EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
I know that’s not real comfort to some of those things that are happening now in the communities, but what I’m trying to say is that we’re trying to establish these processes so that we can address some of these concerns in a fair and equitable manner when they do appear from the communities because these are issues that are fairly sensitive and we’re looking at both the community, of course, and the treatment of the people, and of course, the qualifications of nurses in our communities. We are looking at that, Mr. Chairman.
We’re dealing with these issues on a daily basis.
I realize that there is an enormous pressure put on the Department of Health when it comes to the health of Nunavutmiut.
In other parts of Canada, if a person is not satisfied that a health professional has provided the correct diagnosis or response to their concerns, they often have the option of going to see another health professional to get a second opinion.
However, residents in Nunavut’s isolated communities only have one health centre to go to. When residents believe that they are not getting appropriate or adequate service delivery at their health centre or they are concerned that a diagnosis is incorrect, how can they request a second opinion?
Is there a process in place?
Chairman: Thank you. Minister Curley.
In a particular community, the answer is no. That is why, if the patient is seriously ill, they are normally medevaced and that is why our medical travel cost is really quite high. If they require immediate medical evacuation, we don’t compromise that question.
The nurse will consult with a doctor at all times. There are doctors available pretty well 24 hours a day for consultation. Each community has that reference contact 24 hours a day pretty well.
Doctors, whether they are out of province or not, are on standby. We have a service arrangement with them that they are on standby.
We will call nurses if they need a second opinion.
It would not be correct to say that they rely purely on their own judgment of medical situations. Most of the time, they do consult with doctors that are available if they are not in the community.
Last year, the minister provided copies of his department’s complaints procedure pamphlet to all MLAs.
This document is also available in health centres, I understand.
Can the minister describe what kinds of complaints have been filed with his department to date and what steps have been taken to address the concerns raised?
Mr. Chairman, if I may add to my question or allude to the fact that unilingual members of our communities, especially elders, I’m not so sure if they would be able to go through the process of using this kind of format.
I don’t think there is a perfect solution or perfect approach. If the member has a perfect approach, maybe he can recommend one. That would help us a lot.
But we will invite every complaint. We address every complaint. We don’t compromise on that.
I told the member the other day that I received a call even at home the other day.
I think it was yesterday, my wife received a call.
I don’t know how they got her number from outside of this community, but we did receive one at home yesterday.
We take these complaints seriously; we don’t put them on the shelf nor will we ever put them on the shelf. We take the health of Nunavutmiut seriously and we will respond to every concern or question. We don’t compromise on that.
We probably do a lot better dealing with complaints compared to other jurisdictions, but we take and deliver them and they go down through the pipes, and so on.
For me to release every detail of which kind of complaint, I think it’s bordering on privacy concerns and so on, but we can assure you that we get a lot of them and we address every single one of them. My deputy is going to explain exactly some of what they look like and how we deal with them.
As the Minister of Health and Social Services knows, we are here elected to become instruments to seek, to the best of our abilities, to find solutions for these types of problems that exist in Nunavut especially, maybe not so much in the rest of the country. Often times, we are talking about not being up to par versus our southern neighbours just because they have more facilities and so forth to depend on a lot more than us Nunavutmiut.
I’m only trying to bring up the issue not in a critical way but in hopes that we will be accepted when we are serious about a unilingual member going to the nursing station and given Tylenol only to be medevaced out because the intestines have burst open. That’s serious, that’s very serious.
So I hope the minister will understand that I’m not taking this as a personal agenda or anything of that nature. I’m only trying to address an issue of a problem that exists in Nunavut. I for one would be more than willing to become part of the solution instead of being part of the problem.
Would the minister like to respond to that? Minister Curley.
We will continue to wait for that suggestion. When it’s ready, we will be ready to address it and we certainly appreciate any contribution that we can make.
I know that our primary care workers in communities are there to provide and treat patients as they come in, and I think, by and large, without all of the amenities and resources available to other Canadians, may not be available within their communities because they do have a secondary medical.
There are a lot more advanced facilities and treatments adopted throughout but we don’t have those in our communities, but what we have in communities, I think that they do a fairly good job at this most of the time.
There are some areas that pose difficult questions to the department and to health officials. Hopefully, we will continue to improve and provide a better service to them.
We have learned from the mistakes that have been made, and we will continue to learn and surely, we will continue to work towards solving and not creating other problems.
I just want to state for the record that even as government, we have to be seen to be able to see from the patient’s perspective, not just to protect the interests of the department or our government.
