Thank you, Mr. Chair. I just want to ask a question with regard to page 8-9, the revenue summary and the other recoveries. Some of us spoke about the concerns about reciprocal billing when we were doing our general comments. I would like to know specific to reciprocal billings for services for Nunavut and there are two identified there, I think, the physicians and also for hospital services.

We’d expressed concerns because there certainly was previously some difficulty in collecting all the receivables that were owed to this government for services provided to Nunavut residents. I’d like to ask the Minister what this current situation is, whether or not we are still behind in collecting those receivables and what the current situation is in terms of the 2008-2009 budget year. Are we collecting what we should be collecting? If we are in a deficit position, is it from previous years?

Thank you, Ms. Bisaro. Ms. Lee.

Thank you, Mr. Chairman. We are up to date on collecting money and receivables from Nunavut for the current year. As we move forward we have a clear agreement with Nunavut government as to how much and what we charge the Nunavut government for the services we provide. We’ve basically agreed to follow the same billing practices as the rest of the jurisdictions. There is a uniform standard on how hospital and doctor services are to be charged between jurisdictions.

The dispute had been that for a number of years after division there was not a written document between Nunavut and NWT about what we were going to charge. The problem wasn’t so much on the doctor and hospital services, as something like lab tests where the Nunavut government thought that we would charge them a fee. For example, if you were to do a blood test for them, they thought we would charge them for each sample; whereas we thought we should charge them for each test, because you could have one sample from a person but you may have seven different tests. That sort of thing.

I can advise you that since I have learned about this issue in coming into the office, the officials in the department, as well as the management of Stanton, have worked diligently and we feel we have a good basis as we go forward.

We do have outstanding receivables from Nunavut from many previous years that we want to kind of move on from.

Thank you, Ms. Lee. Next on my list is Mr. Krutko.

Thank you, Mr. Chairman. With regard to the issue of hospital care for Inuit and Indians, what does that cover in regard to the $20 million item on the budget?

Thank you, Mr. Chairman. Under our system in Canada, the federal government is responsible for insured services for Indian and Inuit. So hospital services, medical services, doctor services, DIAND is supposed to be responsible for that. The Government of Canada also provides for non-insured health benefits, which is a separate program. That comes under a separate category.

With regard to the federal government providing funding to this government to provide health care services to First Nations people, I note that a number of years ago the hospital in Inuvik was built because of the commitment made by previous health agreements where there were capital items built by the federal government, such as health centres, hospitals, and whatnot. As part of that I assume that hospital care, to me, also includes the cost to run and maintain health centres for First Nations people in First Nations communities. I think that because of the lack of these services being provided and the federal government paying it, I know there’s a situation now in the Yukon where the Auditor General has slammed the Yukon government with regard to the monies they do get for education of First Nation students in the Yukon and where the money’s been expended. I think the same thing could apply here in the Northwest Territories by way of health care funding and the services that aren’t being provided and why not. For me it’s an issue, especially in the smaller communities.

I’d like to ask the Minister again if any of that $20 million for nurses and health care providers in small communities...

The federal government does not fund us for specifically running our health care facilities or programs in the North. The federal government pays us through the transfer payments and CHT funding, then for insured services for Indian and Inuit through DIAND. Then they also cover non-insured health benefits for residents of the Territories who qualify for that and the GNWT is responsible for administering those.

I understand that the Member is passionate about the need to enhance services in small communities.

The government and the department draw funds from the general pot of money. I would say per capita or in any other standard we do spend lots of money providing services to small communities and we do that by providing block funding to different health authorities.

Just on that, if you are providing funds for community programs to the health authorities and they’re not spending it on those programs in those particular communities, if you look at a budget breakdown by community they have items under that breakdown for policing services, municipal services, health care services, and other details of each of those particular line items. Yet the communities are asking me if that money is being spent in this community, where is it being spent and why are we not seeing a nurse or a doctor? Yet those dollars are being spent on my behalf.

From the statement that you just made, you’re saying you give the money to the health boards and it’s up to them to ensure that it goes to providing those services in those communities. So my question is what happens when they don’t provide those services and they have received that money on behalf of this government?

We provide upwards of about $260 million to health authorities to provide health and social services to communities. For the Beaufort-Delta we provide about $42 million-plus a year; Yellowknife authorities get $43 million; and Stanton is obviously the largest body and it receives $97 million now. We know that the financial and operating relationships we have with the authorities are that they’re given block funding and they do move around positions depending on where the vacancies are or some of their operational priorities are. Because we do have, not detached from the government in any way, but semi-independent operations in these authorities with their governing board and they make priority decisions as to how they will spend those funds.

