Mr. Speaker, Your Standing Committee on Social Development is pleased to provide its Report on Bill 40, An Act to Amend the Medical Profession Act, and commend it to the House.
Bill 40, An Act to Amend the Medical Profession Act, was first introduced by the Department of Health and Social Services on November 25, 2021, and then referred to the Standing Committee on Social Development for review. A plain language summary for Bill 40 was tabled on November 26, 2021.
Bill 40 proposes changes to the Medical Profession Act to:
• Exempt physicians in other provinces and territories providing virtual care to NWT residents from needing an NWT licence when there is a referral from an NWT doctor or nurse practitioner;
• Clarifies a regulationmaking power to adapt and adopt standards of practice for the practice of medicine;
• Allows the Minister of Health and Social Services to enter into agreements with other governments or organizations about physician licensing;
• Creates a new category of registration and licensing for physicians practicing virtual care without a referral; and
• Allows registers of physicians to be posted online.
The main changes made in committee include:
1. Removal of the virtual care register; and
2. Requiring the Minister to consult with the Northwest Territories Medical Association before recommending regulations on standards for the practice of medicine.
The committee thanks everyone who took the time to participate in the review and provided us with comments and concerns on Bill 40.
This bill provides a permanent arrangement for virtual healthcare services based on NWT referrals. During the COVID19 public health emergency, the state of emergency, the Minister of Health and Social Services authorized virtual care through a ministerial directive. In accordance with section 3.3 of the Hospital Insurance and Health and Social Services Administration Act, the Department of Health and Social Services made a temporary agreement with the College of Physicians and Surgeons of Alberta to exempt its members from having to licence in the NWT and to continue to provide services needed in the NWT.
The agreement was renewed by one year and will expire by the end of 2022. This bill provides a more permanent arrangement.
Mr. Speaker, I would like to pass to my colleague for Great Slave further reading of this document. Thank you.
Thank you, Member for Kam Lake. Member for Great Slave.
Thank you, Mr. Speaker. Mr. Speaker,
The committee held a public engagement period from December 22, 2021 to April 31, 2022 and a public hearing on May 16, 2022. Near the end of the committee's review period, the Government of the Northwest Territories Department of Health and Social Services identified issues with Bill 40 that could require substantial amendments. These issues addressed some of the points of contention identified by stakeholders.
At the suggestion of the Minister, the committee sought and received an extension of the review period on March 28, 2022. The committee indicated its willingness to work collaboratively with the Minister of Health and Social Services to improve Bill 40.
When a bill is before a standing committee, it is unusual for the Government of the Northwest Territories to be involved in consultation with stakeholders. However, in this instance, committee took the unusual step of requesting that the Minister of Health and Social Services again consult with key stakeholders on the bill during this extension.
The committee received written submissions from the College of Family Physicians of Canada, the Northwest Territories Medical Association, the Royal College of Physicians and Surgeons of Canada, and the Registered Nurses Association of the NWT and Nunavut, and also heard from the Northwest Territories Medical Association in a public presentation on May 16, 2022.
Submitters expressed two key concerns: The lack of integration of care providers into the NWT medical system if virtual care is permitted without a referral and the role of the government in establishing professional standards of practice.
The committee received additional recommendations on future virtual care access and standards of practice considerations beyond Bill 40.
All submissions welcomed Bill 40 for continuing access to virtual care beyond the COVID19 pandemic emergency measures. As part of clause 9, this change would add subsection 31.6 and create an exemption to the NWT registration and permit requirements for medical practitioners registered in another jurisdiction and referred to by an NWT medical practitioner or nurse practitioner. The proposed addition of subsection 31.6 was not contentious.
The exemption from licensing based on a referral from NWT practitioners has enabled physicians to practice virtual care during the COVID19 pandemic. All submitters made it clear that this was a welcomed practice that should continue.
The Canadian Medical Association and the NWT Medical Association supported the proposed exemption to allow physicians licensed elsewhere to provide virtual consultation to NWT residents beyond the current public health emergency given the care originates in a request from an NWT care provider with a referral. The NWT Medical Association pointed out that the referral allows for integrated and coordinated service delivery.
