Thank you, Mrs. Groenewegen. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, being from a smaller community I appreciate the Member's concern. It's something that we struggled with as we did this document. Very clearly there has been a change in how services are delivered, as the Member has pointed out. All doctors don't do surgery anymore. They may do minor surgery, but even things like appendicitis, unless it's an emergency they are shipped out. There are liability issues. There's cost of having more than one location to do surgery. There's the use, the numbers that would warrant in terms of cost-effectiveness of being able to sustain a service where there's a very low usage. Those are the decisions we had to look at. As the Member knows, the constant pressure of more problems than there are resources, but there is still clearly a need in the area of the things we talked about and being more effective on the public health side. We're moving towards rehabilitation teams that we want to have set up that do occupational therapy and audiology and physiotherapy, speech pathology. We want to move those out to the regions. There definitely has been a change in service delivery over the years.

As the Member will see in the next few weeks when the document is presented to them, we have attempted to address that, because the occupancy numbers, especially on the acute care side in the Northwest Territories were very low. We had a significant surplus of acute care beds in Yellowknife, Fort Smith and Hay River and, to a lesser extent, Inuvik, because they built the new hospital anticipating the drop in acute care requirement and didn't build as many acute care beds as they formally had. It's a significant issue. Thank you.

Thank you, Mr. Miltenberger.

General comments. I have Mr. Pokiak.

Thank you, Madam Chair. I just want to follow up on what Mrs. Groenewegen is talking about. In the smaller communities, it's very difficult with regard to some of the decisions that are made at the local level in the nursing stations. I will give you an example, Madam Chair, of what happened last year and what happened just recently with regard to the decisions the nurses are making with regard to patients. Last year in October, there was a case where there was a young person feeling a lot of pain for about four days. During those four days, Madam Chair, we brought this individual to the local health centre. All they were saying is they had a pulled muscle from playing sports. What happened eventually is after about a week, the nurses in the community sat down and said what is wrong with this young person. It just so happened at that time, Madam Chair, on a weekend, they finally decided to send him to Inuvik. During the pain of this young fellow, he ended up having appendicitis, which eventually burst just when he got to the hospital in Inuvik. Cases like that are very difficult for nurses. How can nurses diagnose things like that when they can't even see there's a problem? It's a concern to the smaller communities.

Another incident I heard about just recently, Madam Chair, is with regard to the same situation where the patient had appendicitis. What happened was they brought the patient to Inuvik with a taxicab that is a medical service. You know, that's a good two-and-a-half hour drive. There is something wrong with people.

The question I had, Madam Chair, is how well versed are the nurse practitioners to diagnose situations like that? They can call the hospital in Inuvik and find out information, but at what point in time can a nurse make decisions with regard to problems a patient might have? Thank you.

Thank you, Mr. Pokiak. Mr. Miltenberger.

Thank you, Madam Chair. The issue of appropriate and right diagnosis in a timely way is a concern and it's a concern as a standard practice in all the facilities. I appreciate the Member's concern and I have heard similar concerns in other jurisdictions too where there are doctors in larger centres. There have been studies done nationally about deaths and misdiagnosis and those types of things. It is an issue that is there and it's a constant concern. The concern that proper care and attention is paid and that you bring your full professional attention to bear at all times.

Nurses who are hired are qualified, registered nurses. If they come from agencies or if they are hired, we look at their resumes and do reference checks. We try to make sure that they are capable. I would point out as well that while the concern of misdiagnosis or missed diagnosis is of concern, we don't want to forget the tremendous amount of appropriate diagnosis provided by service providers. I take the Member's concern and it's something we have to be vigilant about. If there is a significant

enough concern and there are mechanisms for inquires and reviews by medical people who are objective and from another jurisdiction that will come and review things to make sure if there are problems, that we fix them. Thank you.

Thank you, Mr. Miltenberger. Mr. Pokiak.

Thank you, Madam Chair. We do come from small communities, not like Inuvik and Yellowknife and Hay River. The doctor comes about once every six months. That's a long time for some patients if the nurses can't diagnose the problem. It is a big concern in the smaller communities. Granted, like I said earlier, Madam Chair, they can grab a phone and talk to Inuvik if there is a problem, but it's very important that the patient should have access to the right medical care that they require. I just don't happen to see, especially in my region, if something happens and it's misdiagnosed because the government can be liable if something happened like that, just like what happened in this case. The parents probably could have done something with it. Again, I wish the Minister could assure me, Madam Chair. I take it for granted that the nurses who come to the small communities should be qualified and they should have more authority when they do make a diagnosis on whether that person should really be sent to a regional health board, if not even further, say, to Stanton.

