EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
We didn’t really know at that time when we were negotiating with the federal government for the land claims that all the things we should have known were not known to us at that time.
The reason I asked the question is because with that, wouldn’t it be better to have NTI and the federal government and the Nunavut government negotiating on behalf of all the Inuit people in Nunavut.
Mr. Chairman, NIHB is a program under the federal government.
So it’s a program that they run like many other programs.
It is not found in legislation, they don’t have a statutory obligation and that’s the point we made when we had negotiations with them.
The new assistant deputy minister of the department, Mr. Abraham Tagalik, has recently met with NTI on our situation with NIHB negotiations and Mr. Tagalik will be taking over and will be the lead negotiator for the Government of Nunavut on the NIHB in the next rounds coming up.
I think Mr. Arvaluk, has hit a strong and a very important point.
In the money that we receive as a territory, and that’s why we are a territory, we’re not a province, the money we receive as a territory we receive unconditional funding from the federal government.
Under the NIHB program, they say well we give you an extra 10 or 15 million dollars for Inuit specific health care concerns but when we give you your 680 million dollars as a grant, you should be using that to take care of health.
And of course as a government, like the NWT, like the Yukon, we say, you give us the 650 million dollars or whatever the transfer is, it may be a road, it may become a breakwater, we have to pay for teachers, and all the other things we have to do to run a government.
I guess that’s the major concern that we have as a government when we’re looking at the negotiations with the NIHB.
And that’s the tack that the federal government has taken.
The total value of the program is only about 25 or 30 million dollars to the Government of Nunavut that we receive, that’s everything in every area from the federal government now in health care.
But we spend as a government, as the members can see here alone, over 160 million and we could spend 60 more to actually enhance the delivery of programs and services for our population.
Some few years back in Kugluktuk, approximately 100 years ago, they were trying to extend the Treaty 8 and 11.
I think, I’m not sure to that area.
But Inuit thought, what are you trying to do.
What’s your interest in having us sign our X on your paper?
It created a suspicion and they refused it and ever since Inuit never signed a treaty.
That’s why we opted 30 years ago to start negotiating to recognise, or dis-recognise some of the rights that we were entitled to.
A hundred years ago, we were not very well versed in the English system of government, or in fact their treaties which said as long as the sun rises and the waters flow, you’ll never pay taxes.
We will treat you to whatever you need including medical responsibilities.
Can we not simply say, in 1988, we were really stupid for accepting the responsibility of medical programming for Aboriginal people in the NWT and now we’re grandfathering it in Nunavut and we want to renege on that and give it back to the federal government, or at least have an Aboriginal organisation like NTI contracted with the federal government because we simply can’t afford it.
We cannot just continue to pretend that we’re happy with it.
A lot of communities are complaining about the lack of nurses and things like that.
We can’t afford it.
I think there’s going to have to be a big fix in order to have the federal government recognise that we signed something that isn’t working well monetarily.
Mr. Chairman, we have a strong mandate from the cabinet to negotiate with the federal government.
And some of those include some of the historical grievances that the member rightfully addresses right now.
We believe for example, on the 250 dollar co-payment, there should be some movement from the federal government.
And we are in the process of documenting what the federal government is paying for in non-insured health benefits in other jurisdictions and then to show what the case is in Nunavut.
We believe that’s where we’ll have some luck.
I also agree with the member that through the good offices of Mr. Tagalik, and in conjunction with NTI, we should have some extra pressure put on the federal government from our partnership with NTI at those negotiating tables.
At the end of the day, the federal government has to come to the table in a meaningful way on the negotiations with the NIHB and we need to be able to put and articulate our position at that table.
We haven’t been as fortunate as we would like in the last couple of years.
Another round will be beginning in the very near future and at that time, we would like to again, press that point with the negotiating position that has been agreed to by the cabinet.
I have Mr. Havioyak, Ms. Williams, Mr. Nutarak and Mr. Iqaqrialu.