Medical practitioners providing virtual care based on a referral are integrated because they can work within an NWTwide electronic medical record system. The fact that NWTwide territorial staff are all employees of the NTHSSA allows coordination of virtual care within and outside of NWT.
The NWT Medical Association considered those aspects of the act that would enable referrals to physicians outside of the NWT an essential element of NWT healthcare and wants to continue this.
The Registered Nurses Association of the NWT and Nunavut, and the Royal College of Physicians and Surgeons of Canada, welcomed the exemption. Both submitters explain that the exemption would remove barriers to accessing safe and quality care for the NWT residents and leveraging virtual care as a complement to accessing inperson healthcare and services.
Most respondents expressed strong concerns about the proposed creation of a virtual care register. Bill 40 proposed creating a new 12month registration and licensing requirement for physicians practicing in other jurisdictions and in good standing with the Canadian Medical Protective Association to provide virtual care in the NWT (section 31, 81).
The registry would allow out of territory health practitioners to practice virtual care to NWT residents without a referral from an NWT health practitioner. This scenario raised several concerns in the medical profession.
Submitters were concerned that allowing practitioners to see patients without a referral may create a parallel system and leave doctors unable to integrate into the NWT medical system by not having access to NWT pharmacies. The NWT Medical Association expressed that the register would not be necessary and potentially harmful to patient care quality and cultural safety in the NWT.
The Canadian Medical Association saw concerns with continuity of care due to the fragmentation between inperson and virtual patient and physician relationships. Challenges with tests and diagnostics would potentially increase demand in hospital emergency departments. Equity concerns would arise, considering potential private pay options in virtual care services.
To address the lack of integration with NWT systems, the College of Family Physicians of Canada asked to include in the virtual register requirements for physicians. Physicians would need to have the ability to ensure informational continuity so that medical records are available and complete, have established connections with an inperson point of care in the NWT, not be affiliated with forprofit paidaccess solutions, and have experience and appreciation for the uniqueness of the NWT's regions.
Concerned with continuity of care, the Registered Nurses Association for the NWT and Nunavut advocated for physicians practicing virtual care to understand the role nurses have in communities and healthcare in the North. This would recognize that the proposed amendments would affect the practice of registered nurses and nurse practitioners who work closely with the residents in the NWT.
Mr. Speaker, I'd like to now pass this over to the Member for the Deh Cho. Thank you.
Thank you, Member for Great Slave. Member for Deh Cho.
Mahsi, Mr. Speaker.
Bill 40 proposes adapting standards for the practice of medicine by adding a code of ethics and competency programming. The new paragraph would allow the Minister to recommend regulations on code of ethics, continuing competency programs and the nature of those programs, and scope of practice frameworks and guidelines. The medical community responded with concerns that in most provinces, licensing colleges set and enforce standards of practice within the framework of selfregulation of the medical profession physicians.
The NWT Medical Association pointed out that the profession's priorities may not always align with the priorities of the government. The College of Family Physicians of Canada recommended aligning the application of standards with comparable structures in neighbouring provinces and suggested Alberta is the best fit due to proximity and existing integration.
The College recommended considering an affiliation with an existing licensing College for ease of operation. The Royal College of Physicians and Surgeons of Canada encouraged the NWT government to collaborate with the Federation of Medical Regulatory Authorities of Canada and its regional authorities to ensure panCanadian alignment in professional standards of practice.
The Registered Nurses Association of NWT and Nunavut welcomed the new paragraph as it would lead to "increased patient safety and satisfaction by ensuring that virtual practice physicians clearly understand the context of virtual practice in the North."
The College of Family Physicians of Canada noted that the amendments proposed in Bill 40 do not address issues the Physician Executive sees with the current MPA. These include the reliance on outdated certification requirements, the differential and discriminatory treatment of family physicians compared to other specialists, the inability to administer conditional licenses, etc.
The College recommended consultation with the local physician leadership from the Territorial Physician Executive to understand these requirements.
