater number of clients to receive
service from the centre. Group programs range from parenting groups to activities
aimed at boarding-home residents.
The New Westminster Mental Health Centre continued to develop areas related to community education, despite an increasing demand for direct clinical
services. The centre was active in building relationships with both Royal Columbian
Hospital and Riverview Hospital.
The Langley Mental Health Centre emphasized areas related to direct services,
crisis intervention, and consultation. The centre was active in providing training
programs to lay counselling agencies within the area. In co-operation with the
Lions Club, the centre helped obtain facilities for children with special needs, aged
four through six.
The Chilliwack Mental Health Centre managed to obtain the services of a part-
time psychiatrist and clinical social worker, thereby expanding their direct service
capability. A psychiatric assessment of boarding-home residents was undertaken
and completed during the year, with an increased involvement by the centre in
monitoring medication needs within the program.
The Abbotsford Mental Health Centre continued to provide service based on
the Adult Development Training Model. A large number of clients receive service
through the group programs associated with this model. Increased relationships
were occurring with the local hospital which was developing plans to open a 22-bed
psychiatric unit.
The Maple Ridge Mental Health Centre increased emphasis in areas of intervention, related to emergency services and short-term supportive counselling.
Activity continued in community support services, with centre representation on a
wide variety of community groups. Due to increased space requirements, two new
office areas were added to the Mission suboffice.
The Surrey Mental Health Centre, with a catchment area of 140,000, continued
to provide direct treatment services to a current case load of clients numbering over
800. A suboffice in North Delta was opened to help cope with rapidly increasing
demand. A clinic was established to provide services to their patients requiring
injectable medications. The centre continued its heavy involvement with family
and children's services.
The Sechelt Mental Health Centre continued to receive a wide variety of referrals, primarily from physicians and individuals requesting family therapy. The
centre provided considerable support to a local Adult Day Care Program for handicapped adults.
The Squamish Mental Health Centre provided a broad spectrum of service to
all ages and population groups. The centre helped facilitate the approval of a
large community works grant, enabling a community survey of social service needs.
The Whalley Mental Health Centre developed a very successful and innovative
program which involves the joint sharing of staff with the Surrey Memorial Hospital.
The Psychiatric Day Care Program retained a heavy community emphasis, especially
with younger age-groups. Sharing of office space with the Surrey Alcohol and Drug
Society permitted a mutually beneficial growth of service delivery in this area.
 Play therapy is an important aide to working with children who have emotional problems.
Medication requires careful prescription and dispensing to ensure that the mental health of
each individual under care is fostered.
 MENTAL HEALTH PROGRAMS
87
OKANAGAN-THOMPSON REGION
The Okanagan-Thompson Mental Health Region experienced significant
growth in its personnel establishment during 1978. The addition of new staff
is partly the result of an attempt to reconcile the unevenness in the personnel-to-
population distributions throughout the Province, and to provide positions to serve
the newly established psychogeriatric program under a funding arrangement from
Long-term Care. The addition of these new staff now yields a mental health
worker-to-population ratio of 1:13,000 for the Okanagan-Thompson Region.
The Kamloops Mental Health Centre, having a catchment area population
approaching the 100,000 figure, accounted for the addition of four new staff
positions including a clinical social worker and a psychologist, a clinical social
worker to open the new satellite clinic in Merritt, and a social worker to work with
Long-term Care to serve the psychogeriatric population within the region.
Highlight of the year was the opening of the Achievement Centre for the
mentally handicapped. The aims of the program were to help the mentally handicapped to become more self-reliant, self-responsible, and ultimately to function
completely independently within the Kamloops community. A total of 50 mentally handicapped was benefiting from this project.
Kamloops was the host centre for the Okanagan-Kootenay Regional Mental
Health Conference during the fall of 1978, featuring a full agenda of continuing
education workshops under mental health auspices.
Of special significance to the Vernon Mental Health Centre this year was the
opening of the satellite unit in Salmon Arm. Staffed by a clinical social worker and
a psychologist, this unit provides a fairly full range of services to the mentally ill
within this community. In addition, the Vernon Centre, which has traditionally
carried the largest single case load of mentally handicapped and retarded through
the Boarding-home Program was, at year-end, recruiting two additional clinical
social workers to manage a growing psychogeriatric population.
A number of new programs were introduced to the Vernon community during
the year. Of particular significance was a "self-help group" for battered wives;
a therapeutic group program for disturbed teens; and a support group dealing with
the parents and friends of hyperactive children.
The centre continued to provide leadership in the way of primary prevention,
continuing education programs for the professional community, and in adult
education.
The year 1978 was a memorable one for the Kelowna Mental Health Centre.
Of singular importance was the retirement of Dr. Frank McNair following 35 years
of Government service. As the first Director of the Kelowna Mental Health
Centre he will be remembered for his outstanding contribution to this Province's
mental health services, as a pioneer in the field of community psychiatry and community mental health.
During the year the centre relocated to new quarters on Springfield Road.
Two new staff were added, a social work position to bring the centre up to clinical
strength, and a further position in Long-term Care to meet the new program responsibilities entailed in providing services to the psychogeriatric population of the
Kelowna area.
The Penticton Mental Health Centre realized a major goal in 1978 in terms
of its relocation to new quarters. The new complex on Main Street is both spacious
and modern, providing for well-designed interviewing offices, a play therapy and
observation room, family and group treatment facilities, and a much-needed expansion in the area assigned for clerical duties.
 88 MINISTRY OF HEALTH REPORT,  1978
In addition, the new complex will accommodate two new staff positions. One
of these positions has been assigned to serve the psychogeriatric population via the
Long-term Care Program, the other is a clinical social work position which will
provide for a full-time professional to meet the heavy demands for marriage and
family work in the centre.
The long-awaited satellite centre in Osoyoos finally received approval in 1978
and was opened in November.
The Boarding-home Program continued to be a progressive and imaginative
approach to the management of the mentally ill and retarded within the Penticton
and surrounding communities. Significant gains were reached in terms of the
provision of vocational programs for a number of these clients, and several were
able to be fully and competitively employed. In addition to this program, two new
apartment complexes were developed to accommodate six psychiatric clients and
12 retardates respectively.
KOOTENAY REGION
The Kootenay Region, located in the southeastern section of the Province,
is served by mental health centres located in Cranbrook, Nelson, and Trail. There
is also a suboffice of the Trail Centre located in Grand Forks. Surrounding communities such as Golden, Kimberley, Creston, Salmo, Castlegar, and Nakusp are
serviced through travelling clinics and frequent consultation to local professionals.
The total population of this area is over 137,000.
Due to difficulties in replacing staff the centres had several vacancies during
the year. Staff serviced an average monthly case load of over 360 clients at each
mental health centre, or approximately 1,000 cases each month in the region.
There were over 1,900 clients served on an ongoing treatment basis at the region's
mental health centre. An average of over 700 hours a month of short-term or crisis
intervention services were provided to unregistered clients in the region.
In addition to direct client services, the Kootenay Region staff provided community education and support services to their catchment areas. An average of
over 900 hours a month of agency consultation and education was also provided
to the region. Staff also participated in co-ordinated projects in the region, such
as the Children in Crisis Committee.
There were some difficulties in establishing more boarding-homes, particularly
in the Trail area; however, it was hoped that the addition of two Long-term Care
workers in the region would reduce the extra work load generated by that program,
and allow boarding-home staff to concentrate on the development of new facilities.
The addition of a worker for a suboffice in the Sparwood-Fernie area enabled
servicing of the area in November. Similar arrangements are required in other
areas of the region, such as Creston and Castlegar, to adequately meet the mental
health needs of the region.
NORTHERN BRITISH COLUMBIA REGION
The Northern Region comprises the area north of 100 Mile House, and is
served by mental health centres in Fort St. John, Prince Rupert, Terrace, Prince
George, and Williams Lake. Because of its size and scarcity of mental health
resources, the region has priority for the expansion of additional mental health
services. As a result, there has been an increase in resources in terms of new
satellite mental health centres in Dawson Creek, the Queen Charlotte Islands,
Smithers, Vanderhoof, and Quesnel. A total of 26 professionals of various disciplines plus secretarial assistance provide services to the region.
 MENTAL HEALTH PROGRAMS 89
Due to an increase in speech and hearing services in both Fort St. John and
Dawson Creek, space at the two health buildings is limited, and recommendations
have been made that mental health offices should relocate in order to relieve
crowded conditions. The Prince Rupert Mental Health Centre moved into new
quarters and at year's-end the Terrace and Prince George Mental Health Centres
were both scheduled to move into new Government buildings. Other office space
for the Fort St. John Mental Health Centre, as well as the new satellite centres, was
being arranged by the B.C. Buildings Corporation.
The basic mental health related services in the Northern Region are part of
the following 10 mental health programs: assessment and diagnosis; community
education; community support; consultation; counselling; group therapy; individual
therapy; rehabilitation; research and evaluation; and the residential program.
Although the aim is to relate the provision of services to existing needs, limitations in available resources made it necessary to set priorities. Priorities were set
for the people for whom the services were provided, for the types of problems for
which services were provided, and also for the types of services provided. This was
done to achieve a balance between preventive services, early intervention services,
intermediate intervention services, and delayed intervention services. Intervention
stages reflect both the seriousness and the developmental time of existing problems.
Wherever possible, early intervention and prevention services were emphasized.
Emphasis also were placed on trying to raise the awareness of the community on
mental health issues and in the recognition of areas of stress and difficulties.
Another high priority goal was to provide assistance to other community agencies
and self-help groups for dealing with mental health related problems.
Mental Health Programs and the UBC Department of Psychiatry are cooperating in bringing outreach psychiatric services to the Northern British Columbia
Region. Outreach services involve Dawson Creek, Fort St. John, the Queen
Charlottes, Terrace, and Prince George. In addition, the Vancouver General
Hospital, St. Paul's Hospital, the UBC Health Sciences Hospital, Shaughnessy
Hospital, and Riverview Hospital, are co-operating in facilitating the availability
of beds for people in the Northern Region requiring mental hospital type services.
In retrospect, 1978 was a year of positive growth and development.
GREATER VANCOUVER MENTAL HEALTH SERVICE
The Greater Vancouver Mental Health Service (GVMHS), now in its sixth
year of operation, is responsible for the operation of eight community care teams,
providing direct treatment in the community to a current case load of approximately
2,800 patients. During the year each community care team was working to capacity with 250-350 patients on its case load. The community care teams were very
successful in establishing good relations with other agencies working in their community, especially Public Health, Human Resources, local hospitals, and police.
Increasingly, the teams are utilizing community resources and programs which are
available in many areas.
Additionally, the service operates support facilities: Venture, a 10-bed short-
stay crisis residence providing 24-hour emergency service and a four-bed halfway
house for men; Vista, an 11-bed halfway house for women; Blenheim House, a
treatment program for disturbed pre-school children and their families; and Se-Cure,
a program for agoraphobia.    The Greater Vancouver Mental Health Service is
 90 MINISTRY OF HEALTH REPORT,  1978
participating in the development of sheltered workshops and vocational programs
in order to provide additional support systems for patients living in the community.
The primary mandate of the GVMHS is to provide direct treatment services
to the seriously mentally ill person in the community, who would otherwise be
hospitalized, and to provide service to disturbed families and children within available team resources. The effectiveness of the service has been validated through
a series of evaluative studies conducted by its Evaluation and Research Department.
A Management Information System has been developed to provide information on
case management and program implementation. A Clinical Records Department
is responsible for the maintenance of a high standard of comprehensive accurate
and up-to-date confidential clinical records of client care. These systems help to
maintain a high performance standard for each team and facility.
Each multi-disciplinary team is uniquely designed to meet the diversity of the
ethnic communities within its service area. Each team serves an area with a population of 25 to 100 thousand. The teams use the community resources and programs in their area as a vital component of the treatment planning. Through the
clinical expertise of the teams' multi-disciplinary staff and support services, GVMHS
is able to provide a high standard of community psychiatric care.
During the year, two new programs were approved. On February 1, 1978,
the Emergency After Hours Service became a valuable addition to existing emergency programs. The primary goals of this service are to provide immediate,
qualified psychiatric services to persons undergoing personal mental crisis of varying
intensity, regardless of cause, and to develop and maintain a working relationship
between the Vancouver Police Department and the Greater Vancouver Mental
Health Service.
Five psychiatric social work positions were established in order that GVMHS
could assume the responsibility of the development of a Psychiatric Boarding Home
Program.
During the past year, the Greater Vancouver Mental Health Service enjoyed
excellent relations and support from both Mental Health Programs, and the City
and Municipal Health Departments. While there are some components of the
mental health delivery system still to be developed, there is a much higher quality
of patient services available to Greater Vancouver than in the past. When the
financial resources become available to complete the necessary teams and support
services, Vancouver should have a system of mental health delivery unequalled in
Canada.
BURNABY MENTAL HEALTH SERVICES
Burnaby Mental Health Services continues to be British Columbia's only
regionalized, decentralized, integrated, and comprehensive program of psychiatric
services for adults, families, and children, who are resident in this community.
In-patient unit—T\\t 25-bed acute psychiatric in-patient unit treats 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 the Riverview Hospital Intensive
Care Unit, and Vancouver General Hospital Emergency Department, for the
occasional care of dangerous, unmanageable patients.
Adult Day Programs—Burnaby continued to offer two distinct Adult Day
Programs; an intensive five-day-per-week milieu program designed to produce
 MENTAL HEALTH PROGRAMS 91
major behavioural change, and a part-time more gradual re-educative and socially
rehabilitative program. Occasionally an intermediate group-oriented program,
meeting three times a week, was also offered. The gardening group, and formal
courses for patients in cooking and nutrition, and in social skills, continued to be
popular program additions. An "Introduction to Assertiveness" course, and a major
overhaul of the "Creative Job Search Programme," were new additions during the
year and the establishment of regular liaison meetings with the out-patient teams,
the in-patient unit, and the Burnaby Achievement Centre, improved interactions
with these programs.
Adult Out-patient Department—The three geographic Adult Out-patient 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. In order to reduce confusion and improve patient access, the boundaries
between the central and south teams were revised. Considerable effort was devoted
to improving the clinical record system on a co-operative basis, and increased
numbers of specialized out-patient group therapy programs were offered. The staff
were gratified by the increased numbers of seriously handicapped patients who
were sufficiently rehabilitated to be placed successfully in employment.
Children's Out-patient Services—The Children's Out-patient Department
remained somewhat overloaded in spite of development of a number of new
group programs for various ages of children during the year. Consultation programs with Burnaby schools, and the Ministries of Human Resources and Attorney-
General, continued and developed. Educational workshops for pre-school and
day care personnel in Burnaby were presented and were very well received. The
popular summer program for children was offered again with the assistance of
summer students.
Boarding-home and Long-term Care Programs—This year the boarding-home
social worker was able to devote full time to work in Burnaby, with the appointment
of an additional social worker to serve the North Vancouver area.
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 Hospital, Burnaby Pre-schools, Dogwood Lodge, Burnaby Achievement Centre, Parents in Crisis, etc. As well, many
of the staff members were asked to serve on advisory boards for community organizations. This year the centre was pleased to host several groups, of visitors from
Alberta, who are interested in developing similar programs.
Educational placements were offered for students in registered and psychiatric
nursing, psychology, social work, and occupational therapy, and to physicians
serving a rotating internship.
The regular monthly in-service program of education was augmented during
the year by two one-day workshops. In February workshops were given on
"Human Sexuality," "Use of Gifting in Working with Couples," and "Socialization
of Children," while in December a pair of workshops entitled "Coping with
Anxiety" and "Dealing with Bereavement" were offered in conjunction with the
fall regional meeting. Staff also participated in the Community Mental Health
Programs' June meeting at UBC, and the Greater Vancouver Mental Health Services' Fifth Anniversary Scientific Program in September. In addition, a number
of staff were asked to provide workshops and teaching sessions, both locally and
in various parts of the Province. Staff were also active in attendance at professional
workshops, seminars, and courses to improve their knowledge and skills.
 92 MINISTRY OF HEALTH REPORT, 1978
INTEGRATED SERVICES FOR CHILD AND
FAMILY DEVELOPMENT, VICTORIA
During the past year, Integrated Services accepted 457 new children for assessment and treatment. Services were also given to family members which are not
included in that number. Males outnumbered females two to one in new cases,
and the major referring sources were parents, physicians, and school districts, in
that order. Almost half of the referrals were 6 to 12 years of age. The majority of
referrals came from the Victoria School District.
In addition to direct treatment services, a considerable amount of time was
given to various community projects. Nearly 50 talks were given by staff to various
professional and lay community groups. Beyond these one-time efforts, several
special projects were undertaken, including special workshops for teachers, detailed
proposals for special therapeutic and management programs, and the preparation
of major educational materials. Integrated Services is actively involved with a
wide array of human services, educational agencies, and lay groups concerned
with the mental health of children. Integrated Services anticipates a year of
continued vigour in the area of both client services and community project activity,
through teams servicing pre-schoolers, 6- to 12-year-olds, and teenagers.
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 include comprehensive consultation, assessment, in-patient and day care treatment of psychological, social, and learning problems in adolescents. While in treatment, the adolescents interact 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 programs 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
improved motor and expressive skills. Socialization is an important goal in the
activities program. Camping, ski-ing, movies, social events, and regular outings
promote and develop social skills by bringing the adolescents into contact with the
community.
 MENTAL HEALTH PROGRAMS 93
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 co-ordinator, who works with the unit psychiatrists,
social workers, psychologists, and child care counsellors, in developing a curriculum which stresses an integrated approach to the treatment of adolescents.
The in-service training program aims at skill development in 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.
To meet the increasing needs and demand for personnel to more effectively
work with adolescents, the residential unit sponsored a three-day workshop on
"The Growth of the Adolescent" in May 1978, for 85 field workers throughout the
Province.
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 recommendation. During
the year the Residential and Day Centre Programs of the B.C. Youth Development
Centre received 189 referrals. Throughout the year, all of the residential beds
and day centre places were filled. A constant waiting-list of between 30 to 40
adolescents prevailed throughout the year. Approximately 25 per cent of all
admissions during the year came from outside the Lower Mainland. In addition,
there were 869 family conferences held, and 216 adolescents received some type
of aftercare service.
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 out-patient
department, community-based transition homes, and expanded day centre, educational, and recreational facilities.
PSYCHOLOGICAL EDUCATION CLINIC
The need for a specialized unit treating children who have specific learning
disabilities and emotional problems is still very pressing. There are a large number
of referrals and the trend is increasing. This is in part due to the policy pursued
by the Ministry of Education which is in the direction of mainstreaming all children.
It was their intention to provide the necessary back-up services to allow for the
integration of the atypical child into the regular classroom. Desirable as this
policy may be, it has resulted in an impossible situation for many children who
would ordinarily be managed in a protected classroom. The demand for the
clinic's program not only increased but the type of referral became much more
difficult to rehabilitate. The average length of stay increased considerably as a
reflection of this trend, and although it is considered a short-term stay facility
many children stay for up to two years.
