Thank you very much, Madam Chair and members of the committee.
On September 17 I was asked by Minister Leona Aglukkaq to look into the events that led to the delivery of a large quantity of body bags to the Wasagamack First Nation in northern Manitoba. This morning, at her regular news conference, the minister spoke about the report. I'm here today, Madam Chair, to present what I found.
In order to understand the sequence of events, one must understand that Health Canada operates nursing stations in remote first nation communities. The nurses in these isolated communities are required to deliver primary health care, emergency care around the clock and act as a community liaison for Health Canada.
In the spring, 21 of 22 of these remote communities in Manitoba had serious outbreaks of the H1N1 virus. During that first wave there were challenges with getting some medical supplies to some of those communities because of a supply shortage and transportation problems related to the remoteness of the communities. In preparing for a possible second wave of the virus, nurses in remote communities were advised by senior management to generously fill their supplies for the fall and early winter.
There is a nursing station in Wasagamack, which is roughly 500 kilometres north of Winnipeg. There are three nurses on duty in this community of about 1,750 people. A physician typically visits once a week.
Getting to or from Wasagamack can require a combination of air, water and land transportation. During the summer, one must take a plane and a boat. In the winter, you land on ice and then ride on an all-terrain vehicle. When the ice is forming, or when it's breaking up in the spring, a small helicopter is the only way in or out.
It can sometimes take three or four helicopter flights to get one shipment of supplies into the community. Bad weather can also delay flights of both planes and helicopters.
Clearly, getting medical supplies to Wasagamack can be challenging.
On August 12 of this year, an order for a variety of medical supplies was placed for Wasagamack. In keeping with the instruction to order a lot of supplies, the order was for generous amounts of various supplies, including wrist splints, single-use scalpels, surgical gloves, surgical masks, sterile water, and benzoxonium chloride towelettes. The order also included a request for 100 body bags. A total of 38 were delivered. Of those, 20 were returned at the request of the regional office in Winnipeg. The other 18 were confiscated by Wasagamack Chief Jerry Knott and were later returned to the regional office in Winnipeg.
The order for 100 body bags for Wasagamack was disproportionately high compared to other communities. Most nursing stations in first nations communities keep fewer than 10 body bags in stock, or they rely on others if and when they are needed. For instance, a provincial or regional health authority or a coroner or a local ambulance service would be turned to for the supply of that item.
The order for Wasagamack was an overestimation, but the investigation found no evidence of ill will or deliberate calculation on the part of anyone involved.
Our nursing staff is on the ground in those communities throughout the year, and they are the most qualified to assess the needs of the communities they serve. As you may be aware, Madam Chair, a letter of apology was sent to all chiefs and band councils in Manitoba to express Health Canada's regret for the alarm the order of body bags caused.
I met with Grand Chief Evans and Chief Harper on October 2 to present the findings of my report. Our conversation was positive and constructive. It was clear to me that we all share a mutual interest in continuing to address the challenges inherent in providing health care services in northern remote communities. Clearly, a key aspect of this is a shared respect and admiration for the nurses who provide critical services, often in challenging circumstances.
While we have determined that this was an isolated case, we have reviewed our methods. We will be instituting stricter centralized controls in our procurement process for body bags, and regional staff will review ordering patterns when conducting quarterly site visits. We expect that these changes will prevent a similar situation from occurring again.
In looking back, it's possible that some of the concerns expressed were based on the mistaken notion that body bags were sent instead of other medical supplies. My conclusion is that the order for body bags was in fact part of a larger than normal shipment of a range of medical supplies.
Before I conclude, I'd like to emphasize that Health Canada is providing all nursing stations in first nations communities with additional protective medical supplies such as gloves, gowns, and masks. We are pre-positioning antivirals so that if they are needed in a remote community, they can be accessed as quickly as possible. We are prepared to reallocate nurses to where needs are greatest, and we're training home care nurses to be ready to administer the vaccine once it's available. We're also continuing to assist communities to complete and test their pandemic plans.
I hope the results of our investigation and my appearance here and that of Dr. Gully will give everyone a clearer picture of the events. I'd be more than pleased to answer any questions you may have.
Thank you for this question, which is very pertinent.
I think that a distinction has to be made. We have a principle which, generally speaking, is good and should remain. For most medical supplies, the nurse working in the field is in the best position to use her judgment when placing orders. There are certain exceptions. Drugs, narcotics, for example, are an exception and we already monitor such items very closely.
Up until now, the body bags have not been an exception. This was not an item that we ordered on a regular basis, because there was very little requirement for it. In some instances, there are other resources available, such as the RCMP. If the reserve is quite close to one of these detachments, the RCMP may have these items.