1. Leverage virtual care models in an ecosystem that promotes continuity of care (ensure availability of information in the NWT Electronic Medical Record);
2. Provide virtual care within NWT's publicly insured system, which meets the principles of the Canada Health Act;
3. Provide all people living in NWT, including those in rural and remote communities, access to reliable highspeed internet to ensure they reap the full benefits of virtual care;.
4. Design virtual care services in genuine partnership with Indigenous communities of the NWT to ensure care is delivered in a culturally safe manner;
5. Collaborate with people with lived experience (including patients and care partners) to ensure that the virtual care model meets the needs of the people relying on it;
6. Pursue ongoing quality improvement to assure NWT's successful deployment of virtual care;.
7. Integrate virtual care services with inperson care. Consider physician workforce, medical facilities, specialized equipment, clinical teams and other necessary resources, to ensure a proper balance of inperson and virtual specialty care within the territory.
Mr. Speaker, I now turn it over to Member from Inuvik Twin Lakes. Mahsi.
Thank you, Member for Deh Cho. Member for Inuvik Twin Lakes.
Thank you, Mr. Speaker.
The committee considered several motions that would improve Bill 40, including removing the virtual care register, and adding a requirement to consult with the medical professional community before proposing regulations concerning standards of practice.
Committee members noted the strong endorsement of an exception to registration to continue virtual care with referral and to allow the Minister to enter into agreements that would exempt care practitioners from licensing in the NWT and permit them to provide virtual care services to NWT residents. To this effect, subsections 31.6 and 31.7 of clause 9 were maintained.
The committee took into consideration the risks and concerns expressed in the submission. It was noted that the proposed virtual care register would not apply to every situation to prevent unlicensed physicians from practicing in the NWT, not ensure continuity of care or connection in the NWT system, not entirely remove the administrative burden; and, may create a sense of oversight not truly reflective of the situation.
Committee put forward Motions 2, 3, 4, 9, 12 to 19, and 23 to remove the virtual care register from Bill 40.
Bill 40 proposed establishing or adopting standards of practice, codes of ethics, continuing competency programs, and the nature of those programs, and scope of practice frameworks and guidelines.
The committee observed that the Health and Social Services Professions Act uses the exact wording to give Cabinet the power to make regulations to establish standards of practice, codes of ethics, and competency programs and guidelines.
After hearing from various medical organizations about the potential for the Minister to infringe on the independence of the medical profession through this clause, the committee deliberated whether the concern was the regulationmaking power or the standards themselves.
The committee recognizes the position of the professions that creating regulations on standards of practice may infringe on the independence of the medical profession. In connection with those concerns, committee members heard that the concern is not at the level of the standards themselves but that should the Minister choose the standards, it could mean competing interests because the Minister's interest may not be in line with patients' interests.
In conversations with the committee, the Department of Health and Social Services expressed the commitment to consult the medical profession on standards of practice adapted from the College of Physicians and Surgeons of Alberta to bring standards into force in late 2022. The Department plans to include consultations on adopting the Canadian Medical Association's Code of Ethics and Professionalism.
The current legislation allows the Minister to develop regulations respecting standards for the practice of medicine. Therefore, Bill 40 does not contemplate removing or adding the power that the Minister already has. Therefore, removing this power would not be within the scope of Bill 40. The committee considered all comments on selfregulation out of scope but looked to other ways to ensure collaboration as noted in the next section.
The committee proposed that the Minister should consult with the NWT Medical Association before recommending making regulations regarding establishing or adopting standards of practice, codes of ethics, continuing competency programs and the nature of those programs, and scope of practice frameworks and guidelines under clause 24 para 94.
Committee pursued an amendment with Motion No. 10 allowing the Commissioner to make the stipulated regulations only after consultation with the Northwest Territories Medical Association.
Mr. Speaker, I will now ask to pass it on to my colleague, Member for Monfwi. Thank you.
Thank you, Member for Inuvik Twin Lakes. Member for Monfwi.
Thank you.
Several concerns from witnesses were about aspects of virtual care or professional regulations that the committee did not consider in scope with Bill 40. However, the committee found the recommendations relevant to creating a supportive environment for the legislative changes to be successful.