 94 MINISTRY OF HEALTH REPORT,  1978
The main focus is to work with the child that schools cannot help in their
system. The usual reason for referral is aggressive behaviour, but occasionally
a withdrawn child alarms them to the point of concern. Although a referral may
come from any source, it is mainly the schools that initiate the request for help. The
next most frequent source is child psychiatry. Occasionally the schools refer a
child with only a learning problem, but one of sufficient intensity that it has not
responded to their intervention. Some rather specialized approaches have been
developed to help these children.
The child's treatment is augmented by providing a therapeutic service for the
family. This usually takes the form of counselling for the parents on child management techniques and behaviour change principles, but also includes marital and
individual therapy. One of the intake requirements is that the parents agree to
work with a therapist. Although most parents agree to this condition before the
child is accepted, after the child begins the parents often become unavailable.
These are generally the cases that stay the longest and have the poorest results on
long-term follow-up. A liaison worker is required to maintain the success in the
school program after they leave in those instances when the parents cannot be
relied upon.
A very successful in-service training program was conducted for teachers on
classroom management and behaviour change. These were teachers who were
already practising in the field, often in remote areas without specialists to call upon.
They come for a one-month period and received both didactic and practicum
knowledge.
The travelling clinic operates on a request basis, and takes the form of workshops, lectures, consultation, and some limited direct service. It can involve as
little time as one day or up to the better part of a week.
BOARDING-HOME PROGRAM
The year 1978 was a very active one, and a year of change, for the Mental
Health Boarding-home Program.
The introduction of the Long-term Care Program on January 1, 1978, involved
the Boarding-home Co-ordinator and the Boarding-home Program teams in the
field in considerable additional tasks and responsibilities. The Boarding-home Coordinator served on several ad hoc committees established by Long-term Care to
define policy, scope, operational procedures, devise forms, and establish rates. The
field staff participated in the "assessment blitz" which occurred in December 1977
and January 1978, which was necessary to establish clients, already living in residential community care facilities, on the Long-term Care case load. The coordinator continued to serve the program by standing committee membership;
through liaison with the officers of Long-term Care; reports; participation in surveys;
and contribution to workshops. Field staff participated through service on local
Long-term Care Assessment Committees, co-ordination, consultation, and liaison.
Because these additional duties and responsibilities could not be absorbed by the
existing complement of Mental Health Boarding-home Program staff, Long-term
Care agreed to fund 18 new positions for the Boarding-home Program. The expectation is that this additional manpower will increase the capacity of the boarding-
home teams to provide a more comprehensive service to psychiatrically disabled
persons who require residential or in own home support services.
 MENTAL HEALTH PROGRAMS 95
The introduction of Long-term Care had a very positive impact on the Mental
Health Boarding-home Program. It has enabled Mental Health to upgrade the
quality of program in the boarding-homes, and to proceed with the development of
the needed small specialized resources providing more intensive programs. Such
resources will extend the capacity of the Boarding-home Program to discharge
persons to independent living and, alternatively, to receive into the community the
remaining more difficult clients from Riverview Hospital, and possibly the psychogeriatric facilities.
The decision taken in 1977 by the Ministry of Human Resources to assume
responsibility for the provision of all services for mentally retarded persons, including community residential care, had an impact on the Mental Health Boarding-
home Program.
Pending additional staffing in the Ministry of Human Resources, the responsibility for community residential care for retarded persons continued to be delegated
by the Ministry of Human Resources to the Mental Health Boarding-home Program
in those geographical areas where such responsibility previously existed. Staff were
involved during the year in the clarification of responsibilities; development of new
procedures necessitated by the co-ordinated approach of Ministry of Human Resources and Long-term Care to funding of care costs; and interpretation to boarding-
home operators of the new systems.
The Activities Program, headed by the occupational therapists, was expanded
and refined. Several very worth-while projects, such as Work Activity Programs
and Independent Living Programs, were developed by staff, making use of funding
available under Canada Works, student placements, LEAP grants, and contributions
from voluntary organizations. These are considered to be essential and proven
"health" services for mentally disabled persons, and it would be helpful if consideration were given to the provision of a much more stable funding base than exists
at present.
A review of the duties of the program's case-aide positions was undertaken for
the purpose of redefining their role in relation to the new alignment of funding
responsibilities brought about by the introduction of the Long-term Care Program.
The Boarding-home Co-ordinator, together with representative staff from the
field, presented a workshop on the program at the Western Interprovincial Rural
Mental Health Conference, held in Rivers, Manitoba, in March.
A trend in the program that is continuing each year is an increase in the turnover of clients. For example, there were 533 placements made during the reporting
year, but the case load increased by only 65 persons. Placements in the program
of persons who were referred from the community, rather than from the Mental
Health Institutions, increased from 66 per cent average in the previous reporting
year (1977) to 74 per cent average in 1978.
Case load as of January 1, 1978  2,062
Case load as of December 31, 1978   2,127
January 1,1978, to December 31, 1978
Number of placements made  533
Number discharged to independent living  191
Number outgoing for other reasons (death, heavier level of care,
supervision, other agency, etc.)   107
Number of hospitalizations (institutions or psychiatric unit)  95
 96 MINISTRY OF HEALTH REPORT, 1978
CONSULTANTS
PSYCHIATRIC CONSULTATION
The Consultant in Psychiatry commenced duty on June 12, and was seconded
to the Mental Health Planning Survey, which is undertaking a review of mental
health services in British Columbia. This assignment requires considerable travelling and gives the consultant an opportunity to obtain an overview of the many
facets of the Province's mental health delivery system.
The consultant also provided an assessment for the Public Service Commission of medical applicants for Government positions. Psychiatrists provide invaluable service as sessional physicians within the mental health centres, and their
contribution to Mental Health Programs is a primary concern of the Consultant in
Psychiatry.
Relationships with The University of British Columbia "Outreach" department
were being further developed. The consultant provides psychiatric consultation
services on a monthly basis to Fort St. John, involving a collaborative effort with
the Department of Psychiatry, and The University of British Columbia.
Closer communication was being established with Riverview Hospital management and the Lower Fraser Valley mental health centres directors, with respect
to planning, and improved communication on admissions and the follow-up of
patients.
Useful liaison with other agencies is achieved by the consultant's membership
in the Inter-Ministry Service Committee which includes Riverview Hospital, Woodlands School, and the Ministry of Human Resources.
At the year-end other specific assignments involved child care programs, and
an overview of the preventive aspects of Mental Health Programs.
SOCIAL WORK CONSULTATION
With the introduction of Long-term Care, a new and previously unserviced
segment of the mentally ill population will benefit from services. With the approved
funding for 18 Long-term Care psychiatric social workers, mental health professionals were being recruited at the year-end to serve this psychogeriatric population throughout the Province. The objectives of this program are to assist this
particular client population to function as independently as possible within their
own home, and to provide education and skill training to the operators of licensed
facilities with the view also to maximizing their client independence. The consultant, serving on the Executive Board of Long-term Care, was chiefly responsible
for ensuring the orderly development of these services for the psychogeriatric population under Mental Health Programs.
Field staff requests for consultation continued to occupy considerable priority.
The range of requests in this area was very broad, comprising consultation on
complex clinical issues, intervention on interdisciplinary conflicts, development of
position papers in connection with professional education, or a search for comment
in depth on mental health related community concerns.
In headquarters, the consultant contributed to planning and policy development through participation on a variety of committees. Of particular significance
were the Planning Committee; Program Advisory Committee; Long-term Care
Executive Committee; Committee on Social Work Education; Clinical Practice
Standards Committee; Public Relations Committee, and the Committee on Continuing Education for Mental Health Programs.
The Committee on Continuing Education was a major program area during
the year.  The committee's work resulted in the delivery of an extensive range of
 MENTAL HEALTH PROGRAMS 97
workshops to serve the more isolated areas of the Province. These programs are
designed to serve not only the skill maintenance requirements of mental health
professionals, but also those in other relevant ministries and the private or volunteer
sector which would not otherwise have the benefit of continuing education programs
in their areas.
Under mental health auspices, a total of 88 workshops are involved in the
1978/79 academic year to meet the educational requirements of both rural and
urban communities. A faculty of 28 personnel was drawn from the professional
ranks of Mental Health Programs, Riverview Hospital, Forensic Psychiatric Services, and the Greater Vancouver Mental Health Service. All workshops under
this electives program are subjected to a system of formal evaluation.
A further component of the Continuing Education Committee's work had to
do with the planning and organizing of the Provincial Mental Health Conference
in June 1978 at The University of British Columbia. Featuring the theme "Legal
Issues in Mental Health," professionals within the system were helped to broaden
their perspectives on this complex and timely subject. Evaluations of the eight
workshops which constituted the conference confirmed its value to field staff.
PSYCHOLOGY CONSULTATION
The organization of the various aspects of mental health into a concise, meaningful system, which allows for more effective analysis, planning, and the optimization of existing resources, received special attention during the year. In order to
ensure similar approaches in the delivery of mental health services throughout the
various regions and centres, the three major components—people, mental health
problems, and services—have been defined in standardized formats, which allow
the adoption of a uniform system without sacrificing significant local differences.
As a general policy, Mental Health Programs is committed to providing mental
health related services to any citizen and resident of British Columbia, for any type
of mental health problem. As a result, it is necessary to ensure that services are
provided to the total population spectrum. The programs and their services have
three aims. One aim is to assist individual persons to cope with their problems,
the second is to focus on a specific problem as it exists in the community. The
third aim of providing services is to allow the maximum participation of the community, especially the involvement of other community agencies and community
volunteers.
Because the demand for mental health services is much greater than the resources available, it has become necessary to priorize services and to determine
what percentage of the total available resources to allocate to each of the ten mental
health programs. Such a decision also involves the priorization of both people
and problems.
For instance, in evaluating problem priorities, consideration must be given to
the prevalence with which a problem occurs in a particular community; to the
seriousness or potential disablement or dysfunction which results from someone
having the problem; to the local concern about the problem; to the ease of dealing
with the problem; to the duration of the problem; as well as to the stage of development of the problem.
Similarly, in deciding which service to provide for a particular problem consideration needs to be given to the effectiveness of the service; to the length of
administration; to the ease of administration; to the cost per service episode; to the
staff/volunteer involvement, and to the amount of client involvement needed to
implement the service.
4
 98 MINISTRY OF HEALTH REPORT,  1978
If it is not possible to provide services for everybody, it is necessary to consider what the possibilities are for rehabilitation, what level of functioning or productivity can be achieved, what degree of independence a client can achieve, what
degree of client participation which can be expected, and what the availability is
of other resources for the client.
It is clear that cost-benefit ratio of any combination of service delivery is dependent on the type of conditions which is used to priorize either the problem, the
people, or the service. In order to facilitate these decisions, Mental Health Programs utilizes different information systems which allow the justification of the
various aspects of mental health services delivery. These systems include a community needs profile, a client information, and a service information system.
In addition to determining priorities, considerable attention also was devoted
during the year in determining what amount of available resources should be
assigned to preventative, early intervention, intermediate intervention, and delayed
intervention services.
In order to ensure that services are maintained at an adequate standard, a
Standards Committee was established. This committee outlined the basic principles
for the maintenance of adequate standards, and at the year-end was in the process
of correlating the training of various disciplines with the level of skills needed to
provide respective mental health services. This information will allow the determination of areas for which to provide additional skill development.
In order to achieve a more uniform and equitable provision of mental health
services throughout the Province, a number of vacant positions were reassigned
to underserviced areas.
MANAGEMENT ANALYST CONSULTATION
The position of Management Analyst was filled in July 1978. The incumbent
was assigned from the establishment of Management Engineering, in the Ministry's
Planning and Support Services.
Since the purpose of the analyst is to assist managers obtain the most efficient
and effective use of those resources assigned to them for the accomplishment of their
objectives, the main activities of the analyst were focused on the mental health
centres. A major project was to determine mental health centre needs and establish
standards for
(a) clerical staffing;
(b) space requirements;
(c) equipment requirements;
(d) transportation requirements; and
(e) library requirements.
This project will continue into the next year.
Assistance was provided in the development of a means to monitor and assess
the Continuing Education Workshops of the mental health centres. In addition,
the analyst was made responsible for co-ordinating the publication of a policy
manual, which is an ongoing project, and for controlling and monitoring centre
usage of newly acquired audio-visual equipment.
Part-time assistance was also provided at the request of the Director of Management Engineering in the assessment of new methodologies designed to establish
nurse staffing levels for acute care hospitals.
 MENTAL HEALTH PROGRAMS 99
Contact was established with the Regional Management Engineering Units of
Victoria, Vancouver, and Riverview. This contact will be maintained as it provides
awareness of projects of possible mutual interest and benefit, and introduces new
trends and developments in the Management Engineering function.
RESEARCH AND PLANNING
i
The Research and Planning Section was very busy during the year with
implementing and maintaining the new Management Information System. All
mental health centres now report both case load and work activity data via the
new system. Computerized monthly reports are generated from input data and
sent to senior managers, as well as to mental health centre directors. At the year-
end plans were under way to conduct follow-up evaluation, using the goal attainment scaling component of the Management Information System. A grant proposal
to carry out follow-up on 10 per cent of closed cases were submitted to the B.C.
Health Care Research Foundation. Other activities associated with the Management Information System are quarterly training workshops for new staff; the generation of special reports and data analysis from the data base, and processing
problems.
Sort-term evaluation reports or designs were carried out on the community
psychiatric nurse positions, the Long-term Care positions, and the rural mental
health worker positions. The latter positions were the subject of a National Health
and Welfare grant proposal.
The "after-the-fact" planning process was completed and resulted in a set of
10 core mental health service programs. These programs have been accepted as
representative of a comprehensive community mental health service, and they
have been used to help set current priorities and objectives. It is hoped the future
evaluation will focus on each program individually.
Consultation in research and data analysis was provided to field staff and to
other components of the Ministry (e.g., Drug and Alcohol Commission). The
Research and Planning Officer also served on a National Health and Welfare grant
review committee, and as a member of the B.C. Program Evaluation Task Force.
Research papers were published in Canada's Mental Health and the B.C. Medical
Journal, and accepted for publication in Evaluation.
Also developed during the year was a procedure for the rational allocation
of new staff positions. This procedure was put into effect to provide for an equitable
distribution of staff positions throughout the mental health centres.
STATISTICS AND MEDICAL RECORDS
The year was one of consolidation and improvement to Mental Health Programs statistical systems. With the implementation of the service activity component in March the computerized Management of Information System became fully
operational. Every therapist in each of the community mental health centres now
reports daily on the number of hours of service directed toward individual, group,
and family therapy, assessment, administration, education, and consultation to other
agencies. The client component of the Management Information System, phased in
during 1977, provides admission, treatment, and separation data, on all clients
treated in community mental health centres.   Summary reports on service activity
 100
MINISTRY OF HEALTH REPORT, 1978
and client movement are generated monthly for each centre as well as for headquarters staff.
With all client and service activity data being processed by computer, year-end
efforts were being directed toward effecting changes in the data elements collected,
with particular emphasis on increasing the amount and accessibility of data on
boarding-home clients. Plans were also under way to integrate the service activity
reporting system, currently used by the Greater Vancouver Mental Health Service
community care teams with the service activity component of the Management
Information System. A new method of reporting to Statistics Canada was implemented for the in-patient units. Statistics Canada will be supplied with an annual
computer-tape record of admissions and separations from the Burnaby In-patient
Unit, the British Columbia Youth Development Centre, and the Greater Vancouver
Mental Health Service in-patient units, Vista and Venture. The tape replaces
monthly submission of forms from each unit.
In addition to processing requests for data from field and headquarters staff
and other Government ministries, a variety of special requests were handled by
the statistician during the year. These included the provision of a computer tape,
updated monthly, to GVMHS containing data on clients seen by the community
care teams, and the generation of several reports on activity in the mental health
centres for the Cumming Study. The statistician also participated on several committees during the year, and maintained liaison with the Division of Vital Statistics,
the B.C. Systems Corporation, and Statistics Canada.
The Medical Records Librarian continued to work with the Clinical Records
Committee toward standardizing clinical record-keeping systems in the centres and
teams. A project to record old client files on microfiche continued throughout the
year. In November, a clerical workshop was held for mental health centre clerks.
The workshop, which included the Management Information System, standardizing
client files, communications skills, and other subjects relevant to clerical staff, was
attended by 85 clerical staff.
Table 16—Patient Movement Data,1 Mental Health Facilities, 1978
Entries
Exits
Mental Health
a
u
Facilities
s
g »
s
bo
E
3
u
S"
Total
CA
CJ  H
B2
SH
q v
13
Total
■a
%
ll
tn
«
a<
«£
a
o
All mental health facilities	
11,165
10,869
245
51
12,022
11,043
723
41
215
Hospital programs, Riverview	
1,453
1,193
240
20
1,471
749
659
10
53
312
309
3
319
112
44
1
162
Valleyview	
188
188
205
49
43
113
Dellview _	
85
82
3
	
73
40
1
32
Skeenaview...	
39
39
41
23
1
17
Mental Health Programs*	
7,267
7,234
2
31
8,366
8,316
20
30
1 Table compiled from actual data through September 1977 and projected for the remainder of the year.
(Note—In cases in centres/teams opened in 1977, table compiled on basis of available data for 1977).
4 Subtotal does not include community care teams.
 MENTAL HEALTH PROGRAMS 101
Table 16—Patient Movement Data,1 Mental Health Facilities, 1978—Continued
Mental Health
Facilities
Entries
Total
56
.fe-o
a o
Is
Total
o
cs
Q
hJ
800
20
324
20
53
391
32
E o
cj n
Total in-patients..
Burnaby	
BCYDC	
Venture (August 1975)2..
Vista (August 1975)2	
854
356
56
401
41
821
2
345
2
55
	
393
28
Total out-patients-
AU mental health centres..
Abbotsford	
Burnaby3 	
Burnaby Central (March
1977) 2  	
Burnaby Children's (March
1977)2
Burnaby Day Programs (March
1977)2
Burnaby North (February
1977) 2  _
Burnaby South (January
1977)2  	
Chilliwack	
Courtenay 	
Cranbrook 	
Duncan 	
Fort St. John  	
Grand Forks (November
1976)2  _	
Kamloops	
Kelowna  	
Kitimat (July 1977)2	
Langley   	
Maple Ridge 	
Nanaimo  	
Nelson  	
New Westminster..
Penticton 	
Port Alberni	
Port Coquitlam .
Powell River	
Prince George-
Prince Rupert—
Saanich 	
Sechelt	
Squamish	
Surrey	
Terrace3 	
Trail 	
Vernon— —
Victoria —	
VISC (August 1976)2„
Whalley  	
Williams Lake	
All community care teams..
Blenheim House	
Broadway Clinic	
Kitsilano 	
Mount Pleasant-
Richmond	
Secure —	
South Vancouver..
Strathcona ~
West End __.