I personally learned something from this investigation: for cultural reasons, this order raised the alarm in the community. We respect that. We need to add a new exception to this principle where we leave it up to the nurses to decide when this type of product should be ordered.
You mentioned something else. There appears to be a lack of control. I agree with you, that is another aspect. And perhaps there is a certain lack of communication. Once again, there is no ill-will involved. As for products such as controlled drugs, there is communication, control and stringent restrictions.
We need to have a system, and we are in the process of implementing one, although it has yet to be completed. I have made this recommendation in the report. We are going to be doing this to avoid a repetition of this incident, and that will involve the nurses, the employees at the regional head office in Winnipeg, and others if necessary.
We learned another thing. Not only do we probably need better communication between the employees of Health Canada who are in the first nations communities and the Health Canada employees in Winnipeg, but we also have to think about the need to involve the first nations.
Thank you, Madam Chairperson, and thanks to both of you for being here today. The primary reason we've gathered is to discuss the important incident that happened on September 16. You brought us a report today. I think the whole way in which this issue was handled gets at the deeper problem and the reason this became such a headline in the first place, and that is poor communication and the need to build relationships between Health Canada, the Public Health Agency, and first nations, Inuit, and Métis people across the land.
This is a report today on October 7, which is more than three weeks after the incident happened, more than two weeks after we got a letter of explanation from Jim Wolfe in Manitoba and an apology, and more than several weeks since first nations people said this is about the lack of regard the federal government has had with respect to their needs and concerns about preparing for a pandemic.
I don't think this incident would ever have happened if there were better relations. It wouldn't happen with friends or familiar partners. I think it happens when people are strangers, when I think Health Canada was treating first nations as strangers, and the report you've delivered today doesn't even get at the root of the problem, which is that communication, that building of a relationship. So it's going to cause anger among the community. Already Chief Knott from Wasagamack has said he's upset with the report. We've got Chief David Harper from MKO saying this is not good enough. They're both calling for an independent investigation. That's unfortunate.
Why couldn't we have found a way to handle this issue in a way that got to the root issues at hand and dealt with it on the spot? There was no need for us to wait for three weeks for this kind of a report that simply says there was an overestimation of the number of body bags required and we're sorry and we're going to put in place ordering procedures and procurement procedures to fix this problem, and not really a word about the fact that this was an affront because these were first nations communities trying to get the attention of government to get some help. They wanted some help preparing flu kits, and ironically this report comes out today, the very day the first nations community, in cooperation with the Manitoba government, has finally been able to send flu kits into all their communities, so they feel some sense of comfort and preparedness in the event this pandemic starts to spread.
So I think the real question to you today is, where is your response to that root cause of the problem? You acknowledged it by signing a protocol three days after the body bag issue. You did that because you knew there were problems, and this protocol promises comprehensive, well-coordinated communication. So you knew that was a problem. It promises enhanced understanding of the unique challenges facing first nations. It promises joint development of culturally appropriate H1N1 public health information. It promises consistent message and information. Today this report disregards all of that; it only hurts and it keeps the wound wide open.
So I think the real question is, what are you going to do to repair the damage and address the real concerns around working together in terms of flu supplies, protective devices, staff on reserves, and how it's going to be paid for? I think they're still all grappling with the fact that they believe priorities will be revised to take money from existing programs in their communities if it's needed in terms of an influenza outbreak. In fact when folks showed us the Jim Wolfe apology letter of September 21, they also showed us his letter of June 17 talking about how there will be flexibility within the funding that goes to first nations communities to divert funds from there in the event of a pandemic. That worries them.
Are there any additional resources? Is there a plan? What has happened with respect to this protocol? What can you point to, and are you prepared to address the negative reaction to the report you've tabled today?
Thank you for your question. Let me try to respond.
There are a number of things that have occurred since this unfortunate incident, I would say, starting with better communication. I'm not going to defend the situation as being optimal. I think everyone recognizes that we have work to do. That's been the case for a long time, and we are doing it.
A number of things have happened since then. The minister was in Manitoba on a couple of occasions. She did meet with Grand Chief Evans and Grand Chief Harper. As I mentioned, I was in Manitoba last Friday for the express purpose of talking to them about the report and asking them whether they thought the report was a fair summary. I don't pretend that the report is a comprehensive treatise on all of the underlying social conditions in first nations, nor do I deny that those are things that governments in Canada need to work on, and we are working on them. In my discussion with the two grand chiefs—and we agreed, we did talk about these issues—we did talk about the desirability and the need for better communication and consultation. We did talk about needing to develop a process that will deal with some of these broader questions, but we also acknowledged that over the course of the immediate future, in terms of the hierarchy of needs, the priority was to focus on preparation for the fall and the possibility of a second wave in northern Manitoba. Those are some of the things we've done.