The NWT Medical Association requested the NWT government consider the alternate process by contracting organizations such as College of Physicians to develop the standards of practice for physicians. The committee recognizes the position of the professions and accordingly makes the following recommendation.
The Standing Committee on Social Development recommends that the Minister engage the services of an independent body, such as other Colleges of Physicians, to develop standards of practice for physicians practicing in the NWT
The committee noted that while meaningful participation by physicians in discussions of standards for physicians is desirable and necessary, the NWT reality is that physicians are often working at maximum levels of their capacities with little time left for extensive consultation. Accordingly, the committee makes the following recommendation.
The Standing Committee on Social Development recommends that the GNWT work with the NWT Medical Association to ensure they have the ability to meaningfully participate when they are consulted on any proposed standards for physicians in the NWT.
The committee considered further comments by the College of Family Physicians of Canada on the Medical Professions Act. The College notes problems with the current legislation, the reliance on outdated certification requirements, differential and discriminatory treatment of family physicians compared to other specialists, and the inability to administer conditional licenses as current gaps not addressed by legislative improvements. The College states that "consultation with the local physician leadership from the Territorial Physician Executive would be beneficial in gaining further understanding" of these requirements. Further, committee makes the following recommendation.
The Standing Committee on Social Development recommends the Department of Health and Social Services consult with the local physician leadership from the Territorial Physician Executive to understand certification requirements, differential treatment of family physicians compared to other specialists, and the administration of conditional licenses.
The Standing Committee on Social Development recommends that the GNWT provide a response to the recommendations contained in this report within 120 days.
I'll now pass it on to MLA Caitlin Cleveland, MLA from Kam Lake. Thank you.
Thank you, Member for Monfwi. Member for Kam Lake.
Thank you, Mr. Speaker. I respond to all of the above.
The clausebyclause review of Bill 40 was held on March 19, 2022. At this review, committee moved ten motions. The Minister concurred with all ten motions.
This concludes the Standing Committee on Social Development's review of Bill 40. The committee thanks the medical profession and the public for their participation in the review process, the Department of Health and Social Services for the collaborative effort to improve the proposed changes, and everyone involved in reviewing this bill for their assistance and input.
Following the clausebyclause review, a motion was carried to report Bill 40: An Act to Amend the Medical Profession Act, as amended and reprinted, as ready for consideration in the Committee of the Whole. This concludes the Standing Committee's review. Thank you, Mr. Speaker.
Thank you, Member for Kam Lake. Reports of standing and special committees. Member for Kam Lake.
Thank you, Mr. Speaker. Mr. Speaker, I move, seconded by the Member for Great Slave, that Committee Report 3119 (2), Standing Committee on Social Development Report on Bill 40, An Act to Amend the Medical Professions Act, be received by the Assembly and referred to Committee of the Whole. Thank you, Mr. Speaker.
Thank you, Member for Kam Lake. Motion is in order. To the motion?
Question.
Question has been called. All those in favour? All those opposed? Any abstentions. The motion is carried. Report of Bill 40, An Act to Amend the Medical Professions Act, will be moved into Committee of the Whole later today. Thank you.
Reports of standing and special committees.
Colleagues, we will take a short recess. Thank you.
SHORT RECESS
Thank you, Mr. Speaker. Mr. Speaker, these questions are for the Minister of MACA.
Mr. Speaker, we have flood victims sleeping in tents, staying at the shelters, some with friends, and some with no place to stay. Can the Minister tell me when and how we will house those that have been displaced from their homes as residents need immediate accommodation? Thank you, Mr. Speaker.
Thank you, Member for Hay River South. Minister responsible for Municipal and Community Affairs.