I think it’s very crucial to see the intent of frustrations and whatnot that some of the clients or patients have gone through without necessarily making any noise afterwards.
They just try to take it in and then not be able to go anywhere beyond that situation that they have confronted.
I think it would do well, Mr. Chairman, that at least from time to time, we should allow ourselves to not just become defensive but be able to try to understand the other side of the coin.
That’s all I want to say.
I didn’t really see a question there, but if you want to comment to that, Minister Curley.
I don’t think the department will continue to just be complacent with what we see. We said that we will continue to learn and we will continue to apply new techniques that do work.
Our primary care workers have a second opinion available. At all times, doctors are on standby.
That’s not a defensive statement, that’s a fact. And we will continue to improve that.
We will not compromise on the health situation of Nunavutmiut.
I for one will never do that. I have been around for a while and I will not compromise in providing a second type of class treatment available.
My deputy indicated earlier that he had put in place a number of standards that continue to try and provide the best care available within the resources that we have.
We know we cannot compare ourselves to outside of Nunavut borders, but what we have in Nunavut, we must make it work and that we’re committed to doing.
We will give complements where complements are due, and we will continue to improve providing that we receive constructive suggestions on how to improve our services in Nunavut and make it cost-effective as well.
Mr. Okalik (interpretation): Thank you. (interpretation ends) I just want to follow up on my colleague for Nanulik’s questions. I think they were very constructive.
We see news from elsewhere whenever there is a misdiagnosis, for example, and there is a trend of public inquiries held to determine what happened so they can fix it. We haven’t had any here even though there have been a few that we know of that have taken place.
I would like to know what the department will do when there are known cases of misdiagnosis, for example.
What steps will they take so that we can reassure our constituents that their welfare will be looked after in those cases?
We may not have a public inquiry or whatnot to address misdiagnoses of patients throughout Nunavut.
I have only been here for a year and a half and I believe my colleague was there for ten years.
I don’t know what kinds of inquiries or whatnot were initiated at that time, but I would like my deputy to respond because I think some of these questions really involve the actual evidence collected and provided as to those particular institutions where they should be addressed.
I said earlier that we will not comprise the health of Nunavutmiut if there is anything that we can do about it.
I would like my deputy to respond to some of the questions.
We do, as the minister indicated, take these concerns very seriously and we take the recommendations and comments from the members very seriously as well.
Again, this is process and I know people don’t like to hear process.
We have some established processes that we have initiated over the years where we do a peer review right now on instances that do occur where there have been complaints or if there has been a misdiagnosis. We do follow up on those particular concerns in the department.
There is also the process of using the coroner’s process where required.
Yes, if there is a public inquiry required for some of the things like if there is a misdiagnosis and if it requires a public inquiry, that’s likely a step that the government will take and encourage that process in order to ensure that the quality and care of services for Nunavummiut are addressed.
Mr. Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I think the other question that my colleague was trying to get at is that there is no real way of getting a second opinion in the smaller communities.
Perhaps there is some way of communicating a request for a second opinion, like a phone number that our constituents can call to talk to a doctor or something, and a lot of those concerns can be alleviated as well in the future. (interpretation) Thank you, Mr. Chairman.
I don’t know whether I made myself clear or not earlier.
I know that even within the other previous government, there was always a second opinion available.
Doctors are on standby for every nurse in health centres throughout Nunavut. It’s just a matter of a telephone call away.
I remember going into the health centre in Rankin Inlet and they did phone a doctor in Vancouver who was on standby. When a doctor is not available, if he is tied up, in other jurisdictions, they have doctors of different types on standby. I’ll let my deputy explain further that procedure and how it’s used.
I don’t really have too much to add but to say that we do have doctors available that will provide that service.
If patients continue to be concerned about the treatment that they are receiving at the health centre, there is a process for that as well.
We will communicate these processes more aggressively over the next several years or months to come, or weeks and days, so that people understand what process that they need to follow when they do have complaints about their treatment.
Mr. Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I wasn’t talking about Rankin Inlet or Iqaluit, but I’ve had relatives in smaller communities fly themselves to Iqaluit to get a second opinion at their own expense.
It’s a real challenge for those people living outside of the centres where there are readily-available doctors that you can get a second opinion from. So it’s those smaller communities that don’t have that service that we are trying to follow up on.
Is there some way that we can deal with those? Perhaps the department can find a better way of managing those. (interpretation) Thank you, Mr. Chairman.
Mr. Chairman, I don’t think we can indicate in this House that the larger communities have better care.
