Pursuant to Standing Order 108(3)(e), the Standing Committee on Public Accounts has the honour to present its

TENTH REPORT

The Standing Committee on Public Accounts has considered Chapter 15 of the October 2000 Report of the Auditor General of Canada (Health Canada ― First Nations Health: Follow-up) and the Committee has agreed to report the following:

INTRODUCTION

Health Canada (the Department) provides health services to First Nations communities and individuals under two principal sets of programs: community health programs and Non-Insured Health Benefits (NIHB) that fall under the Department’s Aboriginal Health “business line.” For fiscal year 1998-1999, total program spending on these programs was just over $1.0 billion. In fiscal year 1999-2000, the Department reports that it spent $1.155 billion on Aboriginal health. When expected revenues of $8.8 million are factored in, the Department indicates that net expenditures in this area amounted to $1.148 billion. In fiscal year 2001-2002, the Department plans to allocate 50% of its total planned spending to First Nations and Inuit health, a proportion in keeping with previous expenditures.[1]

In 1997, the Auditor General audited the Department’s management of Aboriginal health programs. He reported that, in general, Aboriginal health programs were not being managed in a way that enabled them to meet their stated objective of assisting First Nations communities and people in “addressing health inequities and disease threats, and in attaining a level of health comparable to that of other Canadians.” The Committee’s concerns were reflected in its 5th Report to the House of Commons (36th Parliament, 1st Session) tabled in February 1998.

The Committee is strongly committed to maintaining close scrutiny over the Department’s implementation of its 1998 recommendations as well as those made by the Auditor General of Canada in 1997. Many lives depend upon the Department’s ability to quickly correct the deficiencies that have been identified in its delivery of Aboriginal health programs. Consequently, due to the costs involved but principally because of the lives affected, the Committee decided to review the results of a follow-up audit that reviewed the Department’s implementation of recommendations made by the Auditor General and the Committee. To assist the Committee in this review, the Committee met on 5 April 2001 with officials from the Office of the Auditor General and Health Canada. Dr. Maria Barrados, Assistant Auditor General, and Mr. Ronnie Campbell, Principal, Audit Operations Branch, appeared on behalf of the Office of the Auditor General of Canada. Health Canada was represented by Mr. Ian Potter, Assistant Deputy Minister, First Nations and Inuit Health Branch, Mr. Patrick Borbey, Associate Assistant Deputy Minister, First Nations and Inuit Health Branch, Dr. Peter Cooney, Acting Director General, Non‑Insured Health Benefits, Mr. Paul Glover, Director General, Office of Accountability Implementation, Mr. Jerome Berthelette, Special Advisor on Aboriginal Issues, and Mr. Robert Lafleur, Senior Assistant Deputy Minister for Corporate Services.

Following the April 5 meeting, the Committee became aware of the prescription‑drug related deaths of two First Nations’ individuals in Saskatchewan. Both had been receiving prescription drugs under the NIHB program. In order to determine the extent to which recent policy changes were affecting the recipients of NIHB benefits, the Committee decided to hear from someone knowledgeable about the deaths. On the morning of 5 June 2001, the Committee met with Mrs. Lorraine Stonechild, whose son and brother died three weeks apart from prescription drug overdoses. The Committee made a special point of inviting Mrs. Stonechild to appear before it in order to more fully understand the tragic human consequences that can result when problems with the NIHB are not fully and immediately resolved. Mr. Ian Potter, Mr. Patrick Borbey and Dr. Peter Cooney represented Health Canada. Dr. Harry Hodes, Assistant Regional Director, Alberta/Northwest Territories, First Nations and Inuit Health Branch, Health Canada accompanied them. Mr. Ronnie Campbell appeared on behalf of the Office of the Auditor General of Canada. Mr. Glenn Wheeler, Director, Audit Operations, Office of the Auditor General of Canada, accompanied him. The Committee met again in the afternoon and heard from Dr. Dennis Kendall, Registrar, College of Physicians and Surgeons of Saskatchewan, and Mr. Ray Joubert, Registrar, Saskatchewan Pharmaceutical Association. Dr. Cooney and Dr. Hodes appeared on behalf of Health Canada. Mr. Jerome Berthelette, Special Advisor on Aboriginal Health, First Nations and Inuit Health Branch, Health Canada, accompanied them. Mr. Campbell and Mr. Wheeler appeared on behalf of the Office of the Auditor General of Canada.