PACC Committee Meeting

STANDING COMMITTEE ON PUBLIC ACCOUNTS

COMITÉ PERMANENT DES COMPTES PUBLICS

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, June 5, 2001

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[English]

The Chair (Mr. John Williams (St. Albert, Canadian Alliance)): Good afternoon, everybody.

For the benefit of our witnesses in Saskatchewan, my name is John Williams. I'm the chair of the public accounts committee and we're located in the Promenade Building on Sparks Street in Ottawa.

Pursuant to Standing Order 108(3)(e) of the House of Commons, we are considering chapter 15, “Health Canada—First Nations Health: Follow-up” of the October 2000 Report of the Auditor General of Canada.

Our witnesses today are on video conferencing from Saskatchewan. From the College of Physicians and Surgeons of Saskatchewan, we have Dr. Dennis Kendall, the registrar from Saskatoon. Nice to see you, Dr. Kendall. We welcome you.

From the Saskatchewan Pharmaceutical Association we have Mr. Ray Joubert, the registrar from Regina.

We may be joined in Saskatchewan later on, I understand, by Mr. Hugh Harradence, a lawyer and Q.C. from Prince Albert. He is not there at this point in time.

Here in Ottawa I'll start over here. There's Jean Dupuis from the Library of Parliament, a researcher; Mr. Brian O'Neal, also from the Library of Parliament. He's a researcher. We have the clerk of the committee, Santosh Sirpaul. We have a Liberal member of Parliament, Shawn Murphy; Canadian Alliance member of Parliament, Philip Mayfield; Liberal member of Parliament, John Bryden; Liberal member of Parliament, Alex Shepherd; Liberal member of Parliament, Mac Harb.

Now we move to the Office of the Auditor General. We have Mr. Glenn Wheeler, who is director of audit operations, and Ronnie Campbell, principal, audit operations branch.

We have Mr. Jerome Berthelette, who is special adviser, aboriginal health, first nations and Inuit health branch, Health Canada. We have Dr. Peter Cooney, acting director general, non-insured health benefits; and last, but not least, we have Mr. Harry Hodes, who is assistant regional director, Alberta-Northwest Territories, first nations and Inuit health branch.

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I am sure, gentlemen in Saskatchewan, you have all that, you have it memorized, and you'll recognize us as the camera pans. As the chairman, I'll introduce people slowly. Because we're doing this long distance, we'll try to be as organized as we possibly can.

Gentlemen, we had a meeting this morning. We had Lorraine Stonechild before the committee, together with members from the Office of the Auditor General and Health Canada speaking about her particular situation and the reasons for it. We were dealing with many of the issues that have been raised by the Auditor General.

Before we get into this, I would like to ask Mr. Campbell for just two- or three-minute synopsis of his opening statement this morning. The actual written text, of course, was presented as part of the record.

Perhaps, Dr. Cooney, you can give us some direction from Health Canada to set the stage before we get into talking to our visitors from Saskatchewan.

Mr. Campbell.

Mr. Ronnie Campbell (Principal, Audit Operations Branch, Office of the Auditor General of Canada): Thank you, Mr. Chairman. Once again, thank you for the opportunity to discuss some of the results of our audit on Health Canada's first nations health programming. This is a follow-up to a chapter in 1997 reported in our 2000 report in October.

As I mentioned this morning, we also reported in 1993 on certain issues relating to those programs.

As noted in our most recent report, we are concerned that the department has not made sufficient progress to fix many of the problems identified. We remain deeply concerned that the program allows individuals to access excessively high levels of prescription drugs.

We mentioned, Mr. Chairman, that the chapter in the October 2000 report had also dealt with issues relating to community health programming delivered through contribution agreements and transfer of health programs to community control. I limited my comments specifically to issues of prescription drugs, and in doing so I spoke to four different types of things Health Canada does. This was in an effort to distinguish among them. Some of them happen before the individual has a prescription filled and some are retrospective or audit-type activities that Health Canada does. I'll briefly go through those four issues I talked about this morning.

First, the department has implemented control on prescription drug use through a point-of-service system. This system provides warnings to pharmacists prior to prescriptions being filled. These warnings are intended to highlight potential duplications and drug-to-drug interaction.

Second, the department can retrospectively monitor drug use on an aggregate basis, tracking the use of different types of drugs by geographic area. This can identify trends in use and help to highlight prescribing practices by physicians.

Third, the department can retrospectively monitor drug use by individual patient. We noted the department had some early success when intervening on the basis of such analysis. However, our audit found that this intervention had been terminated.

Finally, the department has various controls over payments. These include system edits and audits of providers.

Mr. Chairman, in discussing Health Canada's responses to our recommendations, it may be helpful to maintain these distinctions between the different activities.

Overall, Health Canada's action in response to our 1997 audit has not adequately addressed our observations and recommendations or those of your committee. Continued and sustained effort is needed to ensure that all the recommendations are implemented.

Mr. Chairman, that concludes my statement.

