In their entirety, first nations and Inuit health programs comprise over two-thirds of Health Canada’s total budget. It is the policy of Health Canada that first nations may take control of their programs at a time and pace of their choosing. We believe the ability to take control of these programs, and to change them to better meet specific local and community needs, is an important step that will enable communities to improve their health status. At the present time, over 30% of all first nations communities are operating programs under transfer agreements, and an additional 31% are in some stage of transfer planning or negotiation. We are encouraged that the Auditor General has recognized the importance of transfer and has indicated this in his report.

In the case of providers such as pharmacists and physicians, we regularly use the colleges when we come across the information and when that information looks at variance. The Auditor General’s report said there is a real problem with the MSB’s national transportation directives. May I suggest that is not as much an aboriginal problem of abuse as it is of unscrupulous Caucasians who are abusing the system.

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The department clearly recognizes the seriousness of prescription drug misuse, and is working very hard to take any action we can to prevent this harmful activity. The Auditor-General reported on all health programs concerning the First Nations and Inuits, but the comments that received the most attention dealt with the inappropriate use of prescribed medications resulting from the Non-Insured Health Benefits Program. Health Canada is working closely with our federal colleagues—particularly DIAND and Human Resources Development—and with first nations themselves to maximize the impact of the resources directed to first nations needs. Where the opportunity arises, we are also working with provincial health departments. This is vitally important in order to avoid duplication of effort and to ensure that new and existing programs complement each other.

As for the issue of street abuse of medication, we have also initiated with a number of the communities in New Brunswick—with chief and council—education programs about the debilitating effects of the misuse of drugs. We don’t accept that, and don’t think it’s in any way an appropriate thing to be going on. We continue to intensify our efforts, but we also need the support of the leadership. If there is a criticism in that area, it is that we do not follow up with an audit on each of those arrangements. As I indicated before, we deal with 630 first nations in Canada.

Clients, and to a certain extent providers as well, are protected by legislation and regulations that limit the use of confidential medical information. I’d like to go right ahead with our discussions on what our boundaries will be, how much of what we want to follow is in the letter. I’m just putting that before you now, if you think we could have a working meeting on Thursday at the regular time, 11 a.m. So when we move these people—geographic disadvantage, linguistic and cultural disadvantage—this program allows for those people to be treated the same way as other people can be treated in a tertiary environment. But I’m not sure that as the senior manager in this program I have alternatives to overcome that.

One of the great dilemmas we face in delivering this program is the issue of language and the issue of children and legal issues around consent. If you move a young child out of Shamattawa and you put that young child in a plane to go the Health Sciences Centre in Winnipeg, the return air fare may cost $2,500 or $2,600. If that child can’t speak English, the child will need an escort. If that child is under the age of majority, he or she will need an escort in case when he or she gets to Winnipeg consent forms have to be signed.

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The specifications for this new contract are certainly more demanding and more stringent than the specifications of the original contract. We learned a lot over the seven years we dealt with the old provider. Hence, our statement of requirements is an enhanced statement of requirements, particularly in the area of audit, where we have increased the audit requirements. The Auditor General has highlighted the fact that the health status of first nations and Inuit people is significantly worse than that of the general population. I expect that in your travels, many of you have seen first-hand the great challenge that first nations communities face as they work to improve their health and living conditions.

We will go in, deal with the provider and try to straighten out the situation. We are not standing at the table saying to Opaskwayak Cree Nation, “You have to sign. We had a negotiator’s agreement; you have to sign.” We are certainly respectful of the wishes of first nations and we will continue to deliver that service to Opaskwayak Cree Nation until such time as they decide they are in a position to accept it themselves.

In closing, I would suggest it is very important to recognize that prescription drug misuse, like other forms of substance abuse, is but a symptom of greater underlying problems for individuals and their communities. I hope you can see from my remarks that we take the problem of prescription abuse seriously. The Auditor General focuses on cases where there are problems, but these same figures also indicate that the vast majority of our clients appear to be receiving prescription drugs appropriately. So where we find issues of misuse and abuse, there is a mechanism in the agreements to terminate them. In other jurisdictions where it’s not an insured program it makes much better sense to have local arrangements.

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We have to ensure that first nations have as equitable an access to the mainstream system as everybody else in the country. But let me assure you that should it be clear that there’s evidence of fraud or misuse, we will refer that file to the RCMP. For us to have 100% audit, we would need—I could use the word “battery”—a significant number of auditors to audit each arrangement, and we just don’t have that, nor do we feel that it is the right way to deal with the situation. We are struggling with what is the appropriate timeframe—and I’m being somewhat repetitive here—to allow those first nations that want to move forward to do so and for those that are more cautious to delay.

