Debates of October 5, 2023 (day 167)

Mr. Speaker, I wish to table the following two documents: 20222023 Annual Report Director of Child and Family Services and Report on NWT Medical Travel Services: 20212022 and 20222023. Thank you, Mr. Speaker.

Thank you, Minister. Tabling of documents. Minister responsible for Industry, Tourism and Investment.

Mr. Speaker, I wish to table the following document: Priorities for Critical Minerals in the Northwest Territories. Thank you, Mr. Speaker.

Thank you, Minister. Tabling of documents Minister responsible for Education, Culture and Employment.

Mr. Speaker, I wish to table the following document: Operating Plans for the Northwest Territories Education Bodies for the 20232024 School Year Ending June 30th, 2024. Thank you, Mr. Speaker.

Thank you, Minister. Tabling of documents. Minister responsible for Housing NWT.

Mr. Speaker, I wish to table the following document: Followup Letter for Oral Questions 159319(2): Housing and 160019(2): Housing. Thank you, Mr. Speaker.

Thank you, Minister. Tabling of documents.

Colleagues, pursuant to section 40.23(2) of the Public Service Act, I wish to table the 20222023 Annual Report of the Equal Pay Commissioner for the Northwest Territories. Also, pursuant to section 99 of the Legislative and Executive Council Act, I hereby table the Annual Report of the Northwest Territories Integrity Commissioner to the Legislative Assembly for 2022. Finally, pursuant to section 21(3) of the Legislative Assembly and Executive Council Act, I hereby table the Legislative Assembly and Executive Council Act Schedule C Amendment Regulations, 2023.

Tabling of documents. Notices of motion. Motions. Notices of motion for the first reading of bills. First reading of bills. Second reading of bills. Consideration in Committee of the Whole of bills and other matters, Bill 23, 75, and 80, Committee Report 52, 53, and 7519(2), Minister's Statement 26419 (2), Tabled Document 681, 973, and 97419(2).

I now call Committee of the Whole to record. What is the wish of committee? Member for Frame Lake.

Merci, Madam la Presidente. Committee wishes to deal with Bill 80, Tabled Document 97319(2), Tabled Document 97419(2), Committee Report 5219(2), and Committee Report 7519(2). Mahsi, Madam Chair.

Thank you. Does committee agree? Thank you, committee, we'll take a short recess and resume with the first item.

SHORT RECESS

I call Committee of the Whole to order. Committee, we have agreed to consider Bill 80, Dental Hygienists Professions Statutes Amendment Act. I will ask the sponsoring Member of the bill to provide opening remarks. MLA for Kam Lake.

Thank you very much, Mr. Chair. Bill 80, Dental Hygienists Professions Statute Amendment Act amends the Dental Auxiliaries Act and the Health and Social Services Professions Act to require the Minister to recommend to the Commissioner regulations under the Health and Social Services Professions Act; to regulate the practice of dental hygienists; designate the profession of dental hygienists as a profession; transfer the regulation of dental hygienists from Dental Auxiliaries Act to the Health and Social Services Professions Act, and replace genderspecific language with genderneutral language from Dental Auxiliaries Act. Our oral health has a significant impact on our overall health. Today, almost half of the world's population suffer from oral diseases and global cases of oral disease have increased by one billion over the last 30 years. The most common oral diseases are tooth decay, severe gum disease, tooth loss, and oral cancers. Poor oral systemic health also directly increases risk of diabetes, cardiovascular disease, cancer, Alzheimer's disease, periodontal disease, and highrisk pregnancies.

Every one of these jeopardizes a person's quality of life, may shorten their life, and is a significant financial cost to this government. The operations budget for the Department of Health and Social Services of the Northwest Territories is over half a billion dollars, and the cost of health care is not going down. In fact, our expectations on our health department continue to grow and the associated budget is not keeping the pace. Changes to prevention have the potential to have longterm cumulated impacts on the government's bottom line and the quality of life of Northerners.

Here in Yellowknife, residents have access to dental hygienists depending on financial resources and benefits the individual has. But in remote communities, access to regular dental care is not consistent and treatment is not timely or immediate. Accessing treatment is complicated by the fact that dental services are not insured medical services under the Canada Health Act. Depending on an NWT resident's ancestry, their funding for dental care and the funding contract that potentially bring oral health care to their community come from different funding or benefit pots. And given the current legislation, it makes it hard for contracts to be tendered solely for prevention.

