Indigenous and Northern Affairs Committee on April 14th, 2016

[Dr. Michael Kirlew]

Reasonable broadband, for initiation of things like telehealth, for example? Recently there was some investment in broadband access. Maybe the Grand Chief will be able to comment a bit more, but we have seen improvements in the broadband infrastructure in the region.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

To me, what was fascinating—and I've alluded to this in the past—is that Kamloops is an urban setting, but they have something they call the Patient Studio. I've never seen telehealth in such an amazing way, where the eardrum was visual and transferred. They have created a patient studio with a nurse, and the doctor was in Ontario. I guess my question is, first of all, is the broadband there? Second of all, I've worked in rural and remote communities, and there are challenges in terms of mental health care workers and doctors. This was quite an amazing patient studio, and I was impressed. In terms of short-term needs, is this part of a solution?

[Dr. Michael Kirlew]

I think that could be part of a solution for sure, with being able to implement high-quality telehealth. We have to understand that telehealth is meant as a plus. It can't be meant as a, “We are going to use telehealth, so we can reduce doctor days”. I look at it in terms of telehealth being something that can help me as a clinician to provide A-plus care, and help give my patients more access to a physician, or more access to a health care provider.

Developing that infrastructure is going to be important. I'm always a bit cautious because I do not want it to start us going down the path where we say, “Well, you can now see your doctor over telehealth, and we're going to cut your physician days”. It has to be used as something that can enhance care. It has to be a plus and not a, “This is something we can now do to take away your physical doctor visits”.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

You look at the issue perhaps with the children with the difficult skin infections, a high-resolution photograph—

[Dr. Michael Kirlew]

Exactly.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

—assessed by a doctor if it wasn't a doctor day.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Your story of shortages in terms of medications is absolutely unacceptable. Why did that happen?

[Dr. Michael Kirlew]

I don't know what the shortage is. I don't know what the issue was at the nursing station, but they didn't have a necessary medication. These are not isolated incidents. I look at it, and I wonder, what is the system for procuring medications? When you go to any hospital, or health care facility, they invest a significant amount of funding to figure out how much particular medication and how many supplies they need. Do those systems exist, or are we just relying on pieces of paper getting faxed back and forth? I'm concerned that those advance systems, which are going to be able to ensure the right medication is there in the community at all times, do not exist currently at the nursing station. That's why we're seeing these drug shortages, including the formulary or the compendium of medications that you have at your disposal. What sort of input do health care providers have on that team to ensure we're getting our patients the best possible medications?

[The Chair, Liberal, Andy Fillmore]

The next questions are for Charlie Angus.

[Charlie Angus, NDP, Timmins—James Bay, ON]

I want to thank you, gentlemen, for your powerful words.

I'm going to start with a technical question to the doctor and then go to Grand Chief Solomon because of his expertise in the region I come from.

Doctor, I get messages on Facebook from mothers in motels in Timmins asking me to get them an extra day of treatment before their child goes home. Then I see the kids in the community, and they're like a mess because that day wasn't enough. Then their pictures are on Facebook, and people are asking, “How did this happen?”

I remember talking to Chief Solomon and saying, “Am I remembering this correctly, Chief, or is this some kind of nightmare I had where the nurses were carrying water in buckets from the river to the nurses' station in Kashechewan?” He said, “No, that was true. That happened.”

I hear you, and you're talking about telehealth. We don't have telephones. This is 2016.

Children are dying because they don't have pain medication, because they don't have Ventolin. I think we have to say that it's not good enough to say we're going to study this. We need change immediately, and I hear the call that this budget has to be augmented immediately because children are dying.

If you could give us one recommendation to give power to the doctors so they could not be overridden by the bureaucrats to deny children their services, what would that tool be that you need as a doctor when you say that child is going to get that extra time in a hospital, they're going to get the extra support here? What is it you need as authority so you can override those bureaucrats in Ottawa?

[Dr. Michael Kirlew]

That's a very good point.

I've surveyed a number of my colleagues, and they described oftentimes the relationship with non-insured health benefits as adversarial.

