Does the Minister wish to bring in the witnesses?

Yes, I would, Mr. Chairman. Thank you.

Proceed with the witnesses, please. For the record, Mr. Minister, would you introduce the witnesses to the committee.

Thank you, Mr. Chairman. On my left is Dr. David Kinloch, the deputy minister of Health, on my right is Darrell Bower who is the director of finance for the Department of Health. Thank you, Mr. Chairman.

Line By Line

Administration

Thank you. When we concluded yesterday on the review of the 1994-95 main estimates for the Department of Health we were on page 14-10. Total O and M, $11.399 million. Mr. Gargan.

Thank you, Mr. Chairman. With regard to administration, have we been able to resolve the whole issue of the denturist thing? I'm on health legislation and policy. It says that there is the Dental Professions Act and you also have a situation where a person operating...I made numerous statements about it, but I haven't had any indication that that issue has been resolved.

Thank you. Minister of Finance.

Thank you, Mr. Chairman. The issue is being dealt with by way of a legislative proposal that is being drafted for Cabinet review. As soon as it has been reviewed, legislation will be drafted and presented to this House. Thank you, Mr. Chairman.

Thank you. Administration, Mr. Gargan.

Mr. Chairman, under Bill C-31, are all the people who have been reinstated as status people being addressed? Are you keeping a record of people? I believe the Government Leader received letters from people who are still having problems. Maybe it is because their health card doesn't indicate that they are status.

Thank you. The honourable Minister.

Mr. Chairman, the Department of Indian Affairs issues identification to those people who are status. We use their identification cards to identify status Indians in the Northwest Territories for the purposes of health.

Thank you. Administration. The honourable Member for Deh Cho.

Under C-31, are status people's children included? In one letter to the Premier, there was a case that when a women's daughter was born and her health insurance benefits were filed, they didn't give the information that she was status, under C-31. I guess that has led to a lot of problems with her receiving health benefits. I don't presume this is an isolated incident. I was wondering how it is being addressed.

Mr. Minister.

Mr. Chairman, as I said, if DIAND tells us that this person is status or has received his or her status back by way of Bill C-31, then we treat them as a status person. Now, if there are problems, I'm quite prepared to have someone in the department go the Department of Indian Affairs to find out the situation with particular people and find out how the problem can be solved. If there are problems of that nature, where part of the family is covered and some aren't, then we'll gladly take up the case with DIAND, Mr. Chairman. Thank you.

Thank you. Administration, total O and M, $11.399 million. Mr. Dent.

Qujannamiik. Mr. Minister.

Mr. Chairman, there are 5.5 PYs in that area. Thank you.

Thank you. Mr. Dent.

Mr. Minister.

Mr. Chairman, not all the positions have been filled for a great length of time. At the present time, there are two vacancies. There was one vacancy filled just last December, I believe, and we've just advertised for another person for Nunavut. That position is presently vacant. Not all the positions are filled. The majority of these people do respond to policy situations, although they do some work, as well, in responding to matters raised in the Legislative Assembly or in committee where they cross policy lines.

I've drawn these concerns to the attention of the department and I believe today I'll receive the review of the department. I've asked for that concern to be addressed when we look at whether there need to be changes in the department. Thank you, Mr. Chairman.

Thank you. Administration. Mr. Dent.

Thank you. Mr. Minister.

Mr. Chairman, we were at a recent conference on health in Ottawa. I think everybody around the table, the provinces, the Yukon, ourselves and the federal government, have some feeling of helplessness about what to do about HIV and, ultimately, AIDS. In some way, I was relieved because I thought it was just us, in the Northwest Territories, but everybody is having a problem with how to deal with it. We're not back to square one, but we're certainly taking an update of the HIV strategy this year. We're going to update the HIV infection rate studies and we are going to provide communities with some money to do their own initiatives. We will do some case management assistance to boards, ongoing education for health professionals and the public. We will be looking at the whole issue of community health and nursing. In particular, I will be interested in what these people, who we are asking to assist us, come up with as a way to get the message across.

