EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Mr. Curley: Thank you. I think we need to be quite cautious, that we do at least a fair accreditation program and we’re going to get into that, to include other regions as well and other facilities.
I have another question with respect to the department’s responsibility. We have heard a number of unexpected deaths have occurred from region to region.
I’m wondering whether or not the department has ever asked for the Coroner’s Office to hold an inquest when something of that nature occurred while under medical care, and if so, how often has that happened if they have any figures?
I’m going to speak to the process that we follow currently with the Department of Justice and the coroner’s responsibility. The Premier is here, so he could correct me if I’m wrong in terms of the procedures that follow when a coroner is called in and the inquest.
In any situation where there is a sudden death, the coroner is involved. The coroner makes the determination when an autopsy is required, and so on, and then the Department of Justice process kicks in.
In any case, whether there’s a death in our facility or outside hospital, in a home, and so on, the coroner is always involved to make those decisions on whether an inquest is required, or an autopsy is required, and so on. And, that falls under the coroner’s legislation as per the Department of Justice.
They’re the ones that make that determination which is independent from us, from the Department of Health’s programs and services.
Mr. Curley: Thank you. I appreciate the response. If I read and understand the minister correctly, the procedure would apply under your department as such.
There was one case here I read in the local papers that a student died unexpectedly and the Coroner’s Office was asked to look into it quite quickly.
So would this kind of procedure apply to other regions as well?
Perhaps, the Premier may want to elaborate on this. In any death, the coroner is involved and in the case, in any death, they’re called in for any death, whether it’s in a home, outside, in a hospital, and so on.
That’s the standard procedure that is followed when a death occurs.
Mr. Curley: Yes, I understand all that. We do want to see the standards applied across the board and in the case of the local student’s death that we read in the paper, the Coroner’s Office was specifically asked for by officials or government representatives.
So we just want to ensure that this procedure applies to any situation where unexpected deaths may occur, that there are no exceptions to following procedures.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) Yes, we don’t govern by region; we govern by territory and we apply the rules as they are set out in legislation and as they’re required by law.
I can’t comment on one specific case. That is yet to be complete and it will hopefully be completed soon. When it’s done, then we’ll provide the report to the family and the people affected. (interpretation) Thank you, Mr. Chairman.
Mr. Arvaluk: Thank you, Mr. Chairman. (interpretation) I would like to ask a question.
Does the minister know how much money was spent in 2007 and 2008 for medical travel on scheduled flights to southern hospitals?
I’m just going to pull the information.
I will ask the deputy minister to go through that information.
Mr. Campbell (interpretation): Thank you, Mr. Chairman. (interpretation ends) Over the last number of years, starting from 2003-04, the actual expenditure for medical travel was $31.6 million; for 2004-05, it was $33.6 million; for 2005-06, it was $38.9 million; for 2006-07, it was $47.2 million; for 2007-08, the budget we’re looking at, was $4.0 million and we’re projecting $4.6 million as the projection for actual expenditures for 2007-08.
This amount includes medevacs as well.
I was asking without medevacs.
Is there a breakdown for scheduled medical travel without medevacs?
I don’t have that breakdown.
I’ll have to provide it to the member hopefully today or tomorrow.
When you’re negotiating contracts with airlines, for example, scheduled airlines, do they commit to improving services from past experiences like trade offs?
How do you determine how to give them contracts?
Do they actually say, “Here is what we think it’s going to cost you on scheduled medical travel this year in caparison to last year and from the trends from the previous years”?
The way I understand the process, it’s more than just the cost associated.
There are other factors that are looked into when we do the Request for Proposals from various service providers, just like we would set the standards for boarding homes; it would be the same for the airlines.
There is a criterion that’s established in any Request for Proposals that’s followed through the procurement process and cost is a factor, of course, but there are other pieces to that.
Canadian North was recently in the news lobbying for an increased share of the GN medical travel business. My friend from Iqaluit learned last night that Canadian North made an announcement that they have a small portion of the contract for medical travel.
Can the minister then tell me what has been the GN's response to that?
Does she have information of what portion has been going to Canadian North who has been recently lobbying?
I can say, for the record, that there’s more than one airline that lobbies the government for business. The other airlines do lobby my colleagues around the table as well for contracts.
In terms of the process that’s in place right now, I can say that the Cabinet/FMB has finalized its decision last week. The file is still being worked on by CG&S as the department responsible for procurement and contract development.
The steps that would be taken, at that point in time, would be that CG&S Manager of Contracts would be then contacting the people that had submitted the proposals to communicate the decision and take it from there to formulate the contracts.
At that point in time, we would be able to provide information to the public is how I understand the process to be.
My colleague, Minister Brown, can clarify if that process is correct or not as I just described it, but that’s how I understand the procedure to be.
