July 14, 1943

NAT

Howard Charles Green

National Government

Mr. GREEN:

Has the plan broken down, or is it being carried on actively?

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

It has been taken over by another department and the reconditioning is done direct by national defence.

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NAT

Howard Charles Green

National Government

Mr. GREEN:

What about this Pension

Act and the insurance principle?

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

That is an old question of discussion between my hon. friend and myself.

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NAT

Howard Charles Green

National Government

Mr. GREEN:

I think the minister would agree with me if he could speak sub rosa, or under the table.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

I will not contradict my hon. friend on that point at all. My hon. friend knows that we discussed it thoroughly, as he mentioned, in 1941. Without a question of doubt a substantial body of opinion in the country favours the adoption of the insurance principle, and among ex-servicemen themselves, I believe, opinion is more or less unanimous, as indicated at various conventions of ex-servicemen.

I think the broadening we were able to effect-in 1941 did a tremendous amount of good. About ten per cent of the cases were allowed under section 11, subsection 3. Of the 7,000, roughly 719 were allowed, which has proved to be beneficial in difficult cases. My hon. friend is aware that we did extend1 substantially the definition of theatre of active war, so that the only people excluded to-day from the

insurance principle are those who never left Canada. Those who go overseas and come back are protected for the rest of their service in Canada until the conclusion of the war, and in regard to the air force, the navy and the army, they are all protected outside Canada and in certain cases, as referred to by my hon. friend, within Canada, although those cases are not likely to arise.

Whether the insurance principle should be adopted or not is a question of government policy on which I am not free to say more than I have said, but I am fully aware of the demand for it, especially on the part of exservicemen, and my sympathies might be strongly in favour of it if I were free to express them. .

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LIB

Roy Theodore Graham

Liberal

Mr. GRAHAM:

I wish to add a word to the discussion that has taken place between the member for Vancouver South and the Minister of Pensions. Speaking as a returned man, I am pleased to hear the hon. member for Vancouver South echo my own thought, that the returned men generally could hardly hope to have a more sympathetic minister handling the affairs of this department than the present Minister of Pensions and National Health. We are all agreed that he is moved by a great desire to be not only fair but very generous, and that is as it should be in our attitude to the men who enlist for active service.

I suggest to the minister that in this particular war the ability to determine health conditions and the true category of enlisted men is much greater than it was in the last war. I can see that in the last war, owing to the difficulty which the medical officers had in examining men on enlistment, there would be some cases that would be open to doubt whether the injury or illness had resulted from service conditions. But in this particular war, it seems to me, we have so improved the X-ray examinations and other methods now known to medical science as to exclude the possibility of certain physical weaknesses not being detected, and we have taken such great care in the application of these new safeguards against men getting into the armed services who are not physically fit that I, like the hon. member for Vancouver South, feel that the time has come definitely when this country should embark upon the insurance principle which he has discussed so ably. As a returned man and a member of the Liberal party, I join with him in urging the minister to continue the struggle to have that principle adopted, knowing how difficult it is for the individual to discharge the onus of substantiating his case before any tribunal if the facts are difficult to ascertain. On the other hand, the department has the

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records and all the ability to determine at the time of enlistment a man's physical condition, and having given him a category and accepted his services, we should assume the responsibility that goes with that acceptance and see that the principle is adopted as a basic principle in the Canadian treatment of soldiers, sailors and airmen on active service.

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LIB

Manley Justin Edwards

Liberal

Mr. EDWARDS:

I would be heartily in favour of what has been advocated by the two previous speakers but for the doubts and misgivings I have arising out of the high proportion numerically of those who have been mustered out of the army, the navy and the air force within a comparatively short time after their enlistment. Those figures would surely give a layman an impression contrary to that suggested by the hon. member for Swift Current.

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LIB

Roy Theodore Graham

Liberal

Mr. GRAHAM:

I believe there is a provisional period that still permits of further examination, and some of those figures will refer to those persons who are further examined and found not to be in a proper state of health.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

That is of recent origin, I am told by my advisers. In regard to those discharged, it is only fair to point out that up to March 31, 1943, 19-5 per cent in the army had less than three months' service, 42-9 per cent had less than six months and 69-4 per cent had less than one year's service.

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NAT
LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

It is 30-6 per cent.

