This is page numbers 4327 – 4378 of the Hansard for the 17th Assembly, 5th Session. The original version can be accessed on the Legislative Assembly's website or by contacting the Legislative Assembly Library. The word of the day was health.

Topics

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Ramsay. Time for oral questions has expired. Item 8, written questions. Item 9, returns to written questions. Item 10, replies to opening address. Item 11, petitions. Item 12, reports of standing and special committees. Item 13, reports of committees on the review of bills. Mr. Moses.

Bill 4: Health Information Act
Reports of Committees on the Review of Bills

March 10th, 2014

Alfred Moses

Alfred Moses Inuvik Boot Lake

Thank you, Mr. Speaker. I wish to report to the Assembly that the Standing Committee on Social Programs has reviewed Bill 4, Health Information Act, and wishes to report that Bill 4 as amended and reprinted is ready for consideration in Committee of the Whole. Thank you, Mr. Speaker.

Bill 4: Health Information Act
Reports of Committees on the Review of Bills

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Moses. Mr. Moses.

Alfred Moses

Alfred Moses Inuvik Boot Lake

Thank you, Mr. Speaker. I move, seconded by the honourable Member for Range

Lake, that Bill 4, Health Information Act, be moved into Committee of the Whole for consideration today. Thank you.

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Moses. The motion is in order. To the motion.

Some Hon. Members

Question.

The Speaker

The Speaker Jackie Jacobson

Question has been called. Motion is carried.

---Carried.

Bill 4 is moved into Committee of the Whole for consideration today. Mr. Moses.

Alfred Moses

Alfred Moses Inuvik Boot Lake

Thank you, Mr. Speaker. I seek unanimous consent to return to item 12 on the Order Paper, reports of standing and special committees.

----Unanimous consent granted

The Speaker

The Speaker Jackie Jacobson

Item 12, reports of standing and special committees, Mr. Moses.

Alfred Moses

Alfred Moses Inuvik Boot Lake

Thank you, Mr. Speaker. Your Standing Committee on Social Programs is pleased to provide the Report on the Review of Bill 4, Health Information Act, and commends it to the House.

Introduction

Bill 4, Health Information Act, is the product of extensive work undertaken over the better part of a decade to develop health-specific privacy legislation for the Northwest Territories. The Standing Committee on Social Programs commends the Minister of Health and Social Services for developing the bill. With its passing, the Northwest Territories will join a growing number of Canadian jurisdictions that have enacted legislation of this kind.

Bill 4 was referred to the committee on November 7, 2013. The public hearing was held on February 20, 2014. Numerous stakeholders and citizens provided written submissions and made oral presentations. The clause-by-clause review was held on March 10, 2014.

It is the considered view of the committee that the act strikes an appropriate balance between the rights of patients and the need for efficiency within the system. At the same time, a great deal is riding on proper implementation.

The committee proposed and adopted two amendments during the clause-by-clause review of

the bill, with the concurrence of the Minister. Both amendments are discussed in this report.

Mr. Speaker, I would like to now return the report over to my colleague, Mr. Dolynny.

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Moses. Mr. Dolynny.

Daryl Dolynny

Daryl Dolynny Range Lake

Thank you, Mr. Speaker, and thank you, Mr. Moses.

Key Issues

Purpose Statement

Through an amendment, the purpose statement was broadened to address the rights of patients to access, correct and protect their personal health information. The committee reasoned that patient rights should be treated on a par with the need for system efficiency. A comparison of purpose statements in other health-specific privacy legislation lent support to this view.

Implementation

Stakeholders stated repeatedly that the act is difficult to understand. Unease about its complexity was widely expressed. Following the public review, the committee identified this as an impediment to the provision of meaningful input and requested plain language material. The department obliged, providing a “Frequently Asked Questions” document and an annotated version of the act. The committee in turn circulated the material to the stakeholders concerned. The department posted the FAQ document on the website, taking a strong first step toward informing the public about this legislation.

Given the complexity of the act and its inevitable future impact, extensive public education will be required to make the legislation understandable. Extensive training will also be required to ensure that key players in the health sector implement the legislation in a consistent and accurate manner. To this end, the committee urges the department to widely circulate plain language material, including annotated versions of the act and the regulations. Real-life scenarios and vivid illustrations should be used to explain key terms such as “health information custodian,” “implied” and “express” consent, and the “circle of care.”

In line with health-specific privacy legislation in other Canadian jurisdictions, “implied consent” is the backbone of this legislation. It does not require written authorization and occurs during the routine course of a patient visit. The act places the onus on health information custodians to inform patients about implied consent and what it entails. The act further states that consent must not be obtained through coercion or deception.