Mr. Havioyak (interpretation): I just want to ask a short question.
All the questions I was going to ask, Arvaluk already raised. (interpretation ends) On page 10-12 on the paragraph above there you have social family emergencies that require transport out of the community or out of the territory.
Can you explain that a little bit? I’m not sure, under emergency, what is the emergency when it’s mentioned under here.
I’m just trying to get the breakdown.
What you meant by that.
Mr. Chairman that could be a variety of different cases, in an emergery case.
For example, if a patient was in a community and needed an urgent appendectomy, then we would be able to medivac them out because that would be an emergency.
If in a family crisis situation we had to bring a person out of a community, that might be a domestic violence situation. That would be another example of those types of emergencies.
Mr. Havioyak (interpretation): Koanaqutit.
So when you say what you mentioned, under travel I guess.
The reason I wanted some clarification when there is an emergency. I know I used the emergency, for example, if the family is away from the community and needs to go back to the community because of the illness of the family, or something like that.
I was not sure of that.
I know some of the airlines are really helpful in that area.
I thought that there might be some covered under that.
I just wanted to get some clarification on that or as to get a picture of that.
So, it is clear now.
I think that is what you meant.
It is not the emergency family travel to another community to see the family that is ill in that community.
I am just trying to get a picture of that.
Mr. Chairman, the member is correct, that would not be covered there.
In that case it would be compassionate travel, and we don’t have compassionate travel anymore within the Government.
I think it is very important to note and thank and congratulate NTI who have come forward with a compassionate travel program now.
They have an insurance program in place and so if the members of your family or your constituents, when there is a need that arises for example if there is a death in the community, that people needed to travel, NTI now has a program in place.
I believe that will be a very successful program and I congratulate them on it.
The incident that the member had talked about I believe would fall under that program that NTI has put in place.
A portion of the question that I wanted to ask has been asked by Mr. Arvaluk already.
In regards to the rising cost of transportation, and the transportation of patients, as Mr. Picco stated, it is going to keep getting more expensive.
We have 3 million 735 thousand for health protection.
This 3.7 million will be very helpful and the minister thinks that medical travel is going keep increasing.
My question is in regards to the travel and transportation and contract services.
I am not exactly sure of what is in there.
My question is in regards to airlines.
There are competing airline up here.
If we utilize all the different airlines up here, would that bring down the cost of medical travel?
Mr. Chairman no, not in and of itself.
Right now, for example, we have an arrangement with First Air which gives us a 25 percent reduction on air prices in the Baffin communities, between the Baffin, Iqaluit and Ottawa.
For example, if I signed off a contract tomorrow with Iqaqrialu Air. And Iqaqrialu Air is going to take me from Iqaluit to Ottawa; he is going to give me 20 percent off with David Iqaqrialu Airlines.
First Air would probably just probably charge me thirty percent more for the route from Clyde to Iqaluit.
They still are going to have to make up the difference.
There may be some economies of scale in accessing the different airlines that are available based on the routes that are being flown.
As Minister Thompson said in a question earlier today in question period, private companies at the end of the day, they want to make a return on their dollar invested.
And it’s not for me to suggest what the dollar return or the amount of the return on the dollar invested should be.
There may be an opportunity where some airlines fly to all of our communities.
For example, in this case, Canadian North Airlines don’t fly into Hall Beach, they don’t fly into Igloolik, they don’t fly into, Broughton Island, and they don’t fly into Clyde River.
It would be very difficult for me to do a contract for them to cover all of Nunavut when they don’t fly into those communities.
So, you want to look at how what type of contract you have in place which would best: number one serves the patients, number two, serves the medical travelling public and number three, that gives us the economies of scale and the savings.
I’ve had discussions with Canadian North, as well as First Air, and some of the other carriers on opportunities that may present themselves as we as with our airlines study, all the major airlines will be interviewed or have been interviewed by KPMG on the routes as well as the logistics, financial and administration of the different airlines in Nunavut.
