Debates of February 18, 2005 (day 39)

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, this is another case where technology and the way the world is unfolding far outstrips the legislation and policy that governs the circumstances. We’ve identified two key pieces of legislation. One of them is the Public Health Act and the other one is the Pharmacy Act, which are both significantly out of date and need to be updated. We have the process underway to do just that and there is consultation on the Pharmacy Act. One of the questions that we’re looking at is that very question within the legislation and the legal base that we have to operate on now and what do we need for the future. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. Thank you for that, Mr. Miltenberger. Back to prescriptions, there was a case a few weeks ago where a man purchased a phoney prescription in a local bar and got the prescription filled and the pharmacist noticed that the doctor’s name on the prescription wasn’t spelled correctly. That’s what gave it away. I’m just wondering how something like that could happen. Are these prescription pads left in the open? How would somebody get access to a prescription like that? What steps are you looking at taking to make sure that doesn’t happen again? Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, just for current day-to-day practice, there is a significant amount of care taken with access to the actual drugs themselves and the forms used to do prescriptions, but it would not, in my opinion from what I’ve seen in doctors' offices, take much to come up with a pad, to manufacture a pad and find the doctor’s name and basically forge his signature. So for those who are intent, there are always ways to try and do that. The normal course of events and practices are fairly stringent in terms of trying to prevent against the abuse, not so much on the Internet side but just on how drugs are accessed and prescribed. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. Thank you, Mr. Miltenberger, for that. One other thing that I wanted to bring up with you today was the case of the Hay Plan re-evaluation at Stanton Territorial Hospital and whether that should have happened or not. I mean, that’s water under the bridge now, but it’s still having an impact on a substantial number of nurses who are employed at Stanton Territorial Hospital and through the government and the union they haven’t been able to really get any type of understanding or resolution to their concerns. In fact, they’re in the process of taking their concerns to the Equal Pay Commissioner in an attempt to challenge the Public Service Act under section 40 that what was done to them and the fact that the Hay Plan evaluation was done at Stanton should never have happened. I know the Minister and I have had numerous discussions regarding the re-evaluation and why it happened and I still, to this day, am scratching my head as to why we would go into a process at a hospital where we would pit nurses against nurses? It’s not done anywhere else in the country, except for maybe a psychiatric hospital in Newfoundland. I’d like to ask the Minister again, why was it done at Stanton and what is he going to do to help the nurses that are concerned about this and are getting absolutely no help or support from the government and no help or support from their union? They’re left out in the cold. Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the Member is correct; we’ve had numerous discussions on this issue and it is, as the Member said, water under the bridge. There were 476 positions affected by the review; 201 of the positions were -- pardon me while I put my glasses on -- re-graded with salary increases, 24 positions were downgraded, 235 positions remained in the same salary range, and 16 positions were new. There were some grievances and appeals filed. There are still about 21 outstanding.

Why did we do this? Because, in my mind, there was pressure from the nurses and in their opinion a lack of recognition that all nurses are not the same; that a nurse is not necessarily a nurse, that there are whole different levels of expertise, skills and experience required. We accepted that position and it was a way to better remunerate the nurses doing the more technical, high-end jobs, the ICU nurses, the obstetric nurses, those requiring extra skill and training. That was one of the big complaints we had was that, yes, at the entry level the nurses always were fine, but we had great difficulty recruiting nurses for these more technically qualified jobs. So the decision was made to do that. We took it through the government system. Once we did that, the processes there have kicked into gear to deal with the process itself and then the subsequent disagreements through the appeal and grievance process. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. Again, I take issue with the fact that if it’s good for 98 percent of the nurses in hospitals across the country, why the government would wade into this with a re-evaluation plan such as the Hay Plan which, to me, like I said, pits nurse against nurse in the same work environment. I don’t understand why they would go down that road. It doesn’t make much sense to me why we would do that in the first place, but here we are today and the Minister spoke of the nurses that saw an increase and the nurses that remained the same and some who even went down, but they’re pay protected while they’re in that same position. But the nurses are upset at Stanton; there are a number of them that are concerned about this. If you don’t pay attention to it and we don’t do anything about it, they’re going to go. Some of them have already left. I know the surgery ward, I don’t even know if it’s open today because of staffing. To me that’s an issue. What you’ve done is created an unequal playing field at that hospital and you’ve got nurses wanting to go into these specialty areas and there’s a real big argument on what you can term as a specialty area, that’s another story in and of itself.