The act gives patients the right to withhold and withdraw consent and to set limits on how their personal health information is shared. It is the

patient’s responsibility to exercise these rights. During implementation, patients should be given repeated opportunities to absorb this information.

Special efforts must be taken to ensure that unilingual Aboriginal language speakers understand their rights and what this legislation means.

The department has allocated $462,000 in 2014-2015 for implementation. To ensure delivery of a comprehensive public awareness campaign and thorough training for custodians and health care providers, the committee urges the department to allocate approximately double this amount.

Several citizens raised concerns about the extent to which personal health information is shared with the “circle of care.” Patients should be able to obtain a log of everyone who has viewed their personal health information. This message should be clearly communicated to the public.

Concerns were expressed about what happens to personal health information when it leaves our borders. Through information-sharing agreements with Alberta, our most frequent partner in the provision of health care, and other jurisdictions, the department should ensure that personal health information is protected to the greatest extent possible when shared with health providers outside the NWT.

“Express consent” is a formal method of giving consent which typically requires written authorization. This method is used for some research purposes and when health care providers collaborate with other professionals such as teachers and social workers. Information about express consent should be communicated to the public and to helping professionals.

Mindful of the government’s goal of promoting service integration and interdepartmental collaboration, the committee is concerned that this legislation may entrench “service silos.” Reasonable measures should be taken to ensure that mental health workers, nurses and other health care providers are not unduly prevented from collaborating with teachers and social workers. Interaction between health professionals, child welfare agencies and schools is often more influenced by institutional culture than privacy legislation. For this reason, training for health workers should include a module on how express consent works in “wrap-around” and integrated case management settings.

Concerns were raised about researchers accessing patient information without their knowledge. Under the act, this can only be prevented if a patient makes an express statement to this effect. Once again, this message should be clearly communicated to patients and the public.

Regulations

The Health Information Act and its regulations, taken together, constitute one of the largest information-sharing endeavours in the history of the Northwest Territories. Numerous details will be worked out in the regulations and while this affords greater flexibility to adjust legislation as required, the public has no opportunity to review them. Numerous stakeholders requested that such a courtesy be extended. The committee strongly echoes this request.

Security procedures will be laid out in regulations to protect against hacking, viruses and other security breaches. The serious breach of personal health information in Alberta recently illustrates the need to proceed with extreme caution. The regulations should establish meticulous and thorough procedures based on best practices nationally and internationally.

With respect to fees, the committee urges the department to continue the well-established practice of waiving fees under the Access to Information and Protection of Privacy Act, ATIPP. To discourage repeated, frivolous or unreasonably large requests, the regulations should stipulate that a fee can only be charged if the cost of processing the request exceeds a pre-set amount.

The committee was alerted to dangers associated with stripping, encoding or transforming information to create non-identifying data. Such dangers are amplified in a population the size of the Northwest Territories and they are not trivial. The committee urges the department to ensure that custodians are trained in de-identification techniques, including measures to reduce the risks of re-identification.

Mandatory Review

An amendment was made to the bill requiring the Minister of Health and Social Services to conduct a review of the act within 10 years of its enactment. This will allow legislators to test the department’s performance against its own rules.

At this time I would like to turn it over to the chair of the Standing Committee on Social Programs, Mr. Moses.

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Dolynny. Mr. Moses.

Alfred Moses

Alfred Moses Inuvik Boot Lake

Thank you, Mr. Speaker. Thank you, Mr. Dolynny.

The Standing Committee on Social Programs strongly urges the following courses of action:

1) that the Department of Health and Social

Services develop and implement a comprehensive public awareness campaign;

2) that the Department of Health and Social

Services provide extensive training for health

information custodians and health care providers;

3) that the Department of Health and Social

Services ensure the quality of patient care is not unduly compromised when a patient withholds, withdraws or places limits on consent;

4) that the Department of Health and Social

Services employ a grace period during the first year of implementation, requiring custodians to provide patients with repeated opportunities to absorb the legislation;

5) that the Information and Privacy Commissioner

be provided with additional fiscal and human resources to support implementation of the act;

6) that the Department of Health and Social

Services ensure consistent application of the legislation across all regional authorities;

7) that the Department of Health and Social

Services take reasonable measures to ensure that unilingual Aboriginal language speakers understand their rights and what the legislation means;

8) that the Department of Health and Social

Services provide an opportunity for the Standing Committee on Social Programs to review and comment on the regulations before they come into force;

9) that the Department of Health and Social

Services provide an opportunity for the public to review and comment on the regulations before they come into force;