The FMB has finalized that already and I believe that the Request for Proposals also goes through the Department of Health.
Does she know about the amount now that after it has been finalized by the FMB?
The proportion of how the proposal has gone forward to FMB is correct. FMB has made a decision and it goes back to the Department of CG&S. I believe the Premier would like to respond to that question.
Chairman: Thank you, Minister. Mr. Premier.
Hon. Paul Okalik: (interpretation) Thank you, Mr. Chairman. (interpretation ends) In light of all the interest provided, I asked the appropriate departments to provide a methodology of what took place. It was fair and everybody was given an opportunity to provide their presentations. I’m sorry but that methodology is not done yet.
So we have acted as fair as can be to all airlines affected and I just want to provide that information for everybody. That information should be coming shortly but I just want to be clear to everyone that the process was open, transparent, and fair for everyone, and I want that methodology presented to the legislature.
That’s why it’s taking a little longer than what we would like to see. (interpretation) Thank you, Mr. Chairman.
Mr. Arvaluk: Thank you, Mr. Chairman. I thank the minister and the Premier for that answer.
I would like to switch a little bit to what Mr. Mapsalak was asking before about the information, and I think Mr. Curley did that too, that is provided to patients when they are going out on medical travel, especially those who are travelling on scheduled medical travel.
Did you say you have a brochure? For example, if a person is travelling from Pond Inlet to Iqaluit on their way to Ottawa, do you have a brochure for them here in Iqaluit and these are the numbers that you can call if you happen to land in Greenland or in Cambridge Bay from Pond Inlet? “Here are the numbers you can call.”
Is that the kind of brochure you are providing?
In addition to that question, Mr. Chairman: are these provided, for example, when a person is going to a medical centre or a hospital, that they are given an envelope from the doctor or the nurse in charge? Is that brochure included in that envelope as part of the travel package?
This is a handbook that’s going to be going to every patient when they travel.
This one here is for the Kivalliq but we have one for the Baffin.
This is a booklet that outlines information for airport arrivals, what to do regarding accommodations, what to do with the appointments, what support is there, and what procedure to follow when they’re returning home. It also has the insurance programs and contact numbers if there are problems arising.
This information will now go to every patient that is travelling, this is new, and it’s starting April 1 this year.
For the first time, we have a book like this to hand out and we’re also having information sessions with our service providers to explain the new policy to all the staff at the frontline that delivers this program so they all have an understanding of the changes that have been made and the handbook in assisting our patients in their travels and to mitigate any problems that they may encounter as a result of travel delays. It’s specifically trying to mitigate problems encountered when travelling for medical.
I believe the first workshop took place in Rankin Inlet last week.
My last question for that particular one is: do you have a prearranged agreement with all the hotels or accommodations in Nunavut to allow any patient who has been flown to an alternate community or became stuck... For example, Mr. Mapsalak was talking about the patients travelling on milk runs.
They have to go through so many communities before they get to their destination.
There’s always a chance, and in fact, it happens quite a bit, that the plane gets stuck in one of those communities before their destination is reached.
Do you have a prearranged agreement with accommodation providers, like hotels, to allow medical patients to be placed with a room and meals, without any authorization, from Iqaluit, or Pangnirtung in this case, because they cannot be contacted at this particular hour; one or two in the morning?
I do know that, through our boarding home, we have prearranged hotels set up in cases where there’s an overflow of patients in the larger centres.
I don’t know if we have prearranged hotels with all the other communities in between the point of departure to the point of destination but I will look into that to see what’s in place.
I’ll make it very simple this way: if a patient is travelling from Pond Inlet, or Resolute Bay, or Grise Fiord, the person from Grise Fiord has stopped in Resolute Bay, Pond Inlet, Igloolik, Iqaluit, or maybe it’s going through Clyde River then to Iqaluit.
If the person is stuck there, does he or she have a piece of paper saying, “If you ever get stuck in these communities accidentally due to a plane going mechanical, here is the contact and you can stay free for everything there, including transportation.”
The information booklet that’s provided provides contacts of the hotels and boarding homes that they’re going to but I will look into that, I think that’s reasonable, and see what we can set up as described by the member.
I would appreciate that. It doesn’t cost the government any money because it would just be a prearranged agreement; it doesn’t cost you any money and you don’t have to do any deposits.
I was asked many times last fall not to ask questions about the Pangnirtung Travel Office because we were talking about capital.
Mr. Arvaluk: Now that we are on O&M, I would like to ask that question in the Committee of the Whole.
Have you made any consideration or reconsideration of moving the Medical Travel Office for Baffin people, especially for Iqaluit patients, from Pangnirtung to Iqaluit?