West Side	
BCYDC (out-patients) .
8,546
6,229
265
151
68
87
117
92
169
244
168
104
28
87
139
431
96
131
193
67
215
177
305
83
280
167
136
41
49
105
29
275
69
236
480
264
401
119
161
2,133
71
349
216
229
163
77
177
267
312
272
184
31
9
1
8
13
850
355
53
405
37
9,382
7,328
213
117
43
99
136
103
244
167
323
53
555
119
121
557
151
193
315
41
168
184
440
25
240
273
171
59
364
8
2
225
89
248
327
269
277
221
188
1,866
36
311
196
179
175
59
177
240
248
245
188
30
11
14
5
1 Table compiled from actual data through September 1977 and projected for the remainder of the year.
(Note—In cases in centres/teams opened in 1977, table compiled on basis of available data for 1977).
2 Month centre/team commenced reporting.
3 Burnaby Mental Health Centre divided into teams for statistical reporting purposes.   Kitimat divided from
Terrace Mental Health Centre for statistical reporting purposes.
 102 MINISTRY OF HEALTH REPORT, 1978
Table 17—Patient Movement Trends, Mental Health Facilities, 1975-78
Mental Health Facilities
Yearly Sum of Entries From-
Oct. 1975
to
Sept. 1976
Oct. 1976
to
Sept. 1977
Oct. 1977
to
Sept. 1978
Resident or Case Load
End of
Sept. 1976
End of
Sept. 1977
End of
Sept. 1978
All mental health facilities 	
Hospital programs, Riverview	
Geriatric facilities 	
Valley view 	
Dell view 	
Skeenaview  	
Mental health programs*  _
Total in-patients— —  	
Burnaby  — 	
BCYDC - - 	
Venture (August 1975)2  	
Vista (August 1975)2_	
Total out-patients 	
Mental health centres  — —
Abbotsford    __.
Burnaby3.— — _	
Burnaby Central (March 1977)2 	
Burnaby Children's (March 1977)2	
Burnaby Day Programs (March 1977) 2„
Burnaby North (February 1977)2 	
Burnaby South (January 1977)2	
Chilliwack 	
Courtenay	
Cranbrook	
Duncan  	
Fort St. John _ 	
Grand Forks (November 1976)2	
Kamloops  	
Kelowna _ 	
Kitimat (July 1977)2	
Langley 	
Maple Ridge	
Nanaimo   	
Nelson   	
New Westminster  	
Penticton	
Port Alberni	
Port Coquitlam 	
Powell River  _ _	
Prince George    	
Prince Rupert   —
Saanich   	
Sechelt   	
Squamish  	
Surrey 	
Terraces 	
Trail   -	
Vernon 	
Victoria 	
VISC (August 1976) 2  _	
Whalley _   _.
Williams Lake   	
All community care teams	
Blenheim House  	
Broadway Clinic   	
Kitsilano	
Mount Pleasant  _ 	
Richmond _ _ 	
Secure (April 1975)2 	
South Vancouver (July 1974) 2	
Strathcona  	
West End  	
West Side	
BCYDC (out-patients)	
15,623
1,612
427
302
97
28
10,820
674
319
45
269
41
12,910
9,941
331
975
258
328
254
331
208
380
426
226
394
319
454
228
381
393
388
205
167
178
396
133
35
345
333
220
669
418
30
463
75
2,764
46
417
262
250
202
132
252
593
237
373
205
15,278
1,432
386
270
81
35
11,139
800
351
57
347
45
12,660
10,067
283
876
128
72
65
194
170
245
277
210
169
143
127
368
455
20
247
316
289
372
287
241
239
341
208
193
131
340
120
76
375
328
221
612
389
271
434
245
2,321
61
371
264
224
140
136
183
388
252
302
272
I
10,680
1,448
323
197
96
30
6,951
803
341
50
374
38
8,106
5,969
232
143
68
89
116
100
170
242
206
134
31
82
136
369
. 97
118
184
92
243
150
316
88
263
161
119
36
33
105
30
280
61
234
404
226
367
102
142
1,958
76
319
201
230
163
77
167
248
224
253
179
17,803
1,244
930
609
177
144
12,823
61
17
30
8
6
15,568
12,661
350
1,253
469
344
237
401
762
496
696
277
783
372
266
273
508
214
306
256
396
96
548
100
59
727
279
372
701
452
181
387
100
2,806
80
692
286
214
248
83
203
365
281
354
101
17,445
1,150
909
581
185
143
12,690
77
23
35
9
10
15,309
12,506
296
I
240
127
17
419
302
455
179
251
207
563
65
613
681
107
384
634
360
428
362
610
290
349
273
486
47
577
79
80
726
135
374
637
397
238
279
239
2,696
104
703
294
260
228
58
192
342
236
279
107
16,325
1,111
866
551
189
126
11,544
70
19
35
6
10
14,208
11,373
276
"245
134
15
397
298
440
252
193
123
180
31
572
583
85
309
504
328
530
330
576
345
337
218
424
32
304
168
109
797
99
367
699
369
281
204
219
2,734
127
667
276
321
222
68
192
325
229
307
101
1 For the residential facilities, this includes permanent transfers, admissions from communities, and return
from leave and escapes.
2 Month centre/team commenced reporting.
3 Burnaby Mental Health Centre divided into teams for statistical reporting purposes.   Kitimat divided from
Terrace Mental Health Centre for statistical reporting purposes.
* Subtotal does not include community care teams.
 Hospital Programs
Prior to the introduction of the British Columbia Hospital
Insurance Service on January 1, 1949, the Province had been
interested in developing a comprehensive program for many years.
In 1932 the findings of a Royal Commission had recommended
that a compulsory health insurance maternity plan be considered,
and in 1936 a Health Insurance Act had been placed on the
statutes but never proclaimed. In 1937, British Columbians voted
in favour of health insurance in a referendum held in conjunction
with a Provincial general election. Finally, in 1948, the Hospital
Insurance Act was passed, establishing a Hospital Insurance Service which, when implemented on January 1, 1949, provided coverage for acute care in approved general hospitals.
The funding of the operating costs of the service (Hospital
Programs) was a 100-per-cent responsibility of the Province until
1958 when the Federal Government agreed to share on a Canada-
wide basis approximately 50 per cent of the approved cost of
certain hospital services. Subsequent to March 31, 1977, Hospital
Programs was brought under the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, 1977, when
shared-cost arrangements under the Hospital Insurance and Diagnostic Services Act were terminated.
In March 1975 the name of the service was changed to Hospital Programs as part of a reorganization of the Ministry of Health.
The following pages contain individual reports of the divisions
which comprise the administrative structure of Hospital Programs,
and brief reviews of pertinent legislation and statistical data.
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103
 104 MINISTRY OF HEALTH REPORT,  1978
HOSPITAL PROGRAMS HIGHLIGHTS
• Gross operating expenditures for public general, rehabilitation, and extended-
care hospitals for 1978 amounted to $617 million.
• In all, 390,150 eligible adult and child patients were discharged in 1978, an
increase of 3,278 or 0.85 per cent more than in 1977; 95.6 per cent of all
patients discharged were covered by Hospital Programs.
• Hospital Programs was responsible for 3,413,050 days of care for adults and
children in public hospitals, an increase of 78,720 days or 2.35 per cent more
than in 1977. The average length of stay was 8.75 days.
• In 1978, 17 major hospital projects were completed, involving an estimated
$85.75 million. This included major expansion and renovation programs at
Burnaby General Hospital and Royal Columbian Hospital (New Westminster),
each costing about $30 million, and at Fort Nelson and St. Vincent's. A new
27-bed general hospital was completed at Sparwood. Fire protection upgrading
programs were carried out at Shaughnessy, Sunny Hill, and Vernon Jubilee.
In addition, this construction program included the following extended-care
hospitals: Langley (75 beds), Mission (50 beds), and Oliver (75 beds). At
year-end there were 5,261 extended-care beds in the Province and about 680
additional extended-care beds under construction or in planning stages.
• Regionalization of obstetrical and newborn services for the Province was established during 1978 with the designation of a Provincial referral centre and six
regional referral centres for neonatal intensive care services.
• Grants totalling $10 million were approved toward purchases of movable and
fixed technical equipment amounting to about $16 million. About 8,200 applications for such grants were received from hospitals. '
• More than 2,200 patient accounts and 2,500 emergency-service and minor-
surgery accounts were processed daily by Hospital Programs.
• During 1978, more than 18,000 day care dialysis treatments for renal failure were
given.
• More than 180,000 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.
• More than 7,200 out-of-Province hospital accounts were processed, resulting in
an estimated total expenditure of more than $7 million.
HOSPITAL INSURANCE ACT
The Hospital Programs branch of the Ministry of Health operates under the
authority of the provisions of the Hospital Insurance Act, which also authorizes the
establishment of the Hospital Insurance Fund, from which grants are made to
hospitals toward operating expenses and capital costs. Grants are also made to
regional hospital districts toward capital expenditures made to hospitals.
• Generally speaking, every permanent resident who has made his home in
British Columbia during the statutory waiting-period is entitled to benefits
under the. Act.
 HOSPITAL PROGRAMS 105
• Reimbursement to public general hospitals is based on an approved annual
budget; for accounting purposes, per diem rates are used for medically
necessary in-patient care rendered to qualified British Columbia residents
who are suffering from an acute illness or injury, and those who require
active convalescent, rehabilitative and extended hospital care. The payment
made to a hospital by Hospital Programs from the Hospital Insurance Fund
amounts to 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 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 which ends at midnight on the
last day of the 12th month following the month of departure.
• In addition to the payment toward operating costs, paid to hospitals as
described above, hospitals and regional hospital districts receive grants of
up to 60 per cent of approved costs of construction or acquisition of hospital
facilities, one-third of the cost of minor movable equipment, 75 per cent of
the cost of major diagnostic equipment, and 100 per cent of the cost of
equipment which results in proven savings in operating costs.
• Also, through an amendment to the Hospital Insurance Act Regulations in
1977, 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 replacement 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 hospitals: Nonprofit hospitals caring primarily for acutely ill persons.
• Private hospitals: This category includes small hospitals, most of which are
operated in remote areas by industrial concerns primarily for their employees, and licensed nursing-homes which are not under hospital insurance
coverage.
• Rehabilitation and extended-care hospitals: These nonprofit hospitals are
primarily for the treatment of persons who require long-term rehabilitative
and extended hospital care.
 106 MINISTRY OF HEALTH REPORT,  1978
BRITISH COLUMBIA REGIONAL HOSPITAL
DISTRICTS ACT
The Regional Hospital Districts Act provides a mechanism for financing the
capital cost of hospital buildings and equipment. The Act provides for the division
of the Province into large districts to enable regional planning, development, and
financing of hospital projects under a formula which permits substantial financial
assistance from the Provincial Government.
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 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 comprising 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 in receiving
and disbursing moneys granted out of the Hospital Insurance Fund. In order to
exercise these powers the board is authorized, with the approval of the Minister, to
raise by taxation an amount not exceeding $200,000 or the product of one-quarter
of a mill on the assessed value of lands and improvements within the district.
 HOSPITAL PROGRAMS
107
BRITISH COLUMBIA REGIONAL HOSPITAL DISTRICTS
FINANCING AUTHORITY ACT
The British Columbia Regional Hospital Districts 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 benefit of the community or the general public good approved by the Minister
of Health.
The financing authority purchases 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.
A new computer program provides Hospital Programs planners with up-to-date information
on expenditures for hospital construction projects.
 108 MINISTRY OF HEALTH REPORT,  1978
HOSPITAL RATE BOARD AND METHODS OF
PAYMENT TO HOSPITALS
The Hospital Rate Board, appointed by Order in Council, is responsible for
advising the Deputy Minister in regard to hospitals' operating budgets and rates
of payments to hospitals for both in-patient and out-patient benefits.
A system of firm budgets for hospitals, which, with modifications, has been
in use since January 1, 1951, provides for a review of hospitals' estimates by the
Rate Board. Under the firm-budget procedure, hospitals are required to operate
within the total of their approved budgets, with the exception of fluctuation in
days' treatment and other similar items. They are further advised that deficits
incurred through expenditures in excess of the approved budget will not be met
by the Provincial Government. However, hospitals retain surplus funds earned as
a result of keeping expenditures within the total amount approved.
The value of variable supplies used in patient-care has been established. It is
generally recognized that the addition of a few more patient-days does not add
proportionately to costs because certain overhead expenses (such as heating, etc.)
are not affected. However, some additional supplies will be consumed, and it is
the cost of these variable supplies which has been determined.
When the number of days' treatment provided by the hospital differs from the
estimated occupancy, the budgets are increased or decreased by the number of
days' difference multiplied by the patient-day value of the variable supplies. Individual studies and additional budget adjustments are made in those instances where
large fluctuations in occupancy involve increases or reductions in stand-by cost.
Policies to be used in the allocation of the total funds provided are approved
by the Government. The Hospital Rate Board reviews the detailed revenue and
expenditure estimates forwarded by each hospital and applies the policies in establishing approved budgets.
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
service, such as X-ray, laboratory, operating-room, etc., provided to patients, in
addition to bed, board, and nursing care.
HOSPITAL CONSULTATION AND INSPECTION  DIVISION
This division provides consulting services to public and private hospitals, and
to other divisions of Hospital Programs and the Ministry of Health, in all aspects
of hospital organization, operation, and management. It is also responsible for
an inspectional program to ensure that minimum standards of care, safety, and
licensure are met.
The services of the division are provided by consultants in hospital administration, biomedical engineering, dietetics, clinical laboratory, nursing, social services,
and X-ray.
 This computerized axial tomographic (CAT) head scanner at Vancouver General Hospital
produces a cross-section picture of the head through the computer processing of X-rays,
enabling doctors to study tissue layer by layer.
L
 110 MINISTRY OF HEALTH REPORT,  1978
During the year the ongoing work of consultation and inspection saw 200
visits made to general hospitals and 181 to private hospitals. Members of the
division continued to participate in board education sessions developed by the
British Columbia Health Association to provide education for hospital society
trustees, emphasizing their role and responsibilities. Personnel hours and work
load statistics from the hospitals' 1977 Hospital Services Form 1 submissions were
analysed to maintain a current Provincial productivity profile.
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 Federal-
Provincial committee which is reviewing the costs of laboratory services in Canada.
Cost-accounting laboratory test studies were carried out in co-operation with the
Medical Services Commission. In concert with the Laboratory Advisory Council,
broad specifications for laboratory computerized data processing systems were
described, laboratory planning guidelines were completed, and laboratory equipment evaluations and assessments were conducted.
In radiology, 1978 was an outstanding year. During the year approval was
given to install three computerized tomographic whole-body scanners, at Vancouver
General Hospital, Royal Jubilee Hospital in Victoria, and the A. Maxwell Evans
Clinic in Vancouver. In conjunction with the latter two, computerized radiotherapy treatment planning systems have been approved for the two cancer treatment centres in Vancouver and Victoria. Approval was also given in 1978 for
three computerized tomographic head scanners, at Prince George, Kamloops, and
Kelowna hospitals; a similar head scanner at Vancouver General Hospital was the
only one in the Province at the start of 1978.
During 1978 the availability of ultrasound services continued to widen and
this diagnostic method is now available in a number of community hospitals across
the Province.
Another significant development during 1978 was the regionalization of obstetrical and newborn services for the Province. This was established with the designation of a Provincial referral centre and six regional referral centres for neonatal
intensive care services.
Work continued toward the development of a system of work load unit measurement, and preliminary investigatory action was taken toward a proposed study
of a staffing methodology for departments of dietetics.
During 1978, several major developments occurred in the field of biomedical
engineering in British Columbia. One was the formation of the Biomedical Engineering Advisory Council, which will be a major contributor to future biomedical
engineering programs, policies, and procedures in British Columbia. The first of
two regional biomedical engineering programs became operational in 1978. An
extensive evaluation of these two new regional developments will determine the
future of biomedical engineering in British Columbia hospitals. The division's
Consultant in Biomedical Engineering became British Columbia's representative to
the Canadian Standards Association Advisory Council on Health Care Technology,
which advises appropriate governments and agencies of the economic, social, and
related technical implications of implementing and monitoring standards in health
care technology.
The division's nursing consultants and Hospital Programs' Management Engineering component continued to take an active interest in the various systems
relating to patient classification and staffing by work load index.
 HOSPITAL PROGRAMS
111
RESEARCH  DIVISION
The division performs a statistical resource function for Hospital Programs
and serves as a focal point for data collection and analysis. Primarily responsible
for examining the need for hospital beds and services, the division is also involved
in a wide range of activities.
The preparation of recommendations for additional hospital capacity, in the
face of an ever-increasing range of benefits and services covered by Hospital Programs, requires 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, studies of hospital
requirements for both acute and extended-care beds were completed, including
those resulting in the establishment of the Provincial 1981-86 acute-care bed
matrix report.
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
according to the Eighth Revision of the International Classification of Diseases
Adapted (ICDA). Through this classification system, the incidence of disease is
analysed by age, sex, 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.
The division also maintains a reporting system for therapeutic abortions performed in hospitals in the Province.
HOSPITAL FINANCE DIVISION
The Hospital Finance Division is responsible for 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 1978 amounted to about $617 million.
The division also reviews the annual budgets prepared by regional hospital
districts, and works closely with the British Columbia Hospital Financing Authority
and the regional hospital districts in financing of hospital capital projects and re-
 112
MINISTRY OF HEALTH REPORT,  1978
payment of debentures. Total regional hospital district debenture sales to the
financing authority amount to $362 million, of which $54 million was added
during 1978.
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 33J/3 per cent on all other movable depreciable equipment. In 1978, after review of about 8,200 applications
received from hospitals, grants totalling $10 million were approved on purchases
of movable and fixed technical equipment amounting to about $16 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 new addition, compare
favourably with other hospitals actually in operation. Where the hospital's pre-
construction operating estimates do not indicate a reasonable operating cost, it
may be necessary for the hospital board to revise its construction plans to ensure
efficient and economical operation. Once a satisfactory pre-construction operating
budget has been agreed upon by the hospital officials and Hospital Programs, the
hospital board is required to provide written guarantees relative to the projected
operating cost. It is considered that this method of approaching the operating
picture for proposed hospital facilities ensures more satisfactory planning, efficient
use of hospital personnel, and an economical operation.
As a means of assisting hospital staff to maintain and develop health care
skills, Hospital Programs provided more than $430,000, 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, 1974—78, inclusive.
1974
1975
1976
1977
1978
$
1,800,299
275,801,859
$
2,438,265
370,927,805
$
3,556,066
483,107,890
$
3,619,325
536,939,951
$
4,253,000
606,186,000
Totals	
277,602,088
373,366,070
486,663,956
540,559,276
610,439,000
FINANCE CLAIMS SECTION
More than 2,200 patient-accounts were processed per working-day during
1978, as well as more than 2,500 emergency and minor surgery accounts.
