EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
It’s always a great pleasure, as I’ve said many times in the past, to welcome people from the Kitikmeot to Iqaluit.
It’s not very often that they get over because of great travel and expenses to get here.
I would like to welcome to the Gallery today a friend of mine and a constituent for a long time, Ms. Cathy Aitoak.
It’s also a special day today being February 29, a leap year, so this day only comes around every four years.
Cathy is sitting right over here. Welcome to the Gallery, Cathy.
Welcome to the Gallery, Cathy.
Bills 21, 24, 25, 26, 27, and 34 with Mr. Ningeongan in the Chair.
Chairman (Mr. Ningeongan) (interpretation): Thank you. I would now like to call the committee meeting to order.
We wish to continue with the review of Bill 24 and the Department of Health and Social Services. If time permits, we will proceed with the review of the Department of Community and Government Services, followed by the Department of Economic Development and Transportation. (interpretation) Thank you, Mr. Chairman.
Chairman (interpretation): Thank you, Mr. Aupaluktuq. Are we in agreement?
Hon. Keith Peterson: Mr. Chairman, yes, I do.
Chairman (interpretation): Thank you. Sergeant-at-Arms, please escort the Minister of Health and his witnesses in.
Hon. Keith Peterson: Mr. Chairman, to my right is Peter Ma, Deputy Minister of the Department of Health, and to my left is Debora Voth, Executive Director of Corporate Services for the Department of Health.
Chairman (interpretation): Thank you, Minister Peterson. I welcome you and your officials.
My colleagues, as you may recall, we were done with page H-6. We are on page H-7. (interpretation ends) Branch Summary.
Treatment. Total Operations and Maintenance. $176,298,000.
I have a question on this page on two separate matters.
In particular, Mr. Chairman, I want to start with medical patient travel, including medical escort requirements.
Can I immediately start off, Mr. Chairman?
Mr. Chairman, as a preamble to my question and to provide some guidance to my question, the Department of Health and Social Services’ policy for medical travel states the basis.
They are in English, so I will try to translate them into Inuktitut.
It states that the first principle of the department is “The Department is committed to the Inuit Qaujimajatuqangit concepts of Pijitsirniq - to serve, and Inuuqatigiitsiarniq - respect for others.” The seventh principle states that “Inuit societal values will be recognized and respected.”
This is written in their departmental policies and that these principles will form their foundation.
Mr. Chairman, I want to ask a question so that Nunavummiut, especially the average person on the street, will be able to have the same understanding with respect to this issue.
Whenever an initiative comes out, each region seems to have a different methodology, even though the legislation speaks to the way it should be implemented.
Mr. Chairman, firstly, I would like to get further clarification regarding the implementation of this policy.
When a person has to attend to medical treatment outside of their community, who decides? If I were to go to the health centre and require travel outside, who makes the determination that I may require an escort?
Mr. Chairman, that is my first question. Thank you.
Mr. Chairman, the nurse-in-charge would recommend whether a person needs an escort or not.
I’m trying to ask questions in relation to page H-7 as well as page 139 in business plan, and this is just for your information.
These sections speak to patients who can qualify for an escort when undertaking medical travel.
I will relate the experiences of people and perhaps I can get a response as to why that situation has occurred in the past or why the policy hasn’t been implemented fully.
Let me first speak to this issue, which doesn’t seem to be included in this policy.
The sections I referred to are the principles of Pijitsirniq and Inuuqatigiitsiarniq, which speak to Inuit societal values and to recognize and respect these beliefs, (interpretation ends) “recognized and respected.” (interpretation) That is how it is written in English.
Some situations we have looked at infer that there are different policies at play whenever a person goes to the health centre.
Mr. Chairman, in order to be completely clear, I have to give some background information.
A patient who goes to the health centre with no apparent physical illness compared to a person with visible physical ailments generally will not be provided an escort.  It seems only the visibly sick patients are receiving escorts.
For example, if they are infirm, they require assistance.
This situation that has been relayed to me on more than one occasion and it involves people who don’t have visible symptoms of sickness. The circumstances usually involve people suffering from cancer, sometimes terminal, but they are generally not provided any escorts when they go on medical travel.
We have even been apprised of situations whereby the doctor looking after the patient has expressed shock that the patient is not even provided an escort while attending to medical treatment.
Since the person doesn’t have any visible symptoms of sickness, the system will treat them like a healthy person since the sickness is not apparent. This can be mentally distressing and it’s probably one of the biggest originators of mental anguish experienced by our people, especially if we personally were to experience cancer as a treatment.
Cancer patients tend to travel a lot more, attending to treatment and doctor’s appointments.
