EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Before we start, I would like to remind members that I am going to be exercising my discretion as Chair to enforce Rule 77(2) in order to allow members to ask questions more than once but not until all members who wish to ask questions have done so.
Mr. Enook (interpretation): Good afternoon, Mr. Chairman, and thank you. Welcome, hon. minister and your officials.
I think we are on page H-4.
I have a question in relation to telehealth.
We have discussed that we will be using telehealth one day.
In the interest of fidelity, we have asked questions in relation to this.
Some of us have said that telehealth is underutilized.
I would like to be enlightened as to how they promote the use of telehealth as a means of communication, for patients visiting hospitals, or where patients could be talking with their counterparts using telehealth.
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. I thank the member for the question.
Telehealth has been operational in the 25 communities. For example, total usage was 5,386 hours last year.
The frequency of use has increased over the last three years.
I would like to ask about the [3,586] hours of use. Is this a lot or not? Can there be an increase?
Along this line, Mr. Chairman, if you can allow me to ask these questions together, as this is being implemented, for patients who otherwise would have had to travel for treatment at a hospital, has this resulted in cost savings that would have been incurred?
I stated that the total usage was 5,386 hours. We anticipate an increase in the number of hours of use ever since its use.
Telehealth has actually decreased the number of trips patients could have taken.
In 2012, for example, 50 patients who would have required kidney operations were diagnosed through telehealth. That is just one example.
Mr. Hickes: Thank you, Mr. Chairman. Mr. Enook drew attention to the telehealth program, which I have spoken to a few times in this Assembly, and I truly recognize its value in alleviating patient travel.
The number of hours that were mentioned of use over the past three years, how many of those hours were health professionals communicating with their southern counterparts to actually alleviate patient travel?
I don’t have the exact numbers in front of me, but Health had partnered with health care providers in Ontario, Alberta, Saskatchewan, the Northwest Territories, and Manitoba to expand telehealth programs and services and offer our staff best practices in monitoring services.
Health has migrated to a new telemedicine network, which allows for more network use, improving the telehealth service available for health care providers and their patients.
I was recently speaking to a young mother from an outlying community and she stated to me that she was very appreciative of the telehealth infrastructure, as she used it to communicate with her husband, who wasn’t able to travel down to Iqaluit for the birth of their child.
Do you have any numbers on how often telehealth is used for patient communication with families back at their home communities?
Hon. Monica Ell: Thank you, Mr. Chairman. I don’t have a breakdown, but the usage across all categories - clinical services, education, administration, and family visitation - is up by 24 percent in 2013-14, with clinical services accounting for 53 percent of all traffic.
I have no more names. Department of Health.
Branch Summary. Directorate. Total Operations and Maintenance, to be Voted. $23,200,000.
Branch Summary. Health. Public Health.
Total Operations and Maintenance, to be Voted. $17,857,000.
On page H-5, I thought this was included. It mentions public health in the English copy. If dental and eye examinations are included in there, Mr. Chairman, I have some questions on those subjects.
Mr. Chairman, it is very expensive to bring in eye specialists, dental therapists, and so on.
I have mentioned that their visitation is not very long, even if there are a lot of people who need to be seen. People have taken as long as two years between the specialists coming into their community.
You may not be able to answer, but how are you considering on making improvements on the visitations of specialists like dentists and ophthalmologists, who provide glasses, and so on, to increase their number of visits, especially for the smaller communities?
Community visits are pre-determined. As to the number of days they could be visited, for budgeting purposes, the federal government identifies how many trips they can be funded. They occasionally increase the budgets a bit.
We are always trying to work in improving the delivery of dental health. For example, there has been an increase of 132 days with dental-related visits and 25 days for the Kivalliq region for the small children who needed sedation in order to have their teeth either fixed or filled.
Since March 31, 2013, there have been more dental services, and we would like a reduction in dental cases for small children.
She stated that there has been an increase of 132 days. Which year was the increase? Where do the 132 days come from?
I thank the member for that question. This is a number of days that the dentist could visit each community in the Baffin region, and it was increased by132 days for the dentist to visit the 13 communities in the Baffin region.
The grand total is much more than that looking at this year.
There are people who need dental surgery done, denturists, and paediatric dental work needed to be included. The total number of days for the Baffin region is 308.
In terms of the contract for dentistry, there were a number of contractors competing to provide dental services.
I don’t know if your department was involved, but I would like an update on that.
At this time, in the Kivalliq and Baffin regions, there is a judicial review. The government is in the procurement process to provide contract services for the travel of those dentists, which are under judicial review at this time.
I don’t know when this judicial review will be over.