I have spoken in Hay River to two large groups of people and said to them, if there is any way that you can advise us about what we should be doing about AIDS and the prevention of AIDS, please tell us. I haven't received any comments back from those people yet. People just say it is like a bullet that is never going to hit them. Young people are saying it is never going to be me. It won't happen to me. It only happens to some other kind of people. Unfortunately, from the latest studies that are coming out of the national AIDS secretariat for Health Canada, this thing is still on the increase. It isn't a bullet that everybody can dodge. It isn't somebody else's problem. It is all our problems because, if it doesn't get you, your family or community physically, it will eventually get us all fiscally. The cost of looking after these people is going to be enormous for this country.

I have probably gone on longer than I should, but I am hoping that we will come up with an update of the strategy and some suggestions about how we can go out there and get the message across. We have booklets dealing with safer sex and so forth, but we really need to get some idea from people about how they believe we should be getting that message across about this disease. Thank you, Mr. Chairman.

Thank you. Administration. The honourable Member for Yellowknife Frame Lake, Mr. Dent.

Thank you. The honourable Minister of Health.

Mr. Chairman, we had some $335,000 last year. Some of it was for one-time funding. We did an educational workshop for 200 Health staff. We had the AIDS hotline operating from 8:30 am to 5:00 pm and received 350 calls. We did the television program, along with Education. Again, we had $60,000 for special community projects and $50,000 for board initiatives. We did the HIV/AIDS manual for health professionals update and sexually transmitted diseases control project in the Kitikmeot and Mackenzie. Some of those are one-time shots. We have, this year, $185,000 and ongoing. That will maintain the community initiatives and complete the sexually transmitted diseases control project in the Mackenzie. It will continue with the case management assistance and ongoing education for health professionals and the public. Thank you, Mr. Chairman.

Thank you. Administration, total O & M, $11.399 million. Mr. Dent.

Thank you. Mr. Minister.

Mr. Chairman, we are providing financial assistance to AIDS Yellowknife in 1993-94. We will certainly work with them again this year. I think it needs more of these kinds of groups that have an interest to get out there and beat the drum and sell the message. I think it pays us to support them. We have also recently paid for an elder to go from Hay River to an aboriginal AIDS awareness conference in Edmonton. I think that there are groups of people who are beginning to get involved in what can be done in this particular area. We will give them as much support as possible, Mr. Chairman. Thank you.

Thank you. Mr. Patterson.

Thank you, Mr. Chairman. Further on the AIDS issue, I know there was another funeral in Iqaluit last week of a young Inuk victim of AIDS. We are increasingly aware of this deadly disease. It seems to me that when we had the discussion in committee of the whole with Dr. Gilchrist on this issue last year, there were some very good suggestions from MLAs about more aggressive approaches that the department might take in its AIDS strategy. I specifically recall suggesting -- and I think there were suggestions of that nature from other Members -- that it is certainly not enough to do advertising in pamphlets and the like and it is not enough to make condoms available in health centres. I think the specific suggestion was made -- and I got this idea from young people I spoke to in my own constituency at the Baffin leaders' youth conference -- to make condoms available in schools, not just in school washrooms, but in school classrooms and in places where kids hang out and can easily obtain them. This suggestion came from kids, themselves.

I wonder if the Minister could tell me if the department has been taking any measures to make condoms more easily available, particularly to young people.

The honourable Minister.

Mr. Chairman, you then get into the sensitive area of educational professionals and parents. We've already had some parents complain about giving out prophylactics at health centres and just having them openly on display. There are people who would say that by actually going into schools and putting them on the teachers' desks and putting them out more publicly than they are right now in washrooms, we're promoting sexual contact for children.

I've been hesitant to do that kind of thing. Being a parent myself and talking to other parents, I know that there would be people who would say this is not right. I respect the position that the Member is putting forward and I'd be perfectly willing to place the issue before the education boards, but that's as far as I would go in asking boards if they think it is a good idea. Thank you, Mr. Chairman.

Mr. Patterson.

Thank you, Mr. Chairman. I think that is precisely what I would ask the Minister to do. I acknowledge that there is some controversy surrounding this issue, but I believe the duly elected authorities' responsible for schools would look at the issue seriously. It may be that some communities will take different positions than others. I would specifically like to request the Minister -- at least in the Baffin region where I believe there would be a progressive attitude on this issue in light of the visibly afflicted people in the region -- to encourage his officials to put the offer at least to school authorities. I acknowledge that they would have to make the decision. They may have to consult parents, but I would like to suggest that the issue should be put to school boards that are willing to consider it. The offer should be made.