The staff of Admission Control reviews each application for benefits under
the Hospital Insurance Act. Details of residence are checked with the verifying
documents; as a result, more than 6,000 claims had to be returned to the hospitals
during the year because they were incomplete or unacceptable, and more than
1,400 letters were written on eligibility, verification, and related matters.
 Staff of the Claims Section processed more than 2,200 patient accounts daily in 1978,
as well as more than 2,500 emergency and minor surgery accounts.
Registered nurses code the medical information on patient's records for use in research
and planning future hospital requirements. In 1978, about 445,000 admission/separation
records and 90,000 day-care surgical services records were audited and coded.
 114 MINISTRY OF HEALTH REPORT, 1978
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 that it is 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 3,000 claims for clarification of information. Preliminary figures for
1978 show that more than 465,000 accounts (excluding out-of-Province) were
processed.
The day-care surgical services, day-care/night-care psychiatric services, outpatient psychiatric services, day-care diabetic services, and dietetic counselling
accounts increased in volume to more than 15,000 per month in 1978. Payment
for out-patient physiotherapy patients was provided and preliminary figures indicate
that accounts for more than 440,000 treatments were processed. During the year,
more than 18,000 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 1978, more
than 600 accounts were processed each month, resulting in an estimated total annual
expenditure of more than $7 million.
The Claims Distribution Centre receives, sorts, and distributes all the forms
and correspondence received in the Hospital Claims Section; about 15,000 claims,
documents, and letters are handled daily.
HOSPITAL CONSTRUCTION AND PLANNING DIVISION
The prime objective of the Construction and Planning Division is to provide
hospital boards of management, their architects and planning committees, and
regional hospital districts with a consultative service in the planning of new facilities,
additions, and alterations to existing buildings, and also to monitor the capital
costs. Special emphasis is placed on the need to develop master programs and
functional programs which contain a clear definition of the hospital's role and the
most economical planning of facilities based on accepted standards. A review of
programs and design solutions is carried out by the division, in co-operation with
the Hospital Consultation and Inspection Division, the Medical Consultation Division, and allied organizations such as the Radiological Advisory Council and
Laboratory Advisory Council.
Reviews are made with several objectives in mind, but the basic intent is to
ensure that available public funds are wisely spent and result in hospitals that are
efficient and economical to operate. In addition, assurance is obtained from
consultants that buildings will meet required building and fire codes. Attention is
also given to the need and method of future expansion to achieve the most logical
use of the hospital site. Applications for grants toward minor building improvements are reviewed in a similar manner.
The division is responsible for processing, and recommending for approval,
the financing of projects through regional hospital districts, as well as direct grants
on minor building improvements. The division works with regional hospital district
staff and the Administrative Services Division in' the processing of capital expense
proposals.
 HOSPITAL PROGRAMS
115
In 1978, 17 major projects were completed in the Province, costing more than
$85 million. The largest were the completion of major expansion programs at
Burnaby General and Royal Columbian Hospitals, each costing about $30 million
and providing modern facilities for diagnostic and treatment services, as well as
new patient areas. Among new acute hospital facilities completed were 75 beds at
Saanichton, north of Victoria, replacing Rest Haven Hospital, Sidney, and a new
27-bed hospital in Sparwood, replacing the old Michel-Natal District Hospital.
Three extended-care unit additions were also opened, providing a total of 125 new
extended-care beds at Mission and Oliver, and replacing the existing Langley 50-bed
unit with a new 75-bed extended-care facility. Further details of projects completed, under construction, or in planning stages are available in the following
pages.
The change to metric measurement which took place in 1978 does not appear
to have resulted in higher construction costs.
The division continued to provide a consulting service for the Long-term Care
Program, until its own staff was hired. The division works with Long-term Care
staff on projects involving the provision of both extended and intermediate care,
such as the proposed St. Luke's Centre in Burnaby.
The division continued to maintain a close relationship with the British
Columbia Construction Association in resolving tendering difficulties and other
contractual disputes.
The division is working on several types of guidelines to aid persons engaged
in planning and construction of acute-care hospital facilities. These include design
guidelines for medical and surgical nursing units, specification guidelines, construction contract document guidelines, and methodologies for evaluation and space
programming for several hospital departments. It is hoped all these guidelines
can be published in 1979. A computer program is being developed to permit
actual expenditures on construction, professional fees, equipment, etc., to be compared with capital funds being made available by the Government for hospital
construction in each fiscal year.
To expedite the development of plans for major complex projects in metropolitan areas, the Minister of Health appointed Alan C. Kelly and John Bell to
serve as his representatives on several Project Building Committees.
During 1978 a study by the B.C. Research Council and The University of
British Columbia, funded by the Federal Government, was established to ascertain
the causes and incidence of fires in British Columbia hospitals. It is hoped the
results will show conclusively that the present National Building Code rating for
hospitals' institutional occupancy is too stringent. With the continued assistance
of the Provincial Fire Marshal's Office, acceptable and economical solutions were
found for the upgrading of both buildings and fire detection systems which meet
current National Building Code requirements. The Canadian Standards Association, the Fire Marshal's Office, and other regulatory bodies continued their efforts
in connection with the preparation of standards and implementation of National
and Provincial codes.
The B.C. Energy Commission has commissioned a study at Kelowna General
Hospital to develop further guidelines for energy conservation. The division now
has a staff member with considerable expertise in system controls available to visit
hospitals, make recommendations regarding energy conservation and, where
necessary, upgrade these controls.
During 1978 the division continued to work closely with the Greater Vancouver Regional Hospital District's Laundry Co-ordinating Committee to provide
 116 MINISTRY OF HEALTH REPORT,  1978
laundry facilities for Lower Mainland hospitals. A new regional laundry capable
of processing 10-20 million pounds of linen annually is being designed. This
facility will replace the existing Shaughnessy Hospital laundry and provide sufficient
capacity to process loads from other hospitals, including the new Children's/Grace
Hospital complex expected to be completed early in 1980.
PROJECTS COMPLETED IN 1978
Matsqui-Sumas-Abbotsford General Hospital—An addition to the Emergency
Department was completed in January 1978. A 20-bed psychiatric unit was
completed in October 1978, and the first patients were admitted in November 1978.
This increases the acute rated capacity to 141 beds.
Burnaby General Hospital—An addition and renovation project providing
additional acute beds for a total capacity of 496 was completed in May 1978.
However, due to the Greater Vancouver Regional Hospital District bed matrix, only
422 beds were finished. The project also provided new or expanded diagnostic
and service areas, including emergency, radiology, laboratory, dietary, surgical
suite, nuclear medicine, surgical day-care, pharmacy, and medical records.
Dawson Creek and District Hospital—On October 28, 1978, the Minister of
Health opened the completed Stages I and II. Stage I was completed in 1976 and
provided 24 additional acute beds. Stage II was completed in August 1978 and
included the expansion of administration, day-care surgery, emergency, and radiology departments.
Delta Centennial Hospital—Site pre-loading for the proposed 75-bed acute
hospital was completed in September 1978.
Cowichan District Hospital, Duncan—An Intensive/Coronary Care Unit upgrading program was completed in November 1978. The program has resulted in
the deletion of three beds in the unit. The revised acute capacity of the hospital
is now 138 beds.
Fort Nelson General Hospital—Stage II of an expansion project including
ambulatory care, diagnostic facilities, and the provision of seven acute beds in
"shell" was completed in January 1978.
Royal Inland Hospital, Kamloops—The relocation of administration offices,
which formed the preliminary phase of the Stage II addition project, was completed
in September 1978.
Langley Memorial Hospital—The new 75-bed extended care unit was opened
by the Minister of Health on March 4, 1978. The new building replaces an existing
unit of 50 beds.
Mission Memorial Hospital—On June 25, 1978, the Minister of Health opened
a new 50-bed extended care unit. The first patients were admitted on June 30, 1978.
Nanaimo Regional General Hospital—A new nine-bed intensive care unit was
opened on June 14, 1978. The beds were reallocated from the existing acute
complement. (Due to unexpected delays this project was not completed in November 1977, as originally anticipated.)
Royal Columbian Hospital, New Westminster—Phase II of an acute and
services expansion program was opened by H.R.H. Prince Philip on August 8, 1978.
The program has provided additional acute beds for a revised rated capacity of 463
beds. The first patients were admitted to the additional beds during the week of
October 20, 1978.
 H.R.H. Prince Philip, accompanied by H.R.H. Prince Andrew, and the Hon. R. H. McClelland, proceed past appreciative spectators on ther way to the official opening of the major
expansion of the Royal Columbian Hospital, New Westminster, August 8, 1978 (see below).
Architects: Thompson, Berwick, Pratt & Partners.
 118 MINISTRY OF HEALTH REPORT,  1978
Lions Gate Hospital, North Vancouver—A new multilevel parking garage was
completed in September 1978.
South Okanagan General Hospital, Oliver—A new 75-bed extended-care unit
adjacent to the existing acute hospital was opened by the Minister of Health on
March 22, 1978.   The first patients were admitted on April 3, 1978.
Saanich Peninsula Hospital, Saanichton—A new 75-bed acute hospital was
opened by the Minister of Health on April 9, 1978. The first patients were admitted to the new facility, which replaces Rest Haven Hospital, Sidney, on April 10,
1978.
Sparwood General Hospital—On October 14, 1978, a new 27-bed acute facility
was opened by the Minister of Health. The new hospital replaces the old Michel-
Natal District Hospital.
Vernon Jubilee Hospital—A fire-protection upgrading program was completed
in November 1978.
Vancouver
Shaughnessy Hospital—A fire-protection upgrading program was completed
in September 1978.
St. Vincent's Hospital—Renovations to the 1939 Wing were completed in the
spring of 1978. The renovations entailed the deletion of five acute beds and the
hospital's acute rated capacity is now 175 beds.
Sunny Hill Hospital For Children—A fire-protection upgrading program was
completed in August 1978.
PROJECTS UNDER CONSTRUCTION AT YEAR-END
Castlegar and District Hospital—Completion of "shell" area for 10 additional
extended-care beds.
St. Joseph's General Hospital, Comox—Additions to provide enlarged diagnostic and services facilities, including renovations to the existing building.
Lady Minto Gulf Islands Hospital, Ganges—Expansion of services and the
addition of 10 extended-care beds.
Royal Inland Hospital, Kamloops—Stage II. Addition to replace 1945 East
Wing, resulting in a net gain of 15 acute beds, plus 37 in "shell." The program
will also provide new service areas.
Mission Memorial Hospital—Additions and alterations providing 30 additional acute beds.
Lions Gate Hospital, North Vancouver—The Northern (Services) expansion
project.
Port McNeill and District Hospital Society—New 10-bed acute hospital
facility.
Eagle Ridge Hospital and Health Care Centre, Port Moody—Phase I of a
project that will eventually provide 110 acute beds and 75 extended-care beds.
The first phase includes site preparation.
Prince George Regional Hospital—Stage I, a new 75-bed extended-care unit.
Stage II, renovations to the nursery and additions to the power plant.
Princeton General Hospital—Addition to provide a further six extended-care
beds.
St. Mary's Hospital, Sechelt—Expansion of service areas.
 HOSPITAL PROGRAMS
119
Trail Regional Hospital—Phases II and III, services expansion, fire protection
and electrical upgrading.
Vancouver
Cancer Control Agency of B.C.—Phase I of an expansion program, an addition to the radiotherapy department.
Children's Hospital/Grace Hospital—New replacement hospitals on Shaughnessy site with 200 psediatric and 90 obstetrical beds respectively, and some service
areas to be shared jointly by these two hospitals and Shaughnessy. The new
Children's Hospital will also replace the existing Health Centre for Children at the
Vancouver General Hospital.
UBC Health Sciences Centre—New 240-bed acute hospital, including teaching
facilities.
Vancouver General Hospital—New Emergency Department; consolidation
of Neurosciences Department in one area, including installation of whole-body
C. T. Scanner; upgrading of Centennial and Heather Pavilions to comply with
Building Code requirements.
Victoria
Glengarry Hospital—150-bed extended-care addition to existing 75-bed unit.
Priory—75-bed extended-care addition to replace an existing 24-bed building.
Royal Jubilee Hospital—A program of essential renovation and upgrading
work.
Victoria General Hospital (South)—Radiology renovations.
TENDERING STAGE AT YEAR-END
Creston Valley Hospital, Creston—Enlargement of Emergency Department.
Delta Centennial Hospital—New 75-bed acute hospital.
Prince George Regional Hospital—Stage III, expansion of all diagnostic and
treatment facilities.
Tahsis Hospital—Additions, and alterations program.
Trail Regional Hospital—Paediatric renovations and elevator addition.
PROJECTS IN ADVANCED STAGES OF PLANNING
Matsqui-Sumas-Abbotsford General Hospital—Expansion including an additional 32 acute beds, plus 22 in "shell."
Fraser Lake Diagnostic and Treatment Centre—New diagnostic and treatment centre with two-bed overnight observation area.
Gold River Health Clinic—Renovations to administrative and service areas.
Maple Ridge Hospital—Expansion program providing approximately 31
additional beds.
New Denver Health Centre—New health centre with 10 beds for short-term
acute and extended-care patients.
Eagle Ridge Hospital, Port Moody—New hospital of 110 acute beds and 75
extended-care beds.
Richmond General Hospital—Expansion program, including 76 additional
acute beds. Also, renovations to Annex (former Richmond Private Hospital) to
provide 20 extended-care and 16 psychiatric beds.
 120 ministry of health report, 1978
Vancouver
Sunny Hill Hospital for Children—Expansion program including the provision of 45 activation/rehabilitation and 30 extended-care beds, and 30 day-care
spaces.
Victoria
Victoria General (North)—New facility with 469 acute-care beds.
ADDITIONAL PROJECTS APPROVED AND IN VARIOUS
STAGES OF PLANNING
Additional and/or replacement acute beds—Bella Coola (number undetermined), Cranbrook (42, deferred), Duncan (12, psychiatric), Mackenzie (seven
plus five in "shell"), Nanaimo (number undetermined), Salmon Arm (12), Squamish (21), Surrey (24), Vancouver—Cancer Control Agency of B.C. (44), St.
Paul's (replacement of 100 beds), Victoria—Royal Jubilee (redevelopment).
New extended-care facilities—Creston (35, deferred), Merritt (10, deferred),
Parksville (55), Princeton (10, deferred), Squamish (8), Vancouver—St. Luke's
Centre (40, plus 40 intermediate care.   Formerly "Metropolitan Council").
Additional and/or replacement extended-care beds—Bella Coola (2), Campbell River (15, deferred), Comox (15, deferred), Salmon Arm (15), Surrey (78,
being assessed), Vancouver—Shaughnessy (150 Veterans), Vernon (38).
Expansion and/or updating of services—Abbotsford, Bella Coola, Chilliwack,
Clearwater (deferred), Cranbrook, Fort St. John (deferred), Grand Forks, Nanaimo, Penticton, Salmon Arm, Surrey, Vancouver—St. Paul's, Shaughnessy
(Children's and Grace), Vancouver General, Victoria—Royal Jubilee.
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 is responsible for a 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. The staff includes a psychiatrist, as
well as occupational and physiotherapists, in order to perform similar functions
for rehabilitation services. Regular visits by the Medical Records Librarian Consultant 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 1978, registered nurses within the division
audited and medically coded about 445,000 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.
The division continues to maintain liaison with other health agencies such as
the College of Physicians and Surgeons of British Columbia, the B.C. Medical
 HOSPITAL PROGRAMS 121
Association, the B.C. Health Association, and the Faculty of Medicine at UBC.
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, continues to be very worth while.
The Medical Consultation Division has responsibility for both the program
and eligibility status of extended-care patients. Through co-operation 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 co-ordination and management of all hospital waiting-
lists. In many areas there are now adequate extended-care facilities and it is
probable that during 1979 responsibility for maintaining the waiting-lists will be
delegated to local long-term care administrators where local conditions permit.
These institutions receive a regular quarterly review by a special team of nursing, physiotherapy, and occupational therapy consultants. This function emphasizes a consultative review of the hospitals to assist in establishing optimal patient
programs. The review also permits an individual audit to establish the need and
eligibility for continuing care. The policy of short-term admission of extended-
care patients continues to be very useful as more and more units take part, supporting and encouraging relatives who wish to take care of extended-care patients in
their own homes, but who require an occasional holiday or other relief.
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
Drafting 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 Attorney-General. Statutes which relate to the
division's activities include:
• Hospital Insurance Act;
• Hospital Act;
• Regional Hospital Districts Act;
• British Columbia Regional Hospital Districts Financing Authority Act;
• Practical Nurses Act.
 122 MINISTRY OF HEALTH REPORT,  1978
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.
Long-term Care Societies
With the introduction of the Provincial Long-term Care Program on January
1, 1978, the Administrative Services Division assumed responsibility 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 DISTRICTS
In conjunction with officials of other divisions, other Government ministries,
and the various regional hospital districts, the division assists in processing capital
expense proposals and in arranging for the necessary by-laws and Orders in Council
for temporary borrowings and related matters.
ELIGIBILITY
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.
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, 1978, a total of $4,138,830.81 was recovered through this process.
 HOSPITAL
PROGRAMS                                                     123
APPROVED HOSPITALS
Hospitals as Defined Under the Hospital Insurance Act Revised to June 1978
(A) PUBLIC HOSPITALS (ACUTE CARE)
A. Maxwell Evans Clinic, Vancouver.
Matsqui-Sumas-Abbotsford    General    Hos
Armstrong & Spallumcheen Hospital, Arm
pital, Abbotsford.
strong.
Mills Memorial Hospital, Terrace.
Arrow Lakes Hospital, Nakusp.
Mission Memorial Hospital, Mission.
Ashcroft and District General Hospital, Ash-
Mount Saint Joseph Hospital, Vancouver.
croft.
Nanaimo  Regional   General  Hospital,  Na
Bella Coola General Hospital, Bella Coola.
naimo.
Boundary Hospital, Grand Forks.
Nicola Valley General Hospital, Merritt.
Bulkley Valley District Hospital, Smithers.
Ocean Falls General Hospital, Ocean Falls.
Burnaby General Hospital, Burnaby.
100 Mile District General Hospital, 100 Mile
Burns   Lake   and  District  Hospital,   Burns
House.
Lake.
Peace Arch District Hospital, White Rock.
Campbell River & District General Hospital,
Penticton Regional Hospital, Penticton.
Campbell River.
Port Alice Hospital, Port Alice.
Cariboo Memorial Hospital, Williams Lake.
Port Hardy Hospital, Port Hardy.
Castlegar and District Hospital, Castlegar.
Powell River General Hospital, Powell River.
Chemainus General Hospital, Chemainus.
Prince   George  Regional   Hospital,   Prince
Chetwynd General Hospital, Chetwynd.
George.
Children's Hospital, Vancouver.
Prince Rupert Regional Hospital, Prince Ru
Chilliwack General Hospital, Chilliwack.
pert.
Cowichan District Hospital, Duncan.