The Chair: Thank you, Mr. Campbell.

Now, Dr. Cooney, please give us a brief, informal position or a reinstatement of what was said this morning.

Dr. Peter Cooney (Acting Director General, Non-Insured Health Benefits, Health Canada): Thank you, Mr. Chairman.

This morning we basically agreed with the recommendations as proposed by the Auditor General's report in 1997. We felt we had made a number of strides ahead in addressing a number of these recommendations. We also accepted that some of these efforts to address the recommendations had been slow because of the complexity of the problem.

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In the 2000 Auditor General's report we also accepted the recommendations. We realize the seriousness of the issues and we have also put additional components into the system to address the concerns, as outlined by the Auditor General in the 2000 report.

This morning we also talked about our involvement with patients and other factors associated with misuse of drugs, such as the responsibility of the patient, the issues associated with providers—be they physicians, pharmacists, and the associations of regulatory bodies of physicians and pharmacists—and our role and the fact that we all need to work together to address what clearly is a serious problem. We recognize that, and we intend to ensure that it is addressed to the best of our abilities.

The Chair: Thank you, Dr. Cooney.

Now we'll go to Saskatchewan. I understand from our researchers that you have been provided with copies of the Auditor General's reports and have been in communication with our researchers regarding this particular meeting this afternoon. I understand, Dr. Kendall, that you have an opening statement. Am I correct?

Dr. Dennis Kendall (Registrar, College of Physicians and Surgeons of Saskatchewan): Yes, I'd like to make an opening statement.

The Chair: Would you do that now, please?

Dr. Dennis Kendall: Yes. Thank you very much.

I assume the committee has some general knowledge of prescription drug abuse. Although a problem society-wide, it is more pervasive among first nations people, probably for various social and economic reasons. Since we're the regulatory body for doctors, I thought I would focus mostly on what we believe we can do, what would assist us in doing our job properly, and what is hampering us in doing our job.

We're convinced that the overwhelming majority of physicians want to do the best possible thing for patients they treat and are not wittingly part of over-prescribing or inappropriate prescribing. But even well-intended doctors often get caught into double-doctoring scams in which patients are seeking drugs from multiple doctors because doctors have no knowledge as to whether these prescriptions have been provided by other physicians. Patients seeking drugs in this manner for their own use or to divert them to others are not inclined to be forthright and honest about their drug utilization history.

I recognize three other much smaller groups of physicians who perhaps are not as well-intended or at least are not practising according to good standards. Those would include physicians who, frankly, just can't say no. They've never developed the capacity or need to have their capacity reinforced to exercise professional judgment. I sometimes liken them to ATM machines. If you put the right card in and push the right buttons, ATMs reliably dispense money. These doctors tend to prescribe almost as if you push buttons.

There are some doctors, frankly, who don't control the size of their practices. They take on too many patients. They don't allow adequate time for interaction with each patient, and, consequently, a prescription is often an easy way to terminate the dialogue and they prescribe too easily.

Then there's a very small number of doctors, but they are very worrisome to us, who probably quite deliberately court patients who are drug dependent and tend to abuse drugs, because they represent a high profit potential in practice, since they move through the practice quickly, and often once they get their drugs, they have little in the way of other demands.

In order for the College of Physicians and Surgeons to do anything effective about this, we really need accurate and timely data about prescribing practices. Our doctors need timely and accurate data about drug utilization histories.

When we had a program of drug utilization review with Health Canada we were encouraged that we were beginning to make some inroads in terms of dealing with physicians who have highly inappropriate prescribing practices. Then suddenly the information flow was terminated. We have a good deal of empathy with the local people from Health Canada who would like to help us. However, they are advised that, on the basis of legal advice Health Canada has been given, they can no longer share this information with us because it involves personal health information of individuals. Unless they have consent, it can't be shared.

I guess we'd like to point out that there needs to be some balance between peoples' rights to privacy of their health information. We don't dismiss that as insignificant. But if we're going to prevent some larger societal problems, statutory bodies such as regulatory bodies for doctors have to have access to confidential patient information in order to do our work.

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Quite frankly, we get access, on a daily basis, to much more sensitive information than the drugs people have used. We handle that information responsibly. We have to find a way around this log-jam so that we can in fact get at accurate information to deal with the aberrant prescribers. In turn, we'd like to see current technology used optimally to make the information available upstream to doctors when they actually are asked to prescribe.

We understand there is a system to try to assist pharmacists, but, quite frankly, often it would be helpful if the doctors could have that information up front. They might not even prescribe if in fact they had accurate information about previous drug utilization history.

With those opening observations, I'll make myself available to questions as the meeting proceeds. It's principally, in our view, a need for sharing of information if we're to try to be part of the solution to this problem.

The Chair: Thank you very much, Dr. Kendall.

Mr. Joubert, you have an opening statement too. Can you please present that now?

Mr. Ray Joubert (Registrar (Regina, Saskatchewan), Saskatchewan Pharmaceutical Association): I'd be happy to. Thank you very much for the opportunity.