That didn’t help me trying to get an answer out of the question I just asked. What do you do when they don’t spend the money where it’s supposed to be going instead of just running health centres in communities? If you have a budget that tells someone that line item is to run the hospital in Tsiigehtchic and make sure it’s fully staffed and functional, and that you do have the resources to have people on the ground in those health centres providing front-line services, the same thing can apply to mental health workers, alcohol drug workers and whatnot. Every health authority gets money on behalf of this government to provide those services.

Again I’ll ask the question, what do you do when the services are not being provided, knowing that the capital expenditure has been given and those dollars have not been earmarked for the line item it was approved for? Again this doesn’t help me one bit, realizing there are services that have not been provided. You talked about the mental health services in my community of Fort McPherson. I talked to the Tl’oondih Health Society where they said there is no agreement. There aren’t even any talks with the Inuvik Health Board to try to get people to fill that position. You mentioned something in the House yesterday that they’re working on an agreement. Sorry, but they’re not even talking to each other. So how can you have an agreement?

I’d like to know what you do when health authorities do not provide services in communities where they receive money on behalf of this government.

With respect to Fort McPherson, the Mental Health and Addictions Program, and the services in Tsiigehtchic, I can advise the Member that I’d be happy to offer the Member as much as what the Minister of Justice offered in terms of providing policing services to Tsiigehtchic. I have offered that to the Member previously. We do want to look at the option of enhancing services, possibly in McPherson, so that we can enhance services in nursing coverage in Tsiigehtchic.

When I was in Inuvik two weeks ago for the Beaufort-Delta leadership meeting I had another meeting with the chair and CEO of the Beaufort-Delta Health and Social Services Authority. Also this issue came up during the discussions with the Gwich’in Leadership Council. The Gwich’in Leadership Council has offered to work with us to enhance housing facilities in Tsiigehtchic so that we can better accommodate having a permanent nurse there. I’ve had discussions with the chair and CEO of Beaufort-Delta on that issue. They are wanting to work with us to see how we can enhance nursing coverage in Tsiigehtchic with the view of having a permanent presence there.

With respect to mental health and addictions programming in Fort McPherson, the Member is right, that when I last visited Tsiigehtchic the commitment was made for the Beaufort-Delta Health Authority CEO to meet with the community and Tl’oondih Healing Society. There was no agreement reached. Tl’oondih Health Society expressed that they don’t want to discuss this issue further. So what I’ve done is we have an agreement with Fort McPherson leadership within the community that Beaufort-Delta Health Authority will provide $75,000 to go to Tl’oondih Healing Society so that the band council, the community government gets that money for mental health and

addiction services for Fort McPherson, and they can have the flexibility to hire the person they want to have, whether it be with the Tl’oondih Healing Society or not.

The Member has been asking that we need to give that sort of power to the community. I’m telling the Member now, I’m advising him that I am accommodating what the Member is saying; that we should provide mental health and addiction services in Fort McPherson. I understand that the lady who used to work for the Tl’oondih Healing Society has left the position, but that it will be the community government that will have the option and choice to provide that services. Beaufort-Delta Health and Social Services Authority has agreed to that. This is a good news item. We are making progress in the way the Member has advocated in this House.

Thank you, Ms. Lee. Next on my list is Mr. Bromley.

Thank you, Mr. Chairman. I’d just like to follow up on my colleague Ms. Bisaro’s inquiry. The Minister finished off by mentioning some of the things that they left behind and charges they left behind. I’m wondering what the write-off was. Was it last year or this year for Nunavut specialist positions, and services, and hospital services? What amounts have we written off there?

Thank you, Mr. Bromley. Ms. Lee.

Thank you, Mr. Chairman. For the record, we have not written that off yet. I will be coming to standing committee with more information on that. We expect that we probably will have to write off up to $2.9 million.

Thank you, Ms. Lee. Next on my list is Mr. Hawkins.

Thank you, Mr. Chairman. I would like to question somewhat similar to what Mr. Bromley just raised. What efforts have been made to collect on that $2.9 million and how long has that money been outstanding?

Thank you, Mr. Hawkins. Ms. Lee.

Thank you, Mr. Chairman. The outstanding amounts with Nunavut are going back up to six years at various stages. I think it should be made very clear that until lately, until last November or December, there was not a working written contract between Nunavut and the NWT. There was an understanding about providing services. I had directed the department to work with Stanton to have Stanton officials and department officials -- because the relationship and contracts are between

two governments and Stanton is a local authority -- meet and discuss how we resolve this. They did, and they came up with a working agreement that could carry us going forward. But we had to agree that given the lack of a written agreement that laid out clearly and exactly how Nunavut was to pay us, that it was necessary that we come to a mutual agreement that we would agree to write off some of the amounts that have been outstanding for a very long time and there was not a 100 percent clear agreement as to exactly how much they were going to be billed for.