Qujannamiik. Mr. Minister.

Mr. Chairman, I will commit to write to the Minister of Education and ask him to contact the boards and see what their positions would be, individually. Thank you, Mr. Chairman.

Mr. Dent.

Thank you. Mr. Minister.

The chairman of the Financial Management Board is looking at that at the present time, Mr. Chairman, and I expect to have something on my desk very quickly. Thank you.

Thank you. Administration, total O and M, $11.399 million.

Agreed.

---Agreed

Supplementary Health Programs

Thank you. Next page, supplementary health programs, total O and M, $16.559 million.

Agreed.

---Agreed

Out Of Territories Hospitals

Qujannamiik. Out of territories hospitals, total O and M, $20.105 million. Mr. Dent.

Qujannamiik. Mr. Minister.

Mr. Chairman, we knew in advance that the cuts were going to be made at the Royal Alexandra Hospital. We're reasonably sure that it is not going to affect patient care, but I would remind the Members that we have not yet concluded the formal arrangement with the Royal Alexandra. Obviously, that will be part of the formal negotiations, that if care is going to be cut back and cut back, it is going to be of great concern to us. We will be monitoring that. But, I would point out that it seems it is not just one particular facility in Edmonton, it is affecting all of them. If they're all cut back in staff and if it does affect patient care, then we don't have much choice in where to go unless you want to go out of province. I was in Calgary recently and I was told the same thing about Calgary.

As I say, when we get further into the formal negotiations with the Royal Alexandra, we will ensure that this is one of the priorities on our list. That is that there is adequate patient care, particularly for the patients from the Northwest Territories. Thank you, Mr. Chairman.

Thank you, Mr. Minister. Out of territories hospitals, total O and M, $20,105 million. Agreed?

Agreed.

---Agreed

Health And Hospital Boards

Health and hospital boards, total O and M, $92.446 million. Mr. Dent.

Merci, Monsieur. Mr. Minister.

Thank you, Mr. Chairman. There is a possibility that we may in some communities be suggesting an increase in the number of CHRs. That would be to take on the environmental aspect of community health. The possibilities are there for us to maybe increase the number of CHRs, and ask them to take on somewhat new responsibilities. Although they would have the same basic training as other CHRs, they would be additionally trained in the environmental aspect of community health. Thank you, Mr. Chairman.

Health and hospital boards. Mr. Dent.

Qujannamiik. Mr. Minister.

Mr. Chairman, before the last training program there were 15 CHR positions vacant. So we know fairly well before, the number of vacancies. If we do see before the end of the year that we still have vacancies, or we see in the middle of the summer that we have vacancies, and if we're able to look at the environmental aspect as well, we'll certainly try to put on another program before the end of the year. Thank you, Mr. Chairman.

Thank you. Health and hospital boards. Mr. Dent.

Minister of Health.

Thank you. The honourable Member for Yellowknife Frame Lake.

Thank you. The honourable Minister of Health.

Mr. Chairman, there have been examinations for discovery, I think the lawyers term it. Mr. Bower has spent some time in Ottawa being cross-examined. The court case is still proceeding. Although, at the last meeting with Mr. Irwin that Mr. Todd and I attended three weeks ago, we did reiterate again our plan to try and settle this dispute out of court. To that end, we're developing a position at the present time. The federal government is aware that we're developing a position. We already know who the contacts are going to be. Sometime within the next six weeks we'll get those people together and discuss this issue to see if we can achieve an out of court settlement. Thank you, Mr. Chairman.

Thank you, Mr. Minister. Health and hospital boards, total O and M, $92,446 million. Agreed?

Agreed.

---Agreed

Medical Care Plan

Qujannamiik. Medical care plan, total O and M, $19.921 million. Agreed?

Agreed.

---Agreed

Medical Travel

Thank you very much. Medical travel, total O and M, $17.578 million. Mr. Dent.

Thank you. Mr. Minister.

Yes, I believe at the present time that we can meet that drop, Mr. Chairman. I think it's a reasonable goal. Thank you.