10)

that the Department of Health and Social Services review the “Pan-Canadian De-Identification Guidelines for Personal Health Information” as prepared by the Office of the Privacy Commission of Canada and ensure the regulations include measures to mitigate against the risks of re-identification;

11)

that the Department of Health and Social Services clearly inform residents about their right to withhold consent to use of their information for research purposes;

12)

that the Department of Health and Social Services provide training to members of the territorial research ethics committee which conforms to the tri-council policy statement: Ethical Conduct for Research Involving Humans;

13)

that the Department of Health and Social Services establish information-sharing agreements with Alberta and other jurisdictions to ensure personal health information is protected to the greatest extent possible when it leaves the NWT;

14)

that the Department of Health and Social Services and other custodians make it their

practice to comply with access and correction requests promptly and without undue delay;

15)

that the Department of Health and Social Services inform patients about their right to obtain a log indicating which individuals have accessed their personal health information;

16)

that the Department of Health and Social Services take reasonable measures to ensure the Electronic Medical Records System is running smoothly prior to implementation;

17)

that the Department of Health and Social Services ensure that mental health workers, nurses and other health care providers are not unduly prevented from collaborating with teachers, social workers and other professionals; and

18)

that the Department of Health and Social Services include a module in their training to custodians and health-sector workers on the “wrap-around,” or team-based, approach, including how to obtain express consent from clients.

Conclusion

The committee is grateful to everyone who provided input on Bill 4 and attended the public hearings.

The Standing Committee on Social Programs advises that it supports Bill 4 as amended and presented to Committee of the Whole.

Motion To Receive And Adopt Committee Report 4-17(5), Carried
Reports of Standing and Special Committees (Reversion)

Alfred Moses

Alfred Moses Inuvik Boot Lake

I move, seconded by the honourable Member for Range Lake, that Committee Report 4-17(5) be received by the Assembly and adopted. Thank you, Mr. Speaker.

Motion To Receive And Adopt Committee Report 4-17(5), Carried
Reports of Standing and Special Committees (Reversion)

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Moses. The motion is in order. To the motion.

Motion To Receive And Adopt Committee Report 4-17(5), Carried
Reports of Standing and Special Committees (Reversion)

Some Hon. Members

Question.

Motion To Receive And Adopt Committee Report 4-17(5), Carried
Reports of Standing and Special Committees (Reversion)

The Speaker

The Speaker Jackie Jacobson

Question has been called. The motion is carried.

---Carried

Committee Report 4-17(5) is received and adopted by the Assembly. Item 14, tabling of documents. Minister Abernethy.

Glen Abernethy

Glen Abernethy Great Slave

Thank you, Mr. Speaker. I wish to table the following document,

entitled “NWT Anti-Poverty Roundtable Final Report, November 28-29, 2013, Detah, Northwest Territories.”

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Abernethy. Item 15, notices of motion, Ms. Bisaro.

Wendy Bisaro

Wendy Bisaro Frame Lake

Thank you, Mr. Speaker. I give notice that on Thursday, March 13, 2014, I will move the following motion. I move, seconded by the honourable Member for Thebacha, that, notwithstanding Rule 4, when this House adjourns on March 13, 2014, it shall be adjourned until Wednesday May 28, 2014; and further, that any time prior to May 28, 2014, if the Speaker is satisfied, after consultation with the Executive Council and Members of the Legislative Assembly, that the public interest requires that the House should meet at an earlier time during the adjournment, the Speaker may give notice and thereupon the House shall meet at the time stated in such notice and shall transact its business as it has been duly adjourned to that time.

The Speaker

The Speaker Jackie Jacobson

Thank you, Ms. Bisaro. Item 16, notices of motion for first reading of bills. Item 17, motions. Mr. Nadli.

Michael Nadli

Michael Nadli Deh Cho

WHEREAS non-timber forest products, including wild mushrooms, can offer wide-ranging health and economic benefits;

AND WHEREAS world-wide demand for gourmet mushrooms is increasing, as well as awareness of their availability, nutritional content and value as a natural resource in the Northwest Territories;

AND WHEREAS commercial wild mushroom harvest may represent a significant economic development opportunity for residents of the Northwest Territories;

AND WHEREAS a large crop of valuable morel mushrooms associated with forest fire burns is anticipated this year in areas accessible by road on traditional Aboriginal lands;

AND WHEREAS these areas are in regions with land claims currently under negotiation;

AND WHEREAS residents, including members of local Aboriginal organizations, have no regulatory

mechanism to allow benefit from wild mushroom harvest, while unregulated, out-of-territory entrepreneurs are actively harvesting the resource;