When someone came to our professionals for services, can I get some sort of understanding of how they did this? Is it a matter of sending NWT professionals to Nunavut to provide services or are we talking about residents of Nunavut showing up at Stanton Hospital saying they have a cold or a sore finger or whatever the case may be and getting health care services? How did this build up to the point of $2.9 million without it being slowed down or some billing process being developed?

I think while we are discussing this it’s really important to put it on record that we have a very good relationship with Nunavut. The Stanton Territorial Health Authority or any other authority, especially Yellowknife Health and Social Services Authority who provide services to Nunavut, are very important to us in terms of our past history and relationship, as well as our physicians, GPs and specialists who like providing services to residents of Nunavut. We have a long history and close relationships. Our work is necessary and our complement of staff and services at Stanton are necessary by having the larger population that we serve in Nunavut.

I want to assure the Member that when doctors do go or specialists provide services to the Kitikmeot region especially, they have a contract with them. There are some specialists who work on separate contracts on their own or contracts with Stanton. Some of the outstanding amounts that we are talking about have been billed for many, many years. After division things just carried on, when you have two very close bodies that work together, thinking that they didn’t think that those written contracts with i’s dotted and t’s crossed were necessary.

I can only speak for what has taken place since I’ve taken over, and it was brought to my attention that we need to have this finalized and confirmed. I understand the contract negotiations went on between 2003 to, say, 2007; it’s just that those agreements were not finalized, signed and sealed. We have concluded that process last winter.

Thank you for that. No, I just find it virtually difficult to understand that we could let it slip that much. I know if you owe $100,000 through one of our lending programs, they chase you to the end of the earth. It seems that if you owe $50,000 or even less, they seem to chase you even more. It’s easy to write off the bigger numbers because I don’t know if it is intimidation or through posturing, but in the end I always get this feeling, from being here almost six years, that the more you owe the less we seem to be interested in collecting.

I will get to the federal and HIV money in a minute, which is even larger, but I am just trying to understand. Did we not send sort of some collection agency over to them that were providing their citizens care? I am just trying to understand, because somebody would have had to of provided a health care card. If I was travelling on a holiday in Alberta and I had to go see the doctor for one reason or another, they would ask me for my coverage card or some sort and I would present them my NWT health care card. That makes the process of either I have to pay up front or it will be billed through the appropriate system, because I am not a resident of Alberta. So they would send the bill, I would assume, in one manner or another to the Northwest Territories. I am just trying to get a sense of have you exhausted every process or did they just come and say, well, we will negotiate only if you write off our existing debt? Thank you.

I do agree with the Member’s sentiment. I think those are legitimate questions as to how this has happened. I was surprised when I think the fact that Stanton Territorial Health Authority was under the microscope, so to speak, because of their large amount of deficit over the last year and a half, that they really had to zero in on their finances. Then we learned in the process that we weren’t collecting or the Stanton Authority was not collecting every penny that they should be collecting. A lot more work has gone on in trying to figure out what is the monies that are owed to them by various parties and how do you collect them.

Another thing is these or health authorities are in the business of providing health services. The paperwork comes after that. The outstanding amounts go back to year 2001. The receivable from year 2001 is $51,000. We expect to write off about $23,000 out of that. The outstanding amount from 2001-02 is about $14,000. We are expecting to write off $9,000 out of that. The 2002-03 receivables were about $11,000. We are collecting all of it. The 2003-04 outstanding receivable is $34,600. We expect to collect all of that. The 2004-05 outstanding receivable is $5,393. We expect to collect all of that. Year 2005-06, Stanton feels that the receivable should be $533,000, but upon negotiation and talking to Nunavut, we expect we could only collect about $45,000 out of that.

The real issues have been the years between 2005-06 to 2006-07. In 2006-07 the receivables that Stanton thought was $1.7 million, but really $1.6 million of that does not seem to be collectible. In 2007-08 we have a receivable of $3.2 million and we feel we could collect about $2.5 million of that.

I have to tell you when I learned of this as Minister of Health and Social Services and learned that there was not a written contract or a clear agreement as to exactly how much you are to charge Nunavut, the first question I said is how could you collect something you don’t know you are owed? I could only say that at that time. I said okay, we need to be very clear about what services we provide and how much we are to charge them, and we have put that in place. Thank you.