If we utilize two communities, the monies won’t get any lower and the minister has stated that he has had discussions with both airlines.
I don’t know what KPMG is because I don’t know what that is but we have to agree to your budget.
What was the feedback you got from the airlines that you had discussions with; the two competing airlines, if we utilize them, I don’t understand why that would not lower the price.
My question is what KPMG is and I’ll have one more question afterwards.
I didn’t say it wouldn’t lower the prices.
I think for example, right at the present time Canadian North as an example, and I don’t want to pick on any airline, but their major route carrying right now is from Iqaluit south.
From Iqaluit to Ottawa, let’s say.
Well our medical patients for example, that fly from Igloolik to Iqaluit had to go First Air.
So if I gave assurances to Canadian Airlines or Canadian North that 100% of medical travel for Iqaluit to Ottawa will be on your airline, First Air, who wouldn’t be getting any of that, would charge you more probably from the Igloolik portion to the Iqaluit portion.
So, whatever I save, from Iqaluit to Ottawa, I would probably lose from the Igloolik portion to Iqaluit portion.
That’s just what makes sense on the economies of scale.
I understand that as a business.
My discussions with the airlines have been, is there a opportunity with their partnership that they have in place with other airlines, for example, Canadian has a partnership with Kenn Borek to be able to access more communities for us.
And those are just very preliminary discussions that we’ve had.
KPMG is the consulting firm, nationally, internationally recognized consulting firm that is undertaking the review of medical transportation in Nunavut and I have the terms of reference of that contract for tabling in the House tomorrow translated in English and Inuktitut for the members.
So, that’s a little bit clearer now and for your information I didn’t mention any names.
I’m talking about all the airlines up here and I would like to know if there are four airlines up here and if we contracted them all, would it lower the price.
So, I would like to, I would want to see the completed report from KPMG.
Mr. Chairman there may be different ways of lowering the price of our travel.
For example at the present time we have medivac contracts in place with different air carriers.
One way of doing that contract may be for example with a central dispatch.
So instead of having a guaranteed, right now with medical travel for example, Mr. Chairman, for emergency medial travel, we guarantee a contract of 800 hours, let’s say 800 flying hours to a company for medivacs.
Even if the company only flies 650 hours we have to pay for the 800 hours and you do that in the contract so that you can guarantee the usage of that plane.
Maybe the opportunity would be to have a central dispatch like they do in other jurisdictions.
The central dispatch could be in Toronto, it doesn’t matter where the dispatch is and you’d be able to call a 1-800 number and say we need a medical plane in Clyde River and they would dispatch it from a central location and you wouldn’t be paying an 800 hour fee or 700 hour fee for a guaranteed plane.
That’s one of the things that KPMG is looking at to bring our costs down and they are also looking at other opportunities with linkages between the airlines that service Nunavut.
I think it’s also very important to point out Mr. Chairman, that prior to the, for example, prior to the hospital services going from Montreal to Ottawa all of our flights in the Baffin were Montreal-Iqaluit.
Within two years of the Ottawa hospital taking our patients all of our travel now in the Baffin is from Iqaluit to Ottawa.
I would suggest to you Mr. Chairman that the major reason for that is because of the medical travel. That’s how much volume is on those routes.
So it can make or break an airline, it’s very important that we do it in a fair and even manner and that’s part of what the study will help us do.
I don’t know what the name is Inuktitut but in English it’s called Aeroplan points. The patients can’t earn Aeroplan points so what happens with those points, do they go to your department? Thank you, Mr. Chairman.
I’d like to say they go to the minister but unfortunately they don’t.
Mr. Chairman the points are not, that’s correct the points are not collected by the patient, they are not collected, they do not go anywhere.
One, I’m not going to say that this is my last question anymore.
It’s not funny. The patients used to be able to earn Aeroplan points and I don’t think that’s a laughing matter.