Today, the Dental Auxiliaries Act stipulates that no dental hygienist shall practice dental hygiene except under the direct the direction and control of a dentist. In our last session or a few sessions ago now sorry, Mr. Chair, the health and social services response to Oral Question 143519(2) stated, quote, Access to dental services for Indigenous residents eligible for the noninsured health benefits program is funded by Indigenous Services Canada through a contribution agreement with the department.

The department, on behalf of ISC, enters contracts to pay for the travel costs of dental providers to provide dental services in communities. ISC determines the number of dental days allocated to each community and funding is in accordance with this number, end quote.

In reality, how services are delivered on the ground across our territory differs and how they are intended. Yes, there are contracts for dental providers to travel to northern communities but on the ground, this means outside of Yellowknife. Dental providers offer dental services in short blocks of time where services are triaged starting with dental emergencies. This makes sense. If someone needs a root canal or an extraction, this will always be the more emergent case. But this means prevention is routinely pushed back or simply does not happen, and the next visit is more teeth being pulled and perpetuates a cycle where preventative care consistently sits on the back burner.

Separating dental providers to allow the option of dental hygienists to work independent of a dentist is key to empowering dental hygienists to secure their own contracts should they choose, provides Indigenous governments with a mechanism to hire dental hygienists and, in turn, provide more equitable access to preventative oral health care across the NWT.

Mr. Chair, earlier this year, the Standing Committee on Government Operations travelled with Bill 85, the United Nations Declaration on the Rights of Indigenous Peoples Implementation Act. A resident of a small remote community asked committee if passing Bill 85 would help their community access equitable health care, specifically dental care, because a dentist has not visited their community since before COVID, and the only dental care seen in the community is through medivacs for oral abscess. Bill 80 will help to create this path.

Today, all Canadian jurisdictions, except the three territories and PEI, have legislation to support dental hygienists to be autonomous and selfregulated to varying levels, even those working in remote regions of northern Ontario, Newfoundland and Labrador and northern British Columbia.

It is also worth noting, Mr. Chair, that this is also a decentralization and economic diversification conversation given the employment opportunities this will potentially create outside of Yellowknife.

As outlined in my Member's statement today, I believe that expanding the scope of practice of some of our health care professionals will help alleviate some of the bottleneck on the entire health care system. This facilitates one of those pieces.

During review of this bill, the Standing Committee on Social Development received concerns from a stakeholder about the timing associated with the bill. I was happy to collaborate with committee and concur with two motions to expand the timeline of the bill to a deadline proposed by committee. But there are reasons I also believe that having a deadline for this work is important, Mr. Chair. I want to start by acknowledging the significant demand on the Department of Health and Social Services over the course of this Assembly. From the demand during the pandemic and subsequent territorial emergencies to the substantial legislative agenda that still lays in front of this department. But the oral health action plan tabled in the last Assembly outlined multiple timelines for deliverables that came and went in the 19th Assembly. Even with the MLA for Deh Cho, MLA for Inuvik Twin Lakes, and myself championing on the floor, calls for improved regulatory frameworks and improved access to oral health care starting in February of 2020, paired with my ongoing conversations about a Private Member's bill, this work still did not happen.

Health care is a high demand, yet evolving system, and the demands on renewal will continue long past the 19th Assembly. In the past, other GNWT departments experiencing significant demand on employee time and legislative or regulatory needs have tendered contracts for legislative and regulatory drafting to continue to meet its mandate. This is an alternative that health may need to consider to get this work done.

Mr. Chair, I'd like to take the time to thank Mr. Toby Kruger, law clerk, for working with me on this bill. I would also like to thank committee for the work they did reviewing my Private Member's bill, the input from stakeholders, including Nigel Lenny, and share my gratitude with my colleagues for their support in this important work. Thank you, Mr. Chair.

Mahsi, MLA Kam Lake. I will now turn to the deputy chair of the Standing Committee on Social Development, the committee that reviewed the bill for any opening comments on Bill 80. MLA for Great Slave.

Thank you, Mr. Chair. Mr. Chair, Bill 80, Dental Hygienists Profession Statutes Amendment Act, received second reading in the Legislative Assembly on March 30th, 2023, and was referred to the Standing Committee on Social Development for review. The standing committee held a public hearing in Yellowknife on May 12th, 2023. Committee heard from two stakeholders at the meeting at the hearing and received two written submissions on the bill. Bill 80 will designate dental hygienists as their own profession and provide dental hygienists with the option to work independently of a dentist.

Committee recognizes the state of oral health care in the NWT, that dental services are so limited that many residents go months, even years, before they can receive dental care. For many residents, there is no other option but to wait with decaying teeth and in physical pain until services are available locally. Because of the limited access to oral health care in communities, committee heard that this has resulted in dentures being made for children as young as 12 years old.