Thank you, Mr. Speaker. Mr. Speaker, I understand this is a very challenging time for residents, as I've experienced that in the Nahendeh riding last year as well as residents from Fort Good Hope and as well as Little Buffalo. Disaster events are stressful and disruptive. And I understand that people just want to get things back to normal so that they can have a place where they can put their head. The reality is that things are not normal and that people have been displaced from their homes for anywhere from a week to several months, depending on what damages have been done to their homes. I know that every day is a very long time when you are out of your homes but we are working as quickly as we can to put but we will it'll take some time to get people into all the accommodations needed, longterm accommodations. Evacuees who cannot return home to do the flood damages are encouraged to contact our pathfinders who will talk them through about what's their available requirements are and to make sure that they're register reflects their full housing situation. So we will work with them. We encourage you to reach out to the pathfinders and we will work as fast as we can to get people into accommodations, medium to longterm accommodations. Thank you, Mr. Speaker.
Thank you, Mr. Speaker. Mr. Speaker, can the Minister confirm the process for approving accommodation requests for those who are displaced and are without accommodation; which department or departments have that responsibility? Thank you.
Thank you, Mr. Speaker. Mr. Speaker, the Department of Municipal and Community Affairs, the health system which was the Hay River Health and Social Services Authority, and the local housing authority are working together to ensure those who cannot return to their homes will be provided with longterm accommodations. So we do have a system in place that will triage them, I guess is the best way to describe it, and then we will see what their needs are and we have a system in place for how we do it. Damage assessments will help determine who requires accommodations and for how long. Pathfinders will follow up with anybody who is registered to better understand who needs accommodations and help support individual specific accommodations are required. So, again, reach out to our pathfinders. We have two in there right now, and we have in the process of hiring additional pathfinders and they're going to be located in the ECE building which is by the courthouse there. So we will have people there as well. Thank you, Mr. Speaker.
Thank you, Mr. Speaker. Mr. Speaker, many residents welcomed those displaced by flooding into their homes when accommodations were needed. Will the Minister confirm if there will been an opportunity to compensate those who opened their homes when accommodations were needed? Thank you, Mr. Speaker.
Thank you, Mr. Speaker. Unfortunately, Mr. Speaker, no. There's no provision within the Disaster Assistance Policy to provide funding to those households who have taken in evacuees. Mr. Speaker, though, the outpour of support for evacuees has been amazing to see. And I know the residents of Hay River and K'atlodeeche First Nation will continue to support their neighbours, family and friends, during this very difficult time. And unfortunately this is the process, and we need to follow it. Thank you, Mr. Speaker.
Thank you, Minister. Final supplementary, Member for Hay River South.
Thank you, Mr. Speaker. Mr. Speaker, accommodations is very important to many people, and I know that right now there are some that are staying in motels and hotels, and you know, they get news that they might get kicked out one day or the next day and they're not sure what's going on. So can the Minister confirm how long will accommodations be covered for those displaced by flooding? Thank you.
Thank you, Mr. Speaker. And I thank the Member for that question. And it is a very important question moving forward.
The duration of longterm accommodations will depend on the level of damage to the residence and their homes and a reasonable duration for the repairs to be completed. So that people understand, from the 2021 flood people put up in the accommodations to meet their needs while their homes are being repaired, some of these people are still in accommodations and so that there is we're not going to kick people out. We are going to put people in accommodations until such time as they can get back into their homes. Thank you, Mr. Speaker.
Thank you, Minister. Oral questions. Member for Yellowknife North.
Thank you, Mr. Speaker. My questions are for the Premier on the work we're doing to implement the United Nations Declaration of the Rights of Indigenous Peoples.
My understanding is that the Premier had kind of at step zero asked the GNWT to take each of the articles of UNDRIP and then do an internal inventory of current programs and services or current policies to kind of show where we already would align or perhaps didn't align, you know. Perhaps there's some areas, some articles which we are considering we are already complying with. So this would kind of just be something the Premier was going to take to the Council of Leaders so we're all on the same page of where we're starting from.
My question is, has this work been completed and, if so, is it something that could be shared? Thank you, Mr. Speaker.
Thank you, Member for Yellowknife North. Honourable Premier.
Thank you, Mr. Speaker. Actually the request to look at the programs across to see if our programs and services align with the United Nations declaration was done by all of the departments across the GNWT. However, it was also that information was also provided to our special committee on reconciliation. I want to make sure I got the Reconciliation and Indigenous Affairs as a part of the research that was compiled to be able to provide the interim report.