Princeton General Hospital, Princeton.
Cranbrook and District Hospital, Cranbrook.
Queen Charlotte Islands General Hospital,
Creston Valley Hospital, Creston.
Queen Charlotte City.
Dawson Creek and District Hospital, Daw
Queen Victoria Hospital, Revelstoke.
son Creek.
Richmond General Hospital, Richmond.
Dr.  Helmcken  Memorial  Hospital,  Clear
Royal Columbian Hospital, New Westmin
water.
ster.
Enderby   and   District   Memorial   Hospital,
Royal Inland Hospital, Kamloops.
Enderby.
Royal Jubilee Hospital, Victoria.
Fernie District Hospital, Fernie.
R. W. Large Memorial Hospital, Waglisla.
Fort Nelson General Hospital, Fort Nelson.
Saanich Peninsula Hospital, Saanichton.
Fort  St.  John  General  Hospital,  Fort St.
St. Bartholomew's Hospital, Lytton.
John.
St. George's Hospital, Alert Bay.
Fraser Canyon Hospital, Hope.
St. John Hospital, Vanderhoof.
G. R. Baker Memorial Hospital, Quesnel.
St. Joseph's General Hospital, Comox.
Golden  and  District  General  Hospital,
Saint Mary's Hospital, New Westminster.
Golden.
St. Mary's Hospital, Sechelt.
Grace Hospital, Vancouver.
St. Paul's Hospital, Vancouver.
Kelowna General Hospital, Kelowna.
St. Vincent's Hospital, Vancouver.
Kimberley and District Hospital, Kimberley.
Shaughnessy Hospital, Vancouver.
Kitimat General Hospital, Kitimat.
Shuswap Lake General Hospital, The, Sal
Kootenay Lake District Hospital, Nelson.
mon Arm.
Lady Minto Gulf Islands Hospital, Ganges.
Slocan Community Hospital, New Denver.
Ladysmith  and District General  Hospital,
South Okanagan General Hospital, Oliver.
Lady smith.
Sparwood General Hospital, Sparwood.
Langley Memorial Hospital, Langley.
Squamish General Hospital, Squamish.
Lillooet District Hospital, Lillooet.
Stewart General Hospital, Stewart.
Lions Gate Hospital, North Vancouver.
Stuart Lake Hospital, Fort St. James.
McBride and District Hospital, McBride.
Summerland General Hospital, Summerland.
Mackenzie and District Hospital, Mackenzie.
Surrey Memorial Hospital, Surrey.
Maple Ridge Hospital, Maple Ridge.
Tahsis Hospital, Tahsis.
Mater Misericordiae Hospital, The, Rossland.
Tofino General Hospital, Tofino.
 124                                   MINISTRY OF HEALTH REPORT, 1978
Trail Regional Hospital, Trail.
Vernon Jubilee Hospital, Vernon.
University Health Service Hospital, Univer
Victoria General Hospital, Victoria.
sity of British Columbia, Vancouver.
Victorian Hospital, Kaslo.
University of British Columbia Health
West Coast General Hospital, Port Alberni.
Sciences Centre Hospital, Vancouver.
Windermere District Hospital, Invermere.
Vancouver General Hospital, Vancouver.
Wrinch Memorial Hospital, Hazelton.
(B) REHABILITATION HOSPITALS
G. F. Strong Rehabilitation Centre, Vancou
Pearson Hospital  (Poliomyelitis Pavilion),
ver.
Vancouver.
Gorge Road Hospital, The, Victoria.
Queen   Alexandra   Hospital   for   Children,
Holy Family Hospital, Vancouver.
Victoria.
Sunny Hill Hospital for Children, Vancouver.
(C)  EXTENDED-CARE HOSPITALS
Delta Centennial Hospital, Delta.
Mount  St.  Mary  Hospital   (excluding  top
Fellburn Hospital, Burnaby.
floor), Victoria.
Juan de Fuca Hospital, Victoria.
Overlander Extended Care Hospital, Kam
Louis Brier Hospital, The, Vancouver.
loops.
Menno Hospital, Abbotsford.
Pearson  Hospital   (excluding  facilities  for
Mount St. Francis Hospital, Nelson.
tuberculosis patients), Vancouver.
Mount Saint Joseph Hospital  (top floor),
Pouce Coupe Community Hospital, Pouce
Vancouver.
Coupe.
Queen's Park Hospital, New Westminster.
(D) DIAGNOSTIC AND TREATMENT CENTRES
Arthritis Centre of British Columbia, The,
Houston Hospital, Houston.
Vancouver.
Keremeos Diagnostic and Treatment Centre,
Cumberland General Hospital, Cumberland.
Keremeos.
Elkford and District Diagnostic and Treat
Pemberton   and   District   Diagnostic   and
ment Centre, Elkford.
Treatment Centre, Pemberton.
Gold River Health Clinic, Gold River.
(E) OUTPOST HOSPITALS
Red Cross Outpost Nursing Station, Alexis
Red   Cross  Outpost  Nursing  Station,  Blue
Creek.
River.
Red Cross Outpost Nursing Station, Atlin.
Red Cross Outpost Nursing Station, Edge-
Red Cross Outpost Nursing Station,  Bam-
wood.
field.
Red  Cross  Outpost Nursing Station,  Kyu-
quot.
(F) FEDERAL HOSPITALS
Canadian Forces Station Hospital Holberg,
Canadian Forces Station Hospital Masset,
San Josef.
Masset.
(G)  PRIVATE HOSPITALS
Cassiar Asbestos Corporation Private Hos
Mica Creek Private Hospital, Mica Creek.
pital, Cassiar.
(H)  HOSPITAL FACILITIES
Division of Laboratories, Community Health
Provincial   Drug   and   Poison   Information
Programs, Vancouver.
Centre, Vancouver.
 A new 75-bed extended-care unit was opened at Langley Memorial Hospital in March 1978.
Architects for this project were The Gardner Thornton Partnership.
 126 MINISTRY OF HEALTH REPORT,  1978
STATISTICAL DATA
The tables below represent statistical data compiled by the Hospital Finance
Division, showing the extent of hospital coverage provided to the people of British
Columbia through Hospital Programs.
In 1978, there were 103 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; five public rehabilitation hospitals,
plus one rehabilitation hospital operated by the Provincial Government. 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, which includes one operated
by the Provincial Government.
Data for the year 1978 have been established, based on reports submitted by
hospitals to August 31, 1978, and are subject to revision when the actual figures for
the year are available.
Table 18 shows that 408,590 adult and children patients were discharged
(separated) from British Columbia public hospitals in 1978, an increase of 2,410
or 0.59 per cent more than in 1977. This table also shows that 95.6 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
1978, Hospital Programs were responsible in British Columbia for 3,413,050
general hospital days of care for adults and children, an increase of 78,720 or
2.35 per cent more than in 1977.
As shown in Table 20, the average length of stay for public hospitals' adult
and child patients in British Columbia during 1978 was 8.75 days and the days of
care per 1,000 population was 1,377. For comparative purposes, the data for
extended-care facilities were not included in the above observations, although an
additional 751 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 continues to reflect a broader provision of hospital-based services, provides greater patient convenience, and reduces the pressure for construction and maintenance of in-patient beds.
 HOSPITAL PROGRAMS                                                     127
Table 18—Patients Separated and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals1 Only (Excluding Federal, Private,
Extended-care, and Out-of-Province Hospitalization)
Total Hospitalized in
Public Hospitals
Covered by Hospital
Programs
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patients separated—
1973 	
1974  	
1975.....	
1976           	
395,120
412,500
415,805
408,278
406,180
408,590
34,544
35,566
36,538
36,117
36,980
37,825
429,664
448,066
452,343
444,395
443,160
446,415
377,719
394,507
398,279
390,641
386,872
390,150
95.6
95.6
95.8
95.7
95.2
95.6
33,599
34,665
35,700
35,292
36,119
37,200
97.3
97.5
97.7
97.7
97.7
98.3
411,318
429,172
433,979
425,933
19772	
19783 	
Percentage of total patients
separated—
1973	
1974	
1975             .               	
422,991
427,350
95.7
	
95.8
 —
95.9
1976	
19772	
19783	
95.8
	
95.4
95.7
1
i Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to August 31, 1978.
Table 19—Total Patient-days and Proportion Covered by Hospital Programs,
British Columbia Public General Hospitals1 Only (Excluding Federal, Private,
Extended-care, and Out-of-Province Hospitalization)
Total Hospitalized in
Public Hospitals
Covered by Hospital
Programs
Adults
and
Children
Newborn
Total
Adults
and
Children
Newborn
Total
Patient-days—
1973	
3,400,453
3,582,774
3,565,532
3,488,179
3,473,838
3,548,950
214,003
213,439
213,846
207,316
208,574
209,950
3,614,456
3,796,213
3,779,378
3,695,495
3,682,412
3,758,900
3,257,106
3,400,873
3,413,630
3,343,172
3,337,330
3,413,050
95.8
94.9
95.7
95.8
9fi 1
206,178
206,376
207,471
201,111
202,751
204,450
96.3
96.7
97.0
97.0
07 7
3,463,284
1975 T~ ".. ~~~-~—~    ;
1976	
19772	
19783   	
Percentage of total patient-days—
1973	
1974	
1975	
1976	
19772
3,607,249
3,621,101
3,544,283
3,540,081
3,617,500
95 8
95 0
	
	
95.8
95 9
96 1
19783	
	
96.2      |        97.4
1
96.2
1 Includes rehabilitation hospitals.
2 Amended as per final report received from hospitals.
3 Estimated, based on hospital reports to August 31, 1978.
 128
MINISTRY OF HEALTH REPORT, 1978
Table 20—Patients Separated, Total Patient-days and Average Length of Stay
According to Type and Location of Hospital for Hospital Programs Patients
Only, and Days of Care per 1,000 of Covered Population
Total
(Excluding
Extended Care)
Adults
and
Children
Newborn
B.C. Public
Hospitals
Adults
and
Children
Newborn
Other
B.C. Hospitals,
Including Federal
and Private
Institutions
Outside
British Columbia
Adults
and
Children
Newborn
Adults
and
Children
New-
bom
Extended-
care
Hospitals
Patients separated-
1973	
1974	
1975 	
1976	
19771-
19782..
Patient-days—
1973	
1974	
1975	
1976	
1977L.
19782..
Average days of stay—
1973	
1974	
1975	
1976 	
19771-
19782..
392,550
404,271
406,000
400,675
394,727
397,775
33,962
34,979
36,059
35,832
36,496
37,560
377,719
394,507
398,279
390,641
386,872
390,150
33,599
34,665
35,700
35,292
36,119
37,200
3,474,733|208,154 3
3,565,198|208,224 3
3,486,573|209,631|3.
3,424,979|204,156|3
3,397,729
3,476,550
8.85
8.81
8.59
8.55
8.61
8.74
205,059
206,585
6.14
5.95
5.81
5.70
5.62
5.50
,257,106 206,178
,400,873 206,376
413,630|207,471
,343,172(201,111
337,330 202,751
3,413,050
8.62
8.62
8.57
8.56
8.63
8.75
204,450
6.14
5.95
5.81
5.70
5.61
5.50
I
8,092
3,572
1,425
475]
3501
3751
155,150
103,064|
15,5171
1,6471
1,615|
1,5001
34
78
72
80
65
60
172
464
336
390
250
235
6,739
6,190
6,296
9,559
7,505
7,250
62,477
61,261
57,4261'
329
237
287
460
312
300
2,293
2,449
3,022
3,592
4,026
3,897
19.17
5.06
28.85
5.95
10.89
4.67
3.47
4.88
4.61
3.85
4.00
3.92
I
2,164 1,044,529
1,384 1,227,949
1,824| 1,357,352
~~ 1,498,797
1,734,227
1,896,275
455.53
501.41
449.16
417.26
430.76
486.60
,160
2,655
,784
2,058
,000
1,900
9.27
6.58
9.90
5.84
9.12
6.36|
8.39
5.771
8.10
6.60
8.55
6.33|
1 Amended as per final reports from hospitals.
2 Estimated, based on hospital reports to August 31, 1978. Estimated patient-days (including newborn) per
1,000 of population covered by Hospital Programs: 1973, 1,600; 1974, 1,531; 1975, 1,512; 1976, 1,474; 1977,
1,432; 1978, 1,376.9. (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 lor extended care amounted to 454 in 1973, 502 in
1974, 555 in 1975, 603 in 1976, 639 in 1977, and 751 in 1978. Population figures according to latest census
figures.
Table 21—Summary of the Number of Hospital Programs In-patients and
Out-patients, 1973-78
Total Adults,
Children,
and Newborn
In-patients
Estimated
Number of
Emergency,
Minor Surgery,
Day Care, and
Out-patients        J
Total
Receiving
Benefits
1973	
1974 	
1975 	
1976 	
19771   ..-
19782        ..'.
428,805
441,699
445,081
440,099
435,249
439,232
1
792,367           j
1,045,460
1,191,650            1
1,228,723
1,297,510
1,390,000
1
1,221,172
1,487,159
1,636,731
1,668,822
1,734,363
1,829,232
i Amended as per final reports received from hospitals.
2 Estimated, based on hospital reports to August 31, 1978.
 HOSPITAL PROGRAMS
129
Table 22—Summary of Hospital Programs Out-patient Treatments by Category,
1973-78
1973
1974
1975
1976
1977
19786
Psychiatry—■
Out-patient-
Day care .
Minor and emergency-
Day care surgery...	
Diabetic day carei	
Physiotherapy2„
Dietetic counse!ling3	
Renal dialysis, day care*..
Others _ 	
8,943
9,277
408,925
50,089
885
162,997
151,251
12,771
19,737
503,492
55,920
1,493
296,863
155,184
17,915
34,219
571,055
62,019
2,354
338,583
5,937
159,568
22,352
40,392
542,223
66,663
3,426
368,867
10,218
10,481
164,101
23,974
46,323
575,000
76,405
4,126
387,993
12,942
18,351
158,565
27,000
52,000
590,000
85,000
5,000
440,000
15,000
20,000
156,000
Totals..
792,367
1,045,460
1,191,650
1,228,723
1,303,679
1,390,000
1 Commenced October 1972.
2 Commenced April 1973.
3 Commenced January 1975.
* Commenced June 1, 1976.
5 Other includes (a) cancer out-patients and (6) rehabilitation day care.
6 Estimated.
Table 23—Patients Separated, Total Days' Stay, and Average Length of Stay in
British Columbia Public Hospitals for Hospital Programs Patients Only,
Grouped According to Bed Capacity, 19781 (Excluding Extended-care
Hospitals).
Bed Capacity
Total
250 and Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
Adults and children	
390,150
37,200
3,413,050
204,450
8.75
5.50
208,000
17,500
1,980,750
102,000
9.52
5.83
99,300
8,950
762,000
49,000
7.67
5.47
47,500
7,200
424,000
37,000
6.63
5.14
24,500
2,500
188,750
11,800
7.71
4.72
10,850
1,050
Patient-days—
57,550
4,650
Average days' stay—
5.30
4.43
1 Estimated, based on hospital reports to August 31, 1978.
Table 24—Percentage Distribution of Patients Separated and Patient-days for Hospital Programs Patients Only, in British Columbia Public Hospitals, Grouped
According to Bed Capacity, 19781 (Excluding Extended-care Hospitals)
Bed Capacity
Total
250 and Over
100 to 249
50 to 99
25 to 49
Under 25
Patients separated—
Adults and children	
Newborn	
Patient-days—■
Adults and children	
Newborn	
Per Cent
100.0
100.0
100.0
100.0
Per Cent
53.32
47.05
58.02
49.90
Per Cent
25.45
24.06
22.33
23.97
Per Cent
12.17
19.35
12.42
18.09
Per Cent
6.28
6.72
5.54
5.77
Per Cent
2.78
2.82
1.69
2.27
1 Estimated, based on hospital reports to August 31,
5
1978.
 130 MINISTRY OF HEALTH REPORT, 1978
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 1977.
Readers interested in more detailed statistics of hospitalization in British
Columbia may wish to refer to Statistics of Hospital Cases Discharged During 1977
and Statistics of Hospitalized Accident Cases, 1977, available from the Research
Division.
 HOSPITAL PROGRAMS 131
Chart I—Percentage Distribution of Days of Care* by Major Diagnostic Groups,
Hospital Programs, 1977 (in Descending Order)
Skin
1.5% X^
Congenital
j anomalies
1.4%            r°
Metabolic
diseases
2.5%^^"°
Infective and
parasitic diseases
1A%/ n
7
Nervous
system
4.1% /
Bones
5.1%/'    ^
Geni to-urinary
system
5.9%            o
Mental
disorders
6.5%
Digestive
system 11.1%
Circulatory
system 18.9%
;;    .:L:l:?S"«j;Jni;j;::::::;fJ- ';   „   J J " ■
Accidents 18.6%
Other
FEMALES
' Including rehabilitative care.
 132
MINISTRY OF HEALTH REPORT,
1978
O
ospital Programs, 1977
DAYS
1 i  i  '  i  i  i i  i j   i  i  i '  i {   i  i  f i  >   i  i i  i   i  i
Males %                                    Females %
irperium)  has been excluded so as to bring out more clearlv
d with the natural process of childbirth.
a   I
■*■"    £
5
<3
b
O
cn
:*
Q
<!
cn
N
cn
Ah
CO
*
S5 and Ovt
SO  -  84
75  -  79
70 -  74
65  -  69
60 -  64
55  - 59
50  -  54
45  - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15  -   19
10 -   14
5  -    9
1  -    4
Under 1
flu-u
*D c
c c
C3 0
P
go
Percentage Age Distribution of Male and Femali
(a)   CASES
1 1  1 1 1 1 1 1  1  1 1  1  1
Females %
Complications of Pregnancy. C
jmales in  respect of hospitaliza
■ait
— C
— .si "*
- «£
> —
— *            Del"
.DO
0 c r;
5|<
— *   C.-i-
£
i        .
|-H   i&
Bi    < S
1
u
Art^-tf^^f^-t            O*        -t        C*        T        C*        **        S>           **       Ov". .    t     ' *~
w3Ct^r^.C^u-,        u-,             tj-        Tf        f.       r*.       ri       ri        —           —                                 l.
1 I
r3        ^        1/"i       O        </-'        O        i/".       o            </"i       ©       "O.     O"     Wt-       ©       wi           C1-^.       —        Jr
X'      f-      r~      sC      sc      v.      v~,          *t     -<t    .«      ft      fN      r.4 —         —                          j
oc
c
 HOSPITAL PROGRAMS
133
Chart III—Percentage Distribution of Hospital Cases* by Type of Clinical Service,
Hospital Programs, 1977
Adult Medical 29.3%
Psediatric Medical       10.0%
Pediatric Surgical        9.2%
Psychiatric
Rehabilitative Care      0.7%
FEMALES
Adult Surgical 42.0%
Adult Medical
22.9%
Maternity
Paediatric Medical
Paediatric Surgical 5.1%
Psychiatric
Rehabilitative Care       0.6%
* Including rehabilitative care.