For those who can afford it, residents resort to paying for their own travel expenses to go to Yellowknife, or further south, to receive dental work. This is not an acceptable solution when dental hygienists could be empowered to work independently. Committee heard from the Inuvialuit Regional Corporation the benefits of enacting Bill 80, specifically that it will potentially allow for greater access to federal funding. It would allow the IRC to bring services into communities faster. It would enhance the quality of life in the region. The IRC recognized the relationship between oral health and mental health, with those having access to oral health having greater selfesteem and selfconfidence.

While committee endeavoured to negotiate a date for implementation of the bill, committee could not find agreement with the department.

On August 3rd, 2023, committee held a clausebyclause review of the bill with the sponsoring Member and moved two motions to amend the dates for implementing the regulation of dental hygienists. Committee recognizes the challenges the department has identified to adhere to the timeline as proposed in the bill. Committee heard the challenges from the department regarding selfregulation but committee also heard there are options, and the NWT would not need to create its own association. Committee wants the department to move faster, to see concrete action to improve oral health for residents in the NWT and not wait until the end of the 20th Assembly to do so.

I would like to thank the stakeholders who engaged with the bill with committee. And individual Members may have additional comments or questions. Thank you, Mr. Chair.

Mahsi, MLA Great Slave. I will now open the floor to general comments on Bill 80. MLA for Twin Lakes.

Thank you, Mr. Chair. Mr. Chair, this bill, I believe, is very important. The reason why I think it's very important is there's probably not many of you that sat in a room with a child waking up, postanesthetic, after oral surgery. In my first career coming out of the nursing program, being a frontline nurse on the floor, that was one of my duties, was to when we had dental day, was we would try to get as many kids through the operating room as possible to deal with the teeth that are rotting in their head. You know, these are twoyearolds, and sometimes they're back again when they're eight years old for the same procedures on the remaining teeth. There are so many children that are going through oral surgery unnecessary oral surgery because of a lack of services in our small communities and our regional centers. And people that are developing these laws and these you know, and making sure that this is being done don't live in those communities. So they don't see it. And that is why I feel that they we can't wait any longer. We can't wait you know, we as a committee, we compromised. We wanted it done now. We want this done now. We wanted it down this Assembly. So we're compromising with, you know, waiting two to three more like, another two years. I think that's in the bill, is what we compromised. You know, and I think any one of us on this side of the House if it was said you want to put this in the operating budget to get more money so that we so health could get this done, we would say get it done, because it's going to save us money in the long run. It's going to save us from the medical travel that we hear about so much. All these children flying in and then having to go through surgery. Surgery is dangerous. It's not normal. But we've normalized in the territories. This is not okay. This is not acceptable. And we need to do better. And we need to do better for our children. And so that's why I am fully supporting this bill. Thank you, Mr. Chair.

Mahsi, MLA Inuvik Twin Lakes. Are there any other general comments? MLA for Great Slave.

Thank you, Mr. Speaker or sorry, Mr. Chair. Maybe next go around.

