Debates of February 10, 2006 (day 27)

Agreed.

Agreed. Thank you. Sergeant-at-Arms, would you please bring in the witnesses?

We’d like to welcome back deputy minister David Murray and Mr. St. Germaine. I can never remember his title, but welcome back. We are still on general comments for Health and Social Services. General comments. Mr. Braden.

Madam Chair, thank you. A bit earlier in this current fiscal year, 2004-5, 2005-06, we were able to flow $1 million, which came from the federal government, into the planning for a dementia facility here in Yellowknife. This was in cooperation with the Yellowknife Association of Concerned Citizens for Seniors. It was a very welcome bit of funding work. Now, there has been also quite a bit of work going on to look into the state of facilities, of care facilities for seniors in other parts of the territory, as well, Madam Chair, in the last few months. This was all with the expectation that we’ve had, here in committee, that this was going to come together in a more or less consolidated plan of how we are going to manage what is inevitably the increasing occurrence of dementia and cognitive illness in our citizens.

Madam Chair, I wanted to ask specific to the $1 million planning project for the facility here in Yellowknife, what is the status of this? Is the department contemplating that this fiscal year, or when we will be able to make the major commitments to see this facility become a reality here, Madam Chair?

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, we are expecting that before the end of summer, or by the end of summer, early fall, the design work that’s currently underway will be done and that we will be building, as per Cabinet direction, this particular item into the upcoming capital planning process for ‘07-08. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Thank you. I’m pleased to see that commitment is there and on track. In tandem with this, Madam Chair, is the additional obligation, commitment, that is required for the O and M of this facility. I’m wondering if the Minister has any sense, at this time, of what that commitment may be, and can we expect to see that incorporated into the base for the department in future years? Thank you, Madam Chair.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the O and M requirements will go ahead concurrently with the capital project. It will be identified in the business plans and the budget for that year. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Okay. Thank you, Madam Chair. That’s all for now.

Very good. Thank you. Next on the list I have Mr. Pokiak.

Thank you, Madam Chair. Just a couple of quick general comments in regard to…(inaudible)…department. I’d just like to say a few things in regard to what’s been happening in the smaller communities, Madam Chair. The first comment I’d like to make is, as we all know, there’s a shortage of nurses in the small communities. Plus we get a lot of information from the department with regard to the reduction of services, especially in the small communities.

Having said that, I’d like to refer to page 2 of page 5 of the Minister’s opening comments. They estimate that $4 million in new initiatives is made possible. It goes on further to say that including additional frontline nursing positions for small communities. I’d just like to ensure that the Minister follows up with some of the nurse resources we have in the communities. It’s been on a number of occasions that it happened anyway. I do have a record of especially what happened in Tuk in the Nunakput riding.

So the other one, Madam Chair, I’d like to touch briefly on, is the one that was raised by some of the MLAs over here on this side. It is in regard to the escort service that the department presently has, and including translation services for the elders that are travelling outside of their home communities. I say this, Madam Chair, because I know of incidents in Tuk where there was an elder that needed to come down to Yellowknife, but she didn’t want to go because the department didn’t allow to have an escort. This is an elder I’m talking about. Whereas, in another instance where there was a younger person in the late 40s who was actually well-spoken in English, the wife was able to come down to Yellowknife to do some data. So I don’t know where the differences are in terms of who can be escorted to the departments, into Yellowknife or to Edmonton for that fact.

Madam Chair, another comment I’d like to make is, on my return trip down here, I was approached by another resident from Tuk. They gave me a scenario where there was one client along with an escort that went to Edmonton for a major operation. Subsequently, Madam Speaker, is that when they arrived in Inuvik rather than flying on a local airline sched, they were on a transport that takes them back by the ice road. That makes it difficult for a patient, especially when you have an operation, that kind of operation. But apparently the people were forceful enough to talk the department into flying back home. That’s just one scenario.

Another incident that I became aware of -- I don’t think it was the first time because I know it happened to my mother a long time ago -- was the issuance of the wrong medication to elders. It did happen again, Madam Chair, so I don’t know what the health services are doing to ensure that the elders are taken care of in the right manner that they should be.