This is all while the person has no idea of their medical situation or whether their sickness is progressing as they are not bilingual. From what I have been told, this causes people great mental distress and anguish when they are in that situation.
Can the department take this into consideration?
To cite this example, this has already occurred recently and I regret that this individual had to experience it firsthand. This person related his experience to me personally, so this is not just theoretical as it has actually happened to an individual.
It caused mental angst and anguish to this person as they had no idea what the doctor would say. All of a sudden, they hear the distressing news.
This person wasn’t allowed an escort at all.
Can we provide this legislation with some compassion? It seems that this legislation is heartless. I wonder whether or not this government can include some leeway for compassionate reasons within this policy.
Hon. Keith Peterson: Thank you, Mr. Chairman. Thank you again, Mr. Enook, for the question.
I appreciate his concern for his constituents and I am somewhat familiar with the situation that he has described.
Mr. Chairman, the policy is developed to provide the department with guidelines to cover a program.
It doesn’t recognize special situations, I guess would be the best I could describe it, but the policy is under review and that is an area where, I think, we are looking to address.
I want everyone to note that I’m fully aware of the fact that our government continually surpasses their budget for the Department of Health and Social Services. I’m not in the dark on this issue, but I’m totally cognizant of that fact.
I’m also of the firm belief that you cannot place a monetary value on a person’s health nor can you replace a person with that type of valuation.
I believe that an individual has the right to receive medical treatment without worrying about the expenses or the monetary value as a person is more valuable and we should place a high priority of valuing our people’s lives.
This policy seems appropriate on the surface. I believe these factors have to be noted whenever this situation is run across.
I would like clarification on this issue. Based on the written sections here, how does a person requiring medical travel get an escort? It states here that any patient requiring medical travel over the age of 60 and a unilingual person who is unable to converse in English requires an escort for any medical travel.
That is how I understand this clause. However, this requirement can be sidestepped if the medical patients themselves state that they’re able to travel alone for medical travel. With that being the case, what response can I expect if I ask about it?
I just recently found out about two constituents who were travelling south for medical reasons with the exact same sickness, requiring the same diagnosis and treatment. Both individuals were over the age of 60, as I know them personally, and neither of them is able to converse in English.
One patient was allocated an escort for their travel while the other patient didn’t qualify for an escort.
Just so everyone can be on the same page in terms of understanding, I would like to get a clear response on this matter, Mr. Chairman.
Not knowing the specific circumstances, it would be very difficult for me to clarify, but I do know the policy specifically states that if you are unilingual and you are over the age of 60, you are entitled to an escort, unless you decline the escort.
I’m well aware that these issues will be reviewed and I have expectations that an enhanced policy will surface some time in the future that meets our needs.
However, I still have some questions to the policy currently in use.
Another matter that I really want to question is this scenario that occurs from time to time. When a patient has been sent south for medical treatment, sometimes there are no spots available. In particular, to continue for the Baffin region, we go to Ottawa; in the Kivalliq, most patients go to Winnipeg, and so on.
Some situations crop up where a patient’s doctor, in addressing their patient, will recommend that the patient would be better served if another family member were to come down to assist the patient.
This can occur if the patient is too sickly or the escort requires further assistance to provide care for their patient.
The doctor then writes his recommendation or passes along his professional view that the patient would be best served with another escort.
I believe that a section is written in here that the deputy minister can deny a request for another escort, even if a doctor requests the second escort. When a doctor requests a second escort to provide assistance to the first escort attending to the patient or as a replacement escort, can the deputy minister deny this request?
Chairman (interpretation): Thank you, Mr. Enook. Minister Peterson.
Hon. Keith Peterson: Thank you, Mr. Chairman. I thank Mr. Enook for asking for clarification.
Since the deputy minister is here, I’ll ask the deputy minister if he can clarify what authority he has. Thank you, Mr. Chairman.
Chairman (interpretation): Thank you, Minister Peterson. Mr. Ma.
Mr. Ma: Thank you, Mr. Chairman. In considering second escort situations, I look at each situation on its own merits because every circumstance is different. Some of the things I consider are the actual medical circumstances.
The member indicated that there are doctor’s notes or recommendations from the doctors, so that’s all taken into consideration. We look at whether or not that service is provided through the facility that we’re using. So in this case, he mentioned Ottawa.
So if the Ottawa General Hospital has that service, they can perhaps provide it. Sometimes those services are available through the boarding home, through Larga. So I try to take all those into consideration.
To answer his question very briefly, yes, I do have the ability to deny the escort. Thank you.
Chairman (interpretation): Thank you, Mr. Ma. Mr. Enook.
Mr. Enook (interpretation): Thank you, Mr. Chairman. That response totally confuses my understanding of the matter.