Mr. Speaker, I'm quite frustrated with this entire process and how this has gone. You know, the decisions and reasons that were given to me, or to us as a committee from the department and the Minister regarding why this could not go ahead as of now or even in the two years that we've compromised on, they don't wash with me. Some of these things are things that such as well, no dental hygienist brought this forward. Well, they're busy. They're working. Everybody's trying to get into dental appointments. So just because they didn't come and initiate this program does not mean they did not show interest. And every single one of them told us this would be a great thing. I had a dental cleaning in the meantime while this bill was going on and my hygienist told me she used to work independently in the south and didn't understand why she wasn't able to do so here in the North. Another reason we were given was that the there needed to be time to do culturallyappropriate standard operating procedures and protocols. However, standard operating procedures for this type of work are available across Canada, and that includes in the other two territories, I'm sure. So to me, it would have just been a matter of taking things that already exist and adapting them for our territory. To put it off as waiting for it to be done culture in a culturallyappropriate manner when all it is doing is impacting Indigenous children is quite laughable, actually, to me. When I look at that as a reason, we're going in the meantime sacrifice the confidence and the selfesteem of Indigenous children. I've seen children in this House, pages come in, who smile like you wouldn't believe at me until the camera comes out. And when it's time to take the picture, the teeth go away because they don't want people to see their teeth being recorded looking that the way that they are. I noticed that, because I tried to take a picture a couple times with a young page who I knew his family and he wouldn't smile the way he'd smiled the whole week before. I've had braces. I've had numerous fillings. I have teeth that are not great. I can thank my dad for that. And I can tell you that it has impacted me as a person my entire life, to have had teeth that didn't feel like everybody else's and were not the same. And I am lucky because I had parents that had benefits. I had orthodontics. I had cleanings. I had everything. So how do you have that when you have poor health already, because you're living below the poverty line given that everything seems to be here in Yellowknife, including dental services, so now you have all of these issues that lead to medical issues. Like my colleague said, surgeries that are unnecessary, other things that can be determined by dental hygienists. I currently am waiting on something to be investigated from my that my dentist has identified. And now I'm in the bog down of health and social services waiting to get that looked at. So if I'm a person who can advocate for myself, I'm a white, professional woman, an MLA in the territory's capital and I find our services lacking, what does that look like in communities? And, you know and it comes back to the same thing as mental health. When we're continuously triaging things because we're so far behind, we will never get to the chronic cases. We will never get to the backlog because we are constantly just fighting to stay ahead of the game of where we're at. And that means, like my colleague said, everybody that's an emergency will get what they need then they're not even getting what they need. I shouldn't even say that. But the people in emergency will get prioritized, and the other people will not, and their issues will escalate. And when I look at this, this could have been an opportunity for this to have been quite creative because this could go out to engagement with the other professions Acts that are on the table for the next Assembly. There are ones that this department will be going out to do engagement on. So how hard is it, Mr. Chair, to add one more on to that where everybody agrees that it needs to be done? They could have just brought it along in the next one, but instead we actually not only did not have a compromise, we have something that is being actually rolled back even further by a Member that isn't even going to be sitting here. Thank you, Mr. Chair.

Mahsi, MLA for Great Slave. MLA for YK Centre.

Mr. Chair, I'm here as the Minister of health to discuss this Private Member's Bill, Bill 80, the Dental Hygienist Profession Statute Amendment Act. I would like to thank the Member for Kam Lake and the Member for Inuvik Twin Lakes for their efforts to advance a modern regulatory framework for dental hygienists. I'd also like to thank the Members of the Standing Committee on Social Development for the time they have taken to hear the department's concerns with the approach taken to this bill, and specifically the time it will take to create new professionspecific regulations for dental hygienists under the umbrella Health and Social Services Professions Act.

The department recognizes that there is a significant gap in the provision of preventative dental services in our communities and agrees that expanding the scope of dental hygienists is one potential solution. We also acknowledge that the current regulatory framework for dental hygienists is outdated and unnecessarily restricts their scope of practice.

Mr. Chair, this bill will not fix this problem. Dental services are not part of the NWT health plan. In small Indigenous communities, dental services are funded by the noninsured health benefits program, which is, in turn, funded by Indigenous Services Canada. The fact is the federal government isn't allocating enough money to attract providers to travel to the small communities to offer services.

All the dental contracts we had expired on March 31st, 2023. And prior to that, we advertised for new regionallybased contracts. What we got out of that was two regions did not receive any bids. Two regions received a single bid however both proposals were noncompliant.

The department and myself, in particular, have been advocating for changes to the requirements of working with Indigenous Services Canada to determine next steps. But until the contracts are awarded, if and when, access to dental services outside of the home community is being assessed by Indigenous Services Canada on a casebycase basis. We need our partners at the federal government to come to the table to understand the challenges that are preventing the delivery of these services. This includes reviewing rates offered to providers for services and working to improve communications on how residents who qualify can access services while they are not available in their home communities.

We agree that the regulatory framework for dental hygienists should be prioritized for modernization. However, we remain concerned about the legislated timing for completing the new profession specific regulations for dental hygienists. Pharmacists and midwives have both applied earlier than this bill arrived to be regulated, and those we are prioritizing those.

There are risks to missing the legislated deadline. If that were to happen, dental hygienists would not be regulated and without regulation, they probably could not obtain insurance. The department would prefer more time in order to manage this risk and looks forward to working with the NWT dental hygienists to update their practice. Thank you.

Mahsi, Minister of Health and Social Services. Are there any further comments? MLA for Monfwi.

Thank you, Mr. Chair. Mr. Chair, I support this bill too because prior we used to have dental therapists and dental assistant workers in our communities working in our school with elementary to higher grades doing more of a preventative work. And it wasn't just only open for the school, but it was also open to the communities at large. You know, a lot of community members took advantage of it because they're they're there, they provided the services. And now when we look at it, the only people that benefit from dental services are children of GNWT workers or other workers with a good dental benefit plan. And others with no benefit, they're denied a lot of services. And this is where we see especially in small communities where we see a lot of young children with poor dental hygiene, and this has to stop. We got to do something to do more of a preventative work because those with a dental plan, the medical travel covers their expense. I am not too sure if NTHSS medical travel covers for those with no benefits. So I do support this bill because it will benefit a lot of small communities that cannot afford to fly into Yellowknife or to other larger regional centres with the dental services. So therefore I do support this program I mean I do support this bill. Thank you.