These are just some of the general comments I’d like to make, Madam Chair. Like I say, a lot of my Members here, you know, as I was watching the proceedings yesterday, that I’ve been asked. So these are just some of the major questions that I have. Thank you.

Thank you, Mr. Pokiak. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the Member is correct that this is a concern that has been raised by other Members, but, very quickly, I will touch on the issues that I’ve noted. We are, as I’ve told the Member the last time he raised this issue in the House, we are continuing to struggle with getting adequate nursing and nurses in small communities. I did talk yesterday about things we’re working on with corporate human resources and the department in terms of setting up our own permanent float pools that we could establish, having one out of Inuvik and one out of Yellowknife.

In terms of the medical travel escort services, I would like to submit that we have, for the most part, a very high level of service in terms of medical travel and escort services, that would probably not be replicated in any other jurisdiction. I do recognize, however, that there are always exceptions and we are very concerned about those, especially when they involve elders. If there are translation issues, then we would like to deal with the exceptions on a case-by-case basis, trying to make sure that while we may not be able to change what happened, we can take steps to try to improve the quality of service. I know the Member has brought issues like this to my attention before and I appreciate his vigilance and perseverance in doing that and will continue to work with him on that.

In regards to, the same applies to the issuance of medication, that there are very strict protocols and standards and policies as to how medications are handed out. When situations arise that there is wrong medication handed out and we become aware of that, we backtrack the situation to make sure that we can ensure, find out what happened, and address those circumstances that caused that to happen. But once again, for the most part, we hand out probably thousands of different types of medication every day across the Northwest Territories and we are still concerned about those exceptions.

So once again, I appreciate the Member for raising that issue and if there are some specifics he cares to share with us on that issue outside of this forum, we’d be happy and very interested in finding out what those circumstances were. Thank you.

Thank you, Mr. Minister. Mr. Pokiak. Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, I have a few things I’d like to bring up. They are specific to Hay River. That’s kind of the way I’ve looked at this topic of Health and Social Services in relationship to the budget. With respect to the doctors, Hay River is the second largest community in the Northwest Territories. It has a population of about 4,000 people. We have quite an expansive health care facility in Hay River. At this time, we do not have one single permanent doctor. Right now, we’re completely relying on locum doctors to take care of the people in Hay River. I’d like to ask the Minister if he has any sense of why Hay River has struggled the way they have to recruit and retain physicians and what he sees as the solution to this going forward. Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, we’re in close contact, especially through the deputy and the other officials in the department with Hay River, working with them and human resources trying to recruit doctors for Hay River. This is not an unusual circumstance, unfortunately. Other communities have still, at this point, the benefit of some doctors, though not enough that are permanent or there for awhile.

In terms of why this is the case, I think a lot of it just pertains that there’s a national shortage and there’s some circumstances, obviously, in Hay River where individual doctors have chosen to go or leave the department. We have met specifically with the board. Some of the things that were being contemplated are looking at making exceptions to the locum contract, as well as there was an interest in possibly seeing if fee-for-service would be a way to in some cases revert or entice doctors to return or come to Hay River.

As well, we’re looking at trying to offset with some nurse practitioners. However, with the indulgence of the chair, I’d ask the deputy to maybe speak a bit more about the contact with Hay River and some of those assists that we’re trying to provide. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen. Mr. Murray, I’m sorry.

Thank you, Mr. Chairman. Not much to add. Just to say that I have been talking with the CEO in Hay River on this and he knows that if he needs to make some exceptions to the standardized locum contract, that we’re more than able to work with him very quickly to accommodate things like that. Other things are being done. I know that Yellowknife, on a number of occasions, some of the doctors from this community have gone down to Hay River to assist, either with clinics or work at the hospital. So other authorities are trying to pitch in, as well, as best they can, with Hay River. Thank you.

Thank you, Mr. Murray. Mrs. Groenewegen.

Thank you, Mr. Chairman. I do know it’s a difficult situation, it just seems that the problem has existed for awhile and with the turnover that we’ve seen, it almost makes you wonder if there’s something that’s evading us in terms of a cause because there’s been such a high turnover.