The opening statement on behalf of our association is quite similar in theme to Dr. Kendall's and the College of Physicians and Surgeons in that we want to identify some areas where we might help in assisting with solutions to the problem while on the one hand identifying perhaps some constraints that exist to meaningful initiatives.

As the college, we are the governing body for the professional pharmacies in Saskatchewan and we are interested in proper conduct of our members. In so doing, we are interested in issues around the optimal use of pharmaceuticals, and in particular issues dealing with preventing the abuse of drugs.

In that sense, pharmacists are, of course, ethically obliged to promote optimal drug use. This means, amongst a variety of things, playing an active role in minimizing or preventing drug abuse. To that end, pharmacists are very vigilant in their practices and engage in activities ranging from contacting the prescriber for clarification on suspect prescriptions, all the way to participating in some very elaborate information-sharing schemes and interventionist-type programs, such as the triplicate prescription program. In Saskatchewan this program is designed to eliminate the abuse and diversion of a select panel of drugs.

We continue to support the program that is operating in collaboration with the College of Physicians and Surgeons of Saskatchewan and the College of Dental Surgeons of Saskatchewan, and we are actively supporting enhancements to this program to electronically capture data for more drugs and for more people, in particular first nations people in this province.

Secondly, those initiatives are in subsequent phases going to be designed, hopefully, to make this data more readily available to both pharmacists and prescribers. In that sense, we are very encouraged with the willingness of Health Canada in particular to collaborate and assist in providing this information to the NIHB program, but we urge federal authorities to expedite their involvement.

These enhancements are compatible with our comprehensive drug utilization management framework that incorporates a vision that attempts to integrate all of the drug use management strategies we have in front of us, including these kinds of information-sharing networks.

For example, in our framework we have identified the benefits of one governing structure that would coordinate all of these initiatives. For example, a specially mandated drug use management authority could integrate drug use review and surveillance activities, plus all kinds of other drug use management activities, such as formulary management drug information efforts, drug reaction reporting, academic detailing, and so on.

Thus, this kind of governing structure could ensure that appropriate strategies are used to deal with quality of care concerns. We are not there yet. We have some information deficits, and like the College of Physicians and Surgeons, our ability to effect meaningful drug use management strategies is hampered significantly by the lack of good and timely information.

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Last September we concluded a 15-month contract with Health Canada under the NIHB program integrity pilot project. This project was developed to provide education and awareness and to detect and deter misuse and abuse of the NIHB program. Under this contract we hired a field officer to conduct program liaison and awareness enhancement activities with pharmacists as well as to facilitate and coordinate audits of pharmacies.

Before expiration of the contract, we proposed it be extended and even expanded and continued for some period of time with an expanded scope for the field officer. This scope was intended to broaden the terms of reference for our field officer to incorporate many more drug use management strategies in his work. These included, for example, drug use evaluation activities, formulary management, pharmacist and prescriber profiling, and academic detailing to improve therapeutic outcomes.

In the drug use review activities of this field officer, we felt that where he or she would identify quality of care concerns, he or she could then liaise with the affected parties to effect some very meaningful and significant solutions to the problem.

Since the termination of this pilot project we are not aware of any decision at the federal level to continue this approach. We also ask federal authorities to seriously consider reinstating the project so that we can be actively involved in drug use management strategies both to enhance therapeutic outcomes and to curb drug abuse amongst first nations peoples.

Finally, as the governing body, we are continuing to uphold our responsibility to ensure the ethical conduct of pharmacists. Through our complaints management and discipline process we continue to encourage Health Canada to identify any pharmacists to us who they feel are not meeting the requirements of the program.

With that, I would be happy to answer any questions you may have regarding this statement or any of the issues identified in the Auditor General's report.

The Chair: Thank you very much, Mr. Joubert.

I'm now going to turn it over to questions by a Liberal member of Parliament, Mr. John Bryden.

Mr. Bryden.

Mr. John Bryden (Ancaster—Dundas—Flamborough—Aldershot, Lib.): Thank you, Mr. Chairman.

Because these drugs, whether they're over-the-counter or prescription, can only be acquired under the program by a written prescription from a physician, I gather from what you just said that this problem could be brought under control if physicians were entitled to share the prescription information among themselves so that they would be able to identify individuals who are getting multiple prescriptions. Is that true?

Dr. Dennis Kendall: It's probably not very pragmatic to expect that physicians can share this information effectively between themselves. More realistically, the information would come from a central data source and be accessible to the physician at the point of contact. We think that in the encounter between patients and physicians, if you seek care from a physician, it should be axiomatic that you're forthright with that physician about your drug use.

Many patients who are seeking drugs for improper purposes actively conceal their previous drug use, so unless you actually have computerized databases that store this information, make it accessible in real time... People will sometimes travel through the countryside and visit 10 doctors' offices in one day. In each case they give them a story about a particular scenario that in and of itself might be a reasonable circumstance in which to prescribe. If the doctor doesn't know that nine colleagues have already prescribed in the day, then he or she is disadvantaged in terms of proper action.