I thought I knew about these boarding homes, that they were nothing more than boarding homes for patients, a place for accommodation and meals, as well as a transportation hub for patients to attend to medical appointments.
Even though I was part of the management team for the Ottawa boarding home for over ten years, I was never made aware that the administrator of the boarding homes had that authority. This is the first time I have ever heard about this fact.
I never imagined that they were part of the decision-making team for these types of decisions.
Mr. Chairman, I still have many questions to ask, but I’m aware of the time as I keep glancing at my time allotment. I would like some direction, Mr. Chairman, as to what your decision is regarding my time. Should I wait until the other members have completed their questions and you can then return to me?
I would like to have another chance to ask questions.
Chairman (interpretation): Thank you, Mr. Enook. I think you asked a question to the minister, so I will ask for a reply to your question.
I have other names on my list and after they’re done, I’ll be able to get back to you. Minister Peterson.
I thank Mr. Enook for the question. To clarify, I think, initially in his question, he was asking about doctors requesting a second escort for a family member. Perhaps, in the translation, it sounded like it’s the deputy’s answer, that the boarding home could ask for a second escort.
No, only a medical professional can request escorts. Thank you, Mr. Chairman.
I have Mr. Ningark on the list.
Mr. Ningark (interpretation): Thank you, Mr. Chairman. I thank the minister and his officials. I also thank my colleague, Mr. Enook, who has related the exact same concerns that I have been privy to from my constituents in Repulse Bay and Kugaaruk.
These are the exact type of concerns he is speaking to that I have tried to voice previously. Obviously, Pond Inlet and Kugaaruk are not the only communities experiencing these issues.
Since we have 25 communities in Nunavut, I imagine the majority of the communities have gone through this as well.
I would like to return back to the Tamapta Mandate. The government needs to ensure the mandate is solidified and followed.
Currently, only some patients are provided escorts under this policy. As an example, a patient goes to the health centre and then they have to search for an escort.
The family is informed for the first time that the patient has to travel for medical purposes and requires an escort.
Too often, when the medical travel date approaches, the escort will be told that they can no longer escort the patient and that the escort recommendation has been rescinded. The patient then has no choice but to travel alone to their appointment.
I have heard from people who have experienced this firsthand. They had to pay their own travel costs to escort their family member as they have compassion for their family member or friend. Under the government hierarchy, the nurse-in-charge has the authority to approve escort requests and, if they approve, then the patient can have an escort.
I know I’m not the only MLA who has heard of cases where a patient goes to the health centre for a number of appointments and they are told that they are fine and in full health.
After many misdiagnoses, the patient is finally diagnosed with the correct medical assessment. By this time, the patient is usually told that they now have terminal sickness and that there is nothing the system can do to treat their illness.
After many visitations to the health centre, complaining of their symptoms, the patients are generally misdiagnosed.
The nurse-in-charge makes mistakes, especially related to escort requests, whereby patients requiring escorts are not provided with one.
Ever since I became a member I have been referring to this concern and it usually ends up with the same entreaty.
The local health committees that are under the municipal council should be provided more empowerment via the hamlet council, who can then transfer that to the committee.
Any patient experiencing problems during their medical travel, such as not being able to attend to appointments, or who required an escort but was not provided with one, would at least have a local organization where they can relay their concerns, complaints, or grievances about the health system.
There are bodies called community health committees of council.
Let us return to using these local organizations.
When we try to request assistance from the government or health department as regular members, we have to go through the House, but we run into legislative issues as the administration tends to just state that the policy is such-and-such.
Later on, we hear that the policy has been revised.
Currently, if a person has any grievances with the health system in the community, whether it is with respect to southern institutions in Edmonton, Ottawa, or Winnipeg, the government maintains that there is an ombudsman available up to the deputy minister. Alternatively, perhaps they have to vent their complaints to the regional offices of the department.
It seems that this complaint process is not being utilized and I don’t see many people taking advantage of it.
I urge the government to conduct a thorough review of this policy and it requires a complete overhaul.
The Tamapta Mandate, including our government, has to work towards self-reliance within our territory. Within that precept, our people try to be self-reliant as they do go to the health centre to resolve their health issues.
I want to ask the Minister of Health and Social Services if he can commit to conducting a review of this policy by using the Tamapta Mandate as a foundation, as well as empowering the local health committees by devolving the responsibility to the local hamlets.
Tamapta means a strong foundation, involving all people.
So if we are to be true to this word, we have to include everyone under the Tamapta Mandate. It means equality for all residents and involving everyone.
Even though we have the Tamapta Mandate, our people are not being treated equally as some of the patients aren’t allowed to have an escort and some of them can have an escort.
I believe the minister said to the member from Pond Inlet that he was going to review the policy.