When I look at the provincial system, for example, the system has a ministry in Ontario and has a Ministry of Health transportation grant. For example, if you live in a small town in Ontario and you don't have access to that particular service or diagnostic test, you have a government program that operates provincially that essentially helps fund your travel there.

When I compare those two forms, the Ministry of Health travel grant versus the non-insured form, there are stark differences. First things first, the Ministry of Health travel grant does not ask for a diagnosis. Non-insured insists on a diagnosis, a reason for visits. Why? Why does non-insured health benefits need to know why a person is getting an MRI? Isn't that confidential between that patient and their physician? There's no mention of that in the provincial health travel grant. You simply sign as a physician and say that this person has an appointment with the specialist, and the same thing applies to escorts. Why? Why does non-insured have to know why a person requires an escort? Isn't that between patients and their clinician?

The problem is that non-insured is trying to insert itself in the doctor-patient relationship inappropriately, and that needs to stop. It needs to stop inserting itself in that doctor-patient relationship. Oftentimes my colleagues and I feel we're being “policed” by non-insured health benefits, but that is not their role.

The same thing applies when you look at the process by which they approve medication. It's archaic. It's time-consuming. It introduces unnecessary delays and it does not meet its goal of ensuring that patients get the right medication in the right time.

In the provincial system, you have a three-letter code that you write on the prescription. You go and you get your medication that day. For the non-insured system for the same medication, a piece of paper gets generated in Ottawa, and it's back-and-forth faxes between the physician and Ottawa to decide on whether or not that medication is.... Why are both systems so different?

I've spoken to people about this before, and they say, “Well, you know what, Dr. Kirlew? It's just different.” It's not different; it's inferior. There's one system that you have—

[Charlie Angus, NDP, Timmins—James Bay, ON]

Doctor, it's not inferior, it's built into the system. The humans rights tribunal found that Canada is systemically discriminating against children.

[Dr. Michael Kirlew]

Yes, exactly.

[Charlie Angus, NDP, Timmins—James Bay, ON]

It's the policy.

I'm sorry, I didn't want to interrupt you, but I need to ask Chief Solomon about this because of Jordan's principle. If we look at the human rights tribunal, this is systemic discrimination against children, denying them service. Chief Solomon and I have been to two funerals this year. I know that you have been to many more.

I was in a community where I was talking to one of the teachers, and we couldn't get counselling for a child because they had been turned down by the federal government because they couldn't prove it was necessary, and this was a child's life.

I want to ask you if there's one thing we can do today to say, “This discrimination has to stop. Jordan's principle becomes Jordan's practice.”

Chief Solomon, what do you think?

[Grand Chief Jonathan Solomon]

This is where we begin to think like humans. Legislation after legislation, policy after policy, has done more harm than good. We've heard stories from the doctor on the ground. We need to start checking our own policies and making them human.

I have nightmares about non-insured health benefits. It's a nightmare in my territory. Some people are missing their appointments because there is a rule now that you have to let them know seven days ahead of time before you make those arrangements. Whoever came up with that policy, I don't know, and these appointments have been on the calendar for months and months. Once you miss that appointment, that's it. You have to do it over again. It's just the way it is.

We're not making things up. That's the reality we live in. The NIHB system, as the doctor said, is so cumbersome with paperwork, with bureaucracy, and that has to change. There's no doubt about it.

Thank you.

[The Chair, Liberal, Andy Fillmore]

You're out of time, Charlie.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Thank you. Thank you, Chair. I know you indulged me.

[The Chair, Liberal, Andy Fillmore]

Good. Next questioner is Don Rusnak.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

I'm going to thank you right off the bat for coming. I know we had a meeting not so long ago with the Prime Minister and Regional Chief Day; Grand Chief Fiddler was at that meeting. It was a meeting in my riding and Patty Hajdu's riding, also with Grand Chief Warren White and Chief Madahbee from the Anishinabek Nation.