Thank you very much. Medical travel. Mr. Dent.

The honourable Minister of Health.

Thank you, Mr. Chairman. We're hoping that our medevac air carrier standards, the revised medical and non-medical escort policies, will continue to work for us. We're hoping, as I said yesterday, to get involved in central dispatching for medevacs. Mr. Chairman, we're not utilizing those airplanes as well as we should. Just last week we had a plane go all the way from Inuvik to Edmonton. In this instance, it probably was the wrong kind of plane. Because of the timing when it got there it was so late that the physicians, staff and pilots had to stay overnight and come back the next day. Sometimes there is an opportunity for us to back-haul patients from down south. That includes Montreal when we are serving Baffin or Winnipeg when we are talking about Keewatin. We are not using that back-haul, so we are hoping that we can get some greater efficiencies there and cut the costs that way.

We are looking at the strengthening of regional accountability for travel. We are going to continue to refine the nearest centre policy and expand advanced scheduling of medical travel. On the area of advance scheduling, if we are dealing with one particular referral centre in Edmonton, particularly for the larger population, which is in the western Arctic and Kitikmeot, then we can do better scheduling of medical travel and hence get some savings in that regard as well. All of those things we hope will contribute to reducing this particular activity. Thank you, Mr. Chairman.

Medical travel, total O & M, $17.578 million. Agreed?

Agreed.

---Agreed

Thank you. Details of grants and contributions. Contributions, $89.375 million. Agreed?

Agreed.

---Agreed

Thank you. Grants and contributions, $89.375 million. Agreed?

Agreed.

---Agreed

Thank you. Information item, health and hospital boards on page 14-17. There is another information item on page 14-18. On the next page 14-19, we have another information item on health and hospital boards. On page 14-20, information item, health and hospital boards continues. On page 14-21, information item on cost-sharing dispute with DIAND. Information item on page 14-22, memorandum of understanding project. Information item on page 14-23, memorandum of understanding project continues. On page 14-24, detail of work performed on behalf of third parties. It continues on the next page and also on page 14-26. Total department, $330,000. Agreed?

Agreed.

---Agreed

Thank you. Back to page 14-9, program summary. Mr. Antoine.

Thank you, Mr. Chairman. Before we approve the total O & M, I wanted to mention a couple of things on health. First of all, in the discussion on the AIDS situation, in my constituency, recently in the last three weeks, there was a tour made by an HIV positive young man and a registered nurse from Vancouver who were sponsored by the youth centre and the community of Fort Liard to go into the communities to talk about AIDS awareness. I think some of the funding came from the Department of Health. I think it was the best way that the department was able to spend this kind of money in the awareness area because there has been some real positive feedback from the communities that they did visit. They visited Fort Liard, Fort Simpson, Jean Marie River, Nahanni Butte and Trout Lake. In each case, people were very tense when they were coming into a community, but as the young fellow and nurse explained the technical nature, the cost of this disease and so forth, it was a very positive reception.

I have been told by members of my family who attended these hearings that they got a great deal out of it and it was the first time they saw somebody with this disease and someone talking to them about what kind of disease it is and their experience. Many of the younger people got a great deal out of it. There is a request to have more of this type of awareness, rather than having posters, television and radio ads and so forth. That helps too, but if they actually have a face-to-face meeting with people who have a first-hand awareness of these kinds of diseases, they become more aware, such as our younger people, elders and adults in the communities. I wanted to mention that this was money well spent in the whole awareness area. I want to make the department aware that if we could do more of this type of awareness, I think it could be well done.

I was told that the Deh Cho Tribal Council also had been working with the federal Department of Health and Welfare to acquire more funds to do a more intensive AIDS awareness program in my constituency. They are pursuing it on their own and acquiring funding from the federal agency to try to provide more awareness in that area. They see it as a very serious threat, health-wise, for people in the constituency and throughout the whole north.

Recently, I made a Member's statement about a retiring health person in Fort Simpson, Maureen McEwan. She has been with us for about 18 of the 20 years that she has spent in the north. People in the community feel that once she goes we are going to be losing a valuable asset to the health service in our area, because she has been there so long. The doctors come and go, but she was there the whole time. She is very dedicated to her work. We are going to be losing somebody there. Hopefully, we get a replacement who will be equal in her dedication and commitment to the health field. I just wanted to mention these two items with regard to health. Thank you.

