EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
I’ve had a few of them approach me, I’ve had it brought up at the KIA AGM by many elders in the Kitikmeot. So I’m wondering Mr. Chairman if the minister or Mr. Blais could comment on the type of patient tracking system they currently have in place and any plans they have to improve it, it’s also noted on the KPMG medical report, so I’d appreciate some comments.
Mr. Chairman (interpretation): Thank you Mr. Peterson.
I will let my deputy respond to that.
In the last two years or so, we have met with all of the out of the territory providers and the boarding homes, to look at how we can improve the issues that you mentioned earlier and more, other things as well.
I think we’ve seen quite a major improvement, we seem to have less of these occurring currently and I think the boarding homes are more sensitive.
One of the issues was that we weren’t advising the boarding home very often that clients would be arriving on Friday, there would be four people coming in from Iqaluit for example.
But I believe that so far we have improved that process, but there’s still a lot of work to be done there.
The implementation of the medical travel center will allow people to have one number to call.
A 1-800 number, so if they’re stuck anywhere, because we will have 24-hour service, they will be able to call and someone will come and rescue them, I guess maybe that’s a good word.
And they will also have the number of the boarding home that they can call directly if they feel that confident or capable of doing that.
So that’s the direction that I hope we will go into.
The other issue is often is in regards to appointments, we haven’t had a habit of calling to make sure that the appointments are still on, cause often the physicians or specialists cancel them, their clinic, and we are not aware of it, so we end up sending clients to Ottawa for example, and arrive there and there’s no doctors.
So, we are in the process, myself and Dr. McDonald are making arrangements to meet with the CEO’s of the Ottawa hospital, the medical director, and the university dean of medicine as well, in trying to get them to understand the challenges that we have when we send people thousands of miles and the cost and the time loss to that.
I don’t think that has ever occurred, so we will probably be the first to make that happen.
We have also done in this in Manitoba recently as well, with the minister present with us, and we would be traveling as well to Edmonton.
So, I think it’s our responsibility, I guess, to try and encourage our referral centres to work with us, and maybe that’s the one thing that I think we are doing well right now.
Mr. Peterson: Thank you, Mr. Chairman, Mr. Blais, minister.
I visited the Larga Home in Edmonton last September and they showed me their patient tracking system.
I think they also told me that if the Government of Nunavut is interested, they would be willing to share it with you guys.
So, I encourage you to talk to them if you had a chance.
Just to touch on the urgent medical evacuations that you referenced in your paragraph up here.
I asked the minister this the other day in the House.
Who exactly makes the decision to evacuate a patient to a hospital in Yellowknife or to Edmonton, say from the Kitikmeot?
The communities are different.
In some communities, they have doctors, but if there’s a serious illness, they are usually treated by the nurses, and they are treated by the nurses because that nurse is the first person to treat that patient and if that nurse can’t treat the patient, then if there’s no doctor, they can talk to a doctor in Yellowknife or Edmonton.
So those are the three regions, Baffin, Kitikmeot and Kivalliq are three different regions, so they usually call a doctor on-call, and usually it’s the doctor and the nurse who decide whether that patient should be medically evacuated.
Mr. Peterson: Thank you, Mr. Chairman and I thank the minister for that answer.
We had a situation just after Christmas; I won’t bring up the case in detail, but the patient was being treated for an earache, apparently, over three to four days before he was actually medically evacuated.
The medical team that came up from Yellowknife determined that he had suffered from an aneurism, so he was medically evacuated directly to Edmonton, where he received immediate surgery, was put into a magnetic resonance imaging, and was operated on.
I asked a question the other day in the House: does the department investigate or do follow-up reports on situations in hospitals or community health centres where patients are diagnosed, just to make sure that the diagnoses was correct or incorrect and make recommendations to improve the diagnoses?
These are very serious matters, and the nurses and the doctors don’t want to see people suffering, and they value the patients’ lives.
I have worked with them, but I will let my deputy, Mr. Blais respond to that.
The answer to that is, yes.
Since my arrival here, we have investigated a number of cases and all of the professional practice unit out of Kugluktuk is to do just that; to review any incidents that’s out of the ordinary.
We also have a committee, a physician committee with other people on it that look at all infant deaths as well, so we look at all of that.
So, there’s a committee that looks at that on an ongoing basis, every death is examined closely.
We are currently in the process and I guess with Care Closer to Home Strategy, we’re enhancing that with what I call a Quality Risk Management Coordinator for all of Nunavut so that the practice and the reporting systems are going to be much more robust.
The expectation will be very different.
All of these cases will be coming to a single source and we’ll be doing that for the purpose of looking at how we can improve the system.
A lot of that is because we have turnover rates that are very high in Nunavut.