If I can continue, Mr. Chairman, during the judicial review, what is the impact to the dental services being provided here in the north?
First of all, I would like to say that the Department of Health is going to continue providing dental services under the Non-Insured Benefits Program.
I can’t really say anything while it’s under judicial review.
The minister is aware that we had a problem in Pond Inlet with respect to dental services.
I’m not sure whether the other communities have any problems similar to us. You usually send people, for instance, to Churchill, Manitoba for dental services.
Can you give us a brief description of whether this is going to continue and at what stage you are?
There’s usually some funding available from the federal government to send people south for dental services to make sure that dental services provided to children are not as many.
It was good that we were provided funding by the federal government, but we’re in discussions with the federal government for us to request some funding to continue to send those people down to Churchill.
Do I understand that this is going to continue as long as funding is provided by the federal government?
Is it okay for the other communities to have problems in their community with respect to dental services as long as it’s good enough in the eyes of the Department of Health?
Do I understand that to be the case?
I asked my department from the legal department to see what else we can do and we were told that we can’t do anything else and we’re going to continue to provide those services that way.
The communities, as you know, want to resolve their problems, that it should not be the only priority of the department to do those things.
The minister has stated that this is going to continue, but unfortunately, for our community, there is no other way to do it because the minister has stated so.
We were told that if we tried to look for other things, it would infringe on the Charter of Rights.
We’re talking about the elders.
We were advised by the elders and we have to think about the people in the communities. We could just ask them to do it, but to make sure that the elders will have to tell us what infringement might occur.
If we’re going to serve the public, we have to be aware that there are going to be problems that arise and we have to be involved.
That’s what I believe in.
We have to provide better services to the people of Nunavut and if the services are not provided properly, then we have to try to help them out.
As the minister, you said that we will not be looking at this again to see how it would be dealt with a lot better.
The Department of Health has a job to provide medical services to the public to lessen their illnesses.
Young people have dental treatment and that’s what we’re trying to provide so that less young people can have dental services provided to them.
We’re trying to eliminate them and we have to try to make sure that elders who are provided medical escorts in Churchill… . We have told those medical escorts that they have to make sure that they have to be aware of what is happening when they provide medical escorts for children.
I understand your response, but what my question is, is that we want to provide good medical services for the people of Nunavut and we have to provide a better service for them, but the way it is right now, it’s not adequate.
We don’t follow what we’re supposed to follow.
I think we have to look for a better way of providing those kinds of services for kids with respect to escorting children for dental services.
I will have my deputy minister respond to that question, Ms. Keenainak.
As the minister stated, we have to talk with Health Canada as to how we can resolve this.
I know that at the hospital here in Iqaluit, there are a lot more children who are given anaesthetic to provide dental services for them and we’re trying to look for a better way to deal with it and to make sure that they don’t go as many times to Churchill, Manitoba.
Last question, Mr. Chairman, if I get a good response, I won’t ask a question again.
The hon. minister said that and I understood her to say that there’s no other way that we can provide dental services for children.
However, the deputy minister stated that you will have to talk to Health Canada with respect to dental services for children who have to be given anaesthetics.
How am I going to respond to the people of Pond Inlet with respect to that?
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. (interpretation ends) We are administering on behalf of Health Canada.
Am I able to tell the people of Pond Inlet that the Department of Health is just providing what they have to according to what the federal government wants?
Can I tell them that?
Perhaps the member can clarify his question.
Mr. Enook (interpretation): It doesn’t matter whether I make… .
What I’m trying to say is that the way it is right now, there is a problem. Can you look into exactly what the problem is?
The way it is right now, it’s not adequate and we feel that it’s not adequate. Is there any other way that you can resolve it?
The Government of Nunavut is delivering the program on behalf of Health Canada and we are the ones who provide the funding. We’re provided additional money to deal with the backlog paediatric dental issues.
We can approach them and talk to them about how we can reduce the waiting list.
The issue is the availability of specialists is limited. We don’t have them in Nunavut, but we are trying to see, as I indicated, with an increased usage of the operating room here in Iqaluit right now, dialoguing with Manitoba and Health Canada. The best place at the moment is the Churchill health facility where they have the facilities and the specialists that we’re able to access.
Moving forward, we can bring the issue of the incident that happened in Churchill, particularly for the residents of Pond Inlet, and we can talk to them about options to try to reduce the number of children who are on the waiting list.
Deputy minister, are you telling me that I can tell the people of Pond Inlet that you are just representatives of Health Canada and you will have no choice but to go to Churchill for dental services?
Hon. Monica Ell (interpretation): I can’t respond to that.