Why is it that they can’t earn Aeroplan points anymore?
Because that’s part of the contract we had signed.
Chairperson (interpretation): Anything else? Ms. Williams.
The company can say that you are flying this particular airline and you can no longer earn Aeroplan points, it seems like we purchase their services and then the airlines says we can’t earn them anymore. Who has this say whether we can earn points or not?
Mr. Chairman the member, I’m not trying to make light of the member’s question.
The member has brought up a question that has come up several times with patient travel.
With the contract that we have in place with First Air with the discounts that is available to us that 25 percent.
In that contract that was signed and again it was signed by the regional health boards prior to Government of Nunavut, that agreement disallowed the collection of bonus points.
Usually standard policy with a lot of airlines that involves discount purchases and so on Aeroplan points are not allowed to be accumulated.
In regards to the patients that are left behind because of full airlines, the minister mentioned that he would do a review of the whole process and see how many have been left behind by the airlines.
What about the patients, who are left behind, is it not possible to get a further reduction in the price because they leave behind our patients?
Mr. Chairman, in the contract that we have with First Air, the tickets are supposed to be a Y class fare.
In that case, the patient should not be left behind and that was the point I tried to make in the House this morning.
We are in conversation right now with First Air to find out exactly what has transpired over the last couple of weeks and indeed ascertain if patients have been bumped and so on.
As soon as we have that information, I will report it back to the House.
But the patients should not be left behind and the 25 percent discount should not be affecting the ticket price because we were supposed to get a full Y class fare.
Mr. Nutarak (interpretation): The patients that are left behind, yes there was a concern by some of the members of the legislature and we heard that they are concerned about the elders.
And I’m glad that the minister is willing to look into this.
We can’t even use Aeroplan according to the contract and there’s a 25 percent discount for the patients’ plane tickets.
Perhaps, I was wondering if you could meet with First Air to improve this situation.
There are other airlines; perhaps if they’re not willing to change it, we should change the airline we use for medical travel.
Mr. Chairman, the contract that is in place right now will be expiring in the next few months.
Again, we have to ascertain that if indeed patients have been bumped or left behind, by First Air, that’s the carrier that we’re speaking about right now, between Igloolik and Hall Beach, specifically in the House today, and we’ll find that information out.
The member is correct, I will be meeting with First Air over the next few days to discuss the situation with them and to make sure that the contract that we have in place is being followed.
On the page in regards to 28 million 574 thousand dollars, what percentage of this is used for emergency medivacs?
Usually the government has a contract for the sole services of medivacs.
What percent of this funding is used for medivacs?
Mr. Chairman, about 15 million dollars is for emergency medivacs.
Mr. Nutarak (interpretation): This 15 million dollars, that’s the best figure you can get after cost savings?
The study that we’re doing with KPMG is to see, one of the major thrusts of it is to see should we be guaranteeing those emergency medivac planes, X number of flying hours when they’re not being accessed and to look at the opportunities that present themselves with what other jurisdictions are using.
And that’s the central dispatch.
So that’s part of the KPMG study, to see if we can have a cost savings there.
Mr. Nutarak (interpretation): The medivac, as I mentioned before, this 15 million is used for medivacs and also usually they charter planes.
Like when you go to Clyde River, we pick up the eye doctor and sometimes the patients travel from Pond Inlet to Iqaluit to see an eye doctor just for a day and they go back, along with the audiologist’s patients.
He stated there was a policy or regulation saying they put so many children together that have to see a dental therapist.
Is that part of the chartering, is this chartering part of the medivacs.
There are two types of travel.
One is the medical travel, and that’s when a patient gets on a regularly scheduled airline and goes to a hospital, goes to Iqaluit, goes to Ottawa, goes to Winnipeg.
The second one is the medivac travel.