And, not just to Iqaluit but in the hospital so that when the patient is checked out, he or she goes to that office or to that lobby and says, “My doctor is done with me, so I’m ready to go home.”
Have you made the reconsideration or arrangement to make that easier for unfortunate patients?
What we’re looking at is examining just that, to address the ongoing concerns.
I think there’s enough time that has passed since the travel office has been established in the Baffin office.
I will commit to the member to examining and addressing those concerns, and report back to the member, hopefully, in the spring session in June, whatever findings we have and recommendations on addressing the ongoing concerns related to the office being located there.
That would be very good because it says right in the Pinasuaqtavut principles of the government that they will listen to people and they will respect the concerns of the citizens.
I think that would be a great move and there’s no embarrassment as much as the three time zones was.
>>Laugher
Mr. Arvaluk: I am looking forward to that positive announcement by the spring session. (interpretation) Thank you, Mr. Chairman. That’s it.
I’m sure that the minister and her officials are ready for this question. It’s a serious concern that I raised during our standing committee review of the budget and that has to do with the amounts that are budgeted for medical travel.
I think the supplementary appropriation for medical travel has been the only thing that has been more consistent than the Power Corporation asking for more money over the years.
I have said over and over again, over the years as well, not only with this but in other areas within the budget: how realistic are these numbers?
We’re expected to vote on something that makes sense and is a realistic amount.
When I look at the amount that’s budgeted for medical transportation, as worded in the business plan, it is $43,959,000 for the 2008-09 year. If you look in the main estimates for the 2006-07 year, their actual expenditures were $49,240,000.
They put in a main estimates amount, and one thing I’m glad we’re finally seeing is actual expenditures in the budget because, in the past, all we have seen is budgeted amounts or revised budgeted amounts; we never see what was actually spent.
My serious concern is how the heck can the department expect… they just acknowledged today that they have entered into a new contract, which I’m sure these numbers in the 2006-07 year are from a three-year-old price and a three-year-old contract.
We are just entering into a new contract just after increasing aviation fuel and all those other costs, the heating costs; everything is going to up for those airlines that are operating in Nunavut.
How can they realistically expect to spend, if you look at the main estimate amount, $3 million less than they actually spent in 2006-07 that they plan on spending next year?
It just doesn’t make any logical sense for me. Thank you, Mr. Chairman.
Could the member ask the question again?
I have pointed it out, as I’m sure the minister will recall, in standing committee that I believe the number that we have here for medical travel is not an accurate number.
The overall expenditures that they’re planning for the 2008-09 year is $46,241,000; in 2006-07, they spent $49 million - $3 million more two years ago than on an old contract.
We’re going to be going into this year with a new contract with a more open client travel policy.
How can she expect us to look at this and consider that an accurate number to be voting on in this budget?
For 2008-09, we’re projecting $46,241,000 for this fiscal year. I understand the member’s questions and concerns related to the previous year’s Supplementary Bills requesting additional funding to cover medical travel.
It’s been a challenging area to manage as medical travel and medevacs are hard to control. It’s very difficult to predict illnesses that will require the transporting of patients, and so on, so we have tried to address the issue around projections and tracking.
I can say though, since the last year or two, we’ve had put in place systems that can better track for us, by month, where we are at in terms of expenditures with our new medical travel budget tracking system within the department. The figures that we’re working with are accurate to the end of March 31, as an example, as of this month, they’re data entered and we have a better projection tool around that.
The other area that we have included in the last few years is to put forward some contingency to the Government of Nunavut around fuel price increases that may impact medical travel, which, in the past, were never part of the Government of Nunavut’s overall contingency when we were dealing with fuel price increases.
So the information before us is the best information that we have gone forward to try and project the expenditures for medical travel for scheduled and as well for medevacs.
I still can’t see how that’s an accurate number. How are we going to spend $3 million less next year than we actually spent two years ago?
I mentioned that I as serious when I mentioned it in standing committee, and obviously, it just went in one ear and out the other. That is not an accurate, realistic number to have there.
Last year, for 2007-08, you had $34,794,000. Do you know where you’re at right now or what you’re projecting to finish off with for the 2007-08 year?
Hon. Leona Aglukkaq: Yes, I’ll have the deputy respond to this current situation.
Mr. Campbell (interpretation): Thank you, Mr. Chairman. (interpretation ends) We fully appreciate the observation that’s been made by the member.
We are always dealing with projections for these expenditures.
As the minister said, medical travel is an area that’s very unpredictable.
As I said earlier, for 2006-07, the actual expenditure was $47.2 million. For 2007-08, we’re projecting an actual expenditure of $46.5 million.