The other thing we've done, and quite importantly.... The gentleman sitting next to me, Paul Gully, who you know, has been here a number of times since he's been back from Geneva. He is a very well-known and credible Canadian public health official who has spent a number of years at the World Health Organization working on pandemic preparedness. We brought him back to quarterback our efforts with respect to first nations across the country, and I would say that probably he has spent a significant amount of his time in Manitoba and dealing with preparedness in Manitoba.
I'd also say that the minister has reached out—and I give credit to the minister and to the new national chief, Shawn Atleo, who had a number of discussions on the day this broke and subsequently. That led to the signing of the communications protocol. I think that protocol, which is really a little over two weeks old, is something we intend to put into effect. One of the issues—I think Dr. Gully mentioned this last week—was the idea of a virtual summit, an Internet-based summit that would enable preoccupations of first nations broadly around pandemics to be addressed, so that there would be opportunities jointly between ourselves and first nations leadership to answer questions.
So I would say there have been a number of significant steps taken. Is that all? No. Could we do better? Yes, we can always do better. Do we learn from some of our mistakes? Absolutely. It's with that spirit that I try to do my work and that we're going to move on in the future.
Dr. Gully, Mr. Rosenberg, thank you very much for being here with us again today. Dr. Gully, I know we've seen a fair amount of you in the last month or so, and that's good. It's nice to see you here, too, again, Mr. Rosenberg.
I thank you for the presentation you've given us today. Certainly it puts the situation as it occurred in a better perspective. I think that was something that we all needed to understand. We do know from your report that the order was given, that there were a lot of supplies ordered, and perhaps there was an overextension on a fair number of different items in that supply order. I can understand that because I think we're working in extraordinary circumstances. I think everybody is doing the very best they can to try to deal with a situation that they hear on a day-to-day basis can be extremely life-threatening and can increase very rapidly at a minute's notice. So I think the people on the ground are doing the best they can to deal with that.
Ordering in extra supplies when sometimes, as your report says, it takes three or four helicopter flights to get one shipment of supplies into the community would be in my mind a natural thing to do. The last thing you would want with fall and winter coming on would be to be left with no supplies and caught in that situation.
We've heard testimony from different people here today about the nursing staff and what a terrific job they're doing. I think they are, and you certainly have corroborated that. I think they're doing an extraordinary job in these extremely trying times.
You've talked a bit about your meeting with Chief Adams and the Assembly of Manitoba Chiefs and Chief Atleo. You have said they have been good meetings. One thing I would like you to do is talk a bit more about that and the virtual summit that you just mentioned, if you could.
The other thing I want to say is that you feel this was an isolated case but you are reviewing the procedures, and I think that's excellent. I think that's what pandemic planning or any type of emergency planning is all about. There will always be various external forces that nobody expects, and that's why they are emergencies or pandemics. I think that to be able to review this, to review the situation and the policies and procedures that are in place to make the proper changes and address those issues as they happen is good planning. I just wanted to make that statement.
Maybe you could tell us a little bit more about your dealings with the various chiefs and this virtual summit.
What I have learned in the few weeks I've been here is that there are large differences in the arrangements between Health Canada, first nations communities, and the provinces. It is not simply that there are some communities where it has been transferred, because communities can actually be responsible but the provision of nursing services can still be the responsibility of Health Canada. That's a particular agreement.
The situations in which planning occurs vary tremendously. The requirements in terms of remote and isolated communities vary tremendously.
What I've seen is a common theme of communication, but this communication is also different. For example, there is a tripartite table in Manitoba that meets weekly; there's also one in B.C. that meets weekly--at the provincial level--and those issues are raised there, in terms of issues that might occur.
We will continue to have to deal with this large number of arrangements when we move on to an immunization program, because the provision of vaccine is totally integrated with the provinces. Therefore, when the vaccine arrives at the provinces it would get distributed to health centres, and then it would be available to Health Canada for distribution to communities. That planning is going on right now, taking into account the time schedule that has been announced--early November--but also then recognizing how the vaccine may receive authorization. So we have to be nimble, we have to prepare, but we have to take account of things that may change. That is occurring.
We have antivirals pre-positioned, we have vaccine plans, and even where we don't have nursing stations, there are health centres that give immunization in southern communities, so we have to work with that as well. On the other hand, in many places in southern communities, communities actually access health care and immunization through the province. This real work is going on.