Mr. Ray Joubert: Perhaps I might add to that.

The significance of that kind of information would be to make it available to both the pharmacist and the prescriber, because for a variety of reasons the pharmacist may have additional information that would lead him or her to need to consult with the prescriber. If they were basing their subsequent discussion on a common set of data, then they could arrive at a much better decision in terms of how to handle the situation.

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Mr. John Bryden: Gentlemen, in a speech given by the federal Privacy Commissioner on May 29, this is what he said: “What are E-Health initiatives trying to achieve?” And for members of the committee, by “E-Health initiatives” he means the computerized gathering of the health information. He said: “They are trying to improve health care. That's the goal. Well, that goal must not come at the expense of privacy.”

Do you agree with this statement that privacy must take precedence over the confidentiality of information that may pertain to the health and safety of individuals?

Dr. Dennis Kendall: Privacy is very important and I don't mean to belittle it, but people individually and society at large can't have it both ways. You can't create regulatory bodies such as we represent and expect us to deal with inappropriate behaviour by our members and then not give us the information essential to do that task.

Quite frankly, addictive disease is a disease in which the person so affected will go to any length to conceal their source of the addictive substance. So this is one circumstance in which there seems to be good reason to say that even for the person with the disease you need to override privacy constraints in order to help them confront the reality of their disease. Many patients who are drug seekers are drug dependent. Some of them frankly aren't drug dependent; they just sell the drugs.

So, no, I don't agree with that position in and of itself. The privacy's important, but I think it's been given too much consideration in this situation.

Mr. Ray Joubert: If I might supplement that, as far as the Saskatchewan Pharmaceutical Association is concerned, we also do not agree in and of itself with that statement.

In the absence of highly sophisticated computer technology where this information would reside, pharmacists every day share private confidential information with other health care providers for the purpose of enhancing health outcomes for no other reason than to ensure that the patient gets the maximum benefit of their therapy. In so doing, they need to disclose personal health information with other providers.

Mr. John Bryden: The Privacy Commissioner, you'd be interested to know, expands on this theme throughout this speech and takes the view that in fact privacy does pre-empt disclosure in the interests of patient care. But ironically in his speech he says this as well, if I may read it to you. He says:

Saskatchewan's Health Information Protection Act is a good model in this respect.

—that is, in respect to privacy—

It upholds patient autonomy and consent. Patients can choose not to have personal information that they confided to their physicians stored on the Saskatchewan Health Information Network or any other prescribed network. Patients control where their information is kept and who has access to it.

What he seems to be suggesting is that in Saskatchewan patients can choose not to have their prescription information stored on a databank for distribution. Is that so?

Dr. Dennis Kendall: The Health Information Protection Act has been adopted by the Saskatchewan legislature but not yet proclaimed; it's not in force. So what the Privacy Commissioner is talking about is theoretical, not real at the moment.

Another interesting thing about that provincial legislation, if and when it does come into force, is it explicitly identifies organizations such as we represent as agencies that have a legitimate right to information in order to discharge their mandate. So we are considered a trustee of private information that other agencies wouldn't necessarily get access to.

I would also say, in response to that position taken by the Privacy Commissioner, think about the implications of the Controlled Drugs and Substances Act, which is federal legislation. It places the onus on the citizen to disclose to the physician all drugs in that category that he or she has obtained within the last 30 days. If the citizen fails to do that, they're subject to criminal prosecution. So it's interesting that we run a program that tries to stem abuse of narcotic and controlled drugs, but unfortunately it doesn't extend to the benzodiazepines or minor tranquillizers, and those have become the drugs of choice in terms of abuse because they aren't effectively monitored.

Mr. John Bryden: I'll put my next question to one of the witnesses here in Ottawa, the evident witnesses.

My understanding is that the Privacy Commissioner's policy statements in this regard are taken very seriously by Health Canada. Am I to conclude that the reason why there's been a chill on this program for information sharing in Saskatchewan may be because Health Canada is giving heed to the Privacy Commissioner's interpretation of the e-commerce act? Is there a possibility that that's the cause?

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The Chair: Dr. Cooney.

Dr. Peter Cooney: Yes. We do fall under the privacy advice and we do fall under this type of recommendation. The approach we have taken is in relation to privacy concerns, so the answer would be yes.

Mr. John Bryden: If I may say so, Dr. Cooney, that's not quite my question. I'm asking whether or not the Privacy Commissioner's interpretation of policy in this regard is having an influence on decision-making on the part of Health Canada with respect to the information sharing we're talking about in the non-aboriginal health benefits plan.

Dr. Peter Cooney: The advice we get in relation to the Privacy Commissioner comes through the Department of Justice and from our legal counsel. So they would take the advice of the Privacy Commissioner and they would process that and pass it to us through their interpretation. So our advice comes to us through the Department of Justice.

The Chair: Thank you very much.