A medivac is when we have to fly a plane, usually a smaller plane, into a community to take someone out who needs an appendectomy or has a heart attack, or whatever the serious medical emergency is.
When we have a charter for example, or if we’ve got a plane scheduled because we have a lot of patients, for example, for the eye doctor or the cardiology clinic and so on.
That would also be considered one of our medical travel costs.
Roughly 15 million dollars or almost half of the money spent on medical travel is medivac costs.
That’s for emergency types of medivacs.
Mr. Nutarak (interpretation): I think I now have a clearer understanding of this figure which is quite huge for medivacs.
It’s used solely for medivacs.
Does this also include the other charters and also part of it is used for medivacs for patients that require emergency treatment and his response it seems like they were together in his response.
For medivacs, approximately how much is for medivac planes?
For medivacs, and that’s the emergency travel, that would be about 15 million dollars and that’s in the amount that has been given in the line item.
And the medical travel is the rest of the travel.
That’s when you’re going for appointments or so on, on a regularly scheduled airline.
The cost of a medical emergency flight could be anywhere between 25 to 50 thousand dollars.
The average cost is 25 thousand dollars; that’s when we have to charter a plane, send them in to take you out, when you have a medical emergency like an appendectomy.
Mr. Nutarak (interpretation): In regards to the 50 thousand dollars, I was wondering if there is a set up whereby the patients that have to see an eye doctor, do you have it set up as to how many times you can charter a plane to see a medical doctor.
Hon. Ed Picco: Thank you, Mr. Chairman. Mr. Chairman, no there is no set area.
What we try to do as a department is where and when and 90% of the time it’s possible if there is a charter, if there is a regular scheduled flight then that’s the type of plane we would use for our usual medical travel.
In some cases for example, in Sanikiluaq and so on we’ve had to use charters for medical flights when there’s a lot of people because of the logistic situation.
But the majority of cases of the patients we fly on regularly scheduled airlines and on those routes.
Mr. Nutarak (interpretation): On the page compensation and benefits for 2001-2002, 25 million 338 thousand and in the revised estimates, it became 27 million 949 thousand and also in the main estimates for 2002-2003, 25 million 384 thousand.
Why were the revised estimates 27 million for 2001-2002 in the beginning it was 25 million and why was it changed to 27 million in the same year?
Are you saying that we can lower it down back to 25 million dollars?
Mr. Chairman under compensation and benefits, during fiscal 2001-2002 the social workers, dental therapists and mental workers in the Kitikmeot region were budgeted at the health centre level in our mains last year.
This year effective April 1, 2002 to provide a more accurate comparability across the three regions these positions have been budgeted now under healthy children, family and communities and that’s why the difference in the amount, the large difference in the amount given.
Chairperson (interpretation): Would you like to continue Mr. Nutarak?
Mr. Nutarak (interpretation): In regards to the 27 million dollars, since there was an increase in the revised estimates in the year 2001-2002, it’s now gone down back to the original 2001-2002 main estimates.
What’s the reason for the reduction?
It became 27 million dollars why did you bring it back down to 25 million.
As I previously stated we had transferred those other positions and accounted for them correctly from the regional office.
As well when that was done the increases that were in there because of the collective agreement negotiations, those monies were also transferred out.
So that’s why you see the reflection from the 27 to the 25.
Mr. Nutarak (interpretation): For medical travel it seems like the department was always getting into a deficit.
Since they were moved the medical travel and transportation has gone down a bit from 30 million to 29 million.
So would it be close to the figures here, do you figure we will have a deficit or surplus for medical travel and for compensation and benefits?
I don’t think the Finance Minister wants me to answer that, but I believe that the member is correct, there probably will be a deficit again, it’s very difficult to control, to control the costs.
We had hoped to receive in negotiations that we were involved with the federal government an extra 5 or 6 million dollars towards our medical travel budget and we weren’t successful and our increases continue.
As soon as the airline charges 9 or 10% more per ticket then we have to pick up those costs.