I'll stop there. I'll get back to that, but the reports and recommendations they were talking about.... Mr. Chair, I'll ask you, do the analysts have those reports?

[The Chair, Liberal, Andy Fillmore]

They do and they'll be included in a future brief.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

Okay, perfect.

Sadly, I'm not shocked by the crises in our communities, and I say our communities because the first nations people throughout Treaty 3 are not just constituents, they're family. I've worked in my past life with Grand Council Treaty No. 3 and I know the huge issues in terms of health and how they're wrapped up in all other kinds of issues. They're wrapped up in economic development. They're wrapped up in the justice system. You only have to look at the problems in our communities and it seems like an enormous task for anybody to start solving those problems.

I know Minister Hoskins from the Ontario government and Minister Philpott met with Grand Chief Fiddler and Regional Chief Day. Can you tell the committee what positive outcomes came from those meetings, and what you see as missing from their commitments?

[Grand Chief Alvin Fiddler]

On February 25, we issued a declaration, an emergency on health and public health in our territory, and the reason we did that was because of all the stories that you've heard here today. Then three weeks after, we made that declaration and we had that meeting with Minister Philpott and also Minister Hoskins in Toronto to talk about our declaration and what we can do to address the issues that were contained in that emergency declaration.

We have agreed on a number of points how we should work together to begin to address those issues. We have agreed on a framework. We've agreed on a process on how we can begin to address not only the immediate stuff, but also the long-standing issues that we have, a process that is now under way. We are in regular contact with federal and provincial officials for us to begin to address the issues as to why we issued that declaration in February.

I'm going to ask Regional Chief Day, who was also at that meeting, to maybe expand on some of the things that we discussed at that meeting.

[Chief Isadore Day]

Again, the meeting was very well attended. The responses from both the federal and provincial governments clearly were something we haven't seen in a long, long time. The former Conservative government did not respond in that way.

And why I say that, and what's most important to recognize here, is that as we've been under a 2% cap, and as we've seen funding cuts over the last decade you will see a culmination of issues that have backed up. We've not done a full health economic assessment in terms of what's needed. That's clearly an area that this committee can help with, and endorse and move forward, because you will find that it's not only the systemic pieces, but there are some glaring areas that need immediate funding, as my colleague suggests.

I'll leave it at this, that what is also missing.... Again, we talk about the social determinants of health. Health is one file, but we can no longer deal with first nations health in silos. We can no longer expect that the ministry of infrastructure or economic development or education cannot have a fulsome discussion and dialogue, which first nations would be part of, in order to determine a framework for the social determinants of health. That's why I'm bringing forward to the committee today a framework that looks at the social determinants of health, a health and social policy framework.

The last thing I'll say is that, again, I'm bringing this to the committee because it's essential to ensure that we are effective, that we're economical, and that we're efficient with the time that's needed because people are dying today. This is why you will see a memo to cabinet come forward that speaks to the emergency health crisis of first nations, not just in this region, not just in Ontario, but across Canada.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

There's often not enough time to ask the questions that we need and want to ask.

I wanted to quickly just ask about something, and perhaps the doctor can answer the question. Is there collaboration between.... I know, because I worked in Manitoba Health in northern Manitoba, that there was difficulty between Health Canada and the provincial system in terms of the nursing stations actually co-operating and working together. And, ultimately like Regional Chief Day said, we can't work in silos. We need to work in partnership and the care has to be continuous, whether the patient moves from a first nations community to, say, Thunder Bay Regional. Has there been good co-operation with Health Canada or has that been a problem?

[Dr. Michael Kirlew]

I would say I've seen a lot of siloing of care. That is a huge issue in our region. There's the fact that, for example, looking at child development, you might have some aspects that are covered by the provincial system, but who is going to fund the travel? Ultimately, how are you going to get that child care? That's what care is about. It's getting the right care at the right time in the right way.

Sometimes it just seems to me that you have these two systems that are operating and they're not talking to one another as effectively as they could be, and they're not focused on putting the child at the centre and saying, how are we going to get the child care? That's where you get these huge jurisdictional challenges.