Anyway, the nurses are wanting to go into where they’re going to get more money and it’s leaving the other wards left to fend for themselves. I’m wondering if the Minister can answer that question. What are we going to do when the surgery ward closes because it doesn’t have enough staff? Thank you, Madam Chair.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, a statistic of interest is the fact that there are 124 nursing positions at Stanton and we now only have five vacancies, which I believe is a good indicator that the things we’ve done to deal with recruitment and retention with the nursing profession have borne fruit. I also recognize that when there’s change, there are always some people who support it and invariably whatever decision is made some people don’t support it. As Minister, I have to make choices and decisions in the broadest, most careful, measured way I can, recognizing that not everybody will possibly agree. In this case, we made a decision that I think was the right one and we have tried to make sure that we can address everybody’s concerns and in some cases we’ve been able to. Clearly, as the Member states, there are some that are still not satisfied. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. I’m just wondering if I can get the Minister’s response to this. The nurses are, like I mentioned, going to launch a complaint with the Equal Pay Commission; Nitya Iyer is her name and she’s the Northwest Territories Equal Pay Commissioner. They’re going to challenge the Public Service Act under section 40. I’m wondering what are the Minister’s thoughts with them doing that and how that might proceed and have an impact on his operation. Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, clearly we, the Legislature, the government, have supported the creation of these processes to give people every protection and access to due process when dealing with government and decisions made. That is a process that’s available for use. Should it be put to use and a judgment is made then, of course, as a government we would be looking at how we comply with whatever the decision is. Thank you.

Thank you, Mr. Miltenberger. I have Ms. Lee.

Thank you, Madam Chair. I’m assuming that we’re on page 6-17 or 16. If that’s so, I’d like to ask questions under policy in order to highlight an item that the Social Programs committee discussed that is to do with the FASD policy government-wide.

Madam Chair, I think we are all aware of this issue as an emerging potential catastrophe in the North. I think we’re just not aware to what extent this is an issue. We know it’s an issue, we just don’t know what it looks like. I think that if we don’t know what it looks like, it is really hard for the government to plan for it and come up with programs that would address these needs. I would suggest to you, Madam Chair, that we don’t really have a comprehensive assessment plan to work this out. For example, in Yellowknife I believe there is a full-time person who assesses learning disabilities and FAS needs, but one person is shared between two boards. If that’s the case in Yellowknife, I would venture to say that there are not a lot of resources being put into seeing what the situations are NWT-wide. I just feel that it’s very important that we put the resources there to make sure that we know what we are dealing with in order for the government to prepare for it.

I’m not sure I agree with the approach taken lately about testing babies or testing the biological movements of babies after they are born to see if the children are FASD. I think that’s going a little too far, with lots of questions to be answered there in terms of rights of parents and privacy, et cetera. Overall I think this is a very important issue and the committee has recommended that the government does more to highlight this issue and the committee has put the government on notice that during the next business plan we expect to have a lot more and full-detail discussions about this. I’d like to ask the Minister for comment on where the department is at and how he plans on responding to that. Thank you, Madam Chair.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, once again, we’re aware of the committee’s recommendation and we’re going to be looking at responding to that. I would also, as I did in committee, point out that we have been dealing, even though it may not have had the label FASD, I would suggest for generations now that we are in the midst of it. We are becoming more aware of it. There’s more and more effort being put into the research side. We’re just heading down next Friday to meet with the Pacific Northwest FASD Partnership which is comprised of the three territories, Manitoba, Saskatchewan, Alberta and B.C. There’s a research centre being set up in B.C. with a satellite research centre being set up in Edmonton with the intent of trying to better understand the pathology of FASD and how it exists, how you test for it, how we can do better in dealing with it.

