Public Accounts Committee on June 1st, 2006

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. LeBlanc.

Thank you, Mr. Bains.

We're now going to move to Mr. Sweet for eight minutes.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you, Mr. Chairman.

Madam Fraser, it's good to see you again.

You know my obsession with objectives and outcomes. You made a suggestion in your report that you found the land claims process was more services based and the objectives were not clear. With the short time that we have, can you identify some of the objectives, outcomes, and results that could be identified in the land claims process?

[Sheila Fraser]

I'll give you an example that we looked at when we did the audit. One of the land claims had an objective of increasing the employment of the Inuit, I believe it was, in the north. That was the overall objective. Then there were a number of specific actions that were laid out, one of which was to have a meeting once a year with interested parties.

When we did that audit, we were asking whether employment of Inuit in the north had increased. The department came back and said, well, we had the meeting and we met our obligation to do the specific action. We basically said that isn't good enough; you have to know if you are making progress on the overall objective and to even evaluate if those actions that were initially listed are successful in attaining the objective. You have to be looking at the overall objective, not simply limiting yourself to that action.

At the time, there was actually a disagreement with the department. They said in their response that they were not tasked with the objective, but rather that their responsibility was to meet the activities that had been specified. After that, the minister changed the position of the department. But I think it's still not clear to us if it's fully accepted that the department should be trying to attain the overall objective and that it doesn't just have a responsibility to do the actions that are listed.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Maybe I'll just ask Mr. LeBlanc right now, then.

I was very happy to hear there's the political will to put in the legislative framework around water. What about this aspect as far as clarifying results and objectives is concerned?

[Paul LeBlanc]

I would say, briefly, that as recently as yesterday before the parliamentary committee, the minister commented on the importance of the claims area and the fact that it is a priority area for him and one to which he intends to bring particular attention. I would limit my comments to that for now.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you.

Also in your comments, Madam Fraser--just to dignify the people who are of concern here, as far as drug use is concerned--you mentioned that the number of clients obtaining more than 50 prescriptions over a three-month period had tripled. What kinds of numbers are we talking about here in actual human lives?

[Sheila Fraser]

I'll ask Mr. Wheeler, perhaps, to provide that information.

[Glenn Wheeler, Principal, Office of the Auditor General of Canada]

Mr. Chair, that reference to the number of people accessing 50 or more prescriptions is a reference to a finding we made in an audit in 2004, when we followed up on observations made in 2000 and in 1997. We didn't report the absolute number of individuals in the current audit, but in the previous audit it was about 1,000 individuals.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

You said that it has tripled.

[Glenn Wheeler]

We reported in our 2004 audit that the number had tripled from 1,000.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Okay, we're talking about 3,000 lives at high risk here. Is it 3,000 now? That 1,000 has tripled?

[Glenn Wheeler]

Yes, but I would also like to add that in this current audit we didn't continue with that analysis. We focused predominantly on paragraph 15.69 regarding the drug utilization review.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

This is a tragedy waiting to happen.

Do you know about this, Madam Gosselin?

[Hélène Gosselin]

Yes, we do know about this, and we've undertaken further analysis to look into these numbers. In our system right now, we use some of the analysis that Mr. Campbell mentioned earlier to identify our high-risk cases. We look at the number of prescriptions and the number of doctors and we do that analysis. We follow up with pharmacists and doctors--

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

If you will forgive me, it sounds more like critical intervention is required, not analysis.

[Hélène Gosselin]

We need the analysis to identify the particular clients, and then we need to follow up with the doctors and the pharmacists, which we do right now. But on the issue of the 50 prescriptions, we've done specific analysis to try to find out what's going on, and I would ask Mr. Potter to take you through it, because we were a bit surprised—and we just got these results--by some of the results.

[Ian Potter]

I would just indicate that we did an analysis of the number of clients who had 50 claims. It showed that there were actually 50 claims in our system. But no clients are receiving 50 prescriptions in a 90-day period--none.

What we then did was look at the clients to find out whether these clients were at risk. And the reason there were clients who had made 50 claims in a 90-day period was largely attributable to things like the growth in chronic diseases, where a number of drugs were taken, and the increased use of methadone—and methadone has to be delivered by the pharmacist each day, so it produces a claim each day. And some pharmacies were actually reducing the interval in order to control drugs. Instead of giving a patient a prescription for 60 days or 90 days, they were reducing the period of time, so they were giving the prescription for five days, ten days--

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

I'm sorry, I just have limited time.

This changes the complexion. Is this the case? Is it prescriptions, or is it claims?

[Ronnie Campbell]

Thank you, Mr. Chair.

When we did the original audit work, I think the information came as a surprise to the department. At that time, they were doing no analysis. They didn't know why. They didn't know the numbers were there. They had the information in the databases, but they hadn't done the analysis. So we started that analysis in 1997 and in subsequent audits. What we really wanted them to do was, in large part, what we're hearing they are doing now. They are finding out why.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you very much.

You had mentioned, Mr. Campbell, 1997 and 2000 work that was done around coroners' reports in this drug area, as well, in Alberta. Has there been any initiative to do that nationally, so we can begin to track those people who have succumbed to drug abuse?

[Hélène Gosselin]

No, in fact, that's part of why the Auditor General is encouraging us to pursue this work. The work that was done in Alberta was done in Alberta only. We tried to work with the coroners' offices to try to get access to that type of data from across the country. The responses we had--that was in 2000, if I'm correct--were that they were not necessarily collecting in every jurisdiction data about the first nations status or Inuit status of the people they were registering as deaths. So they didn't have the information for us to collect, to access.

We've tried, by hiring a specialist in this area, to see if we couldn't do a specific study, and the answer came back that the data was not available. We're going back again this year to try to find a way. We're going to look specifically at what was done in Alberta so many years ago to see if we can't try to use the same type of methodology across the country. But we don't know. It's under provincial-territorial authority.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Some jurisdictional congruity, yes.

Thank you, Mr. Chair.

[The Chair, Liberal, Shawn Murphy]

Thank you very much, Mr. Sweet.

Right now, colleagues, that concludes the first round. The second round is seven questioners. We don't have time for that. What I propose is reducing it from five minutes to three minutes. Is that acceptable? We started late.

[Borys Wrzesnewskyj, Liberal, Etobicoke Centre, ON]

On a point of order, we started late, and it's late, and I think it would be appropriate to make up that time.

[The Chair, Liberal, Shawn Murphy]

I'll ask the clerk.

That's fine with me. We'll revert back to the five minutes, and Mr. Wrzesnewskyj, you're up first.