 134
MINISTRY OF HEALTH REPORT, 1978
Chart IV—Percentage Distribution of Hospital Days* by Type of Clinical Service,
Hospital Programs, 1977
* Including rehabilitative care.
 HOSPITAL PROGRAMS
135
Chart V—Average Length of Stay of Cases* in Hospitals in British Columbia, by Major
Diagnostic Groups in Descending Order, 1977 (Excluding Newborns)
Certain causes of perinatal
morbidity and mortality
in
■
Diseases of the circulatory
system
Mental disorders
Neoplasms
Endocrine, nutritional, and
metabolic diseases
Diseases of the musculoskeletal
system and connective tissue
Congenital anomalies
Diseases of the skin and
subcutaneous tissue
Accidents, poisonings, and
violence
PROVINCIAL AVERAGE
LENGTH OF STAY
i
Diseases of the digestive
system
Diseases of the blood and
blood-forming organs
Diseases of the nervous
system and sense organs
Infective and parasitic
diseases
Diseases of the genito-urinary
system
Diseases of the respiratory
system
Complications of pregnancy,
childbirth, and the
puerperium
Symptoms and ill-defined
conditions
* Including rehabilitative care.
  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.
I
O
u
</>
ui
u
>
<
5
137
 138 MINISTRY OF HEALTH REPORT,  1978
MEDICAL SERVICES COMMISSION  HIGHLIGHTS
During the past year the commission continued its endeavour to provide a
high quality of service to residents of the Province, with emphasis on prompt payment of physicians and improved relations with the public and health professions.
Changes in the level of taxable income applicable for eligibility for premium assistance eliminated the 50-per-cent assistance category and significantly increased the
number of subscribers eligible for 90 per cent premium assistance.
The total expenditure for insured benefits under the Medical Services Plan rose
11.2 per cent to $334,086,613 in 1977/78 from $300,467,866 in 1976/77.
The increased costs to the Medical Services Plan are a result of upward revisions to the fee schedule, increased utilization of benefits, changes in the practitioner/population ratio, and increased population.
BENEFITS UNDER THE PLAN
BASIC MEDICAL SERVICES
The Medical Services Plan provides insurance coverage for all medically required services rendered by medical practitioners, including osteopathic physicians,
in British Columbia, and certain surgical procedures of dental surgeons where
necessarily performed in a hospital as provided under the Medical Care Act (Canada). A contribution from the Federal Government is payable to the Province
toward the cost of these insured services.
ADDITIONAL BENEFITS
In addition to payment for the above services, additional benefits, when
rendered in the Province, are provided without extra premium by the Government
of British Columbia. All payments are paid only at a tariff of fees approved by
the commission. "Year" means calendar year. A brief description of these additional benefits follows.
Chiropractic—Payment for the services of a registered chiropractor is limited
in any one year to a total of $75 per patient under the age of 65 years and $100
per patient 65 years of age or over. There is no payment for X-rays taken by a
chiropractor.
Naturopathic—Payment for services of a naturopathic physician is limited in
any one year to a total of $75 per patient under the age of 65 years and $100 per
patient 65 years of age or over. There is no payment for X-rays taken by a naturopathic physician.
Orthoptic treatment—Payment for orthoptic treatment is limited to $50 per
patient in any one year and a maximum of $100 per family in any one year when
rendered to an insured person on the instructions of, or referral by, a medical practitioner.
Physiotherapy—Payment for the services of a registered physiotherapist on the
instructions of, or referral by, a medical practitioner where performed other than
in general or rehabilitative hospitals, is limited in any one year to a total of $75 per
 The Data Entry Division of MSP currently uses MDS 2400 Key Display Systems. Operators
key-enter data from source documents for temporary storage in a magnetic disk unit.
Upon completion, the data is transferred to magnetic tape for input
into a larger computer facility.
 140 MINISTRY OF HEALTH REPORT,  1978
patient under the age of 65 years and $100 per patient 65 years of age or over.
Out-patient physiotherapy services in general hospitals or in rehabilitative hospitals
on referral by the medical practitioner are benefits provided by the British Columbia
Hospital Programs.
Podiatry—Payment for services of a registered podiatrist is limited to $50 per
patient in any one year and a maximum of $100 per family in any one year when
rendered other than on the instructions of, or referral by, a medical practitioner
within the year.   There is no payment 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, protheses, or for general dental services other
than those referred to under basic medical services involving certain medical procedures of dental surgeons, where necessarily performed in a hospital.
Special nursing—Special nursing services of a registered nurse are paid, including the cost of board, to a maximum of $40 per patient in any one year, but
only where such services are deemed advisable by a medical practitioner.
Under existing arrangements, the services of a member of the Victorian Order
of Nurses, acting under or with an attending medical practitioner are paid under
the plan at a rate of $2 net per visit to a maximum of $40 per patient per year, but
this limit does not apply to the administering of injections on the instructions of
a physician.
No payment is made for any of the additional benefits when the service is
performed outside the Province of British Columbia.
SERVICES EXCLUDED UNDER THE PLAN
Services which are provided under other Federal or Provincial Acts such as
the National Defence Act (Canada), the Hospital Insurance Act, and the Workers'
Compensation Act of the Province
Pathology, radiology, and/or electrodiagnostic services performed within the
Province at a laboratory that, at the time the service is rendered, is not an approved
laboratory for the performance of the service.
Services which are not considered to be medically required by the patient,
e.g., cosmetic services, examinations at the request of a third party, medico-legal
services, advice by telephone, travel charges of a practitioner.
While unexpected medical services arising when an insured person is temporarily absent from British Columbia are covered at British Columbia rates, prior
authorization in writing from a medical director of the plan is required where the
insured person elects to seek medical attention outside the Province, otherwise
payment may not be made under the plan.
 MEDICAL SERVICES COMMISSION 141
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) of $1,680 or less for the immediately preceding taxation
year qualify for a subsidy of 90 per cent of the full premium rate.
Monthly premiums payable by subscribers, effective July 1,
1976, are as follows:
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
(b) Temporary premium assistance is available for a three-month period
under unusual circumstances which, by reason of illness, disability,
unemployment, or financial hardship render an eligible person unable to pay his currently required premiums for coverage under the
plan. Temporary premium assistance is at 90 per cent of the full
premium rate.
LABORATORY APPROVAL
A six-member Advisory Board on Laboratories, appointed by the commission,
continues to provide advice and recommendations to the commission pertinent to
its determination of approval of laboratories for the performance of insured services
under the regulations set down by the Lieutenant-Governor in Council in September
1971. The commission is responsible for ensuring the reasonable availability of
quality laboratory services for insured persons throughout the Province, 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 has continued to work closely with the peer
review committees of physicians and other practitioners providing services under
the plan.
The commission provides data to the professional licensing authorities or other
relevant practitioner bodies with respect to the volume and type of services rendered
under the plan and various other statistical information on an annual basis. The
commission also provides various statistical information to them on a request basis.
 142 MINISTRY OF HEALTH REPORT,  1978
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 employes physicians in this
way, there are many other organizations within the Province which make arrangements with physicians to provide insured services on this basis and arrange with the
Medical Services Commission for reimbursement of their costs.
When the Medical Services Commission reimburses an organization which
employs a doctor performing insured services on a salaried basis, a payment is made
to the organization for the shareable portion of the doctor's salary, that is, the
proportion of the salary which represents the time he spent on providing insured
services to individuals. An additional amout 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.
In the year 1977/78 the total expenditure on insured services by the Medical
Services Commission was $334,086,613, of which $316,336,656 was in the form
of fee-for-service payments and $17,749,957 for salary and sessional payments.
STATISTICAL TABLES
STATISTICAL HIGHLIGHTS
The total expenditure for insured services under the Medical Services Plan for
the 1977/78 fiscal year was $334,086,613, up $33,618,747, or 11.2 per cent from
the prior year.
A similar increase was reflected in the per capita costs for insured services
which rose from $12.08 in 1976/77 to $13.40 in 1977/78, an increase of 10.92
per cent.
Administration costs at $13,207,188, representing 3.8 per cent of total plan
costs for 1977/78, showed little change from the previous year.
Due to a payment being made on the last day of the 1976/77 fiscal year,
25 claim payments were made to practitioners instead of the usual 24. As a result,
only 23 payments were made in the following 1977/78 fiscal period.
Since all statistical tables related to claims payments for the two years were
compiled on a cash basis, the data is not truly comparable.
 MEDICAL SERVICES COMMISSION 143
SUBSCRIBER STATISTICS
Table 25—Registrations and Persons Covered1 by Premium Subsidy Level
at March 31,1978
Subsidy
(PerCent) Subscribers Persons
90      249,204 397,964
50        25,231 47,786
Nil      830,219 2,066,048
Totals.
1,104,654
2,511,798
Table 26—Persons Covered by Age-group at March 31,1978
Persons
  31,655
  142,184
  412,184
  478,181
  696,087
  493,543
  88,282
  108,923
  45,010
  8,600
  7,149
Age-group
Under 1
1-4	
5-14	
15-24 _
25-44 ___
45-64 ._-
65-69 __.
70-79 -
80-89 	
90 and over
Unknown 	
Total
2,511,798
i Coverage data do not include members of the Canadian Armed Forces, RCMP, and inmates of Federal
penitentiaries.
Chart VI—Coverage by Age-group at March 31,1978
1
696,087
6
5
478,181
493,543
o
o
o
o"
©
r.   d
412,184
VI
a
o
■•§
1
1           1
'Hj
o
250,815
s
3
Z
1
142,184
31,655
0
7,149
Under 1 1-4 5-14 15-24 25-44        45-64    65 and Over   Unknown
Age-group
 144
MINISTRY OF HEALTH REPORT,  1978
Table 27—Coverage by Family Size at March 31,1978
Family Size
(Persons)
1  	
2 -	
3	
4	
5 11
6	
7	
9 or more
Total.
Number of
Families
477,847
256,660
121,011
143,936
68,027
25,204
7,779
2,678
1,512
1,104,654
Chart VII—Coverage, by Family Size, at March 31, 1978
Number of Registrations (100,000)
Family Size (Persons)
477,847
o
o
o
60
u
E
a
Z
I
I
256,660
1
■
121,011
143,936
I
l_l
68,027
25,204
7,779
2,678
1,512
4 5 6
Family Size (Persons)
9 or More
 MEDICAL SERVICES COMMISSION
FEE-FOR-SERVICE PAYMENTS
Medical Practitioners and Dental Surgery in Hospital
145
Table 28—Distribution of Fee-for-service Payments for Medical Services
(Shareable)
Specialty
Amount Paid*
1976/77
1977/78
Percentage of Total
1976/77       1977/78
Cost per Persons
1976/77        1977/78
General practice	
Dermatology 	
Neurology	
Psychiatry....	
Neuropsychiatry  	
Obstetrics and gynaecology-
Ophthalmology 	
Otolaryngology	
Eye, ear, nose, throat	
General surgery.	
Neurosurgery   	
Orthopaedic surgery	
Plastic surgery 	
Thoracic surgery	
Urology	
Paediatrics   —
Internal medicine 	
Radiology _ _ _
Pathology 	
Anaesthesiology.— 	
Physical medicine _	
Public health-	
Dental surgery in hospital-
Osteopathy 	
Nuclear medicine	
Unclassified	
Totals 	
121.
3
2
$
.268,241
267,459
.215,236
,107,198
270,201
,591,056
793,888
,802,170
78,040
,445,619
,470,098
350,110
211,734
,790,910
676,948
.373,353
,031,588
,331,364
,930,983
,559,120
387,558
82,323
,042,896
253,008
5,418,988
282,750,049
124,791,368
3,250,763
2,259,449
8,241,292
275,854
10,321,327
10,804,395
4,992,076
23,840
17,321,077
1,504,199
7,844,253
2,130,013
1,783,085
4,682,651
6,125,164
18,839,807
21,380,257
25,185,101
10,839,860
402,193
86,765
1,142,858
264,384
192,132
5,724,579
290,408,742
42.89
1.16
0.78
2.87
0.10
3.75
3.82
1.70
0.03
6.17
0.52
2.60
0.78
0.63
1.65
2.25
6.38
7.54
8.11
3.73
0.14
0.03
0.37
0.09
1.91
100.00
42.97
1.12
0.78
2.84
0.10
3.55
3.72
1.72
0.01
5.96
0.52
2.70
0.73
0.62
1.61
2.11
6.49
7.36
8.67
3.73
0.14
0.03
0.39
0.09
0.07
1.97
$
48.7422
1.3133
.8904
3.2585
.1086
4.2569
4.3384
1.9301
.0314
7.0119
.5909
2.9542
.8890
.7198
1.8798
2,5616
7.2474
8.5737
9.2166
4.2440
.1558
.0331
.4192
.1017
2.1780
100.00
113.6455
$
50.0206
1.3030
.9057
3.3034
.1106
4.1371
4.3308
2.0010
.0095
6.9429
.6029
3.1442
.8538
.7147
1.8770
2.4552
7.5516
8.5699
10.0950
4.3450
.1612
.0348
.4581
.1060
.0770
2.2946
116,4056
1 Includes only those payments which have been made during the respective fiscal periods.   As 25 payments
were made in 1976/77, 23 in 1977/78, the figures are not truly comparable.
2 Based on insured population as at October 1, as derived from Statistics Canada Data (October 1, 1976=
2,488,000; October 1, 1977=2,494,800).
 146
MINISTRY OF HEALTH REPORT,  1978
Table 29—Distribution of Medical Fee-for-service Payments and Services,
by Type of Service
Type of Service
Number of Services
1976/77
1977/78
.Amount Paid*
1976/77
1977/78
General Practitioners
Complete examination	
Partial examination   	
Subsequent office visit-
Night, Sunday, holiday, or emergency visit-
First house visit	
Subsequent house visit-
Hospital visit	
Subtotals-
Consultation—
House visit—
Office visit	
Hospital visit.
Speciallsts
Subtotals-
Other Medical
Anaesthesia-
Obstetrics	
Surgery-
Special procedures-
X-ray.	
Laboratory-
Common office procedures-
Psychotherapy	
Electrodiagnosis 	
Pulmonary function 	
Miscellaneous	
Subtotals-
Totals	
921,305
5,138,438
1,928,602
532,592
120,128
51,652
1,615,598
915,871
5,119,693
1,773,645
543,568
118,834
48,044
1,494,821
17,833,752
49,650,511
11,644,309
12,920,042
2,176,642
742,415
8,347,479
10,308,315    |      10,014,476
103,315,150
872,218
8,705
446,491
597,871
846,305
8,561
457,934
577,402
31,708,063
292,389
3,725,470
5,232,490
1,925,285    |        1,890,202
40,958,412
1,950,739
56,577
473,023
711,401
1,245,188
6,429,943
1,301,000
203,227
16,543
14,183
12,401,824
24,635,424
1,913,457
53,456
445,099
702,636
1,146,177
6,653,367
1,201,537
182,016
30,526
5,268
14,591
13,307,831
8,530,339
37,591,620
11,598,083
20,834,883
29,576,147
7,486,805
6,245,203
610,518
2,695,088
12,348,130
24,252,808
282,750,049
18,851,791
52,375,048
11,195,382
13,686,480
2,300,897
729,593
8,447,352
107,586,543
32,210,484
304,440
4,001,333
5,297,692
41,813,949
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
3,209,638
138,476,487    |    141,008,250
290,408,742
i As 25 payments were made in 1976/77, 23 in 1977/78, the figures, which are prepared on a cash basis, are
not truly comparable.
 MEDICAL SERVICES COMMISSION 147
Table 30—Average Fee-for-service Payments by Type of Practice1
Type of
Practice
Number of Active
Practitioners
1976/77
1977/78
Average Payments
1976/77        1977/78
Median Payments
1976/77
1977/78
General practice-
Dermatology	
Neurology.	
Psychiatry-
Neuropsychiatry.	
Obstetrics and gynascology..
Ophthalmology	
Otolaryngology.	
General surgery	
Neurosurgeiy-
Orthopsedic surgery-
Plastic surgery
Thoracic and cardiovascular surgery-
Urology 	
Paediatrics-
Internal medicine..
Aniesthesia 	
Physical medicine-
Nuclear medicine-
Osteopathy..
Surgery, general practice 3 	
Paediatrics, general practice3 	
Internal medicine, general practice3..
1,598
36
28
123
2
112
114
52
166
17
86
25
12
48
57
183
179
5
5
42
22
14
1,681
38
27
129
2
112
120
53
166
18
90
24
13
50
63
194
195
5
1
5
43
19
16
$
69,272
90,458
82,162
60,817
134,678
91,443
95,006
96,052
84,846
82,405
86,192
87,955
157,909
96,862
76,568
87,192
59,632
68,067
50,492
67,609
69,169
59,353
I
$
68,111
83,575
87,045
59,873
137,724
89,308
91,416
95,602
85,068
83,414
86,667
87,298
143,391
92,135
73,072
88,918
58,455
69,632
315,722
52,877
63,021
63,681
51,671
$
68,367
88,257
79,584
61,367
134,678
91,068
90,735
95,224
82,583
83,530
81,870
84,907
124,081
87,559
72,601
81,650
61,169
63,302
29,325
60,359
66,437
54,647
$
67,125
75,887
89,578
58,430
137,724
84,608
83,936
95,042
83,430
79,311
84,324
83,367
116,187
90,916
66,442
83,046
59,323
66,980
315,722
26,766
59,213
58,998
51,932
1 Type of practice is based on practice being carried out, rather than on certification.
2 Includes only those physicians whose services on a fee-for-service basis grossed $20,000 or more.    Also,
as 25 payments were made in 1976/77, 23 in 1977/78, 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 per cent or more of their income from general practice services.
ADDITIONAL BENEFITS
Fee-for-service Payments
Table 31—Distribution of Fee-for-service Payments for Insured Services,
Additional Benefits
Type of Service
Amount Paidi 2
Percentage of Total
Cost per
Person3
1976/77
1977/78
1976/77
1977/78
1976/77
1977/78
$
3,284
13,604
8,117,112
371,719
3,225,027
5
5,405
1,630,866
4,300,985
88,528
80,872
$
2,242
820
14,846
7,831,627
384,653
3,278,521
0.02
0.08
45.51
2.08
18.08
0.00
0.03
9.14
24.11
0.50
0.45
0.02
0.00
0.09
44.50
2.19
18.62
0.07
9.63
24.24
0.58
0.06
$
0.0013
.0000
.0055
3.2625
.1494
1.2962
.0000
.0022
.6555
1.7287
.0356
.0325
$
0.0009
.0003
.0060
Chiropractic	
Naturopathic	
Physiotherapy (office)	
3.1402
.1542
1.3146
Orthoptic	
Podiatry	
Optometric	
Orthodontic
Unclassified.	