Finally, and probably most importantly, there's our collaboration between Health Canada and the surveillance systems in the provinces and how we get information from our nursing stations, how we share that with the provinces, so we know precisely what's going on and if there is an issue we have to then concentrate more resources on.
Thank you very much, Madam Chair. Bonjour, tout le monde.
Good afternoon. I'm very happy to be here to speak to you today about the House of Commons H1N1 preparedness approach and our response to the issue of the pandemic.
I'm joined today by Kathryn Butler Malette, who is the director general of Human Resources and as such is responsible for occupational health and safety as well as corporate planning and communication services, and the Sergeant-at-Arms, Kevin Vickers, who is responsible for business continuity in a larger umbrella.
To begin with, I would like to provide you with some background to our approach. I will then explain the purpose and the scope of our pandemic plan. I will also give you an overview of the governance structure of the plan and explain how the information will be forwarded, and the corresponding responsibilities. I will conclude by providing you with information on the resources available to members.
As of April 2009--and I'm speaking basically to the PowerPoint slides that have been distributed to you--the draft pandemic plan of the House of Commons administration as it was then was activated at an accelerated rate as a result of the increased pandemic alert levels. We developed the plan with expert advice from Vanguard Emergency Management Consultants, who specialize in business continuity and emergency and pandemic planning and management.
In April 2009 the House administration also created what we call the influenza monitoring committee. It's a senior-level House administration committee that is chaired by Kathryn, and her alternate is Kevin, with experts from across the House administration, and it continues to meet regularly and is closely monitoring the pandemic situation. In the spring it took a number of mitigating actions, including installing additional hand-sanitizing stations across the precinct, increasing cleaning measures in high-traffic areas, issuing regular communication updates to the House of Commons community, and holding information sessions for front-line employees.
We are working closely with our employees, both those represented by unions and the non-unionized, to ensure they are aware of the evolving situation so they can take responsibility for their personal health. The pandemic plan was presented and approved by the Board of Internal Economy on September 28, 2009.
The House of Commons Administration pandemic response plan is designed to, to the extent possible, continue the two business lines of the administration, namely administration as employer and administration as supporting the House of Commons and its members in carrying out their constitutional functions.
The plan is also designed to help the House of Commons, as an institution, and the members of Parliament to manage the impacts of the pandemic on their operations and functions. What is most important is that the House of Commons be able to carry out its activities as part of the state's legislative power. This is a priority for us. This imperative may therefore override the provisions of the plan. We may have to give priority to various services and resources that directly support such activities so that the House of Commons can continue providing the services it deems necessary.
The overall approach of the House of Commons administration pandemic plan is to address appropriate mitigation and preparedness for a worldwide infectious disease outbreak and to define incident response and business continuity objectives that align with a public health emergency. The steps outlined in the plan are modelled on industry best practices and guidance and information that has been offered by the World Health Organization and by federal, provincial, and municipal public health authorities.
To ensure an integrated approach, the pandemic plan supports the House administration's overall business continuity management program and crisis communications plan. The House of Commons administration has extensive business continuity plans in place for potential events that could disrupt the primary business functions of the House of Commons administration, but we're here today really to focus on what we are doing with regard to the pandemic.
I would also like to stress that obviously the pandemic plan is intended to be a living document. It will continue to be revised as additional information and guidance are issued by public health authorities, and we will also be testing the plan through various tabletop exercises to continue to improve upon it.
This is the organization chart, which presents an overview of the governance structure for the pandemic plan for the House administration in the event that an outbreak of influenza results in a high level of employee absenteeism within the parliamentary precinct that affects the level of service normally provided to members. Any decision that would need to be taken on resources that are provided to members and the impact on House administration service levels generally would be brought forward by me to the Board of Internal Economy.
As you know, I'm the senior permanent officer of the House and therefore the head of its administration, and as such I'm responsible for the management of the House in accordance with the policies, decisions, and directions of the Board of Internal Economy. Therefore, I'm responsible for activating the plan, ensuring that it is effectively carried out and that the administration supports the House of Commons and its members in carrying out their constitutional functions, including their roles as employers and as administrators of their members' office budget. It's certain that the influenza monitoring committee itself, which I mentioned earlier, is responsible for implementing the plan here on the Hill and ensuring that the pandemic risk mitigations and response actions are implemented on a timely basis as risk levels change.
As I mentioned, Kathy is the chair of the committee and Kevin is her backup. One of the things I wanted to make clear as well is that I'm working very closely with the whips of the various caucuses, because you all have operations back in your constituencies; you have staff back at the constituencies. So it becomes important that you become partners with us in terms of managing those employees. Obviously, again, because there have been regional outbreaks and these things tend to be sort of localized, you'll need to be paying close attention to what's happening in your region or city and to the advice given by the local public health authorities there.