Madam Chair, if we also accept the assumption that we’ve been dealing with this for generations, then the next assumption is that many of the people that we deal with as adults now in our correctional centres and those requiring assisted living, those who are having trouble finding and keeping gainful employment, possibly are suffering from that same affliction; not only the babies, not only the young children. We have a whole host of programs that we currently fund. We spend millions trying to find adequate placements for adults requiring assistance, as we do with children.

We are not moving towards testing of babies, as the Member indicated. The Yukon has taken that tack, but we are not advocating that. We attempt to deal with FASD in a number of ways and the most fundamental success is going to be, of course, on the prevention side when it comes to convincing pregnant mothers not to drink. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Yes, on that point, yesterday, Madam Chair, you were asking whether there was any piece of good news that we could speak about. I think there has been some good news about less drinking and there are fewer people being caught drinking and driving. Even though the laws have been made to be more stringent and restricting over the last Christmas, I think the statistics there turned out to be a lot better than it was in the past.

Staying on the prevention of FASD and what the government is doing and what kind of work is being done on this issue, what are we expecting to come out of the discussions you’re having with other governments? Are we anywhere near, as a government, coming up with a strategy or an initiative that could speak to the kind of resources we’re putting into assessing and diagnosing problems? Is there any kind of a focused effort like that that we’ve done on maybe a non-smoking strategy or even sexually-transmitted diseases to that extent on any of the recognizable initiatives that we know of that the government has been working on? Could the Minister be more specific about what the government is working on in this area? Thank you, Madam Chair.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, through the chief medical health officer’s shop, we do work on prevention and health promotion. We also work in conjunction with active living and healthy living initiatives with Education, Culture and Employment. We work with MACA, as well, and Education, Culture and Employment as it pertains to youth; trying to work on the prevention side, active living, healthy choices, right choices. We’re also part of the Pacific Northwest FASD Partnership because it is a concern clearly across the country, but in the northwest it’s a big issue and there are benefits to partnerships. The research is going to cover a number of areas, but as of yet there is not a clear, simple way to diagnose or assess an individual that may have FASD. As far as I understand, it’s a very complicated, time-consuming process where you have to do family histories and a whole number of things. There is not a simple test that can tell you if a child has FASD or an individual or to what degree. You have to try and sort that out.

So there is great benefit to us if they can come up with a way that can indicate even if there is FASD present, and then it would affect how we respond to the individual in question. Right now if they have behaviour problems, what motivates it? Is it just because they’re a rebellious teenager or because they have some other genetic issues that they were born with; for example FASD? Sorting those things out requires time, which is why we’ve invested and we’re part of that partnership as well. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you, Madam Chair. On the basis of what the Minister just said, I have two questions. One is, given the difficulty associated with this commission and the fact that it’s so hard to determine diagnoses, is it safe to say that we do not have a mechanism yet to identify FASD as a specific disability nor do we do that in terms of determining treatment or benefits or the people with suspected FASD? Are there cases where people have been specifically diagnosed as having FASD and, once they are, are there accompanying programs they can enter into, or is it a case where the people who are suffering from this largely go undiagnosed and they just tap into different programs as they’re available?

My second question has to do with the partnership that the Minister mentioned, the Pacific Northwest, this Minister-to-Minister level partnership, from what I understand. What is the time frame in terms of the work that this group is doing to see when we’re going to know more and to know answers to those questions that we’re discussing here? Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, when dealing with individuals, often assumptions are made based on behaviours. There are times, depending on when alcohol was ingested by the mother, when there may be some clearly visible features that are indicative of an individual with FASD which would be a clear indication of what may be at issue with this individual. But the Member is correct that there are assumptions made that the high number of FASD people are individuals that there may be in the Northwest Territories, but there isn’t a lot of testing done.

On the time frame for the partnership to show results, all the jurisdictions have been working on FASD on their own. What we’ve done is there’s been an agreement to coordinate and concentrate the research efforts. That was done through a fairly extensive process that’s being put together so that it’s located in Vancouver and Edmonton and they are going to continue to work on it and they are going to share their work not only in Canada, but in the States and wherever this work is being done on FASD. I can’t give the Member any specific timelines on when they are going to have success in any particular area. It is just ongoing research and work. Thank you.

