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If you review this Auditor General’s report you’ll find that in terms of the community health programs, the arrangements we have with first nations, indeed the Auditor General takes our arrangements and breaks them into two groups. It talks about contribution arrangements on the one hand and transfer arrangements on the other hand. Indeed, in terms of the transfer arrangements, it complements Health Canada on the transfer protocol and in the way we work with first nations in ensuring that the transfer arrangements are put into place appropriately and that accountability is built into those transfer arrangements. Indeed, again, I want to express concern that we as a committee with so little time have spent a lot of time on one particular problem facing aboriginal people when it comes to health and well-being. In fact, when we’re looking at cost-saving measures and trying to deal with deteriorating health, there are so many more serious issues.

We are continuing negotiations with pharmacy associations in all other jurisdictions with the aim of eliminating dispensing fees on OTCs by the conclusion of our negotiations at the end of our next fiscal year. We are increasing our review of the prescribing and dispensing patterns of physicians and pharmacists and have developed a protocol for follow-up with professional bodies when potential disciplinary issues arise. The colleges and professional associations that govern physicians and pharmacists operate under provincial jurisdiction. Where criminal activity is suspected, there is a role for law enforcement, which is also often under provincial jurisdiction.

We had authority from cabinet for up to 30 pilot projects. We are in negotiations for approximately 10 of those pilots across the country. Some first nations have indicated a real willingness to take down their dental program, their transportation program and their drug program and manage them against their program parameters but within negotiated financial limits. May I suggest to all of us here on this committee and to those who have come as witnesses that we are sitting on a powder keg in this country. I’ve just come back from one week in the riding, where I held town meetings and talked with people. I am very concerned about the undercurrent of anger out there, particularly amongst the white population, about the way government handles aboriginal concerns.

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The fact that Alberta is high in terms of all three columns in this report certainly must be taken in context. If you look at the number of clients accessing this system during this quarter when the sample was taken, there were 257,000 first nations individuals who accessed the system in this quarter. The total number in the column where the Auditor General has pointed out excessive numbers of prescriptions is 710 individuals. That represents 0.001% of all the individuals who access the system. I would also like to add a comment about the point-of-service system. We are currently rolling out a point-of-service system under the terms of our old contract.

If there’s anything being criticized in the report, it’s the regime that we have to monitor the arrangements. I can think of no occasion in this report in which there was any indication that anybody had found, throughout the course of this audit, any particularly outstanding difficulties with the delivery of health services in first nations communities. Again, the major criticism is that we do not have the resources to follow up on as many program reports and contribution arrangements as we should.

In fairness, I don’t think I should even make an estimate. There are nurse practitioners in every isolated community. But physicians going in and providing clinics also make referrals to specialists. I was heartened to hear that the new first nations health has a mail-in component—is that right?

Our greatest demand on transportation is out of isolated communities in the north. For those of you who are aware of environments such as Sandy Lake or Round Lake in northern Ontario, or Fox Lake in Alberta, these communities are geographically disadvantaged. A large percentage of our transportation budget is spent ensuring that first nations can have the same access to the Health Sciences Centre in Winnipeg as can somebody living in the north end of Winnipeg. The majority of our transportation costs go to ensuring that first nations are not geographically disadvantaged in terms of being able to access tertiary health care services.

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If there is a legitimate reason for dispensing the drug, the pharmacist can override the warning. And we are also developing monitoring and audit functions to check on the effectiveness of the warning system and the frequency of overrides. When fully functional, we believe this system will be at the forefront of systems currently used in both public or private sector drug benefit plans. We don’t have to decide that right now, but I’m just letting you know that he’s quite willing that we do that. Even in those situations we are now more closely monitoring patient movement to see if there are more efficient ways serve to more patients.

In our transfer agreements we have had very few— In fact, I cannot remember—and I’ve been involved in this program since the beginning—one major problem we have had with a transferred community. That provider, I think it’s important to note, came about as a result of the utilization of the aboriginal procurement policy, and resulted in a very competitive situation where we are now in position that a contract has been awarded to First Nations Health. That company will take over the provision of the automated service in the summer of 1998.

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We compared what we called the regulatory environment of prescription medications in those provinces and we found that we could make a correlation between the tighter regulatory environment and a lower usage of these types of drugs. 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. From time to time, we undoubtedly run across situations where we go in and audit, and then remedial measures have to be taken.