At the same time, you'll be in contact with your whip and the whips will be in contact with each other. For example, let's take a kind of extreme geographic example: if there were a severe outbreak in British Columbia, what one would likely see is the whips getting together to suggest, first of all, that travel to and from British Columbia be limited, if not done away with altogether, and they would take the kinds of decisions among themselves with regard to the pairing of members for votes and so forth. Those are the kinds of decisions that need to be taken at the political level.
Our discussion at the Board of Internal Economy—without revealing the secrets of the star chamber—was in that vein. Each caucus has its own way of operating. The whips have their own ways of operating with their members. This is a very important partnership for us. If it turns out that there is at any point some kind of difficulty with a member serving his or her constituents because of a very high level of absenteeism in a particular region that's been particularly hard hit, for example, then the whip would likely be bringing that to my attention and I in turn would likely be bringing the whole case, the whole issue, before the board for some kind of mitigation. Again these are hypotheticals.
The important thing is to keep the lines of communication open so that we are aware, each of us in our various roles, what exactly is happening. So the kind of information that is going out from us and from the IMC—the committee that is monitoring these things—that goes out to all employees, will also be shared with all members because we're all part of the Parliament Hill community, and that, obviously, of course, would apply as well to constituency offices in the national capital region.
We have also made a commitment to work closely with our parliamentary partners. In addition, we have regular meetings with the Senate, the Library of Parliament and the Office of the Conflict of Interest and Ethics Commissioner to discuss issues such as communications, labour relations and the planning of the continuity of operations.
The activities mentioned in the pandemic plan are based on three distinct risk levels: low to moderate, high and severe. The appropriate risk level is determined on the basis of several factors, such as the seriousness of the cases, the spread of the flu, Health Canada's recommendations regarding closures, restrictions on public gatherings, travel and, of course, absenteeism.
Slide 9 gives an overview of the decisions and communications between the clerk, the Speaker and the Board of Internal Economy.
The slide show is an overview of decision-making authorities, communication flows, and responsibilities. Based on the pandemic risk level, decisions would be brought forward to the appropriate body.
The Board of Internal Economy is, of course, responsible for administrative decisions at the policy level, and these would include decisions on mitigation measures to cope with high absenteeism that might, perhaps, for example, affect levels of service in certain administrative functions. One thinks perhaps of IT, information technology, where a lot of our workers are quite young. So it's not only that they, themselves, might be affected, but because a lot of them have young children, we might be in a situation where they're at home taking care of sick kids.
Along with the Board of Internal Economy, I'll be working closely with the whips, as I mentioned, to monitor impacts on your office and research staff and the mitigation measures that may be required if a member's ability to respond to constituents is affected. Whips are responsible for monitoring the impact on their members and for bringing forward to me problems on a case-by-case basis.
In keeping with standard practice, members will continue to be guided in the management of staff by the Members' Allowances and Services manual in such matters as the administration of leave and the terms and conditions of work.
Up-to-date and accurate information about the pandemic will be provided by the House administration to members and their staff and to the employees of the House administration, as I just said.
As the pandemic could have varying impacts across Canada, it's important to note—and I repeat this, because I think it is a very important feature—that members need to be guided by their local health units in their local constituencies for their constituency office pandemic planning. That is in addition to the guidelines provided by WHO and the Public Health Agency of Canada. Likewise, on Parliament Hill, we are guided by these matters.
I guess the last matter I should mention, because there have been questions about it, concerns what we have every year, usually around this time, or maybe a little bit later, which is the vaccination for the seasonal flu. It's important to understand that the vaccination program for seasonal flu is not within our control. That is something that is recommended and managed by the Public Health Agency. Public health authorities have told us that at this time they are not going to go ahead with vaccination programs, and we're going to be issuing, tomorrow, a communiqué to staff and members to advise them formally of that. There are no plans for the traditional seasonal vaccination day, if you will, nor are there any plans for vaccination for H1N1.
The recommendation coming so far from the Public Health Agency is that vaccinations for H1N1 are available to people over 60 years of age, and that's in the community at health clinics or at family doctors' offices. That, as I say, is not really within our control. That's something that's controlled by the health agencies. I wanted to make that clear, because of course people have come to count on that every fall.
Lastly, I just want to mention that there is a tool kit for members that provides Qs and As about leave and dealing with employees and so forth, and that's available on the Internet site.
The House Administration has prepared this information kit. In addition to these tools, resources and general information on pandemic awareness, it includes questions and answers designed to help members in their role as an employer. The kit is available on Intraparl.
I hope this very brief overview has been useful. We would be happy to take your questions.