Thank you, Mr. Bryden. We'll now turn to Mr. Mayfield, the Canadian Alliance member of Parliament from British Columbia.

Mr. Philip Mayfield (Cariboo—Chilcotin, Canadian Alliance): Thank you, Mr. Chairman.

Thank you, gentlemen, for being with us this afternoon.

The privacy concerns are of great importance, but I want to follow up on some of the things you said in your statement. You mentioned the various categories of doctors, from those who may want to provide the very best to those who would like to get them through the clinic as quickly as they can and perhaps benefit as much as they can personally from that.

The College of Physicians and Surgeons is responsible for investigating and disciplining all doctors in Saskatchewan whose standards of medical care, ethical care, and professional conduct are questioned. Has the college ever investigated doctors in relation to prescribed drugs to patients in general, to first nations individuals in particular? If so, what were the college's findings, and what were the actions taken as a result of this?

Dr. Dennis Kendall: Yes, we do investigate doctors' prescribing practices. As I alluded to earlier, we do run a monitoring program that monitors the prescribing of narcotic and controlled drugs. From that database we regularly direct inquiries to doctors to explain why they are prescribing in the manner they are. If they can't provide adequate explanation to us, we make recommendations to them in terms of how we expect them to change their prescribing practices. Frankly, when practices don't change, we've gone the full length of revoking licences. We have taken licences away if doctors actually fall into that category in which they're exploiting the system.

But to take a licence away requires an enormous due process. You have to have hard evidence. So now, for instance, if somebody from Health Canada phones us and says, we have concerns about Dr. X's prescribing, I'm afraid that doesn't cut it, because doctors are represented in their interface with us by the Canadian Medical Protective Association, a very well-resourced organization that defends doctors in every way possible. Unless you can cite the absolute evidence that proves the drugs were not appropriately indicated, you can't really build a case that allows you to discipline a doctor. To do that, you actually have to access patient records.

It's interesting, in this country we do access patient records to monitor the appropriateness of doctors' billing practices. That happens in every province, because it's a trust system. You send in your bill, the government pays. So you have to have an audit system. When doctors' billings are audited, this committee needs to understand that patients' records are accessed by a select committee, which is sworn to confidentiality, to actually review what those doctors are doing in their practices.

So in other domains of life we are accessing highly personal information in order to make sure doctors are kept honest, and yet here we seem to be exempting or permitting practices that occur that are very harmful on the basis that it would invade the privacy of individuals. There seems to be some imbalance in this.

Mr. Philip Mayfield: To bring it to a case in point, this morning we had Lorraine Stonechild as a witness and she spoke of the death of her brother, Darcy Ironchild. There's been a coroner's report, which I presume you're familiar with.

Dr. Dennis Kendall: Yes. I was a witness at the inquiry and I'm very familiar with it.

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Mr. Philip Mayfield: Mrs. Stonechild mentioned that when her brother died he had had some 300 prescriptions filled in the year just before he died. In addition to that, there was a variety—and quite a large number in that variety—of other medications that had been purchased over the counter.

Do you have an explanation for how an individual like this could have so many prescriptions—almost one a day, it would seem—and at the same time have so many over-the-counter medications at his disposal as well? Do you have an explanation of how that can be?

Dr. Dennis Kendall: Darcy Ironchild was addicted to a number of drugs, including chloral hydrate, which is the drug that ultimately culminated in his death. Chloral hydrate isn't a drug that's subject to monitoring under the program we have at the moment, so we have no knowledge of his drug utilization history. Had we had knowledge, we would have intervened, and perhaps it would have saved his life—we can't say with certainty.

We have a great deal of empathy for the Ironchild family. In fact, the recommendations from the coroner's inquest are ones that our governing council is doing its best to implement. But if you look at those recommendations, at the very core of them is the point we're trying to make about the need to use information more intelligently to stem this problem.

When I describe those three categories of doctors, or four categories—one that largely wants to do well, and then the other three—within the prescribing for Darcy Ironchild, I believe there were some doctors who, frankly, just didn't say no. They ought to have said no, and we are interacting with those doctors to make sure they learn something from this tragedy.

Mr. Philip Mayfield: The issue of privacy is one that is taking a fair bit of time with our committee today. We're concerned that Health Canada has been dealing with this problem for a long time. In one report, the Auditor General mentioned that it was almost 10 years, and that report was delivered some time ago.

With regard to privacy, I want to know what communication exists between the physician and the pharmacist, because it seems to me that in the point-of-service system, it does not provide the dates of the last three prescriptions. I'm wondering how that can be, why there is this lack of information.

Mr. Ray Joubert: My understanding, if I can respond, is that there are some technological limitations to providing that type of very interactive data. I'm not aware that the limitations in data have anything to do with privacy legislation.