This is clearly the case, and it means that the solution to the problem must involve the co-ordinated effort of all parties. Notices of Meeting include information about the subject matter to be examined by the committee and date, time and place of the meeting, as well as a list of any witnesses scheduled to appear. The Evidence is the edited and revised transcript of what is said before a committee. The Minutes of Proceedings are the official record of the business conducted by the committee at a sitting. “While the bulk of the donation will be used to assist Canada’s frontline medical personnel, a portion of it will be provided to Canada’s Indigenous communities,” it said.

• In fact, I think you should be aware that at our management meetings, in which we bring together our regional directors from across the country to discuss issues, the AFN has a seat at that table.
• We compared what we called the regulatory environment of prescription medications in those provinces and we found that we could make a correlation between the tighter regulatory environment and a lower usage of these types of drugs.
• May I suggest to all of us here on this committee and to those who have come as witnesses that we are sitting on a powder keg in this country.
• It is the aboriginal community who has used the term “dump and run”.

When stuff like what we see in the Auditor General’s report becomes public knowledge, it begins to increase that anger level and the frustration many people in this country have about the whole concern we have about our aboriginal people. Alberta, I think, has a more open regulatory environment, and I’ll give you one example. Codeine-containing drugs are, in three of the western provinces, regulated by a triplicate prescription program—in Saskatchewan, right down to the 15-milligram level; in Alberta, codeine drugs up to 60 milligrams are not governed at all through a triplicate prescription program. As for your point on what the anticipated savings are, that’s a difficult question to answer.

A cheque is still sent, but there are no measurements and no information. I have been told that there are 30-year-old programs that no longer meet people’s needs. They are not effective, but they are still there and a cheque is still sent for these programs, which do not exist for all practical purposes. The Auditor General recognizes that the causes of poor health status are many and varied. For instance, he mentions the poor socio-economic conditions that are a determinant of poor health among first nations people.

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The difficulty does arise from time to time, though, that certain providers of services do have a preferred status in terms of certain communities in delivery of the services. But what they don’t have to report against is a set of standard program delivery criteria, which is the normal way that Health Canada would deliver the program, so it allows them flexibility. Also, they are supposed to provide accountability to their band membership each year in a transfer arrangement. In fact, I think you should be aware that at our management meetings, in which we bring together our regional directors from across the country to discuss issues, the AFN has a seat at that table. For those who don’t—and we detected it— and I know cases in Saskatchewan where we have brought ambulance, where we have brought pharmacists—we have involved law enforcement agencies in trying to deal with those providers.

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I mentioned the Montagnais du Lac St-Jean band in Quebec, which is a perfect example of a community that has met all its obligations under its transfer agreement. It has submitted annual reports every year to all its membership and to Health Canada. They are enthusiastically looking forward to the next five years in their transfer agreement. I was pleased to hear Mr. Cochrane’s comments, particularly his statement that the question of prescription drug misuse is but one symptom of far greater, deeper underlying problems pertaining to the higher incidence of ill health among the first nations and Inuit communities.

In terms of some of the other strengthening of the systems, such as the new contract and its enhancements and the drug utilization review, I’ll ask Jay if he could respond to that. This is an important development, because the system is programmed to detect multiple doctoring, multiple pharmacy use, multiple prescriptions for the same drug, prescriptions filled too soon or too often, and other parameters that suggest drug misuse. When the system identifies one of these potential problems, it signals the pharmacist before the drugs are dispensed. The pharmacist must then determine whether or not the drug should be dispensed.

If we’re dealing with remote communities, for some maintenance drugs, to actually have to go the pharmacy— I think we’ve actually seen pharmacies fill a prescription for only a month when somebody needs to be on it for a year and when it hasn’t changed https://cryptolisting.org/ in the five last years. They should be able to get a three-month supply at a time. I think there are innovative new ways of delivering the goods. What we don’t have is 100% audit of each of the contribution agreements that exist across the country.

I’ll try not to cut off the first group too quickly this time. We just ask that the witnesses keep their comments as short as possible. I’d like to welcome our three witnesses from the department. Just before we introduce them, I’ll just go through the procedure quickly.

My sense from speaking to those people is that it’s an agenda being pushed by the federal government. It is not to their liking or according to their needs, and they’re very worried about it. Transfer is about community development and community control of programs. So transfer has been a very successful tool in allowing for that self-determination and control. We are doing some analysis now to determine how much of that is a result of audit and drug utilization review activity and how much of that is a result of reducing the misuse of prescription drugs. To us, at first glance, it appears that we can have an effect in reducing misuse, and we do see it in the bottom line in terms of how much we spend in our pharmacy program.