Mr. Chairman, I’d also like to ask the Minister if he could please update me, then, on the status of the capital for either renovations or upgrades or replacement of the hospital in Hay River. Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, as I indicated in this House initially, yesterday when the question came up about the Stanton renovations, there’s a link with the three projects, Stanton, Hay River and Smith, in terms of trying to have the work being done in terms of the master plan and design done in a coordinated way. The money is still in the budget. The last time I met with the board, there was a concern to see -- given the fact that in some people’s mind it may be better value for money -- to look at building new versus renovating. When the final assessment was done of the health centre and the physical infrastructure, that determination would be made. But the money in the budget is there for, there’s been $1.2 million in prior years and there’s $500,000 for this year, and then we start into the major expenditures in ’07-08 with $4.3 million, $3.8 million in ’08-09, and then finishing it off with another $3.8 million to a total of, at this juncture, about $14 million. So as the planning work is done, a determination will be made as to what is the best course of action in terms of the value for money in terms of renovation versus the potential, possible rebuilding of a new facility. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, to the issue of doctors as is related in Hay River, for a number of years now we have not had delivery for babies available in Hay River. So expectant moms are required to travel south or travel north and spend at least three weeks out of Hay River, sometimes away from their families and other children, in order to await the arrival of their newborn. This is something that different patients deal with in different ways. Some do go south where they have family they can stay with. Some do come north. Some are able to stay at the boarding home in N’dilo and have a place to stay there for three weeks. Others are kind of falling between the cracks, so to speak. I know some companies have made arrangements for staff that are on their payroll, or on maternity leave, to have accommodation here in Yellowknife. It’s kind of all over the map. Given the number of births originating from Hay River and, like I said, this kind of hit-and-miss approach to their accommodations while they’re here in Yellowknife, I would like to ask the Minister if he would support the Hay River Community Health Board in securing or renting, perhaps, a townhouse or three-bedroom apartment or some place that would be fairly economical where expectant mothers, families, could stay when they’re in Yellowknife awaiting the arrival of a baby? Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, I am interested in working with Hay River, as I have indicated this in the past as well, to provide them the sufficient comfort where they would be prepared firstly to entertain the alternatives that are out there to have birthing in Hay River. That being the use of midwifery to tie into a birthing team that would be there with midwives, nurses and doctors that would deal with what are characterized or determined to be normal births, which would probably be about half or more of the babies born in Hay River. We’re fully prepared to look at getting the resources in there to do that, to make use of all the protocols and all the regulatory issues that were already hashed out in Fort Smith to allow that to happen. If that was done, it would put, I believe, a different complexion on the issue of having to come to Yellowknife and those circumstances would be a lot less. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen.

Thank you, Mr. Chairman. Yes, I know there were some obstacles to getting the midwifery program off the ground in Hay River and that is, in my opinion, unfortunate. But I don’t speak for the health board or the physicians or however that decision was arrived at, and I don’t want to second guess their reasons. I’m sure they had their reasons. Right now, under the assistance that is provided to expectant mothers, unless you’re staying in the boarding home, I believe the rate that they can receive for their accommodation and meals and so on here in Yellowknife is $50 a day, which, obviously, isn’t enough. It would just be a lot more efficient and a lot more economical if there was a place designated that could be used for people that are waiting. I’m thinking that if the health board did come forward with a proposal -- and it’s probably something that’s already identified in the Hay River health board budget -- would the Minister be supportive of such a proposal? Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, we’ll, of course, look at any proposal that’s brought forward, but I would indicate here that I will engage in the initial discussion of the clear way to deal with this initially is to try to provide the comfort and support necessary to get the alternative services there for birthing so they can have the majority of their babies born in the community. We will look at what is being proposed by Hay River Health and Social Services Authority, but I will continue to make my best case to the board and community that birthing services involving midwifery is a very, very good service that they should access themselves, too. Thank you.

Thank you, Mr. Minister. I don’t have anybody further for general comments. General comments. Mrs. Groenewegen.

Well, thank you. I didn’t get all the way through my list, Mr. Chairman, so I appreciate this. I understand what the Minister is saying with respect to getting birthing services available in Hay River, but it has been a number of years now since that has been available. So in the interim and in the short term, I do think we need to find some way to make it easier for the young moms or, for that matter, any mom that needs to spend three weeks or more in Yellowknife waiting for the arrival of a baby.