My understanding is that it has everything to do with technological issues and the way in which the system is actually designed, delivered, and programmed to interact with each pharmacy computer system. Short of that, the limited amount of information does create a barrier against the pharmacist being very effective in his or her communication with the prescriber. Sometimes a pharmacist just simply doesn't know, or doesn't have the time to investigate it further. Nor are the incentives in place to encourage the pharmacist to take the time to investigate the circumstance further and obtain the detailed information that he or she needs to consult effectively with the prescriber.

Dr. Dennis Kendall: I'd like to make one observation, though. It's interesting, in this country, in which health care for all citizens other than first nations people is primarily a provincial responsibility, if you look at the province of British Columbia, there is, compared to the rest of Canada, a state-of-the-art pharmacy network database into which goes every prescription for every person who gets a prescription filled in British Columbia, even if you visit British Columbia as a tourist. Every pharmacist in British Columbia has access to that information online, and they're now in a pilot project that is rolling it out to 100 medical clinics in which the information would be available online.

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The Province of Alberta is building an even more up-to-date system. We're hopeful that in Saskatchewan, once the system in Alberta is rolled out, which we expect to happen in about a year, our government will actually purchase the system and implement it here.

The interesting thing about it, though, is that if we get access to the information for everybody except first nations people, then we're going to be able to protect most of the population, but first nations people will still be at risk if for some reason there's a barrier in terms of getting information about that particular population.

It seems incongruous that a federal interpretation of a privacy act is having an impact on one sector's population across this entire country, yet the provinces are dealing with non-aboriginal people in a very different way. We don't know why citizens should be dealt with differently in this matter.

Mr. Ray Joubert: I might, sir, just elaborate on the point I made.

The POS system was designed to capture, adjudicate, and pay claims as efficiently as technology permits, to which is added the secondary capability of drug utilization review. In other words, where it identifies a possible duplicate, a simple warning goes back to the pharmacist with no other information, because no other information resides in that particular transactional piece of data.

Mr. Philip Mayfield: To conclude, Mr. Chairman, very quickly, I'd like to ask Mr. Campbell of the Auditor General's department, is it your understanding that there's a separation between the privacy issue and the technology issue, as the gentlemen in Saskatchewan have just described? Is that your understanding of the separation of these two here?

Mr. Ronnie Campbell: Mr. Chairman, I don't have the answer to that question.

Certainly in 1997, when Health Canada was about to implement the POS system, it was intended at that time to have the dates of the last three prescriptions. As I mentioned earlier, it doesn't have that, nor did the department strengthen the warning messages the witness was referring to.

The extent to which it was a technical question or a privacy question I think would be better put to Health Canada.

Mr. Philip Mayfield: Thank you very much, Mr. Chairman.

The Chair: Maybe we'll put that question to Health Canada right now.

Dr. Cooney, is it a technical question or is it a privacy question?

Dr. Peter Cooney: Mr. Chairman, this question can be answered by looking at what happens in B.C. We discussed this area this morning.

In B.C., it becomes a technical issue associated with the Pharmanet program. Our patients are part of the large pharmacy network, so first nations patients are included in the B.C. pharmacy system.

If provincial systems worked similarly to that, our patients would be included in them. So as provincial systems develop—and this is the issue where information gets shared between the pharmacist and the College of Physicians and Surgeons—our patients will be included in that database.

The Chair: So the short answer is that it's a technical issue, not a privacy issue.

Dr. Peter Cooney: That's correct.

Mr. Philip Mayfield: That brings up the whole issue of privacy in Health Canada again.

The Chair: Okay. We're now going to move to our second round of questioning, which means that we don't allow the same amount of time.

We normally go for four minutes, but because we're interactive with Saskatchewan, I think I'll go with five to six minutes, if all can agree with that.

We'll start with Mr. Murphy, please. Mr. Murphy is also a Liberal member of Parliament.

Mr. Shawn Murphy (Hillsborough, Lib.): Yes. Thank you very much, Mr. Chairman.

My question is to Dr. Kendall.

In my previous life, I've had some experience dealing with the doctors that you have classified and spoken about. My experience indicates that these doctors are very unlikely to change their habits until they're seriously disciplined, suspended, or in some cases incarcerated.

I read some of the facts here, and I find them somewhat disturbing. One of the statistics was that 124 clients received at least 150 prescriptions during a three-month period. It's your job, your organization's job, to discipline and investigate these doctors. Can you give us some indication as to how many doctors a formal complaint would be processed against each year in Saskatchewan?

I'll just go over a couple of questions.

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My second question is, in this particular instance, did Health Canada ever come to you and ask that a formal investigation take place?

My last question to you, sir, is, do you really think that you as the executive director of this organization are fulfilling your mandate not only with regard to the professional conduct of doctors but also with regard to the protection of the public? Are you fulfilling your statutory mandate?

Dr. Dennis Kendall: There are several questions there. First of all, we have about 1,500 doctors in active practice in Saskatchewan. We receive about 200 complaints a year from citizens, but we are also open to complaints from other agencies.

Yes, I believe we are fulfilling our mandate within our capacity to do so. Our organization is 100% committed to the public interest. We do not represent doctors. We're the regulatory body. There's a medical association that represents doctors' interests. We are not here to protect doctors from any accountability.

