I think that possibility does exist. Dr. Grant can probably speak to the ability of any of the regulatory colleges to actually enforce their standards on reserve.
A good example would be any of the multiple news stories you've seen of patients who have died in northern communities that existed under federally provided Health Canada clinics. We know that they don't meet standards. When you look at a family medicine clinic that exists in, let's say, northern Alberta—Fort Vermilion is under Alberta Health Services—they're required to have certain things available. If they don't have those things available, that clinic gets shut down and all the patients get re-streamed to another place where they can receive care until those standards are met again. When the same thing happens in a federal jurisdiction, that does not happen.
Now, as to whether or not that's legal, I don't think we've actually had a court case that outlines it. We talk about jurisdictional ambiguity, but in the case of child and family welfare services, where we found there was discrimination between children under federal care and children under provincial care, it took a lawsuit for people to actually say whether or not this was the right thing to do.
There are two ways in which this whole system is sustained. The first is by maintaining ambiguity and encouraging patients that, you know, this is just how it is; there's nothing you can do about it. But I think there will be a court case coming, whether it's with physician-assisted dying or something else in health, in order to clarify that responsibility and the responsibility for seamless transition of care, which has already been outlined in Jordan's principle. Second is ensuring that the programs are uniform across the provinces.
Do they have to be carved out? I don't think they do. Are they currently carved out? Absolutely.