Evidence of meeting #36 for Health in the 40th Parliament, 2nd session. (The original version is on Parliament’s site, as are the minutes.) The winning word was supplies.
A recording is available from Parliament.
Conservative
The Chair Conservative Joy Smith
Good afternoon, everyone. Welcome to this meeting of the Standing Committee on Health. I'm so glad you're here.
I want to thank our guests, Dr. Gully and Mr. Rosenberg, for being here today. Mr. Rosenberg, of course, is the Deputy Minister of Health. We're very pleased that you're here.
I'm going to ask that you give a ten-minute presentation. Then we'll go into the question period of seven minutes each.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Madam Chair, I don't think my question is of the witnesses; it's more of the committee.
As I expressed, we are a little bit concerned that today our normal update is not happening, in terms of an update on the flu and the number of cases and all of that. We need to have it, and I also need to know that we will have it next week, in the week off, as a regular briefing, which we are expecting for the sake of the committee's doing due diligence concerning oversight of this pandemic.
I'm not quite sure, but I think today the coincidence is that—
Liberal
Carolyn Bennett Liberal St. Paul's, ON
No, I did not agree to have it taken out of our seven minutes of questioning the witnesses.
Conservative
The Chair Conservative Joy Smith
Well, if we could save committee business until the end, let's have ten minutes of committee business then, so that we can present our presentations first. Then we will have this full discussion, because I know you have some concerns.
Is it agreed by the committee that we hear our witnesses first, before we get into committee business, and that we suspend 10 minutes...I guess that's at 5:20, for committee business.
Is that agreed?
Conservative
Morris Rosenberg Deputy Minister, Department of Health
Thank you very much, Madam Chair and members of the committee.
On September 17 I was asked by Minister Leona Aglukkaq to look into the events that led to the delivery of a large quantity of body bags to the Wasagamack First Nation in northern Manitoba. This morning, at her regular news conference, the minister spoke about the report. I'm here today, Madam Chair, to present what I found.
In order to understand the sequence of events, one must understand that Health Canada operates nursing stations in remote first nation communities. The nurses in these isolated communities are required to deliver primary health care, emergency care around the clock and act as a community liaison for Health Canada.
In the spring, 21 of 22 of these remote communities in Manitoba had serious outbreaks of the H1N1 virus. During that first wave there were challenges with getting some medical supplies to some of those communities because of a supply shortage and transportation problems related to the remoteness of the communities. In preparing for a possible second wave of the virus, nurses in remote communities were advised by senior management to generously fill their supplies for the fall and early winter.
There is a nursing station in Wasagamack, which is roughly 500 kilometres north of Winnipeg. There are three nurses on duty in this community of about 1,750 people. A physician typically visits once a week.
Getting to or from Wasagamack can require a combination of air, water and land transportation. During the summer, one must take a plane and a boat. In the winter, you land on ice and then ride on an all-terrain vehicle. When the ice is forming, or when it's breaking up in the spring, a small helicopter is the only way in or out.
It can sometimes take three or four helicopter flights to get one shipment of supplies into the community. Bad weather can also delay flights of both planes and helicopters.
Clearly, getting medical supplies to Wasagamack can be challenging.
On August 12 of this year, an order for a variety of medical supplies was placed for Wasagamack. In keeping with the instruction to order a lot of supplies, the order was for generous amounts of various supplies, including wrist splints, single-use scalpels, surgical gloves, surgical masks, sterile water, and benzoxonium chloride towelettes. The order also included a request for 100 body bags. A total of 38 were delivered. Of those, 20 were returned at the request of the regional office in Winnipeg. The other 18 were confiscated by Wasagamack Chief Jerry Knott and were later returned to the regional office in Winnipeg.
The order for 100 body bags for Wasagamack was disproportionately high compared to other communities. Most nursing stations in first nations communities keep fewer than 10 body bags in stock, or they rely on others if and when they are needed. For instance, a provincial or regional health authority or a coroner or a local ambulance service would be turned to for the supply of that item.
The order for Wasagamack was an overestimation, but the investigation found no evidence of ill will or deliberate calculation on the part of anyone involved.
Our nursing staff is on the ground in those communities throughout the year, and they are the most qualified to assess the needs of the communities they serve. As you may be aware, Madam Chair, a letter of apology was sent to all chiefs and band councils in Manitoba to express Health Canada's regret for the alarm the order of body bags caused.
I met with Grand Chief Evans and Chief Harper on October 2 to present the findings of my report. Our conversation was positive and constructive. It was clear to me that we all share a mutual interest in continuing to address the challenges inherent in providing health care services in northern remote communities. Clearly, a key aspect of this is a shared respect and admiration for the nurses who provide critical services, often in challenging circumstances.
While we have determined that this was an isolated case, we have reviewed our methods. We will be instituting stricter centralized controls in our procurement process for body bags, and regional staff will review ordering patterns when conducting quarterly site visits. We expect that these changes will prevent a similar situation from occurring again.
In looking back, it's possible that some of the concerns expressed were based on the mistaken notion that body bags were sent instead of other medical supplies. My conclusion is that the order for body bags was in fact part of a larger than normal shipment of a range of medical supplies.