There may be more resources and whatnot in terms of the population and the number of nurses or health care workers available in some larger places, but the health centres in each community have access through local health workers to additional help if they do need it.
It’s not something that is not available; it is available.
Like the deputy minister indicated, we probably have to promote that a bit more, I’m sure.
Probably the local nurses normally make judgments of their own, but from the administration side, we can certainly encourage them to be more proactive on that.
I’ll have the deputy explain further on exactly what I mean.
Again, I don’t have much to add to the minister’s response, just to say that we do hear the member’s recommendations and observations, and their request for improved services to the department.
What we can commit to doing is reviewing these on a case-by-case basis as well as reviewing whether we need a system of referral or a second opinion process. So we will take those under advisement and we will follow up accordingly.
I would like to move on to another subject.
I would also like to thank Mr. Elliott for asking questions with respect to smaller communities and the need for local residents to go to the health centres.
They usually go on local radio stations to announce who should be going to the health centre and I have said that the health department expressed concern that this is a breach of confidentiality.
The fact is, however, that this is a long-established practice and it seems like it’s something that needs to be fixed.
The deputy’s response doesn’t seem complete.
I requested that your department consult with the Information and Privacy Commissioner to find out if there was a breach of any laws. It seems like there was no connection or they didn’t ask the Information and Privacy Commissioner.
So my question is: did you consult the Information and Privacy Commissioner on this long-standing practice?
Mr. Chairman, I think we can do that.
Certainly, we did not get a request from the Assembly to ask the Integrity Commissioner or the Privacy Commissioner on that, but it was alluded too that it may infringe on a privacy related issue, but the deputy minister will respond to that further.
I can confirm that we have started the process of consulting with the Privacy Commissioner’s office on getting their advice on that.
Even after what I said yesterday that we have always used this as a practice to do the radio announcements, it’s just something practical that we have done over the years in Nunavut, but we will be following up on that.
Mr. Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I wouldn’t be pressing this if the department was not overly concerned of other privacy matters. When you’re dealing with a rather dangerous disease, privacy seemed to override that part.
It costs us quite a bit of money by the looks of it, so that’s why I’m following up on this.
If there are breaches, usually, if I’m going to have my rights overruled and overwritten in some way, I sign it away on a form and I do not see this practice for those individuals whose names are advertised via radio every day.
I think their rights are being waived and they should be given a clear understanding that that’s taking place in those cases.
That’s all I ask and I look forward to the opinion that you get from our Privacy Commissioner.
I’ll leave it at that for now. (interpretation) Thank you, Mr. Chairman.
I didn’t hear a question there and I don’t have anybody else on the list here for questions, so we will go back to H-7. Branch Summary. Health and Social Services.
Treatment. Total Operations and Maintenance, to be Voted. $157,063,000. Do you agree?
I would like to raise this question.
I had raised the same issue during standing committee regarding the reimbursement of expenditures, such as this $150,063,000 funding that the federal government administers.
I’m aware that the federal government has appropriated this funding for the operations of the health department, specifically as it relates to medical travel and treatments.
However, we are also aware that every dollar that is spent for Inuit has to be reimbursed by the federal government.
That was why I asked questions pertaining to whether every dollar used for Inuit health matters is fully reimbursed.
The answer I received was that it was unclear as to how much of these funds would be reimbursed under the federal programs.
My question to you is: is it still unclear as to what percentage is to be reimbursed from the federal government?
Let me clarify that, Mr. Chairman.
Way back when the federal government enacted the Indian Act, okay… I apologize for not using the proper parliamentary procedure.
I should not use the term “okay.” In any event, I was just trying to be as concise as I can.
When the Indian Act was enacted by Parliament, it included amongst its provisions, which have never been retracted yet, that any treatment requiring hospitalization or medical services for Inuit falls under the Indian Act.
Do you apply these provisions to ensure that the department is fully reimbursed by the federal government for providing health care to Inuit?
The question asked by our colleague is quite complex as it revolves around the Constitution and the aboriginal rights administered by the federal government.
Due to this reason, I feel that it is impossible to respond fully to this question, although I understand where he is coming from.
However, in relation to Nunavut in particular as well as the Northwest Territories, there are different funds within the pool of funds contained in the Non-Insured Health Benefits Program. The difference is that we also service the general public, which is above and beyond the program parameters, such as public insurance.
Some of the items that cannot go through public health insurance, such as eye care, ear care, and other services under the Non-Insured Health Benefits Program, are reimbursable. Every penny is reimbursed.