AND WHEREAS in 2006, the forest management division of the Government of the Northwest Territories’ Department of Environment and Natural Resources made commitments to advance this industry, including a commitment to draft a policy paper to lead the process for developing appropriate policy and regulations for non-timber forest products by 2014;

AND WHEREAS updates to legislation to regulate the commercial harvest of wild mushrooms are still required;

AND WHEREAS this legislation is not expected to come forward in time to govern this year’s harvest;

NOW THEREFORE I MOVE, seconded by the honourable Member for Weledeh, that the Government of the Northwest Territories, prior to summer 2014, honour its commitments and work with those Northwest Territories First Nations and entrepreneurs that have an interest in harvesting morels and other mushrooms, to implement interim measures that regulate and manage the commercial harvest of wild mushrooms;

AND FURTHER, that the Government of the Northwest Territories immediately begin drafting legislation to provide for the responsible management of the wild mushroom resource and provide a comprehensive response to this motion within 60 days.

The Speaker

The Speaker Jackie Jacobson

Thank you, Mr. Nadli. The motion is in order. To the motion. Mr. Nadli.

Michael Nadli

Michael Nadli Deh Cho

Mahsi, Mr. Speaker. I’d like to thank the seconder of the motion, the Member for Yellowknife Centre, Mr. Robert Hawkins.

I’m presenting this motion because there’s a growing interest in wild mushrooms. Northerners are interested in the harvesting of mushrooms as a business opportunity and livelihood that complements the northern lifestyle of the outdoors.

Recently, we are witnessing people coming into parts of the NWT and harvesting mushrooms. They are taking our natural resources and leaving the NWT. Currently, there are no regulations on wild mushrooms, on morels, to manage and regulate this growing industry.

This motion asks for interim measures to be put in place before this summer’s harvesting season begins. Things such as residency criteria, pricing of seasonal harvesting licence and permits for harvesting are some suggestions that could be considered based on consultations; further, that work begins towards developing legislation that addresses non-timber forest products such as wild mushrooms.

What are wild mushrooms, morels? They are a small fungi type plant that has a growing monetary value. There are many kinds of mushrooms. This particular species of wild mushrooms, morels, referred to as morels or Morchella esculenta, are described as prize morel mushrooms and are cone-shaped sponge. They are hard to find and are commonly found in newly burnt areas after forest fires. The plant species proliferates in growth in June.

Mr. Speaker, I’d like to remind the public that it is important to know the good mushrooms from the bad, poisonous mushrooms.

In terms of morel mushrooms as a product in the economic market, there is a high demand. Wild mushrooms, morels, sell at about $100 per pound, based on 2012 prices. Dried and then sold, most are destined for European restaurants.

In 2013 the Northwest Territories experienced some big forest fires. One that is of particular interest is in the area between Trout River and Jean Marie River. Besides the Mackenzie Highway cutting into the heart of the area, there are also service roads that run north and south of the highway and may provide easy access to the burnt areas.

After the forest fire of 2013, it is expected that the mushrooms, morels, will experience a bumper crop this summer. Morel mushrooms are hard to find. Recently, harvesting activities were in Behchoko, Sandy Lake and Fort Smith areas.

There is interest from local entrepreneurs in my constituency for the harvesting of wild mushrooms, morels. Like berry picking, wild mushroom harvesting complements traditional activities where you go out and harvest the bounty of the land.

This is a great opportunity in a growing industry. There are people in the NWT who harvest wild mushrooms, morels, both in Fort Smith and Yellowknife.

Recently, some communities have achieved forest management agreements with the GNWT. There is also a strong possibility of a wood pellet plant being established and planned activities for forest timber type operations. Potentially, morels could become a secondary industry for those communities that have forest management agreements.

In 2006 there was a conference on mountain timber forest products. Then, this government committed to work on the five points. Eight years later, those commitments have yet to be realized.

The wild mushroom industry is growing. The potential monetary value of wild morel mushrooms is appealing for Northerners because of the lifestyle it promotes: the great outdoors and easy pickings.

Media, such as TV, have played a part in promoting the industry. In December 2003 the future on

mushroom harvesters aired on Dragon’s Den. At that time, the panelists agreed to invest in the group that harvested wild morel mushrooms that perhaps could venture in the Northwest Territories.

In closing, this motion asks that the GNWT take action in developing interim measures and respond in 60 days. Today is March 11th and June 4th is four

months away and there is a need to prepare for the summer harvest. The other thing is to start working on the legislation and, in the meantime, begin examining interim measures to ensure ways to regulate and manage mushroom resources. Mahsi, Mr. Speaker.