• In some cases it has resulted in dramatic changes in the prescribing practices of some physicians.
• We feel that the balance has to be made between investing the resources in the communities and allowing the communities to run the programs as they can within a transfer agreement, where they can make decisions that affect the programming at their level based on their membership.
• As for where all of this will lead, we hope we will see a significant response to RCAP.
• We learned a lot over the seven years we dealt with the old provider.
• Every region regularly visits communities to discuss their programs with the chief and council.

We negotiated an agreement with our old contractor to do that even though the contract is approaching its end, and we achieved that without any additional cost to us. There’s a random selection of audits on our key agreements to ensure that the terms and conditions are being followed. Last year, the Standing Committee on Health conducted a study of child health. Aboriginal groups, particularly women’s groups, told us they know of certain programs that could be helpful for them but the specific programs have never been set up in their communities. However, they knew that the cheque had been received by certain band chiefs. Indeed, outside of that contract, we are working on a separate audit protocol to ensure that where we detect problems we will be able to have a broader base of audits so that we are ensured that the providers are aware of our requirements and adhere to our requirements.

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This is not a “dump and run”, as the Auditor General has reported it; this is putting the information on the table and allowing those communities to make informed choices. Very directly, how are you going to deal with, and how are you dealing with, for instance, ambulance services that abuse the system? We were asked to strengthen the audit capacity to ensure that the programs were being delivered in the appropriate fashion. But again, it’s a balance between allowing the resources to flow to communities for programs or using the resources to become more diligent in our follow-up.

But getting back to an earlier point, it is our policy—and we are being very tenacious with this policy in our negotiations—to remove the dispensing fee from over-the-counter medications. We will still require a medical authorization before we pay for those drugs, though. However, what I am hearing from the community itself and in discussions with members of the Assembly of First Nations is that it is their perception that what we are dealing with is very much a dump and run situation vis-à-vis the federal government. It is the aboriginal community who has used the term “dump and run”.

From time to time, unfortunately, as you point out, certain providers of services for one reason or another have decided they can manipulate a system to their advantage. So indeed over the last four or five years, other than increases in our non-insured health benefits program, which have now as I say basically plateaued, we have https://cryptolisting.org/ provided resources to first nations communities themselves to look at issues such as suicide and mental ill health. We see promise that once the resources are placed in the hands of first nations they can find solutions to problems, which as a government we just don’t have the same sort of flexibility to be able to apply.

At our last meeting Mr. Hill, I think, mentioned the fact that in Alberta it’s not necessary to have a prescription. Yet Mrs. Barrados seemed to be in conflict with that point. We had a meeting in Alberta where we brought the chief summit from Alberta to the table. There is no unanimous position in terms of first nations on this subject. As for where all of this will lead, we hope we will see a significant response to RCAP. We know that this government has, both in the Speech from the Throne and in its red book promises, indicated support for initiatives such as aboriginal head start on reserves, the Aboriginal Educational Institute and other initiatives of that kind.

About the $200 taxi ride for a bottle of aspirin, I’m glad we’re not talking about it, because the number of cases where it actually happens is very, very, very small. But in any system where you have a client using a system—and God forbid that this client might be a Canadian taxpayer who is interfacing with the tax system—from time to time situations arise which aren’t 100% kosher. In most communities we deal with in transfer, accountability to the community in fact increases in a transfer arrangement, rather than decreases. Again, we are trying to strike a balance between having a framework in place that will allow first nations to take control and, at the same time, address the needs of those who would like to go more cautiously. I’m not sure this is ever a completely win-win situation on either side of the coin, but those are the competing pressures. I have a son who works for the British Columbia Ambulance Service.

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So this year the department has gone to cabinet, cabinet has approved the removal of transportation as a non-insured health benefit, and has mandated that it be placed in community-based programs and that it be run as a local program so that it’s best able to suit local conditions. In this way, as well, we will have a much more stringent ability to look at the provision of those programs on a local basis rather than having a national directive that tries dotc coin to fit the norm rather than dealing with the situation in each region. In assessing possible solutions to this problem, it is important to bear in mind that as the payer of pharmacy claims, the non-insured health benefit program is but one of a number of parties involved in providing prescription drugs. Physicians, pharmacists, and the clients themselves all participate in any transaction that might result in the inappropriate use of prescription drugs.