Thank you. Mr. Minister.

Mr. Chairman, I think what Mr. Antoine has been saying about AIDS is precisely what we believe as well. Governments have failed with the posters, handouts, television ads and so forth. That is why I am saying that suggestions from people in communities is where we should be going. Just so that Members are aware of what happened in 1993-94 in these community areas, in Rankin Inlet there was a theatre project. The AIDS student, Arctic College and Rankin Inlet put it on. There was a three-day interactive training workshop for youth. The youth then developed and performed a play on HIV and AIDS issues. In Lake Harbour there was a project called Making AIDS Real. The Kingmirut Asapi Committee put it on and a person living with HIV was invited to the community to participate in school and public discussions.

In Cape Dorset, a similar thing occurred, but this time the community chose to do a logo contest. The winning logo was printed on clothing as promotional material. As Mr. Antoine mentioned, there were activities in Fort Liard, Fort Simpson, the Deh Cho Regional Council and outlying communities, and, of course, AIDS Yellowknife that I mentioned. There was also a cost of living tour put on by the Northern Arts and Cultural Centre in Yellowknife which we supported. There is also community HIV/AIDS awareness funded by 1994-95 dollars in Arctic Bay. That will be a poster contest again. I think Mr. Antoine is correct that when the community gets involved, people take more notice. I appreciate his comments, Mr. Chairman. Thank you.

Thank you, very much. Mr. Patterson.

Thank you, Mr. Chairman. I may be behind with this question, but I would be grateful if the Minister could give me a status report on the hospital health planning for the Baffin region. How is it progressing? Is it on target? Thank you.

Thank you. Mr. Minister.

Mr. Chairman, I believe that they're through the third draft right now and that's for the profiles. There have been ten communities consulted. The last I heard is that tenders have been called for a planning consultant. It's coming along in the Baffin, Mr. Chairman. Thank you.

Program summary for Health, total O and M, $178.008 million. Mr. Patterson.

I have just one question that I overlooked asking earlier, Mr. Chairman. Could I ask the Minister how is the health insurance decentralization operation going in Inuvik and Rankin? Is it running smoothly? Are these services able to do the monitoring of positions and billings that I believe the department had wanted to do to ensure value for money? How is it working now that these facilities are up and running?

Qujannamiik. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, we got Inuvik off the ground fairly quickly and it went smoothest, there's no question about that. It is running well, it is up and standing on its own. In Rankin Inlet we had a few setbacks with training and so forth, but eventually we did get going over there. Now we've run into another setback, and that is the manager has had a coronary. So, we have a setback in Rankin Inlet. We're still supporting it, but I'm sure it will come. Thank you, Mr. Chairman.

Thank you. Mr. Patterson.

Mr. Chairman, the other thing I asked about is that I understood that the department, as part of its cost-savings measures, was going to be paying closer attention to the physicians' billings. They were going to review, screen, and monitor the billings to ensure that there were no anomalies, shall we say. Has that strategy of the department been implemented, even while the health billing operations have been decentralized? Thank you.

Mr. Minister.

Mr. Chairman, for the most part, physicians in the Northwest Territories have been responsible and have been cooperative with us. With regard to health billings, our aim right now is to set up those two programs in Inuvik and Rankin. Then, we'll look into the business of either auditing, having less fees for service or more people on staff, et cetera, et cetera. Are we going in and auditing the books right now? No, we're not, Mr. Chairman. But, for the most part we are getting, from most physicians, responsible billing. Where there are problems, and we believe there are problems, we will use one of those methods to solve the problem, either close monitoring and auditing, or having less for fee for service delivered to us. Thank you, Mr. Chairman.

Thank you. Program summary, total O and M, $178.008 million.

Agreed.

---Agreed

Thank you. Does the committee agree that the Department of Health is concluded?

Agreed.

---Agreed

On behalf of the committee, I would like to thank the honourable Minister for Health and his witnesses for appearing before the committee. Thank you very much.

Thank you, Mr. Chairman.

Does the committee agree that the details of 1994-95 are concluded?

Agreed.

---Agreed