We are generally allocated a lump sum with an imposed ceiling and the funding that is segregated for Inuit health care is not broken down, so I don’t think we get every penny that is due to us.
Perhaps if the member can add some details as to his question in regard to the program, I can better grasp where he is trying to go with his line of questioning.
Yes, this issue is very complex and it’s quite obvious that it’s challenging to attempt to get what is due to us, but there is a danger here.
If we, as an aboriginal people, don’t push for full reimbursement, especially since we comprise a tiny portion of the Canadian population, we may find ourselves being abandoned financially by the federal government in the future.
This may apply to most of the remote territories of Canada.
This would apply especially as the glitz of Canada’s newest territory fades away and perhaps as we work towards devolving powers, such as through the Mineral Accord.
Is there not a danger that under the Indian Act, which is part of the fiduciary duty of the federal government to its aboriginal peoples in cases where there is no other government such as provincial governments, the agreements that were made will result in the loss of Inuit rights?
For example, you said that this is unclear and therefore, difficult to determine how much money should be reimbursed by the federal government.
Almost all of the funds under the Non-Insured Health Benefits Program are fully reimbursed.
However, some of the funds are pooled together and ceiling constraints are imposed, as you so succinctly pointed out.
Is it not a danger that if we don’t get all funds reimbursed, then this fund will be pared down, perhaps even to the point of being completely abolished and thereby sidestepping the federal government’s obligation to fully fund all health care for Inuit as per the Act?
Yes, I fully comprehend where Mr. Arvaluk’s concern is coming from. I thank him for providing more details on his concern because this is something the government has to keep in mind in the legislature and I believe that these concerns have to be voiced politically as this is a political question.
This doesn’t just apply towards my department and perhaps the whole cabinet ought to deliberate on this matter.
As an example, we could possibly add health facilities and capital projects that are consuming a lot of funds currently and seem to just keep rising.
We have never received any reimbursement for these health care facilities from the federal government.
The rising costs associated with health care eats up the majority of the budget. The health department budget alone consumes one-third of our entire budget.
For this reason, although this has never surfaced in the cabinet discussion agendas, it is an issue we find ourselves discussing more and more, especially the issues raised by Mr. Arvaluk. I believe that we have to keep our MP apprised of our situation and this is becoming obvious as we face these challenges.
I’m unsure of how best or through which avenue I could provide a response, so I’ll leave it at that, Mr. Chairman.
We’re going to take a five-minute break here. Our health minister requested a five-minute break for health reasons and seeing as he’s the health minister, I think we will grant him that. We will be back in five minutes.
>>Committee recessed at 17:25 and resumed at 17:34
Mr. Arvaluk, do you have any more questions?
Indeed I do. Be that as it may, it is beneficial to know these things when we are administering programs for them.
Perhaps in asking about this example, it is sometimes difficult to delineate the funding eligible for reimbursement under the Indian Act that determines how much the federal government must fund. If an Inuk gets sick, is the priority on delivering essential health services and not so much on the correct category for costing out the service as per the federal government?
I would then like to raise this question with regard to southern provinces and perhaps one or two of the other territories, as I’m unsure of Yukon’s status. Are communities or reservations completely funded by the federal government?
In those cases, does the federal government directly administer health care either by providing public servants for administration or the nurses directly for this health care?
Is it transferred to the provincial government as part of their jurisdiction?
If that is the case, are these agreements similar to the ones between the provinces and the federal government? Do they have to try and get reimbursed for their administration of health care for the First Nations as per the Indian Act?
These are real questions we must ask and are quite important to remember.
Personally, I’m not the minister responsible for the Indian Act nor am I the aboriginal affairs minister.
However, we do know that as it pertains to health services, at least based on my knowledge… Mr. Campbell may supplement my response in more detail as he is more familiar with these issues than I am.
He is also quite familiar with the situation in Manitoba.
As far as my understanding of the Indian Act, the provisions relating to health care are not part of the provincial jurisdiction. As a matter of fact, the First Nations don’t want the provinces to have anything to do with health care.
They have treaties and health care services are directly administered by the federal government.
They prefer not to involve the provinces as they don’t want to transfer their rights. Perhaps in different cases, there may be partnerships, particularly in more remote areas, but in some places, 100 percent is funded through the Indian affairs department of the federal government.
With respect to how health centres and medical administration is dealt with, I will have to defer that to Mr. Campbell as he has a better understanding than I do. I would ask that he explain how it is dealt with in other areas.