Mr. Enook (interpretation): I thought you were working under an agreement.
How many years will that agreement stand?
As I stated, it’s one-time funding and we got it and it was already over. It ran and ended.
Right now, we’re trying to come up with a new agreement in an effort to reduce the number of children who need dental surgery.
Before we go to the next member, I just want to remind members that the purpose of our meetings during Committee of the Whole is the review of the GN’s proposed 2014-15 budget. I suggest to members that we stick to the issues as they are related to the proposed budget.
Next, Mr. Hickes.
As the contract for dental services is done through the Government of Nunavut, I believe that it is relevant to continue on a couple of questions.
There are a couple of numbers that were given to my colleague, Mr. Enook, that kind of piqued my interest.
When this charter had to take place to go to Churchill, from what I recall, 120 children were flown to Churchill to receive paediatric dental services.
When I looked at the RFP for the dental services for the Baffin region that was issued on November 30 of 2012, I see a number for the paediatric dental services as a minimum of 48 days at the Baffin Regional Hospital in Iqaluit.
With these services that were provided in Churchill, is that in addition to what’s necessary under the contract or is that exempting services being provided here in Iqaluit?
I don’t have the specific details that the member is referring to, but we do have a very high waiting list in the regions.
Chairman: Mr. Hickes.
The minister led right into my next question. How extensive is that waiting list?
I’m looking for that figure; I saw it somewhere, how many are on the waiting list.
Just so I don’t have you all waiting, Mr. Chairman, we will give you the details once we have them.
In the number of days that dental services are to be provided to Nunavummiut under this contract for the Baffin region itself, I took the liberty of going through the RFP.
Using my calculator, Minister Peterson, I was totalling up the days of dental services from the different categories from general practitioner denture services, which my colleague, Mr. Sammurtok brought up recently, orthodontist services, oral surgeon services, paediatric dental services, and treatment planning for dental services, the total I came up with is 1,088 days of dental services across Nunavut per year.
Just for the Baffin region itself, I know I realize that’s stretched out over a number of different communities, but to me, there should almost be a dentist going full time and then some in the Baffin region alone.
Is the minister able to assure me that these commitments under the RFP are being met by the contract?
Just to mention, the total number of contracted general dentist days for the communities per year totalled 1,692.
In Iqaluit, it was around 50.
With your question, I’m not a doctor, but I can tell you that the dentists, oral surgeons, and things like that need a facility.
They can’t just be going to the communities.
Right now, the services are not available.
Children between the ages of zero to seven years need to be assessed by a dentist for oral health issues and referrals need to be made to the dental professionals for preventative and restorative procedures.
You need the clinical profession and with that, you need a group to deal with the oral surgery that has to take place with some of these children.
I recognize that it needs an oral health care group and, again, I’ve got a listing from the RFP that was put out late in 2012.
I won’t bore everyone with the listing of all the practitioners, but when you’re stating that those services are not available here, isn’t that a condition of the contract that’s in place right now to provide those services and those professionals?
I don’t have the contract that the member is referring to in front of me, but I can assure you that Health Canada and Health meet regularly to review the contracts, including the days that are needed in each community.
Mr. Hickes: Thank you again, Chairman.
I do understand, Minister Ell, how challenging it is sometimes to get professionals here, but at the same time, one of the things that you mentioned is a lack of ability for the hospital here to take care of the operating room and the clinical room.
We have quite a fairly new wing to our hospital right now, and I have to question how our infrastructure here in Iqaluit is not capable of handling dental services. Would the minister maybe be able to educate me on that?
Again, this is a clinical question, but the new wing that he is referring to, at the present time, is being taken up by offices for the doctors and renovations are still continuing up at the hospital where they would be.
Currently, there are two operating rooms for surgeons.
Those also have to be used for emergency basis, but I do know that there are discussions on how best to proceed with using that facility to include oral surgery. I do know of a few cases that will be happening here in Iqaluit next month.
Chairman: Thank you. Mr. Hickes.
I as well do not have a copy of the contract in front of me and I understand there is some litigation that you mentioned earlier, but in the RFP, which is to meet what the contract would be based upon, it states that the contractor will submit to the regional dental coordinator, territorial dental coordinator, as well the benefits coordinator for health insurance programs on a quarterly basis an updated travel calendar.
Is that calendar being submitted on time and is it being adhered to?
I would like to refer that question to my assistant deputy minister.
Chairman: Ms. Keenainak.  Ms. Keenainak: Thank you, Mr. Chairman.
As the minister had previously indicated, Health Canada and the Department of Health do meet on a regular basis to ensure that the contractors are abiding the number of contract days in each community.