11,558
1,695,300
4,"266,804
101,364
10,915
.0046
.6798
1.7108
.0406
.0044
Totals	
17,837,407
17,598,650
100.00
100.00
7.1694
7.0564
1 Includes only those payments which have been made during the respective fiscal periods.   As 25 payments
were made in 1976/77, 23 in 1977/78, the figures are not truly comparable.
2 These amounts are fee-for-service payments made under the plan only, and in no way reflect the total for
the services of these practitioners.
3 Based on insured population as at October 1, as derived from Statistics Canada Data (1976=2,488,000;
1977=2,494,000).
 148
MINISTRY OF HEALTH REPORT, 1978
Table 32—Average Fee-for-service Payments by Type of Practice,
Additional Benefits
Type of Practice
Number of Active
Practitioners
Average Paymenti
Median Paymenti
1976/77
1977/78
1976/772
1977/782
1976/772
1977/782
180
9
80
29
135
192
10
96
31
139
$
43,328
39,571
35,178
53,452
29,833
$
40,107
37,956
35,379
52,986
29,541
$
40,258
37,528
24,483
54,833
28,889
$
35,969
37,127
29,460
52,625
28,250
1 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.
2 The commission made 25 payments in 1976/77, 23 payments in 1977/78. The average payment, compiled
on a cash basis, is therefore not truly comparable.
Table 33—Summary of Expenditures, 1969/70 to 1977/78
Medical
Fee-for-service
Salaried and
Sessional
Additional
Benefits
Administration
Total
1969/70	
1970/71—-
1971/72	
1972/73	
1973/74	
1974/75	
1975/76	
1976/77.	
1977/78	
105,700,011
122,818,267
127,000,505
139,532,341
159,614,356
190,452,494
250,026,093
268,496,749
298,900,495
$
3,677,387
4,375,798
4,788,365
6,022,920
7,991,062
10,424,602
15,437,520
14,880,410
17,749,957
6,929,779
6,611,815
5,534,520
7,897,244
8,963,080
11,089,892
15,045,516
17,090,707
17,436,161
5,687,035
6,030,059
6,567,847
7,320,137
8,581,794
12,501,015
12,659,521
13,040,063
13,207,188
121,994,212
139,835,939
143,891,237
160,772,642
185,150,292
224,468,003
293,168,650
313,507,929
347,293,801
Whereas preceding statistical tables are prepared on a cash basis the above summary is compiled on an
accrual basis.
 z
o
z
Government Health Institutions
Although the emphasis in mental health care is on community-
based services, there will continue to be a need for specialized
facilities to accommodate those whose treatment cannot be adequately taken care of at the community level. Facilities for specific
types of care have been developed under Government agencies.
These include facilities and services for those of the mentally ill, the
emotionally disturbed, and the senile aged, as well as the tubercular
and the profoundly physically disabled whose condition requires
admission to a specialized treatment unit.
Effective November 7, 1977, I. Manning was appointed as
Director of Government Health Institutions. These institutions
comprise Riverview Hospital and Valley view Hospital (Essondale),
Dellview Hospital (Vernon), Pearson Hospital, and the Willow
Chest Clinic (Vancouver). A brief report of these facilities follows:
<
ui
X
z
>
o
149
 150 MINISTRY OF HEALTH REPORT,  1978
GOVERNMENT INSTITUTIONS
RIVERVIEW HOSPITAL
The patient population at Riverview stabilized at the 1,100 to 1,130 range,
representing a reduction of fewer than 100 patients during the past year. Pressure
for admissions, however, continued and increased, varying from 86 to 108 admissions per month. Those figures represent a range of 13 to 43 admission requests
per month that the hospital has been unable to accommodate.
Lengths of patient stay in acute areas averaged 46 days, with 88 per cent of
the patient population averaging 30 days or less. For chronic areas, the average
patient stay was 450 days (approximately 15 months), with one-third staying three
months or less, one-third staying between three and 12 months, and one-third
staying one to nine years.
The time of hospitalization for acute-care patients corresponded reasonably
well to other acute hospitals, considering that Riverview's clientele generally constitutes the more severely disturbed patient population.
Perhaps the most pressing service problem at Riverview reflects the hospital's
inability to accommodate admission requests for organic brain syndrome patients.
Riverview's 86 beds proved to be singularly ineffective in meeting demand and in
spite of personal screening of all referrals and continued updating of the waiting-
list, 90 patients were on the waiting-list for beds in the organic brain syndrome unit
at the year-end. Development of this service requires priority consideration for
planning in the near future.
In addition to the planned opening of two additional 20-bed wards, the hospital
was negotiating means for providing organic brain syndrome back-up services for
Pearson Hospital and the G. F. Strong Rehabilitation Unit.
Other active proposals to augment services include a proposal for the disposition and treatment of referrals from Vancouver city jails; the offering of potential
back-up psychiatric services to Royal Columbian Hospital; and extension of the
facility's management of admission and separation data to Valley view, Dellview,
and Skeenaview Hospitals.
Within the hospital, medical-surgical consultation services were consolidated
in North Lawn Unit, and medical-surgical care throughout the hospital, as well as
that of Valleyview and Riverside, was more effectively co-ordinated.
With assistance from systems analysts in the Ministry's management engineering division, the hospital also completed exhaustive studies and proposals for
streamlining its dietary services. Such revisions will include closing of the hospital's
bakery and could potentially involve closing one of the five hospital kitchens, as
well as the introduction of an improved food tray service for patients.
The possibility of a central commissary kitchen was also under consideration.
Similar massive surveys involving outside consultants were undertaken for the
laundry services. These studies should bear fruit early in 1979 with the installation
of extensive new laundry-processing equipment.
The hospital's strong, working relationship with the Canadian Mental Health
Association was being further enhanced by development of a new collaborative
service entailing volunteer follow-up visits for patients recently discharged from the
hospital. This should prove to be a particularly beneficial service to patients in
outlying communities.
Regular meetings were also set up with representatives of the Mental Patients'
Association to assist in the development of patient councils for each of the major
units in the hospital.
 GOVERNMENT HEALTH INSTITUTIONS
151
Another recent development in the Riverview complex was the Patients' Advocate Project on hospital grounds. It provides easy patient access to independent
legal services that ensure patient rights are protected, and establishes that the legality
of Mental Health Act committals is closely scrutinized.
Finally, the Panel of Enquiry into Alleged Patient Abuse became officially
operational in September. Appointed by Order in Council, it has been conceived
as an independent, fact-finding body in cases of alleged patient abuse.
Of the numerous special projects and investigations conducted by the various
committees within the hospital, the following are among the more noteworthy:
The initial development of a hospital-wide policy and procedure manual, including intensive deliberation on a core of priority policies and procedures
(e.g., seclusion; emergency procedures).
Surveys and critiques on the use of lithium, electroconvulsive therapy, and
closed-ward utilization by the psychiatric audit committee.
Intensive studies of nursing staffing standards with the aid of outside nursing
consultants.
The delineation and dissemination of nine specific patient "program" areas
with definitive admission and discharge criteria for each.
The latter represents a massive hospital endeavour over the past year in the
direction of progressive planning and revamping of hospital services. The major
project of program definition throughout the hospital began with the intention of
delineating specific areas of the facility for special care and assigning appropriate
patients to each service area. The reorganization of treatment services constituted
a major priority for the development of hospital commitments in the months ahead.
PEARSON HOSPITAL
Pearson Hospital, located in South Vancouver, continued to provide in-
hospital care for tuberculosis patients; for persons with severe respiratory disabilities, primarily from poliomyelitis; and for extended-care patients. In the latter
program, the emphasis is on younger age-groups, with female patients averaging 51.6
years and males, 48 years.
A therapeutic out-patient program, aimed at delaying or preventing the need
for hospitalization of those patients who have qualified for intermediate or extended care, operated on a pilot-project basis for the past 18 months and in 1978
received full approval following an assessment of its effectiveness.
The Willow Chest Centre in-patient unit, also administered by Pearson Hospital, was vacant pending major renovations and planning was under way to return
the 40 or so hospitalized tuberculosis patients to that facility.
The possibility of using beds that will consequently be released at Pearson
Hospital for the establishment of a program for head injury patients was being
discussed as one that could be operated in co-operation with the G. F. Strong Rehabilitation Centre.
Discussions were also under way with Shaughnessy Hospital to work closely
with that spinal cord injury unit in providing longer-term care for respiratory-disabled patients whose condition has somewhat stabilized but require continued and
specialized in-hospital care.
During the year, efforts continued toward obtaining the release of funds to
convert the old auditorium into an education centre to make in-service and community education programs more effective. An increased involvement in community education, particularly in relation to long-term care, was undertaken despite
the present inadequate facilities.
 152 MINISTRY OF HEALTH REPORT,  1978
Serious recruitment problems were experienced with regard to registered
nurses, affecting the morale of both staff and patients. The low point occurred in
August when one-third of these positions were vacant and considerable reassignment of duties was necessary. However, strenuous recruiting activity during
August and September resulted in a reversal of the situation by late September.
Most of the new staff came from other provinces.
Mrs. M. L. McKay, Director of Nursing, retired and a replacement was being
sought. Prior to her retirement she completed a proposal for the implementation
of a multidisciplinary quality assurance program at the hospital.
The nursing administrative reorganization plan was completed and Phase 1
was implemented. Considerable economies resulted and communications within
the nursing department and with other members of the treatment team improved.
The women's auxiliary continued to be very active and, in addition to the
many services and entertainment activities provided for patients, it donated a fully
equipped wheelchair mini-bus costing approximately $16,000.
Other significant community interest was provided by a group of citizens who
formed a society to raise funds for the provision of a therapeutic swimming-pool
for the hospital and the disabled in the community. Much to their delight the
Premier, who had been invited to attend the campaign kick-off ceremony, presented
the society with a cheque for the full cost of the project, $750,000. He was
accompanied by Deputy Premier Grace McCarthy, who had arranged the donation
from lottery funds.
Because of the number of severely disabled young people at Pearson Hospital,
the Vancouver School Board agreed to assign a teacher to the hospital. Those
patients are now receiving classroom instruction that otherwise would have been
unavailable to them and the program is going well.
On September 18 and 19 the hospital was surveyed by the Canadian Council
on Hospital Accreditation, which again granted accreditation to Pearson Hospital.
NEW DENVER PAVILION
This 28-bed personal and intermediate care facility became the responsibility
of Government Health Institutions on April 1, 1978, and planning was under way
for its transfer to the Slocan Community Hospital and Health Care Society by the
end of the current fiscal year. The hospital society will build a 10-bed diagnostic
and treatment centre on the pavilion site and operate both units under one administration.
The average age of the residents is 80.5 years and there is full occupancy and
a waiting-list of five. A professional nurse is on duty daily and otherwise available
and a physician and a physiotherapist visit every two weeks.
The pavilion is located on a beautiful site at the lake's edge in New Denver,
and is a fine asset for community health resources.
VALLEYVIEW HOSPITAL
Valleyview Hospital had a busy and fairly productive year. Admissions
reached 231, while there were 240 discharges, including 130 deaths. This represented a reduction of approximately 17 per cent from previous years.
The Province's new Long-term Care Program started in January. Since the
majority of persons discharged from Valleyview need continued care in a residential
facility, it was obvious that the new program would affect the discharge arrangements.
 GOVERNMENT HEALTH INSTITUTIONS
153
New working practices had to be developed in co-operation with the staff of
the Long-term Care Program, and communication between them and Valleyview
staff has been excellent.
The Long-term Care Program has removed financial barriers that formerly
blocked some discharge prospects. However, the extra documentation and some
slowdown in achieving placement in certain geographic areas resulted in a reduced
flow of discharges. It was expected that this problem would be resolved in the
near future.
A major event last summer was the rather sudden development of a shortage
of registered nurses, which appeared with little warning during late May and early
June. With July and August having the heaviest vacation rate, it was obvious the
hospital could not expect relief before September.
Since the reduction did not allow safe coverage of all wards, all admissions
except emergencies were discontinued. A concentrated drive to discharge as many
patients as possible emptied one ward. This enabled redistribution of staff to
safely cover the remaining 14 wards.
Full resumption of admissions was possible in mid-September and two months
later waiting-time for admission was back to about three weeks—normal for that
time of the year.
Advantage was taken of the break in admissions to reorganize some ward
functions and to plan a new admission policy. Admission is now separated into
three categories, which are handled in separate admission areas. This has resulted
in better patient and family acceptance and allows for more efficient planning and
activity of nursing service.
In the last quarter of the year realistic planning for future expansion of this
hospital's clinical role was under discussion. This covered such matters as how
to develop a day hospital to serve the population within reasonable transportation
distance of Valleyview; the initiation of a consultation service to community residential care facilities; and working out more formal types of educational experience
for the staffs of those facilities.
Administratively, the program started in 1977 reached full implementation
with the appointment in the late fall of a director of activation services to co-ordinate the various rehabilitative services in the hospital, and a training and development manager working within the personnel department who is responsible for
co-ordinating the education and training resources available to the hospital.
The nursing department also reorganized to free certain senior staff for a
specific role in the clinical function of the hospital. At the year-end reviews were
under way regarding the delivery of pharmacy services, the physical plant of dietary
services, transportation, and a number of other administrative services.
These will aid Valleyview in coping with the projected changes in clinical
service, necessitated by the introduction of the Long-term Care Program, and
the administrative reorganization brought about by the proposed decentralization
of the Government health institutions.
DELLVIEW HOSPITAL
Dellview Hospital at Vernon continued to provide for the needs of the geriatric
patient over 70 years of age with mental illness. With the implementation of the
Long-term Care Program, all of the hospital's admissions and discharges now are
through the new program.
 154
MINISTRY OF HEALTH REPORT,  1978
Early in the year an internal day-care program was started to provide rehabilitation therapy to patients from the main ward. These patients sleep in the main
wards and spend all their waking-hours in the rehabilitation unit.
The hospital implemented a quality assurance program for patient care. The
program closely followed the guidelines of the Registered Nurses Association of
B.C. This included a review of hospital and departmental philosophies and objectives, hospital and departmental policies and procedures were rewritten; standards
of nursing care were established; the patient-care charting system was upgraded
with the purchase of a modern charting system. An ongoing educational program
presenting "Quality Assurance" to hospital staff has been an integral part of the
program since the early planning stage.
Sixteen summer students were employed for a total of 36 man/months and
greatly assisted various hospital patient programs and provided extra activities and
interests for the patients.
Dellview's in-service education program was very active, conducting some 102
programs over 555 sessions. Staff attending totalled 2,998, plus 86 visitors, for a
total of 2,387 employee hours. In addition, staff have taken educational courses
outside of the hospital, knowing in advance that they in turn will be conducting
similar programs for their hospital peers. This has been most encouraging and
rewarding.
Dellview's medical coverage continues to be 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, pharmaceutical, radiological, and
regional laundry services are available under contract from the Vernon Jubilee
Hospital, with psychiatric support available through the Vernon Mental Health
Centre.
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;
(/)   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.
 A call is taken by ^dispatcher in the Emergency Health Services ambulance dispatch
centre for the Capital Regional District, Victoria.
More than 100 Emergency Health Service, ambulances have been manufactured by
the Vehicle Modification Depot in Victoria.
 156 MINISTRY OF HEALTH REPORT,  1978
To these functions have been added the responsibility for the medical aspects
of the Provincial Emergency Program such as medical involvement in disaster
planning, responsibility for Federal stores stockpiled around the Province, and
involvement when actual disasters occur.
During 1978 one full-time ambulance attendant was added to the following
volunteer-manned stations: Burns Lake, Vanderhoof, and Fernie. In addition
a second ambulance attendant was added to the following one-man stations: Squamish, Ganges, Port Hardy, and Grand Forks. A third attendant was added to the
Parksville station, an additional crew member was added to Nanaimo, and the
Regional Dispatch Centre at Prince George was established with the recruitment
of five dispatchers. New volunteer stations were opened in Tofino, Field, Zeballos,
Wells, and Port Clements.
The training program consists of three levels of instruction to ambulance
crews:
Emergency Medical Assistant I—80 hours, basic course;
Emergency Medical Assistant II—240 hours, more advanced training;
Emergency Medical Assistant III—1 year, advanced pre-hospital care
("paramedic").
Thirty-one EMA I courses were conducted in various centres throughout the Province involving 261 part-time personnel. Three EMA II courses were held, two in
Vancouver and one in Victoria, involving 81 full-time employees. Seventeen
"paramedics" graduated from the EMA III program and another 13 are presently
on course in Victoria. In addition to the full EMA III program, modules of that
course are being taught under the EMA II-A program in Chilliwack, Nanaimo, and
Kamloops with 20 full-time personnel participating. Eight crew members graduated from an intensive course in infant transport which was given under the direction of a medical specialist in this field.
An instructor's course was held in Vancouver with six employees involved,
all of whom are now instructing in the field.
Industrial First Aid Certificates were obtained by 406 personnel, both full-
time and part-time.
A physician was again employed by the commission to provide medical coverage for the fishing fleet for a 10-week period divided between Rivers Inlet and Port
Renfrew.
The Vehicle Modification Depot produced 69 new ambulances, all of which
have been placed in service, thereby allowing the removal from service of 56 older,
high mileage units.
The use of air ambulance is steadily increasing and will exceed the commission's estimate for 1978 by 45 per cent, bringing the number of patients carried to
2,320.
Call volume on road ambulances increased 11 per cent from 9 per cent the
previous year, bringing the total patients carried to 158,150.
The commission has assumed responsibility for co-ordinating a program of
instruction for members of the public in cardiopulmonary resuscitation (CPR) by
using instructors within the ambulance service. Communities interested in'holding
such a program will be placed in contact with the nearest available instructor.
The Executive Director participated in a number of meetings during the past
year, including the Traffic Injury Research Foundation of Canada, of which he
was elected Vice-President; the University Association for Emergency Medicine;
 GOVERNMENT HEALTH INSTITUTIONS
157
a seminar sponsored by the Workers' Compensation Board of British Columbia on
spinal cord injuries; meetings of the subcommittees of the Greater Vancouver Regional District relating to disaster planning; and the annual directors' meeting
sponsored by the Federal Government attended by representatives of all the provinces and devoted to emergency health measures including disaster planning.
The Provincial ambulance service continued to be of interest to other provinces and, in the past year, visits were made by representatives from the Provinces
of Quebec and Ontario, the City of Toronto, and representatives from Health and
Welfare (Canada).
STATEMENT OF EXPENDITURES FOR THE FISCAL YEAR, 1977/78
Emergency Health Services Commission
Salaries	
Travel expenses	
Professional and special services
Office expense.
Office furniture and equipment.
Advertising and publications ._
Materials and supplies	
Motor-vehicles 	
Rentals 	
Acquisition/construction of land, buildings, and works	
Acquisition/construction of machinery and equipment	
Other expenditure (includes payments to Workers' Compensation Board and salary fringe benefits)	
Recoveries (nonrevenue)	
Total expenditure	
$
13,048,432
298,429
588,574
120,042
27,416
2,440
1,875,336
695,743
888,738
133,393
215,482
2,263,287
(93,948)
__ 20,063,364
FORENSIC PSYCHIATRIC SERVICES COMMISSION
There was little change during 1978 in the volume of services offered, the one
additional service being that of a travelling clinic to Prince George. However,
great emphasis was laid on improving existing services. For example, a number of
commission staff now help the court in Vancouver by assisting in the documenting
of persons directed from the criminal justice system as requiring psychiatric care.