I do know that the Member is part of that committee and had access to that information. But right at this moment that information is not public. We are also working with the working group of the Council of Leaders to to also identify what programs align and what don't align and then develop an action plan from that work. Thank you, Mr. Speaker.
Thank you, Mr. Speaker. I guess I'm curious about any internal work that's kind of occurring. I recognize that there are larger questions that the declaration raises, you know, how we are going to operationalize free prior informed consent is obviously a very large question we have to work with the Council of Leaders. But to me, there's a number of smaller internal changes to GNWT internal policies, perhaps our consultation policies, perhaps how we structure the government to empower regions differently. I think there's probably a lot of work that we just need to do internally.
So my question for the Premier, has any of that work started; have we made any internal changes to how the GNWT operates in the hopes of implementing the declaration? Thank you.
Thank you, Mr. Speaker. We're always trying to improve our services, programs and services. I'm just thinking a couple of them that stick off my head right now are the Indigenous Government Procurement Policy. That has never been attempted in any government that I know of before this so that's work that we're starting now. And then of course the government already has their mandatory Living Well Together, which is an Indigenous cultural awareness and sensitivity training that we're asking every employee and every MLA to actually review. So that services people. All staff are more cognitive of the issues Indigenous people have faced and hopefully will reflect on the services that they provide.
And like the Member said, there's lots of small things but those are the two bigger ones that stick in my head right now. Thank you, Mr. Speaker.
Thank you, Mr. Speaker. I heard the Premier state that the plan is, you know, we're doing this inventory exercise and then hopefully there will be an action plan. I'm just wondering whether we have a timeline on when that action plan will be public? Thank you.
Thank you, Mr. Speaker. I do appreciate the Member always looking at this. It's really important work, the United Nations Declaration of Indigenous Peoples. However, I keep having to remind Members that this work is done by Indigenous people in partnership with us. They're taking the lead on this. And so as when that work plan will be done, there is a working group of which the GNWT has one Member and all the Indigenous governments have membership on that. So I can't say at this point when that work will be done. It's contingent on when the Indigenous governments have said "we're done." Thank you, Mr. Speaker.
Thank you, Honourable Premier. Final supplementary, Member for Yellowknife North.
Yes, thank you, Mr. Speaker. Well, it's my hope that since this was a priority of this Assembly that we would see something in this Assembly. And if we have to live with an action plan that, you know, we get on the last day and we actually don't do any of the work in it in the life of this Assembly, well, that's better than nothing. And I guess the other debate here is that BC and the federal government have introduced actual legislation which create a legal obligation for the government to do this work and for departments to do this work. Are we going to see legislation to implement the declaration in the life of this Assembly, Mr. Speaker?
Thank you, Mr. Speaker. I also want to acknowledge, again, and thank the Member for when he did his opening comments today in talking about the issue, talking about we can't do this unilaterally, I agree 100 percent. Nothing about us without us is a comment to be pointed with me.
We did bring the concerns to the Council of Leaders table and stated when legislation that we're getting I'm getting pushed in the House to get legislation across by MLAs and then gave them a timeline of when we could expect what work had to be done before legislation could be done to get into this term of this government. I've had mixed reviews. Some Indigenous governments are saying, yes, let's get on it now and other ones have said, I don't care what MLAs say. I care about this and this has to be done on our time.
So we did hire a facilitator to help with that process. They are aware. The Indigenous governments are aware of the timelines and the work that has to be done before. So I'm hopeful, Mr. Speaker, that we will have some legislation during the term of this government. But I'm also respectful that if they decide that it's not to be, then the next government gets the glory for that as well. Thank you, Mr. Speaker.
Thank you, Honourable Premier. Oral questions. Member for Thebacha.
Thank you, Mr. Speaker. Mr. Speaker, in my Member's statement, I spoke about a shortage of RCMP staff in the community of Fort Smith. I would like to ask the Minister of Justice if he believes that a lack of RCMP staff would translate to a lack of overall public safety for the people of Fort Smith? Thank you, Mr. Speaker.
Thank you, Member for Thebacha. Minister responsible for Justice.