There are also meetings with contractors and the reports that they provide on a regular basis to make sure that they are meeting the obligations that are set out in the contract that was advertised in the RFP.
If I understand correctly, those meetings are occurring on a regular basis so that means that that calendar is being adhered to and all these community visits are happening as scheduled.
I would like to get my deputy minister, Ms. Keenainak, to respond to that.
I can’t say an affirmative until I confirm with my staff.
For sure, when the last meeting was, and things like that. We can provide that at a later time, just to confirm.
Based on the information that I have, there are regular dialogue with Health Canada on the contracts, as well as with the contractors.
To actually confirm the type of information, I would have to get back to the member through the minister.
Mr. Hickes: I totally understand, Mr. Chairman.
I thank the deputy minister for that response. I look forward to the information.
I am going to switch gears and go into the Public Health portion. According to the department’s business plan the Public Health branch no longer has a stand alone TB and nutrition provisions.
I’m assuming that these are being looked under more of a division of the Department of Health.
How is this organizational change improved the education and the access to healthcare under TB and nutrition across Nunavut?
I will hand this over to my deputy minister, Ms. Keenainak.
The reorganization under the Chief Medical Officer of Health I think has provided better leadership around health promotion and protection.
These particular files are quite active still within the Department of Health.
We do still have specialists that are dealing with tobacco and also tuberculosis. I don’t think there has been a reduction in the level of work that’s happening.
Actually, there is more activity and better leadership on those particular files.
On page 101 of the business plan in the priorities of 2013-2014, the very last bullet; it talks about as part of the Public Health Strategy to develop priorities to support the strategies and goals that was tabled in 2010-2011.
In the status it is work is underway on the next phase of the consolidated public health program.
Can the minister update the members on what status currently is on that strategy?
I will hand this over to my deputy minister.
The department is working on the public health renewal rather than calling it strategy, which usually has a set timeline. We’re working on something that’s called public health renewal. It’s going to be replacing that.
Some of the activities we’re doing is we are integrating public health protection and public health strategy initiatives and how it’s organized in the main estimates now.
The intent of the renewal is that it’s going to strengthen public health programming that is more evidence based and more responsive to community needs.
We are hoping that the department will be able to present something in the upcoming year. As an example, internally there was a stake-holder meeting held in October to move forward on some ideas and initiatives that would be part of the healthcare renewal program.
Just one last question. I am sure a number of my colleagues have questions on medical travel and a number of other issues under this category.
Also, on the business plan, page 101, it is introducing a new public health act in 2013-14; it had proceeded through the legislative process. When can we expect to see a legislative proposal to look at the public health act?
We are expecting that this public health act could be rolled out in 2015.
Next on my list is Ms. Angnakak.
My first question is how many health inspectors do we have in Nunavut?
Perhaps if I hand this over to my deputy because I do not exactly know how many inspectors we have.
Ms. Keenainak
I do not want to make any assumptions so I will have to get back to the member through the minister.
I know there is at least one environmental health officer in each of the regions, and I think there may be two, but I would rather confirm that information for the member.
Chairman: Ms. Angnakak
Ms. Angnakak: Thank you, Mr. Chairman How often do they inspect and monitor activities and the premises that may affect public health?
In terms of the frequency of inspections of buildings that needed to be inspected, we do have them. However, I cannot locate them right this minute.
Could the member ask a different question and I will get back to her later on this one?
I am told that in reference to the public facilities the inspections are frequent and they usually they visit or inspect them twice a year.
As far as the environmental health officers are concerned, (interpretation ends) the public facilities are regularly inspected. Inspections occur a minimum of twice yearly, and are conducted by environmental health officers.
Inspections occur without prior notification. Environmental health officers provide guidance and recommendations, and may issue an order to remediate or a closure order based on the findings of a risk assessment.
Ms. Angnakak: Thank you, Mr. Chairman. I thank the minister for that answer.
I am just wondering as to how often they visit private businesses in the business of selling and serving food.
I can tell the member that public facilities inspected regularly, but if concerns are identified during a routine risk assessment and/or if complaints are brought forward by the public, additional inspections can occur.
The environmental health officers can be reached through regional Department of Health offices, community health centres, or by contacting Public Health in Iqaluit.
I have often heard people talking about buying bad food at one of the stores, meat that is rotten, etc.
Is this something that a health inspector would inspect?
Environmental Health Officers assess the general sanitation of public facilities. Inspection requirements differ by the type of establishments, such as food premises, establishments that prepare, cook, store, or serve food, including caterers.