I can say that for sure.
It’s one of the flags that we have identified.
The other thing is the lack of ongoing training.
There are two issues that I can say without question is that all of these reviews seem to be pretty consistent.
We are tracking.
We are improving the system currently and we have a pretty good idea where the major opportunities for improvements are including education and training and also making sure that we reduce our turnover rates.
Those are probably our two biggest risks.
It’s good to know that you follow up on all of these medical diagnoses because we can learn from good diagnosis and poor diagnosis and help future patients.
I wanted to ask you about the relationship between the Regional Health Departments and the Health Centres.
Who exactly is in charge when it comes to Health Centres?
Is there a nurse in charge or a doctor in charge or is it administrated over at the health department, if you could answer that, please.
That’s a very good question and I want a good response for the member so I will ask my Mr. Blais to respond to that question.
The rule of thumb is that the Nurse in Charge is the nurse in charge.
That’s what they’re called and that’s what we expect of them.
There are times, if we have a person that is more qualified than the nurse.
For example, on the mental health issues, we may have a Director of Mental Health in the region that would have more knowledge about that particular area and therefore that person, if called would then have the authority to make directive decisions to happen.
So, it depends on whether a certain expertise is available.
If we have a physician working in the community, that would be another case where the physician, even if there was a nurse in charge, that governs or manages the care of individuals coming through that Health Centre, the physician then, being the highest trained person in that particular field would have authority over that decision as well.
So, there is no black and white answer when we’re asking those questions but for the most part I think the Nurse in Charge tends to kind of coordinate most of the activity except where a certain specialist or specialty is required then the person we call to would have the authority to make a decision in regards to that case.
I would say that 100 percent of the time that is always done in consultation with the nurse as well.
So what you’re telling me is that non-medical people do not interfere with the medical professionals or making medical decisions on whether to treat the patients.
Is that what you’re telling me Mr. Blais?
I think Mr. Blais is being asked a question so I’ll get him to respond.
Again, there is no black and white answer to that. I have been CEO for at least 25 years and there are times when I have had to intervene.
I have intervened here.
There are times when if there is a sense that there may a risk, I think that the Executive Director would have the ability to make a decision for an action to occur.
That privilege is rarely used but it can be used if necessary.
Ultimately, in this case, the Deputy Minister is responsible for quality as well as the Medical Director.
So, we have the ability to step in, and have done so since I’ve been here, to ensure that something that needs to be dealt with, the quality risk management is dealt with.
So, again, it’s a black and white answer.
There are times when we do intervene.
Chairman: Thank you. Everyone who lives in Nunavut in our communities they know that the nurse in charge is in charge of the community’s health program.
These questions, I think they’re quite irrelevant.
If you want to know what is available in the program we go to the Nurses in Charge. Mr. Peterson.
I, as a patient, if I’m being treated, I want to be confident that I myself, or my relatives and my constituents are receiving treatment and that the decisions that are being are made with a view that my treatment or the treatment of the other people is first and foremost, is not related to some issue back at the Health Department.
Time is valuable and seconds count in medical emergencies.
So, I’m hoping that the minister and Mr. Blais will ensure that that thought is kept paramount in the minds of your administrators.
It’s not so much the medical professionals that I’m worried about, it’s the administrators who like to control a lot of happening going with the decision making that goes on out there.
I wanted to follow up on agency nurses.
I was taking some notes here.
Could the minister or Mr. Blais tell us how many nurses there are in Nunavut and give me a rough breakdown of total in Nunavut, total indeterminate, total agency and total that are on contract.
All together, the total number is 169 nurses but sometimes not all the positions are filled.
Sometimes there are nurses that come in and out for a short time.
Could the Minister break that total down by full indeterminate positions and then agency nurses and then contract nurses.
Do you have a break down figure on what he is requesting?
I have them with me and I’ll give them to Mr. Blais because I think it will be faster for Mr. Blais to respond to that question.
Currently, this varies from day to day and from week to week.
I can only give you what looked like two weeks ago.
We had 169 indeterminate positions.
We had about 71 of those who were filled with both agency nurses in CSA in the following; I believe we had about 21 vacant positions that weren’t filled, but we were recruiting four.
We had approximately 25 agency nurses filling some of those vacancies and 30 or so casual nurses under CSA.
Again, if I looked at it this week that number would be slightly different I would presume at this point in time.
I would like to thank Mr. Blais for that information.
Have you ever had occasion to fire a nurse and banish the nurse from working in Nunavut for any inappropriate work habits in Nunavut.
Hon. Levinia Brown: Thank you, Mr. Chairman. I will my Deputy Minister, Mr. Blais to respond to this question because it’s under operational.
I would not want to respond to that question because if I did, then it might identify a person in Nunavut because it is something that may or may not happen.