So will there be a review on the medical travel and escort policy?
If you can go straight to your question, I would appreciate it. There are a lot of names on my list.
However, that is a good question. Minister Peterson.
I thank Mr. Ningark for his questions.
Mr. Chairman, the existing Client Travel Policy is almost five years old and it expires at the end of March 2012. It is required to be reviewed.
We have heard many concerns and complaints over the years about the Client Travel Policy and in my short time in the Department of Health, it’s one of the top two or three concerns that we keep hearing about constantly.
Yes, the review is underway. There’s a consulting firm that is working with our officials to see what works, what doesn’t work, and looking at best practices from other jurisdictions.
We certainly want to make it better to serve Nunavummiut.
With respect to health communities, I’m not sure what you mean by empowering, but what we would like to do is to work with the health committees in all the communities. There are 25 of them. We’re developing a document called “Guiding Principles,” I believe, and that we would work with the health committees to strengthen their role in the communities so that they don’t feel that they’re being left out of the decisions or the public health initiatives in the communities.
As a minister, I’m very interested to hear what happens at the community level because that’s where all the people live. If they have concerns, the committee can work with the hamlet council, interagency groups, and the health centre. They call it a community health centre for a reason.
Bring those concerns to our attention as officials here in Iqaluit and we can look into them.
But certainly, the health committees should have a stronger role at the community level.
Perhaps I can ask two questions to the minister.
I would like to ask the minister if the health committees of council in the community should meet with the nurse-in-charge on occasion whenever they need to discuss issues.
That is my first question since the minister is the head of the hierarchy for the department, as well as his deputy minister, who is sitting in front of us.
The second question I want to ask to the deputy minister is: to date, after the election of the Members of the Third Legislative Assembly, how many concerns or complaints has the deputy minister’s office received or any other office of the Department of Health and Social Services?
Have you heard of any concerns or complaints from Nunavut communities?
I thank Mr. Ningark for his question.
Certainly the health committees, again, as I said, have an important role in the communities. They are the voice of the people in the community.
If the health committees are hearing concerns about how the community health centre is operating, if they want to make some suggestions for improvements or understand how the community health centre operates, for example, the hourly operations, after-hour calls, and that sort of stuff, I wouldn’t see it as unreasonable for the nurse-in-charge to be required to meet regularly with the health committee. If I was the nurse-in-charge, I would welcome the opportunity to talk to the committee members about how I’m providing the service in my health centre.
With respect to the numbers of complaints, I would have to ask my deputy to answer that.
He has been in the heath portfolio approximately 11 months now, a little bit longer than me, so he’s probably heard a few more complaints than I have.
I’ll ask him to respond.
So we have two of what we call territorial client coordinator service positions. One is located in Iqaluit for the Baffin region. The other one is located in the Kitikmeot in Cambridge Bay and that’s because some people in the Kitikmeot speak Inuinnaqtun.
For January 1 to December 31, 2011, there were 24 calls to the Kitikmeot office and 34 calls to the Baffin office, which also covers the Kivalliq.
However, I must admit that the number is probably a bit low because there are some complaints that don’t go through this process and they come directly to my office or to other offices, but that’s the stats that we have on file at this time.
Chairman (interpretation): Thank you, Mr. Ma. Mr. Ningark.
This will most likely be my last question. I wish to thank the minister and his deputy.
In my opinion, not many people are aware of the complaints phone number or office. In many communities, the numbers are not available locally, so they have to call Iqaluit if they have complaints or concerns.
The people who want to complain or register their concerns don’t do so because of the fact that they don’t know of the availability of this service and that may be why the office doesn’t get very many phone calls or complaints.
(interpretation ends) For the record, (interpretation) to complete my comments, the statements I’m making under H-7 are not meant to paradoxically be construed as complaints against nurses working in the local health centres nor the regional offices nor offices in Winnipeg.
I’m not saying that the health system is beyond repair; we’re looking for enhancement of the system and compassion towards the patients who have experienced problems. Improvements need to be made in the system.
The government has continually stated that the residents of Nunavut have to try to become self-reliant. These statements are meant to try to improve our self-reliance and to improve what we have today.
I thank the minister and his deputy, and you too, Mr. Chairman, for letting me speak on behalf of my constituents under H-7.
I, too, have questions concerning medical escorts.
I guess I should start by asking if the minister or his officials can explain exactly what the role of the medical escort is.
I thank Mr. Rumbolt for the question.
I’m going to ask Ms. Voth to answer that question.
She has worked closely with this policy.
To be eligible for an escort, the client would have to be able to help with language barriers in the south, so assist the client in travelling if they’re unilingual and if there are no interpretive services available where they’re receiving their medical care.