I would have to take a little exception to an answer that was given earlier about whether this is a technology issue versus a privacy issue. If we have a concern about doctors prescribing to a non-aboriginal person, I can ask our provincial department of health to print a profile for me, and I will get disclosure of every drug prescribed to that person under that drug plan. Yet when it's an aboriginal person and we suspect there's a problem, we can't get answers. How can you discipline a doctor without evidence? Have you ever been in a courtroom against a lawyer when in actual fact you have no evidence to prove your case? It's very difficult. We need evidence.

The Chair: There was one question in the middle, Dr. Kendall, which was, have you ever received a complaint from Health Canada regarding a potential or perceived abuse of prescriptions by a doctor that should have been investigated?

Dr. Dennis Kendall: When the drug utilization program was in place, we would get a printout showing a prescribing pattern, and Health Canada officials would say, we think there's reason for concern. Then we would investigate.

I don't know how much more plainly I can say it. We feel that the local Health Canada people with whom we interact have their hands tied behind their backs, because they can't give us any information. In the past we used to receive referrals. Now we don't.

The Chair: Pardon me for interrupting, Mr. Murphy. When did Health Canada stop referring these problems to you?

Dr. Dennis Kendall: I think May 1999 was the cut-off.

Mr. Shawn Murphy: I have one supplementary question, Dr. Kendall. It goes back to your answer that you're not getting the printouts and the information from Health Canada that deal with first nations. When you get a situation reported to you, can you not just go out and ask the client for consent to release his or her information or just ask him what drugs he's getting and what doctor he's getting these drugs from?

Dr. Dennis Kendall: Have you ever asked a drug addict to disclose their source of drugs? They will not tell you because it's not in their interests to do so. Most of these people are chemically dependent. They are not going to disclose their source of drugs.

Mr. Shawn Murphy: My experience is that a lot of times if you go and ask them, they will tell you.

Dr. Dennis Kendall: With a drug addict?

Mr. Shawn Murphy: Yes.

Dr. Dennis Kendall: You must have had a very different experience in life, because I work with drug addicts every day, and they'll do their utmost to conceal their source of drugs.

I'm not sure if Mr. Joubert has a different perspective on that.

Mr. Ray Joubert: Our perspective is the same. Our members, in dealing with this problem, as well as our organization in handling complaints of this nature, are hampered by the fact that we can't get information. It's not the person who's addicted to the drugs who will provide you with information. If he or she does, it's likely to be highly unreliable in order to protect his or her interests and not to jeopardize his or her source of supply.

The Chair: We should point out, by the way, that Mr. Murphy was a crown prosecutor before he became a member of Parliament. He perhaps had a little bigger stick than you have out there in Saskatchewan. But we'll leave that debate for another day. That's why I think they were more willing to volunteer the information. I'm sure you must have held something over them, Mr. Murphy, but you don't have to answer that.

Do you have any more questions, Mr. Murphy?

Mr. Shawn Murphy: No.

The Chair: Now we're going to turn to Mr. Mac Harb, a Liberal member of Parliament from Ottawa. Mr. Harb.

Mr. Mac Harb (Ottawa Centre, Lib.): Thank you.

• 1625

First, I want to thank you for your frankness.

I'd like to ask you a two-part question. How big a problem are we talking about, both in the native communities as well as in the community at large, when it comes to drug abuse? Is it really a major one? What percentage are we talking about, 5%, 10%, 20%?

Have you or the Government of Saskatchewan carried out any studies in terms of the number of deaths in the general population as well as in the native population as a result of a drug overdose? Are we making a big deal out of something that is the norm in a sense, or is it a substantial problem that requires a national action plan?

Dr. Dennis Kendall: Our sense is that it's a very substantial problem. I can't point to a particular Saskatchewan-based study correlating drug-related deaths with inappropriate prescribing. Such a study was done in Alberta, and we don't have any reason to believe the problem is any less profound in our province than it is in Alberta.

Whether they're using prescription drugs or street drugs, many people will eventually die of a drug overdose unless you can get them into rehabilitation. So prescription drug abuse isn't the only source of these deaths. Some of them are related to street drugs.

With regard to benzodiazepines, they were never intended for long-term use. When they're prescribed long term, they're really masking many other problems in life that people need to deal with. Quite frankly, this is a huge threat to health. It doesn't necessarily lead to death. But there still is a lot of inappropriate drug use going on that may not be life-threatening but is harmful.

Mr. Mac Harb: We are talking about a problem that exists, and that is the abuse of a substance. I wonder whether we are chasing the tail rather than the head. Maybe we should be focusing on the whole issue of dependency, whether it's drugs, alcohol, or some other type of substance abuse, rather than putting the blame squarely on the pharmacists or the doctors when in fact the problem really lies elsewhere in society and needs other types of care.