Mr. Chairman, there’s been a case recently in the media quite extensively, it’s actually happening in British Columbia, where a child in foster care, a toddler, lost their life. They had been placed in the care of relatives and I understand that the principle behind this was to consider it a priority to place a child with family, even extended family, rather than in a home who didn’t know the child or was not culturally similar to the home that the child had been apprehended from. I’m sure that we have, in the Northwest Territories, a family reunification program and probably a priority that would be placed on relatives who would be willing to take a child into care, as opposed to any others that would be in a group of foster homes. It raises the question, though, Mr. Chairman, as to the kind of home study that takes place when people apply to be foster parents. My question is, when a child is placed in the home of a relative, is the same due diligence undertaken in terms of assessing that home as they would assess any other home, or is that process somewhat circumvented because of the fact that the receiving home would be relatives to the child being apprehended? Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, the process of home assessments has to have the same rigour in all circumstances that once a child is, for due reasons, deemed to be in need of protection or not being able to stay in their family home, that it should be checked out. Every potential placement should be checked out with the same thoroughness. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen.

Thank you, Mr. Chairman. So that is the stated policy of this government? Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, there is no double standard that I’m aware of, that there is one standard for assessments and that social workers and child welfare workers are to follow. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen.

Thank you, Mr. Chairman. That is good to hear because that is certainly an unfortunate set of circumstances which lead to the death of this child in care in British Columbia.

Mr. Chairman, I’d like to just touch, for a moment, on the volunteer fire and ambulance service in Hay River. I know I raised this with the Minister last week in the House here.

---Applause

But I just wanted to say again, I didn’t get a chance to say it then, that I think that the fire and ambulance volunteer service in Hay River is of extraordinary value to not only Hay River, but to the surrounding area. If the Government of the Northwest Territories had to pay for those services at realistic cost, we would be looking at a very considerable amount of money. That being said, the Minister is aware that the Hay River volunteer fire department and ambulance service does receive a $25,000 contribution through the Hay River Community Health Board for their operations. The rest of the costs are absorbed by the Town of Hay River. So this service has been provided for quite a number of years. We need some assistance to assess the service, what’s available now, what’s going to be anticipated to be needed for the future, and I had asked the Minister about some funding in order to put together a document identifying the relevant details with respect to what is needed going forward. I got a sort of a favourable response, but I didn’t really get an answer. I wanted to put it in the context of what that service is worth and what we’d have to pay for it if that was not being done by volunteers. So I think the request of the Hay River fire department for $10,000 in order to do this good work that needs to be done anyway is a very small amount of money and I wanted to put it in the context of what they do. So I don’t know if the Minister wants to respond to that again, or if he’s had a chance even since last week to give this any more thought. Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, I don’t disagree at all with the Member’s assessment of the value of the volunteer firefighting and ambulance services in Hay River. The same can be said in every community that has volunteers, that without volunteers, we would be unable to provide many services. I will honour the commitment I made in the House, which is we will sit down and we will look with the other departments that the Member mentioned in her statement, it was being MACA I believe, and ITI, and we will work with community of Hay River and volunteer firefighting and ambulance services to get that information put together in a way that will allow planning to be done. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen.

Thank you, Mr. Chairman. One last thing that I have on my list, and I don’t know if I will think of anything else or not, but the last thing I have on my list is, I’d like to ask the Minister to update the House and me on where we are in terms of bringing the Hay River health board employees and operations into the fold, so to speak, so that we’re not a one-off in Hay River in terms of pay and benefits, union, and so on. When this initial discussion started, the request of the workers in Hay River was that they would be on par and have equity with their counterparts who work for every other health board in the Northwest Territories. I’m not sure how much we’ve actually closed that gap or what any of the obstacles are now to standardizing that, but I’d like to ask the Minister for an update because we haven’t talked about it for a while. Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, this is an outstanding issue, as the Member has noted, and we have engaged the services of the HR department as it's newly structured. They’ve had one of their senior people who came over, in fact, from Health and Social Services, spearheading the work. I understand that we’re expecting a document to be available for our review by about the middle of next month. Thank you.

Thank you, Mr. Minister. Mrs. Groenewegen.