Madam Chair, I just want to make sure that the Minister will commit that these people, the nurses in the small communities, are qualified and will make the right diagnosis at the right time and be able to get the assistance the patients require. Thank you, Madam Chair.

Thank you, Mr. Pokiak. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, I agree with the Member and his concerns. We will commit to ensure that we work with authorities in Inuvik to ensure that that is the case. Thank you.

Thank you, Mr. Miltenberger. Mr. Pokiak.

Thank you, Madam Chair. Another issue I would like to touch on briefly has to do with medical services, especially for dental care and an ears, nose and eyes doctor. It takes a while for them to come to the communities. What can the department do to get some of these specialists to the communities more often, especially for doctors or dentists? They are coming to Tuk this week, but they are only there for about four or five days. They are working a good 12-hour day. How can we make sure that some of these specialists can stay a little longer? Thank you.

Thank you, Mr. Pokiak. Mr. Miltenberger.

Madam Chair, the issue of dental services is a chronic problem that we struggle with, especially when it's a service that is basically provided by us on behalf of the federal government, especially for Indian and Inuit people. The dental days are set by them. Scheduling is always an issue. We will continue to work with the federal government trying to get them to increase the amount of service they are providing. It's something we haven't been successful at in any ongoing way. We've had some short-term funding to try to deal with backlogs with dental surgery and such through negotiations, but the federal government is very slow to move on any improvements to dental services. It's very difficult. It's the most common health issue in the communities when we go there, is the area of dental services. I appreciate the Member's frustration. It is very difficult. Thank you.

Thank you, Mr. Miltenberger. Mr. Pokiak.

Thank you, Madam Chair. I would just like to make a quick comment. I know my colleague Ms. Lee touched on this earlier but I would like to pursue it a little further with regard to the new funding that's coming from the federal government. There's $150 million. I thought when the discussions were taking place that they identified certain areas like medical travel and long-term health care. I guess the question is with a few subjects like that that they have already identified, why is it taking so long for this money to come forward? Thank you, Madam Chair.

Thank you, Mr. Pokiak. Mr. Miltenberger.

Thank you, Madam Chair. The Member is correct; there were three major areas that the money was identified for, the key being what would be acceptable for the two parties or all the parties involved in terms of usage. For example, we are proposing in some of the initiatives we would like to see funded to basically upgrade our infrastructure to provide service to dementia, long-term care, those types of things. The federal government normally has a great reluctance to see money spent on capital projects when they see it as designated for program use. So we are trying to negotiate with them to make sure that we have the flexibility to meet the same needs, but through the way that is most appropriate for us.

In the area of medical travel, what we have done is we didn't move ahead with the increase to the co-payment, which was initially on the list for reductions for the department. We didn't move on that. So in some cases, we've already made the decision to put the money back. We've left the funding for the third year of the alcohol and drug strategy. We are going to move on that and when the money finally comes in, we hopefully will use that federal money to offset that. It's the same as the issue with the Joe Greenland Centre. That was on the books and that is a facility that's since been deemed necessary. So we are going to offset that by some of the federal money. So we have identified some of the areas where we would like to put the money to use, some we have already moved on, others we haven't. Negotiation with the federal government takes time. Thank you.

Thank you, Mr. Miltenberger. General comments. Detail.

To the detail, committee. Mrs. Groenewegen.

Thank you, Mr. Chairman. I want to make some more general comments, if that's okay.

Mr. Chairman, one of the areas I wanted to touch on is when we talk about health and social statistics for the Northwest Territories -- and this is a fairly broad and general question, but hopefully the Minister can help us out with it - whenever we hear the statistics quoted, everything from alcohol consumed to rates of FAS to teenage pregnancy to STDs, all these statistics, suicides, the Northwest Territories seems to be near the top end on the statistics side on just about everything. Yet in reality, when you look around it seems like there's progress that has been made. As a government, we spend so many millions of dollars trying to address these issues that I guess as an elected person, I find it frustrating and sometimes kind of depressing that we really don't have any good news to hang our hat on that we can go out there and say here is a real result, here is improvement, here is movement in a certain area.

So as to how we quantify if we are being successful or if we are making an impact with all of the resources and energy that we bring to bear on some of these issues, what I would like to ask the Minister to elaborate on a little bit is could we be doing a better job of quantifying our progress, gauging our outcomes on some of the programs and services that we provide in terms of the results? Again, I just never cease to be overwhelmed by how we rank nationally when it comes to many of these social and health indicators. It would be good to have some good news once in awhile. Thank you, Mr. Chairman.