Studies were under way at the year-end to determine whether similar services might
be offered to courts elsewhere in the Lower Mainland.
Commission staff continued to devote a great deal of energy to the perennial
task of education of referring agencies. Request visits to explain the nature of the
specialized services offered to the courts by the commission took place throughout
the Province. The steady increase in the percentage of appropriate referrals for
service continued, the time taken for court assessments dropped dramatically to
less than half of that required two years ago, and communications with the courts
improved substantially. Transfers of persons convicted and serving a sentence who
become mentally ill and require treatment in the Forensic Psychiatric Institute are
accomplished within a few hours.
 158 MINISTRY OF HEALTH REPORT, 1978
Although the total number of patients under the care of the commission remained remarkably constant, there was a steady and gratifying increase in the number of in-patients recommended by the Review Board of the Attorney-General's
Ministry for conditional discharge. A number of these former in-patients lead
closely supervised lives in the community.
Exchange visits took place during the year with the staff of the Metropolitan
Forensic Unit in Toronto, which performs a similar function to that of the commission. Objectives included a study of compatible record systems and treatment
methods. The first joint research project was completed during the latter part of
the year.
The executive director visited forensic psychiatric facilities in five European
countries and submitted a report to the commission. The director of the Vancouver
clinic was guest lecturer on the function of the commission at a forensic convention
in Singapore.
The work of the commission received international recognition, which will
increase as a result of the planned International Symposium on Law and Psychiatry,
being held for the first time in Vancouver in May of 1979. Invited speakers are
internationally recognized leaders in the forensic psychiatric field from all over the
world.
ALCOHOL AND DRUG COMMISSION
The first three quarters of fiscal 1978/79 saw a consistent and increasing
capacity by the commission and its direct and indirect service agencies to provide
support to the individual caught up in an alcohol or other drug dependency.
Under the direction of the Minister of Health, the chairman of the commission
was developing at the year-end, a health entry program for the treatment of heroin
addiction in British Columbia which was implemented December 31, 1978.
This realistic and compassionate program is designed not only to come to
grips with a person's dependency but also to deal with medical, psychological, and
social problems that must be treated before dependency can be eliminated. The
program will offer a combination of treatment options not available anywhere else
on the continent and a community support and supervision program which is unique
in Canada.
The regionalization of the Province into four areas has been completed and a
more effective and equitable distribution of alcohol and non-narcotic services has
been achieved.
By the end of the third quarter, one new out-patient clinic in Cranbrook was
developed and programs in Nelson, Campbell River, Dawson Creek, and Port
Alberni were expanded and adapted to serve a wide geographic area. A new
residential program was being developed in the Queen Charlotte Islands.
Where treatment services do not presently exist and where developing services
would not bring treatment to the area, the commission staff has had a supportive
role with existing community agencies and groups through consultative service,
audiovisual and print materials, workshops and training programs.
In conjunction with the regional director, Health and Welfare Canada, the
commission has assumed co-ordinating responsibility for native Indian matters
relating to alcoholism. In 1979 a new residential program for native Indians
funded jointly by the Federal Government and the Alcohol and Drug Commission
will open.
 GOVERNMENT HEALTH INSTITUTIONS 159
ADVISORY COUNCIL TO THE MINISTER
At the request of the Minister of Health, a special advisory council was formed
comprising representation from Government and other organizations. It offers
advice and operates as a sounding board concerning proposed policies drafted by
the commission for eventual consideration by the Minister.
The council, under the chairmanship of Dr. G. F. R. Elliot, includes representatives from B.C. Medical Association, Federal Department of Justice, Ministry
of Attorney-General, the community, Ministry of Human Resources, Ministry of
Education, Ministry of Labour, and the Co-ordinated Law Enforcement Unit.
COMMISSION SUPPORT SERVICES
The Professional Development Division continues to design and conduct
education and training programs for professional and paraprofessional people,
who are working directly with alcohol and other drug users and abusers, or those
affected by the addicted persons. These are the people who are on the front lines
and who every day face persons who are in need of help.
The activity of the Employee Assistance Program continues to place a heavy
demand on Professional Development Division staff. This program provides one
good opportunity for early intervention which results in a higher rate of treatment
success.
This year professional development officers pursued those companies and
organizations that indicated an interest in an Employee Assistance Program. Responding to training needs in industry has been a major thrust for this division.
It has designed and conducted training workshops for three companies. Training
groups are limited to a maximum of 25 people thus requiring several sessions with
one company.
One of the highlights of 1978 was the culmination of the joint Provincial-
Federal effort to establish a new native residential treatment centre. A 24-bed
treatment centre was under way in the Vernon area at the year-end, using trailer
units. The centre is scheduled to open in early 1979. The Professional Development Division continues to provide education and training programs to Indian
bands and other native organizations.
AGENCY LIAISON DIVISION
The Agency Liaison Division is an auditing, evaluative, and consultative link
between the commission and the boards and staff of 43 funded, granted, and direct
service agencies. The division is consultant to all commission-funded programs in
the four regions for training and program standards.
RESEARCH AND PLANNING DIVISION
The Research and Planning Division has three main areas of responsibility:
evaluation, planning, and monitoring.
The primary focus of the evaluation section was the development of a comprehensive data collection system for the Health Entry Plan. This system, designed to
provide information for administration, treatment, and research will provide a sound
information base which can be used for decision-making by program managers and
treatment personnel. It will also provide information related to public accountability regarding the Health Entry Plan. It is expected that this data system will
be one of the most detailed and comprehensive systems of its kind in the health and
social service field. Work on this system will continue into 1979.
 160 MINISTRY OF HEALTH REPORT,  1978
The planning section helped document the commission's accountability mechanisms with regard to its funded agencies. The section also carried out an extensive
needs assessment for treatment services for teenagers and was involved with other
divisions in work regarding possible alternatives for detoxication. Reports on these
activities will be prepared in 1979.
Work continued on the commission's client agency monitoring system. A
number of training sessions were conducted for staff of new agencies and feedback
on agency operations was provided to several of the newer agencies in the system.
Two new agencies began to participate in this system on a voluntary basis in 1978.
INFORMATION AND EDUCATION SERVICES DIVISION
Information and Education Services, the division of the commission responsible for creating and disseminating information related to alcohol and other drug
use and abuse, concentrated its activities in the areas of public relations and con-
sultive services. It had become apparent to the commission that it was necessary
to take a more active approach to increasing public awareness of the nature and
extent of alcohol problems in British Columbia. To fill this need, Information
Services was given the responsibility of developing a Provincial advertising campaign
aimed at increasing awareness generally and publicizing commission services.
In order to provide the most current information to the greatest number of
citizens, Information Services provides both consultation services and information
materials. The division has been consulted in the development of advertising campaigns by other Government ministries.
With a collection of more than 2,100 catalogued books and a wide variety of
other materials, the commission's library has one of the largest addiction collections
in Canada. During 1978, circulation increased by 10 per cent and there was a
corresponding increase in the number of research and reference requests handled
by the librarian.
ALCOHOL AND DRUG COUNSELLING SERVICES
A new Burnaby/New Westminster clinic was to be in operation by the end of
1978. This new unit will be an important step in the development of out-patient
treatment services in the Burnaby-New Westminster areas. The focus on development of awareness, recognition, and early intervention in industrial and community
programs has grown in the past several years. An advertising campaign added a
very powerful impact on public awareness and demand for service.
Primary out-patient services provide a range of information, assessment, treatment, referral, and follow-up to individual clients and their families. A secondary
essential service is our contact, liaison, and ongoing work with professional, industrial, and service personnel who seek and require consultation and help with alcohol
and drug problems in their area of work and services.
YOUTH AND FAMILY COUNSELLING SERVICES
Youth and Family Counselling Services in Vancouver provide counselling and
supportive programs for young people involved with drugs, or are at risk, including
their family members. From April 1, 1978, to December 31, 1978, YFCS provided
treatment services to 321 individuals. The client services load represents a 21-percent increase over the same period during 1977. About 60 per cent of our clients
are under the age of 20. The majority are between 13 and 17.
 inF   gg     hk
3     I
The new Maple Cottage Detoxication Unit in New Westminster completed its first full
year of operation in December 1978. Services include treatment during withdrawal, professional
counselling, and referral.
 162 MINISTRY OF HEALTH REPORT,  1978
NARCOTIC ADDICTION SERVICES
Narcotic Addiction Services has continued to offer co-ordinated health and
specialized services to clients who seek treatment.
There are four community-based out-patient clinics in Vancouver. In addition, there are out-patient clinics in Coquitlam and Kelowna. The Narcotic Addiction Services provides out-patient counselling to opiate dependent individuals using
methadone for the medical management of their addiction. All clients enter the
program voluntarily and are either self-referred or referred from various agencies
in the community.
Since the Narcotic Addiction Services will become part of the Health Entry
Plan on January 1, 1979, there have been some changes in regards to the use of
methadone. All voluntary clients being treated as of June 1, 1978, may continue
their current program as voluntary clients after January 1, 1979. This will include
continuation of their methadone maintenance program as long as the client remains
in treatment.
For clients coming on the program after June 1, 1978, a methadone withdrawal
regimen will be used until December 31, 1978. In addition, a period of grace was
announced by the Ministry of Health from October 1, 1978, to December 31, 1978,
which offered all individuals who wish to be withdrawn from narcotics a three-month
period in which to achieve a medically supported withdrawal.
PENDER STREET DETOXICATION CENTRE
The Pender Detoxication Centre is a 22-bed, noninstitutional facility providing
a supportive and comfortable environment for men and women withdrawing from
acute alcohol intoxication and/or drug dependency. During the first nine months
of the 1978/79 fiscal year, 1,386 persons were admitted to the centre. Of these,
54.5 per cent had no previous admissions, 15.8 per cent had one previous admission, 10.5 per cent had two previous admissions, and 19.2 per cent had three or
more previous admissions. Of the first admission, 26.3 per cent were females,
73.7 per cent were males. In addition to the 1,386 clients admitted to the facility,
there were 270 drop-ins (prior to being admitted) whose average length of stay
was 6.4 hours. Over 76 per cent of the drop-ins had no previous contact with the
centre.
Of all clients admitted, less than 10 per cent left the Detox Centre during the
first 20 hours after admission. An encouraging 90.9 per cent of the total clients
admitted completed treatment.
MAPLE COTTAGE DETOXICATION UNIT
In the nine months covered by this report, Maple Cottage Detox admitted
1,069 persons. Of this number, 78 per cent were male and 22 per cent female.
Eighty per cent of all persons admitted had not been in a detox unit before. Of
the remaining 20 per cent, those being admitted twice numbered 12 per cent while
only 8 per cent required three or more stays in the unit.
 The Syva EMIT Drug Abuse Assay System is used to rapidly identify drugs of abuse
in the new Heroin Treatment Program.
 164
MINISTRY OF HEALTH REPORT,  1978
Table 34—Expenditure by Principal Categories in the Ministry of Health
for the Fiscal Year 1977/78
Total Expenditure
Fiscal Year Ended
March 31,1978
$
Minister's Office  103,293
Deputy Minister's Office and Support Services 1,215,216
Community Health Services (including Long-
term Care)   62,935,9721
Hospital Programs (including Long-term Care) 594,828,155
Government Institutions  49,058,810
Forensic Psychiatric Services  2,867,246
The Medical Services Plan of British Columbia 347,293,8011
Emergency Health Services  20,063,364
Building Occupancy Charges  15,863,461
Computer and Consulting Charges  168,000
Total
1,094,397,318
Chart VIII—Expenditure by Principal Categories in the Ministry of Health
for the Fiscal Year 1977/78
Hospital Programs (including
Long-term Care)
$594.8 million
Government Institutions
$49.1 million
Forensic Psychiatric Services'
$2.9 million
Senior Administration and
Community Health Services
• (including Long-term Care)
$64.3 million
Building Occupancy and
Consulting Charges
• $16 million
Emergency Health Services
$20 million
Total Health Services
in 1977/78
$1,094,397,318
i The expenditure of $347,293,801 shown for the Medical Services Plan is the gross operating cost as shown
in the detailed statements in Section F of the Public Accounts. The actual charge to Vote 180 was $207,300,000
and covered the return of the Federal sharing under the Medical Care Act (Canada) and Hospital Insurance and
Diagnostic Services Act, subsidy by the Province for low-income residents, and the estimated deficits not covered
by premiums and other revenues. Similarly, the total for the Ministry of Health is shown as $1,094,397,318,
whereas the net total is $954,403,517. This latter figure was $306,540 less than the total shown in Section D of the
Public Accounts as half of the Accounting Division expenditures were made on behalf of the former Ministry of
Provincial Secretary and Travel Industry.
 MINISTRY OF HEALTH EXPENDITURES, 1977/78 165
Table 35—Detailed Expenditure by Principal Categories in the Ministry of Health
for the Fiscal Year 1977/78
Total Expenditure
Fiscal Year Ended
March 31, 1978
$
Minister's Office   103,293
Deputy Minister's Office and Support Services  1,215,216
Community Health Services:
Deputy Minister and Branch Support Services  2,437,540!
Public Health Programs  24,658,817
Long-term Care     1,237,646
        25,896,463
Mental Health Programs        12,561,368
Special Health Services        13,723,667
Other Health Care expenditures         8,316,934
Total, Community Health Programs       62,935,972
Hospital Programs (including Long-term Care):
Office of Deputy Minister (Medical and Hospital
Programs)   61,745
Administration   3,856,217
Payments to hospitals
Claims   545,013,211
Grants in aid of equipment  10,094,851
Capital and debt services  18,788,838
Subtotal, Hospital Programs  577,814,862
Subtotal, Long-term Care Programs  17,013,293
Total, Hospital Programs (including Long-
term Care)  594,828,155
Government Institutions:
General Administration  1,371,143
Riverview Hospital   29,707,512
Valleyview Hospital   9,876,157
Dellview Hospital   2,188,096
Pearson and Willow Chest Clinic  5,915,902
Total, Government Institutions 1       49,058,810
Forensic Psychiatric Services        . 2,867,246
The Medical Services Plan of British Columbia
Expenditure:
Benefits—
Medical care  316,650,452
Additional benefits     17,436,161
334,086,613
l This figure was $306,540 less than the total shown in Table D of the Public Accounts, as half of the
Accounting Division expenditures were made on behalf of the former Ministry of Provincial Secretary and
Travel Industry.
 166 MINISTRY OF HEALTH REPORT,  1978
Table 35—Detailed Expenditure by Principal Categories in the Ministry of Health
for the Fiscal Year 1977/78—Continued
Total Expenditure
Fiscal Year Ended
March 31, 1978
$
Administration—
Salaries and employee benefits     10,550,890
General office expense      2,656,298
        13,207,188
Total, Medical Services Plan of British
Columbia2  347,293,801
Emergency Health Services  20,063,364
Building Occupancy Charges  15,863,461
Computer and Consulting Charges  168,000
Total, Ministry of Health  1,094,397,318
2 The complete 1977/78 Financial Statements and Notes for the Medical Services Plan are on pages 167
to 170.
 MINISTRY OF HEALTH EXPENDITURES, 1977/78
167
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 Services Commission of
British Columbia as at 31 March 1978 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 circumstances.
In my opinion, these financial statements present fairly the financial position of the Plan
as at 31 March 1978 and the results of its operations for the year then ended in accordance
with generally accepted accounting principles applied on a basis consistent with that of the
preceding year.
The financial statements for the year ended 31 March 1977 were reported on by the Acting
Comptroller-General of the Province of British Columbia.
Erma Morrison, CA.
Auditor General
Victoria, B.C.
27 June 1978.
 168 MINISTRY OF HEALTH REPORT, 1978
Table 36—Statement of Financial Position as at March 31,1978
Assets:
Cash        	
1978
$
2,026,029
1,707,487
12,500,000
1977
$
Accounts receivable _     _ 	
Due from the Government of British Columbia _
11,445,000
16,233,516
11,445,000
Liabilities:
Bank overdraft    	
188,014
15,023,691
38,000,000
9,373,013
Accounts payable	
Premiums received in advance	
Estimated liability for unpresented and unprocessed benefit claims (Note 1 (b)) 	
218,383
15,404,807
29,550,000
Working capital deficiency (see Table 37)	
53,211,705
36,978,189
54,546,203
43,101,203
16,233,516
11,445,000
 MINISTRY OF HEALTH EXPENDITURES, 1977/78 169
Table 37—Statement of Operations and Working Capital Deficiency
for the Year Ended March 31,1978
1978 1977
$ $
Revenue:
Subscribers'premiums (Note 1 (a)) .... 146,287,327 131,089,957
Government of British Columbia premium
assistance      29,917,948 26,746,879
Interest income           169,915 183,517
176,375,190 158,020,353
Expenditure:
Benefits—
Medical care  316,650,452 283,377,159
Additional benefits     17,436,161 17,090,707
334,086,613 300,467,866
Administration—
Salaries and employee benefits     10,550,890 9,835,061
General office expenses       2,656,298 3,205,002
13,207,188 13,040,063
347,293,801 313,507,929
Excess of operating expenditure over revenue  170,918,611 155,487,576
Contributions (Note 2):
Government of British Columbia  177,041,625 38,940,904
Government of Canada           — 128,140,535
177,041,625 167,081,439
(6,123,014) (11,593,863)
Working capital deficiency—beginning of year     43,101,203 54,695,066
Working  capital  deficiency—end  of  year   (see
Table 36)       36,978,189 43,101,203
 170
MINISTRY OF HEALTH REPORT, 1978
NOTES TO FINANCIAL STATEMENTS
For the Year Ended March 31, 1978
1. Significant Accounting Policies
(a) Income determination—Premiums from individual subscribers and commercial groups
and interest are included in income only when cash is received. Premiums from other sources
are recognized as income on an accrual basis.
(b) Liability for benefits—The liability for benefits, consisting of unpresented and unprocessed claims for medical care and additional benefits, has been calculated, as in prior years,
on the basis of past experience.
(c) Fixed assets—The cost of furniture and equipment is charged to administration
expense.
2. Contributions From Governments
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 unconditional
transfers to the Province under new Federal-Provincial fiscal arrangements, and the Province
now provides the entire Government contribution to the Medical Services Plan.
3. Comparative Figures
The 1977 comparative figures have been restated where necessary to conform with the
statement presentation adopted for the year ended March 31, 1978.
ANNUAL REPORT ADVISORY COMMITTEE
Editor: R. H. Thompson
Co-ordinators:
J. Doughty, J. Matters, J. Mackin, K. Williams, I. Smith, J. Berry.
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1979
2,230-479-912

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