Thank you, Mr. Miltenberger. I have Mr. Ramsay.

Thank you, Madam Chair. I have a few more questions for the Minister while we’ve got him here. One of the things I heard the Minister mention was the fact that there are currently five vacancies at Stanton. Is that correct?

Thank you, Mr. Ramsay. Mr. Miltenberger.

Yes, Madam Chair.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you. Five vacancies of registered nurses that is. If there are only five vacancies, why would Stanton look at closing a ward down due to lack of available staff? Thank you, Madam Chair.

Thank you, Mr. Ramsay. Mr. Murray.

Thank you, Madam Chair. What happens on some weekends with a low patient census and we may have only a few clients say in paediatrics and surgery because those wards are next to each other, you put the patients together in the same ward as opposed to having them in two separate wards with one or two people. The ward isn’t closed, they just put the patients in the same area so that the staffing can be done together and there’s more than one person with the patients. It’s not because of the shortage of nurses.

Thank you, Mr. Murray. Mr. Ramsay.

Thank you, Madam Chair. So you’re not closing the surgery ward due to a lack of nurses. Is that correct?

Thank you, Mr. Ramsay. Mr. Murray.

Thank you, Madam Chair. Yes, that’s correct. It is my understating and I checked this morning over at Stanton before we came today.

Thank you, Mr. Murray. Mr. Ramsay.

Thank you for that, Mr. Murray. I’ll move on now to another issue I brought up with the Minister last year when he was here and that was the issue of a palliative care unit at Stanton. Currently people live their entire lives paying dearly in terms of taxes and other things that they pay to the government throughout their whole lives. I think it’s important that when it is time to go and some people get diagnosed with a terminal illness and they know that their days on this earth are numbered, I think it’s very important that we have a place where people who are terminally ill can go and live their last days on this earth with as much dignity and respect as possible and I don’t know if that is currently the case here in the Northwest Territories. I think if we can get some funding or we can look at channelling some funding in to make this happen, it’s an initiative that this government should take on. Thank you, Madam Chairperson.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, this is indeed a very sensitive, crucial area. There is capacity in Stanton on the long-term care side, as well as other facilities I have been in that have capacity with families who may have an individual, as the Member indicated, who is dying and where there is capacity for the family to be together where it is set up to be as comfortable and as soothing as possible so that the family can be supported along with the individual. In Stanton, as I indicated, the capacity is there and since we have the public administrator here, I’ll ask if he would speak a bit more specifically about the services at Stanton. Thank you.

Thank you, Mr. Miltenberger. Mr. Murray.

Thank you, Madam Chair. Just to add to what the Minister said, in the long-term care ward the staff there is excellent at dealing with the individuals and the families in their final days. It’s quite frequent that the staff get special recognition from the families because of their care and sensitivity in how those individuals are treated near the end. As well, they also have in that area a chapel and places like that where people can go for support and peace of mind.

I’d be interested to hear the Member’s specific ideas as to what he would want to see beyond what good service those people at Stanton do provide. Thank you, Madam Chair.

Thank you, Mr. Murray. Mr. Ramsay.

Yes, thanks, Madam Chair. I certainly wouldn’t want to downplay the work that our staff does out there. I know they do a yeoman’s job out there and they should be commended for doing that. I guess what I am trying to get at here is not necessarily the staffing. That’s another issue. What I’d like to get at is a dedicated ward for palliative care where the atmosphere and the surroundings are much different than they are in the long-term ward or any other ward in Stanton for that matter, because it needs that extra nice touch, I guess, Madam Chairperson, that people should be afforded and an area for families to gather. Maybe the rooms could be nicer. It’s just something I think and feel strongly about that I don’t think the government pays enough attention to, especially for people who are terminally ill like I mentioned. I think we can go a ways in getting there.

The staffing though -- and I do commend the Minister and his staff out at Stanton -- I think they do a first-rate job, but we need to give them, I think, a few additional tools to be able to look after people in their last days if they are terminally ill. Thank you, Madam Chairperson.