Before I conclude, I'd like to emphasize that Health Canada is providing all nursing stations in first nations communities with additional protective medical supplies such as gloves, gowns, and masks. We are pre-positioning antivirals so that if they are needed in a remote community, they can be accessed as quickly as possible. We are prepared to reallocate nurses to where needs are greatest, and we're training home care nurses to be ready to administer the vaccine once it's available. We're also continuing to assist communities to complete and test their pandemic plans.
I hope the results of our investigation and my appearance here and that of Dr. Gully will give everyone a clearer picture of the events. I'd be more than pleased to answer any questions you may have.
Thank you.
Conservative
Dr. Paul Gully Senior Medical Advisor, Department of Health
No, I don't.
Conservative
The Chair Conservative Joy Smith
Okay, we'll let it go at that. Now we will go into questions and answers.
We have our first seven minutes, and apparently that's going to be shared by Dr. Bennett, Dr. Duncan, and Ms. Murray. So you each have about two minutes.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
As you know, Anita Neville and I travelled to Wasagamack, and we were very impressed with the nurse who ran your clinic there. This is a real professional with a huge occupational health and safety background. I am concerned that this report today, in some way, blames this nurse. In fact, Jim Wolfe, who we have heard describe many of the problems in the community since June and then in July and then at the AFN meeting, sent a letter of apology.
I'd like to ask the deputy minister if there is a reason why there is no ministerial accountability and why the minister has refused to apologize to these communities.
Deputy Minister, Department of Health
Let me try to answer the issue about the nurse.
I was in Winnipeg on Friday, and I did two things in Winnipeg. In the morning, I met with regional staff to give them an opportunity to see the draft report and ask if it was fair. In the afternoon, I met with Grand Chief Evans and Grand Chief Harper.
In the morning, the nurse from Wasagamack, who I think had been away, was not at the meeting, but we were able later in the morning to connect with her by telephone, and I was able to speak with her. I read her the pertinent parts of the report, both the front end, which is basically the bottom-line conclusions, and the part of the report that summarized what she had told us. I asked her if she thought it was fair, and she did.
Certainly, it's not my intention to blame anybody. As the report points out, we're dealing with extraordinary circumstances. I think the people are doing their best. I think she would acknowledge in hindsight that it was an overestimation, but that's not a statement of blame; it's just the way it is. Everybody, including Chief Knott in Wasagamack, shares your view that she is a terrific nurse and that she is doing a terrific job in that community. In fact, after all this broke, he asked her to go on local television with him while he expressed his gratitude for the work she was doing.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you, Madam Chair.
Thank you to the witnesses.
I'm going to follow up on that. Who is ultimately responsible? Is it the ministry? Is Health...? Who is accountable? That nurse reports to whom?
Deputy Minister, Department of Health
I think there's accountability all the way up the line. I would categorize this, as I say, as an honest overestimation, an administrative issue very well within the purview of the bureaucracy.
Liberal
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
And you are a part of.... You're Health Canada. Someone needs to take responsibility and apologize.
Deputy Minister, Department of Health
We have taken responsibility. I know Jim Wolfe sent a letter and apologized. There was a media event. I'm certainly prepared to stand in Jim's shoes and do the same thing.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
I just think it would have a lot of power, if the minister issued a formal apology.
I will do my two questions.
In reading paragraph IV, “H1N1 in Manitoba...”, I see the wording that this “occurred only two months after the virus was first detected in Mexico...”. It sounds as though we didn't have time to respond. We had theoretical modelling of how we would respond and buy time if it started in Asia. We had our health people down in Mexico immediately.
A tremendous concern I have is that we waited before going up to northern Manitoba. We have historical hindsight. We know what the health issues are today and we know what the socio-economic conditions are that made people particularly vulnerable. So why did our people get down to Mexico right away and not into northern Manitoba? That's one question.
The second issue is this. There have been close to 900 confirmed cases in Manitoba, and 38% of these cases have been identified as first nations or Métis persons living off reserve. If we look at the priority sequencing list for vaccination, are they going to get the vaccine? I remember Dr. Gully telling us that 17.5% of those who were hospitalized were aboriginal, and 12% in ICU were aboriginals. I think this is really important and that we have to address it.
Deputy Minister, Department of Health
Madam Chair, given that there are some important public health considerations to this, I'm going to turn to Dr. Gully, whom we have brought in essentially as the incident commander for first nations and Inuit health, as you know. I'm going to ask Dr. Gully to try to respond.
Senior Medical Advisor, Department of Health
Thank you. Thank you, Madam Chair.
My understanding is that in fact there was a response mounted to assist the communities in northern Manitoba, as well as the Government of Canada supporting the Government of Mexico.
The normal state of affairs would be that the situation in the community would become evident, and then the region, together with the province, would add to the capacity in the community—and I understand that was done. In addition to that there was extra support from headquarters—the Public Health Agency of Canada—and from the first nations and Inuit health branch that was added to that community.
Now in terms of the experience of the community, as I did say last week, yes, absolutely, first nations were overrepresented in terms of hospitalization and in terms of ICU admissions. I think that is not unexpected given the extent of the disease, the rapid spread of the disease in those communities, and given the challenging circumstances in those communities, the youth of that community, the number of pregnant women, and the high prevalence of chronic diseases.
I believe there was a response. Certainly there were lessons learned from that response. One of those lessons learned was in fact that we would have to increase our assuredness in terms of the ability to get further supplies to communities.