Mahsi, MLA Monfwi. Are there any other general comments from committee? MLA Hay River South.

Thank you, Mr. Chair. You know, I support this bill as well. I guess it kind of brings back memories, I guess, to when I was a child and I had to go into the dentist's office and sit in the chair and, you know, and deal with the pain that came with it. And, you know, that's due to lack of oral dental health opportunities or that were available to us at that time. And, you know, and that memory never goes away. You know, and because of that, I made sure that my children didn't have to go through that. I made sure that their teeth and their dental was looked after and, you know, they got what they needed.

You know, it's unfortunate that, you know and that was many, many years ago. And now we're in 2023, and we're still talking about it. It's still happening in small communities where which are predominantly Indigenous. And, you know, we talk about the Minister talked about NIHB. Well, you know, that's got to be one of the you know, if we're when it comes to dental health, it's not great for Indigenous people. You know, I endured it when you know, with you know, with not having oral health opportunities or being able to get that type of service. So now today, you know, like, a month ago, I went, and it cost me $8,000 to you know, to get bridge work done. And, you know, if I would have probably had you know, been able to look after my teeth when I was younger and had services available, I probably wouldn't have to do that. But that's what happens when you're under NIHB. And it's unfortunate that's just the way it is. And we have to do something different. You know, and I understand that, you know, the federal government has a responsibility to Indigenous peoples but at the same time if they're not going to do anything, somebody has to do something has to do something. Somebody has to step up. You know, I'm tired I'm sick and tired of hearing that it's always somebody else's problem. As long as we're sitting here, it's our children, it's our problem. It's not somebody else's. So I support this bill, and I'm glad that the Member for Kam Lake brought it forward. And thank you.

Mahsi, MLA Hay River South. Are there any MLA for Thebacha.

I want to thank the chair for recognizing me. I just want to make a couple comments.

Fort Smith is a regional centre, and we have no dentists or no dental anything there right now. The dentist that used to come has stopped coming since I think way before Christmas of last year. That's a large community and, you know, we have a lot going on there, and I'm very concerned about the dental services that we need in that community and have, you know, the absence of the oral health that is required and, you know and we have to also look at the whole issue of ways of life and people people who do or have substance abuse. The decay in their within their health system is it's just not there. They don't they have they don't they're not even covered to get their teeth fixed properly when something and they want to change their lifestyle. It's always there. And so, you know, dental health is probably one of the most important things that to make sure that a person is healthy and well. It not only affects Indigenous people. It affects everybody. You know, I have a big population in in the community of Thebacha and Fort Smith. And dental services are lacking, and we have no the chair is there. There's an office there but there's no dentist. And it's a major problem that we face for the community. And so with this, I'm going to be supporting the bill that has the Private Member's bill. Thank you, Mr. Chair.

Mahsi, MLA for Thebacha. The MLA for YK North.

(audio).

The MLA for Frame Lake.

Yeah, thanks, Mr. Chair. Yeah, I love Private Member's bills. I'm 50/50. I appreciate the comments from the Minister but sometimes if we don't have deadlines, things just don't get done. And I'm just going to leave it at that. I support the bill. Thanks, Mr. Chair.

Mahsi, MLA for Frame Lake. MLA for Tu NedheWiilideh.

Thank you, Mr. Chairman. I just want to thank Caitlin Cleveland for putting this Private Member's bill forward. And I agree with my colleagues, the issue of dental hygienists in the communities are needed. And I come from small communities and, you know, it's welcome. This should have been done a long time ago. And, and so, Mr. Chairman, I just want to say that I will be supporting this bill. Thank you.

Mahsi, MLA for Tu NedheWiilideh. Are there any other general comments? Seeing none.

Is the committee agreed that there are no further general comments?

Agreed.

Can we proceed to a clausebyclause review of the bill?

Agreed.

Committee, we will defer the bill number and the title until after consideration of the clauses. Please turn to page 3 of the bill.

Clause 1, does committee agree? Minister of Health and Social Services. Pardon?

My apologies, committee. Does the sponsor wish to bring in witnesses?

Yes.

Mahsi. Sergeantatarms, please escort the witnesses into the House.

MLA for Kam Lake, please introduce your witness.