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LIB

Manley Justin Edwards

Liberal

Mr. EDWARDS:

On the basis of those

figures it does seem to me that if you are to adopt the insurance principle, using that term in its best sense, there would need to be considerable tightening up in the medical examination of the men at the time they are inducted into the Canadian army. The tact that there is such a high proportion suggests to my mind at least that the medical examination of these men at the time they were inducted into the service was not of the kind to which the hon. member for Swift Current has referred; otherwise surely there would not be those numbers or that proportion of men discharged from the army in category E within such comparatively short periods. It seems to me inconceivable that a proper medical examination would not have disclosed a much higher proportion of those who were diseased or suffering from other disabilities than the records apparently show. I think there is some criticism to be directed

to the medical officers in the three armed services who admitted these men. I had an example of one man who was certainly away over the age limit specified during the first year of the war, who got as far as England and was then returned to this country. In speaking to him in an effort to help him I said, "It is perfectly obvious, sir, that you have one eye that is bad; I would judge that probably you cannot see out of that eye." He admitted that this was correct. Then I said, "The question naturally arises, how did you get by?" The suggestion was that he had memorized the chart and was able to fool the medical officer.

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LIB
?

William Cameron Edwards

Mr. EDWTARDS:

I have not the slightest

doubt he did, and in that he was aided and abetted by others in the armed forces, a practice which is not unknown to old soldiers. He was a fine patriotic citizen, but the fact that he was permitted to pass, I believe, three medical examinations before he was eventually sent back to this country as unfit for service raised doubts in my mind as to the propriety of the medical examinations that are given brave men who offer their lives in the service of their country. I think the figures quoted disprove the foundation for the argument advanced by the hon. member for Swift Current. But it was not with respect to that that I rose to question the minister. I was prompted by the question directed to the minister by the hon. member for Edmonton East. I did not know this department had a wing of the civic hospital, which, apparently, it built and operates or to which it contributes. In Calgary we are fortunate in having what we are led to believe will be, when completed, one of the most modern and most completely equipped hospitals to be found anywhere in Canada or perhaps on this continent, for all of which we are duly grateful and appreciative. I commend the minister and his department for having provided, even at this late date, a fine hospital for our pensioners. I think it was a disgrace that the building on 8th avenue should have been used as a hospital all these years; I am sure the rents paid would have been sufficient to build two or three first class hospitals.

I come now to a question which has bothered me, as a result of the discussion which has been precipitated here by hon. members from the fair city of Toronto, in regard to the location of these hospitals. I was of opinion not only that the hospital in Calgary was badly located from every point of view, but that the new hospital might properly have

War Appropriation-Pensions and National Health

been located where I, as a layman, naturally would think a hospital should be situated- in some place with broad grounds, away from the noise, dust, smoke and distraction of city life. But every doubt or misgiving that I had in regard to the location of the new hospital in Calgary was answered, to my satisfaction at least, by one consideration, namely, the representations of the pensioners themselves. When the Canadian Legion and the representatives of these invalid soldiers come forward and say, "We want a hospital, not out in the foothills, not out on the shores of a lake but as centrally located as we can get it, so that we may have access to the movies and to the attractions afforded by a downtown district, where we will be readily accessible to our friends and relatives who want to come and see us," that settles it for me. When I am told by the men and women whose duty it is to wait upon these soldiers that the men undergoing treatment want to be downtown in the city, for the reasons I have mentioned, I say that where the soldiers want it is where it shall be, as far as I am concerned. I believe that that consideration should outweigh all others, because if the soldier undergoing treatment would'be unhappy or lonesome, no matter how beautiful the grounds might be in some remote district, where his friends would have difficulty in getting to him and he would not see the people going by, then I say the wish of the soldiers should determine the location of the hospital. I should like to hear some expression from the minister as to what the soldiers undergoing treatment in Christie Street hospital have to say with regard to the location of the hospital and what they would say if, as has been advocated, the hospital should be located six or eight miles from downtown Toronto.

I should like the minister to state also the policy of his department in regard to the suggestion I have heard enunciated and which I would understand has been carried out in some cases at least, that at certain points his department cooperates with the municipal authorities in building additions to civic hospitals, and under what circumstances that will be done, if at all. I am reminded now that at the time the new hospital in Calgary was being considered, very strong representations were made to the department that it might well cooperate with the city of Calgary in building a new civic hospital, so that I should like to know whether there is any principle underlying the policy of the department

of not going into partnership with municipal authorities in the construction of hospitals for pensioners.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

In the first place the policy of the department is to utilize as far as possible the hospitals they have had through the years, and to extend them, because as a rule the men themselves prefer those hospitals to any others. In the second place, where the pension department has no hospital facilities at the present time, we may agree, as we have done in two instances already-in Edmonton and in Ottawa-to take steps to extend existing hospital facilities in these places. That step is in contemplation at one other point at the present time, but that only happens where there are no hospitals of our own as such,

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LIB

Roy Theodore Graham

Liberal

Mr. GRAHAM:

I cannot let the argument of the hon. member for Calgary West go unanswered. He suggests that my argument in favour of the insurance principle is not borne out, because some figures might seem to indicate that medical officers employed by the government may not have performed their duties thoroughly in examining men who offered themselves for enlistment. I submit that his very statement, accepting his inferences as correct, places the onus still more squarely upon the government and this country. What is the position? In a moment of patriotism a man comes to offer himself for enlistment in the service of his country. Such men know that if they were accepted they will have to give up their ordinary work and leave their homes. I do not think it is possible for any person to say what will be the result of service in a theatre of War, particularly to those who were not examined thoroughly enough to have any defects discovered; but I believe the principle should be recognized that the onus is on the country to say to that man, when he appears to enlist, "You are well enough to undergo the sendee we expect of you" or, after examination, "You are not fit to undergo that, and therefore you can not enlist and must return to your civilian environment and occupation". But if we as a country accept the man in a given category, despite the fact that the medical officers who examined him may have been careless, or even derelict in their duty, I think the onus is upon us, and that no man can thereafter say just how much that man's disability has been increased by reason of active service. Certainly it would be unfair to the individual to say, "We made a mistake; we were careless in our examination. We should never have accepted you. And because of that we refuse to accept the responsibility of recognizing that your

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duties may have added to your physical disabilities." So that I do not think .the argument advanced by the hon. member for Calgary West in any way changes the principle I urged1 upon the minister as one which should be recognized in dealing with those who enlist in our armed forces.

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CCF

Major James William Coldwell

Co-operative Commonwealth Federation (C.C.F.)

Mr. COLDWELL:

In the discussion I have heard I agree with the hon. member for Swift Current. However, that is not what I rose particularly to say. I understand the minister has allowed a great deal of latitude in the discussion of this item, and as I have been unable to be in the house because of other matters perhaps I might be permitted to say a few words on another problem. I wanted to bring the attention of the minister again to a condition which exists by reason of the number of medical men taken into the army, particularly from our rural districts in the west.

I have heard medical men say that if our armed services had one medical service; if it were united instead of being divided four ways, there would be ample medical attention for both the armed forces and the civilian population. I know that during the winter the minister made every effort to meet the conditions in the rural areas, and for that I wish to thank him. However, his efforts were unsuccessful. I am thinking of the situation which applied in my own constituency at Lucky Lake, a very large area in which there are some 7,000 people and two or three hospitals, but no doctor, no nurse and no medical aid of any description. During last winter, which was a bitter and a long one, there were occasions when people were actually unable to get medical assistance before they died. This is a very serious situation, and one which exists not only in my own province, but also in other provinces, including that represented by the minister himself. I am wondering if some plan cannot be worked out whereby aid could be given to the rural districts to relieve this situation. It is indeed a terrible situation when we find people living twenty, thirty and forty miles away from a doctor, sometimes in communities where there are hospitals, and yet unable to obtain attention when that attention is needed.

I am not criticizing the minister, because I know that in the past winter he did endeavour to relieve the situation, but without success. It is true that, owing to the fact that medical men have moved away from some of the cities, others have gone in to take their places. I am told by medical men -of course, usually by the well-established ones-in these large cities that there are quan-

titles of doctors in the cities, and that the men who are coming in are really not needed in those areas.

One hesitates to suggest that anything in the nature of compulsion should be exercised. However, we are exercising compulsion in respect of men required to join the army, and it seems to me that if voluntary efforts fail we shall have to work out some scheme of compulsion applied to medical men and nurses, so that they may be placed in districts where they are needed, districts in which the emoluments and living conditions may not be quite so attractive. Would the minister say a word on this point?

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

I thank the hon. member for Rosetown-Biggar for bringing this matter to the attention of the committee. We had some correspondence in the winter months about the situation in Saskatchewan. Since that time I have been reading some dispatches describing the condition in the United States. I find that the situation in parts of that country was much more intense than it has been in Canada. The trouble has been, first of all, on account of doctors moving away from the country to the oities. That difficulty is pronounced. For instance, the city of Winnipeg, with the greatest number of medical enlistments of any part of Canada, has actually more doctors at the present time than it had before the war. The medical procurement board has been conducting a national survey, as my hon. friend knows. I understand that the report, has nearly been completed or is about to be completed, and that it deals with this situation. However, I have not yet seen the report myself, and I do not know what has been recommended.

In Australia compulsion has been exercised, giving medical doctors the rank of major. They have been compelled to serve in districts where they were required. Similar action has been taken in Great Britain, so that doctors might be moved to certain places, and I understand such action is about to be taken in the United States. That may be the only remedy in Canada, unless we succeed in meeting the situation in another way.

Our conditions have been greatly helped by defence service doctors who assist us in the hospitals. But the greatest difficulty has been experienced in remote areas, like Lucky Lake. However, I shall look into the report on the matter and see if there is any further information I can give my hon. friend at a later date.

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SC

James Alexander Marshall

Social Credit

Mr. MARSHALL:

Will the minister make a statement with respect to the future policy

War Appropriation-Pensions and National Health

of the government in connection with the Colonel Belcher hospital?

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July 14, 1943