I don’t believe that that is an appropriate question to be asked in this forum in this point in time.
I appreciate Mr. Blais’ sensitivity to that.
There are 21 vacancies in positions and you have to hire nurses from overseas.
I am aware of a nurse who doesn’t work in Nunavut now, and apparently that nurse has been banished from working in Nunavut.
We can’t get a reason why.
It seems to me that we have shortages in nurses and we have nurses that want to work up here and this particular nurse, I am sure Mr. Blais knows who I am talking about, she has worked in Nunavut for 15 or 20 years all over the north.
I am wondering why a nurse with that background and skills and experience would not be able to work in Nunavut, but yet she would be able to work in the Northwest Territories, where she presently works.
Again, it is an operational issue and I will ask the Deputy Minister to respond to that question.
I am unable to answer that.
I think that issues dealing with employees and employers are confidential and it is not a question that I would be able to answer to any individual, in regards to an employee of the department.
We will go on to the next person.
It’s not really a question, but I will explain it.
In regards to the RFP, I would like to make a few comments and some questions on that.
I can understand it a little bit but it doesn’t seem to have too much strength to it.
As far as I can see, they are requesting for providers.
There should be more done if there is a RFP from the airlines.
How did you advertise it?
How far did you advertise it?
Do you do advertising just in Nunavut?
Or do you it to the southern centres?
Or do you try to request for an airline from the region?
I will get Mr. Whitworth to respond to that question.
Mr. Whitworth: Thank you, Mr. Chairman. I am going to make an assumption here that the member is talking about the RFP regarding medical travel.
Normally we follow the contracting procedures set out by the Government of Nunavut through the Department of Community and Government Services, which we advertise in the north.
For a service like this it would probably be mostly in the north.
If it’s in reference to other RFP’s in general, it depends on the service, we will advertise in the north and in the southern papers depending on the services that we are looking for.
I guess you have to state what kinds of services that you want from those individuals that will be providing the services.
I guess you allow people that want to respond to the RFP to respond to your department.
In the RFP package, there are forms that have to be filled.
Are there any guidelines whereby those airlines have to follow the Ministry of Transport’s guidelines as well.
Is that included in the RFP that they have to follow the Ministry of Transport’s guidelines and stuff?
I will get Mr. Whitworth to respond to that question as well.
Normally in most of our RFP’s, especially for airline travel, yes, you’re right, we do request certain services in the proposal and Transport Canada is one of the criteria.
In our current contracts that we have in place, it’s prevalent throughout the contract, it makes reference to Transport Canada or the department of transportation rules and regulations for flying.
It seems like we have ongoing problems.
We have the Transport Canada guidelines.
Even though that’s the case, there are the contractors who seem to be doing what ever they want.
Ever since we started we have seen the regulations of Transport Canada, and it seems like there aren’t enough details added on the part of the government.
I’m not quite sure where the problem is but you said that we’re going to be putting out an RFP in the near future.
The transport regulations never seem to be adhered to by the contractors.
Like, it states that you have to have toilet facilities if it’s going to be over an hour.
There has to be hot or cold meals after a certain number of kilometers.
It seems like the contractors are not following the provisions.
Is it possible for your department to have a meeting with the committee?
What I’ve been hearing in the House is that there is an ongoing problem and the people out there in our constituencies aren’t kept informed.
I don’t think that it would be right if we didn’t know the details and come up with a solution.
We have people in our ridings that arrive to their destination barely making it to the washroom.
If you award a contract to an airline that doesn’t have washroom facilities, then they’re not following the rules and they will have to have proper facilities.
As a contractor, they will have to follow the regulations of Transport Canada.
So, my question again, is it possible for your department to provide a copy of the contract or the guidelines to the Committee so that we can review it and make sure that we will be able to contract an airline that will follow through with the guidelines and the regulations.
Chairman: Minister Brown.
I feel very strongly about the comments made by the member.
Of course, we have to work together as we are all elected individuals.
Following my authority I will do a thorough review and investigate the discrepancies and find out where we can make improvements.
We are improving at a slow pace, but I will have Mr. Whitworth supplement my response.
Just in the final response for the minister, the supplementary to the minister.
I don’t feel we could release some of the specifics or details in the RFP that were currently putting together, that we can release.
It clearly articulates what services we are looking, what types of cabin configuration, what types of planes, it’s quite detailed, so we can release that to the members, but as far as specific contracts with other airlines, I’m not 100 percent sure if we have the authority to release that.
I mentioning I want to look at the dollar figures but I’m sure there has to be a back up plan, in case of an emergency and that plane is not available.
Again they will have to be another back up plan just in case back up plan A is not available.
