Nishnawbe Aski Nation challenges health policy

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A sit-in by Nishnawbe Aski citizens that began April 23 in the office of the zone director for Health Canada in Sioux Lookout has ended peacefully, yet the citizens of Nishnawbe Aski are remaining vigilant to ensure their concerns about Health Canada's national directives for First Nations are dealt with expediently.

Now Health Canada has weeks, not months, to negotiate with them in good faith, the chiefs say.

Occupation of Zone Director for Health Canada Jamie Adams' office arose from the latest and most immediately catastrophic move by the feds, which was to implement service reduction in accordance with its medical transportation policy that came into effect April 1. In fact, the new interim policy is said by the chiefs to put people's lives at risk and deprive sick and disadvantaged members of northern First Nations their right to access medical treatment.

In addition to medical transportation, however, the disputed national directives affect dental, vision care, pharmacy, medical supplies and equipment, and mental health (crisis intervention) services in isolated northern communities.

Dean Cromarty, chief of Wunnumin Lake First Nation, took the lead in occupying Adams' office, a move that was supported by Stan Beardy, grand chief of Nishnawbe Aski Nation, and Charles Fox, regional chief of the Chiefs of Ontario. On April 25, the third day of the sit-in, Cromarty said, "We will continue with the sit-in until an acceptable outcome is obtained."

Around 3 p.m. that day, a letter of understanding was signed between the First Nations leaders and Health Canada, represented by Ontario Regional Director Al Garman and Adams. At that time, band Elders and other First Nations members left Adams' office.

Formerly, Wunnumin Lake ran its own medical transportation program, but as funding was capped at 1994 rates, the local tribal council advised the First Nation to return the program to Health Canada.

Health Canada, according to the chiefs, has been saying it would conduct a program audit that would determine a new budget, but the audit is continually delayed.

The reason for delaying the audit, according to Fox, is that Health Canada currently funds uninsured health benefits at $1.3 billion a year, while the need is $1.5 billion. There is a quarter-billion deficit this year alone, he said, and 3 per cent to six per cent annual growth in First Nations' requirements.

The final insult, so far as Cromarty's people were concerned, was that eight of them were denied the chance to keep medical appointments on the first day Health Canada implemented changes to its transportation policy.

Their grievances on the issue of medical transportation alone, which galvanized support for the office occupation, include restriction of escorts for the people travelling to medical appointments.

Chief Cromarty was en route to his community and could not be reached for comment at press time.

But Beardy said the transportation policy had "an immediate negative impact on our people" that led to the sit-in.

He explained that Nishnawbe Aski has tried to pursue the path of negotiation in the past with Health Canada bureaucrats.

"Back in 1998, there was a joint technical working group-AFN and Health Canada-to jointly develop the directives. But what happened was (Health Canada) implemented its own interim policy framework, and this was developed solely by them," the grand chief said. Despite the joint process they undertook with the AFN, Health Canada developed the national policy it intended to follow unilaterally.

"We tried to believe that the joint technical working group's work would more or less provide the parameters of how those directives would be developed."

The glitch came about, Beardy said, because Health Canada was trying to develop directives that were "consistent" across Canada. But what might be feasible in Toronto, e.g., no large cost for an escort to accompany a patient to the doctor's, is not feasible on a remote reserv.

"The majority of my First Nations are isolated," explained Beardy. About 40 of the 50 communities in Nishnawbe Aski are fly-in.

"The policies were developed in isolation from our participation, so obviously there was never any consideration taken of the fact that there are different challenges and different scenarios to deal with as you go across Canada."

Along with the regional and zone directors, Beardy said he even brought the man with national responsibility for the First Nations and Inuit Health Branch, Ian Porter, into two isolated communities in the Sioux Lookout district April 1, to see the effect the directives would have on their people, but Porter was not moved.

"His attitude was, 'Well, you know, we only have x number of dollars to work with. Priorities have to be decided.' So, in other words, his directive from the minister is to balance the budget and that's all you have to work with."

Beardy said about their attitude prior to the sit-in, "They're not interested in what the needs of Aboriginal people are. It was obvious."

One of the communities Beardy took the officials to visit was Wunnumin Lake, with a population of about 400 on reserve, where that very day the eight denials of transportation service occurred.

"The denials of escort had to do with an eight-year-old Down's Syndrome kid that needed to go to Toronto; two other teenagers that were transplant patients, and others were ill. So those are very severe cases that needed an escort; they couldn't talk English, they couldn't function on their own."

While work at the AFN level has not resolved the issues, Beardy said the sit-in has brought considerable attention to the hardships that Health Canada is creating for First Nations.

As a result, "We were able to reach a process, I guess, of how we begin to deal with it. Some of it has to do with the interpretation of the policy itself."

A technical working group has been created to iron out a solution.

Beardy said, though, that the chiefs "ejected the interim framework outright." They said they would work with the old policy and jointly develop policies that will "address both parties' issues."

Beardy thinks the move to reconsider the policy came about because Health Canada likely "didn't expect such a negative impact immediately . . . starting day one of their policy implementation." But when it did create severe hardship across northern Canada, they saw "how flawed their framework was," and realized they had to "revisit" it.

Another sticking point for the First Nations is that the new directives provide that anyone missing their medical appointments will have to pay all costs of future appointments, including air transportation and accommodation.

The letter of understanding addresses a number of issues to be resolved by the joint technical working group just formed.

For now, Health Canada is committed to continue previous services.

They will continue to provide access to medical services and pay for escorts if there is a "medical/clinical need."

Barriers to accessing medical services will be discussed, and specific concerns relating to further discussions will be clarified, for example, the medical needs of off-reserve members.

There is a commitment to provide the money to do the work.

Health Canada also has committed to discuss the non-benefits section of the applicable legislation-currently section 10.

Finally, work under a district delivery mechanism will replace directives in the contribution arrangement.

Fox said there is a timeframe of five to six weeks to come to an agreement. If, however, Health Canada does not act in good faith to resolve outstanding issues, "alternative action," such as the occupation of additional Health Canada offices, closure of highways and litigation is possible.

Chief Cromarty is co-ordinating the schedule of meetings for the Native side, Fox said.

Negotiation will take place immediately on three main points raised by Wunnumin Lake. First is "restriction o escorts. They've more or less agreed to lift that, but they want to hammer out the specific details of what are the actual guidelines that will govern the use of escorts."

Fox said even when doctors and nurses were signing off on the need for a medical escort, Health Canada was denying them.

The second point to be dealt with during the five weeks, said Fox, is access to preventative services. Services such as mammography were being denied, but Health Canada has agreed to lift the ban for now and review its policy in that area.

Finally, access to medical services will be reviewed. That is, whether patients are being denied travel because of lack of an escort, language difficulty, because they are elderly or physically handicapped.

The tight time frame will be "a measuring stick in terms of the credibility or sincerity of Health Canada to resolve issues. If we see a lack of movement on their part, we're going to have to rethink our position and look at alternative action that we might have to take."

Fox said the First Nations are prepared to take a hard position if Health Canada does not negotiate in good faith, because other health issues remain to be dealt with in the coming months.