What we’re trying to do as a department is, at the same time, do some financial management processes in the department where we’re reviewing most of the travel as they occur and trying to minimize some of the other expenses that we incur as a department.
So we do have an expenditure management initiative on the go in the department and we’ve had that implemented since May of last year. We have to try and play a balance between trying to control our expenditures and trying to balance the overall budget as a department. I appreciate that there are going to be some increases in fuel prices as well.
The budget that we have of $43 million projected for medical travel may not be enough for next year.
I can say that now but I don’t know that; maybe the budget will come in under. I’m not sure what that’s going to entail.
This is our best guess right now given the circumstance that we have as a department and given some of the projections that we have made internally as a department.
I know that these are just projections but I just want to know if I heard Mr. Campbell correctly. For 2007-08, they’re projecting $46 million. Is that what I heard?
Hon. Leona Aglukkaq: Thank you, Mr. Chairman. That’s correct.
I know I can appreciate Mr. Campbell’s comments when they’re trying to work within their budgets but I think, when they come back to the Assembly saying, “We don’t have enough for medical travel,” they know already.
They’re budgeting $3 million less than they’re actually looking at spending for next year, than they’re actually spending this year.
To me, that’s not an accurate reflection and that’s not a best guess. You know darn well that it’s going to come in way over that.
To live within the targets of the budget, targets that the department has to work with, they say, “Okay. Well, let’s just put it at this and then it allows us to do other things.” This is not a realistic number.
If it’s already $3 million, or just over $2 million, they’re looking at $46 million for 2007-08 and they’ve got just under $44 million for 2008-09, and again, the fact that the $46 million that they’re looking at for the 2007-08 is based on a three-year-old price off of a three-year-old contract and we’re going into 2008-09 year with a new contract, I imagine that it would be silly to think that it would be a lower price after all the increased costs to the airlines and everyone else, that I don’t know how they can even put forward a number like that that’s less and expect us to buy it. I don’t buy it.
I think they should go back, and that’s what I suggested during the standing committee, and come back with a realistic number there. Now, you know, obviously, what the prices of the new contract are going to be.
Use that and come back with a more accurate number in there.
To me, that’s not an accurate number, and as I have said for years, we should be getting accurate information in front of us. That’s not accurate.
You’re already saying, “Well, we’re going to budget just over $2 million less than what we’re actually looking at spending the year before.”
Every year, it has gone up. For the 2007-08, you said $46 million; you had budgeted $34 million.
I can’t support or agree with a plugged number; just a number in there to work within to make it look like the department is within their targets knowing full well that they’re going to go over that.
I would like to make a more informed decision. If other things got to go because of that, then, you know... We know that whenever they come forward to the Assembly saying, “We need more money for medical travel,” that they’re not going to get said no to.
They have done that over, and over, and over again, so I can’t support that.
I would like to request that the minister take this back and come back with a more realistic number in there for medical travel because that’s a totally unrealistic and, if we could use the term, bogus number that they have in there.
It’s already $2.1 million less than they’re planning to spend this year.
So would the minister do that: take this budget back and come back with a realistic number for medical travel?
I appreciate the member’s concerns and frustrations around this file. I share that concern too.
To try and accurately predict or to accurately forecast medical travel would be asking me to adequately forecast the number of people I’m going to have to send out because they got sick. They are directly tied together.
It’s very difficult to predict the number of medevacs we’re going to issue and the number of sick people we’re going to send.
It’s directly tied into the money and it’s hard to predict; the two go hand in hand. It’s very difficult and we try our best.
I can say though that 2007-08, our projection for medical travel is what the actual is, the $46 million area.
What we were asked to do at that time was to come back at a later date and we’re given a partial of what we requested. So we are getting pretty close to projecting actuals.
The actual amount that we had requested in 2007-08 was around $46 million, but given that we were developing our tracking system and our reporting, and so on, we were asked to come back at a later time to FMB, which is what we have done this year; I can say that. The information before us, I can say, is as accurate as we can predict to today.
The other decisions around the contracts, we can speak to more of those once they are finalized without getting into the details, but we anticipate there will be some savings in those contracts. I can’t get into that at this point in time because those are not complete, and as the Premier stated, that information will be coming forward to the members.
I still can’t see... like I know in the business plan, it shows, for Medical Transportation, $34,794,000 for 2007-08 and she said they’re coming in at $46 million. I know in the main estimates here, it says the revised amount for 2007-08 was $44 million; that’s still less money than they’re planning to spend.
I know you can’t have a crystal ball and determine exactly how much is going to be there, but just take a look at the numbers over the years, look at the numbers every year; it’s always way over.
You shouldn’t be coming forward with amounts that have never been less than what’s budgeted or what’s spent the previous year.
I don’t see how they could think that this is a realistic number; we know it’s not.