There would be one airline being engaged to provide the service then they would be two back up planes.
I don’t want to see any dollar figures or anything like that, I just wanted to see the guidelines or the provisions that will be used to provide what type of service they would require.
I would make sure that the Transport Canada regulations are being adhered to.
What I want to see is the type of planes, the configurations in every detail that is required by your department.
I believe that, we as the Member of the Legislative Assembly or the Committee of the Whole should be able to see those.
If you understood me correctly, is it possible for us to see those specifics.
After the response, we’ll take a brief break.
I could agree to provide the specifics.
Chairman (interpretation): Thank you. We are breaking for half an hour.
>>Committee recessed at 18:14 and resumed at 18:44
We are on page H-13, and the next person I have on my list is Mr. Curley.
I had another question (interpretation ends) I wasn’t really too sure exactly what the procedure was with respect to the medical evacuation charters’ requirement.
When the contract is not in place, would the minister or her officials tell me whether or not there still has to be an aircraft on 24-hour standby?
I will have Mr. Whitworth respond to the question.
If we are talking about a specific region, like for example, the Kivalliq Region, yes, in those service contracts, we pay a base fee for those planes to be dedicated to the Health and Social Services for medivac purposes.
Yes, my question is that if prior to the contract, obviously, you never really would not know exactly when the medivac would be required.
So even before the contract was signed, was there a requirement that one or the following of the aircraft, whichever they may be, that there was a requirement for one of them or some of them to be on standby?
If not, how did it work for a number of years when there was no contract in place?
I am going to direct it to Mr. Whitworth.
If we are talking again just the medivac contract for Kivalliq, it’s hard for me to answer that because it was prior of my time, but just based on my knowledge, a lot of it, there was mainly one provider for many years that was doing a lot of the medivacs and then there were two that came on.
That’s my understanding, and then there was no real contract in place that I was aware of prior to the ones that we just put in place.
Well the government’s procedures and policies are for perpetuity, really pretty well unless they are changed by a major policy announcement.
So I could not say to you that I was in the House two years ago, so I couldn’t ask her questions, which would be irresponsible of me to break that link.
The government procedures are all linked with policies.
So it wasn’t too long ago, a year and a half ago, there was an old contract for medical evacuation services in the Kivalliq.
So was there a requirement for one or more of these aircraft to be on alert or standby or have a team in place, and what was the policy?
Did you just pick something up in the air and say: ‘We want you to fly to Coral Harbour there’s someone that needs to be medivaced.’ How did it work in a case like this before the contract was signed?
I would like Mr. Blais to respond to the question.
I am unable to answer that question either in terms of specifics.
The only thing I can say is that to me, there were several suppliers or providers of medivacs at that time.
Hence why the reason for the KPMG Report, which looked at medivacs in detail and made some very serious recommendations to our department, which majority of them as it relates to medivacs and scheduled medical travel have been implemented.
So hence the policy of government has changed since that time, but the fact that we have implemented many of the recommendations that have been identified in the KPMG Report and are reflected today in the contracts themselves.
I know the minister has attempted to say to me that now we have all of the procedures that are working properly and everything else.
There was never a, for instance, a fixed standby monthly fare prior to the contract being signed.
Is that what I am hearing you say that there was never such thing as a standby charter fare that was required?
They just had to wait and hope that somebody gives them a call that they were not never in the life of any, that there were no procedures in place, that they were just free for all and they sort of remain and hope that one of you are going to give them call and say, fly to Repulse Bay.
I know a little bit about how it went in the Keewatin region.
When I was a member of the Health Board and from the mid 90’s, I think they contacted Keewatin Air to provide the medical services to the south and some of them use Calm Air.
I remember those days when they had a contract, but from 1997, I can’t respond from then on.
I am trying to answer from what I remember and what I know, but there used to be a contract to provide medical services.
It didn’t answer my question.
The question was really quite specific.
The Minister of Energy may be tempted to respond to that question, but the question is really for the minister and her team.
That there was never a shared stand-by arrangement when that contract was not in place.
It was never a factor.
Is that what I am hearing you say; the minister and her officials?
I will have Mr. Blais respond to the question because he has been there longer.
I wasn’t here during that time so I don’t have a lot of knowledge on that.
My understanding that there were no base fees established at that time.
So if that is the question that has been asked, that would be my best understanding of what was taking place at that time.
I wasn’t here either but I pretty much can follow what was the practice; the policy was different.
There was no policy in place.
The practice and procedures, we all know of course as to how they operate.
What I am trying to get at in the midstream they now change and say oh yes, there is now stand-by aircraft policy so that current aircrafts can charge you a monthly fee, whether they are going to operate or not.
What you are telling me is that to say to this House that you never had that policy and procedure in place.