I'm not here to say that everybody in the medical or pharmaceutical communities is perfect, but these are people who are trying to serve the public as best they can. Nonetheless, there are holes in the system. I'm just trying to get some insight on this situation from your end.

Dr. Dennis Kendall: I think you're quite right. The problems are much farther upstream in terms of social and economic issues that increase the tendency to use a substance in order to escape problems in life. That's true of everybody in society. About 10% of society has a problem with chemical abuse of some sort, and it involves every class.

At the end of the day we are the regulators of two different professional groups. I think Mr. Joubert made the point very well that our members shouldn't be contributing to the problem. They ought to be part of the solution, and we want them optimally equipped to be part of the solution. For that small percentage, and it is small, who wilfully do this, we need to deal with them very forcefully, because it's a betrayal of public trust when in fact those in these positions exploit the system.

Mr. Ray Joubert: Just to supplement that and to add a couple of other points, a task force was assembled about a year ago of members who were actively involved in this area and who had some experience with drug abusers particularly in the context of crimes committed against pharmacies and pharmacists. They made that very same observation, that even though the proportion of the people they're dealing with may be small in terms of the rest of the public, dealing with those drug abuse issues consumes an inordinate amount of time and resources at the expense of others.

• 1630

Secondly, interventionist-type measures and control measures at the systems level are needed, but they are not the only solution; they are not the panacea. What's needed are broader social solutions that deal with the root causes of the problems so that people don't become addicted, don't engage in drug-seeking behaviour that leads to addiction in the first place. We need to put those kinds of tools in the hands of health care providers, in particular pharmacists and physicians in this province and in this country.

The Chair: Thank you very much, Mr. Harb. We'll now turn to another Liberal MP, Mr. Alex Shepherd, before we return to Mr. Mayfield.

Mr. Alex Shepherd (Durham, Lib.): Thank you, and once again my question is to Mr. Kendall. This would appear to me to be mainly an administrative problem in the sense that the patient is in Saskatchewan, the pharmacist is in Saskatchewan, and the physician is in Saskatchewan. So the basic data is there. The only thing that Health Canada brings to the table is they pay the cheques. If all of that data exists within Saskatchewan, why can't you put that information in your current data system? You can identify drug abusers without the fact that Health Canada is the one that pays the bills, could you not?

Dr. Dennis Kendall: We have done that, sir, with regard to narcotic and controlled drugs. Ten years ago we created, through legislation, a provision that said you can only prescribe these drugs if you use a triplicate script: the pharmacist sends us a copy, we enter it into a database, and we track that. Provincial ministries of health are generally disinclined to process data about aboriginal prescriptions unless there's actually some agreement between the provincial government and the federal government, because they don't want to have the offloading of federal responsibilities onto provincial governments. So for drugs that aren't in that small panel that we monitor, we have no access to the information. The shear number of benzodiazepines that are prescribed would overburden our system; it would crash the first day. We don't have the resources to basically operate a larger system.

Somewhere in the system those data are in a computer. So I take your point that somewhere they're in a computer, and in today's age it shouldn't matter where that server resides, the information ought to be accessible.

Mr. Alex Shepherd: Okay, I guess my question would then be to Mr. Cooney.

In view of your comments that British Columbia is already administering this on behalf of the federal government, why not so of the Province of Saskatchewan?

Dr. Peter Cooney: This is exactly the reference I was making to technology. The triplicate prescription program does work well in Saskatchewan, but it's a slow manual system.

My belief is that there have been quite a number of discussions between our regional office in Saskatchewan and the College of Physicians and Surgeons of Saskatchewan to ensure that this system can be brought to an automated level so it will become a real time transaction issue. That can be done, and that really is just replacing the manual system with a technological system. That was my reference to technology, which is still trying to catch up with that in Saskatchewan.

Mr. Alex Shepherd: When do you see that eventuality occurring in that we will no longer be dealing with this kind of a dysfunctional system where there's a lack of communication?

Dr. Peter Cooney: The discussions are continuing, and I discussed this with Dr. Kendall yesterday. We are prepared to get into the sharing of information. Our problem, and again, it comes back to the privacy issue, is that we cannot share patient names. However, what can be done is the pharmacist, as under the system there, and we discussed it this morning, can share patient names under the provincial legislation.

We are about to go into a testing stage with the College of Physicians and Surgeons of Saskatchewan to ensure the technology in the pharmacy area comes up to speed. After that, the intent would be for the information to be shared between the providers and the regulatory bodies such that Health Canada won't have to share personal, private information.

• 1635

Mr. Alex Shepherd: To clarify, in the case of the Province of British Columbia you've found a way around this privacy thing, and this is being dealt with under provincial jurisdiction.

Dr. Peter Cooney: That is my belief on how Saskatchewan can also get around it.

Mr. John Bryden: Thanks a lot.

Mr. Alex Shepherd: What's the timeframe?

Dr. Peter Cooney: We're looking into the agreement with the Saskatchewan College of Physicians and Surgeons within a matter of months.

Mr. Alex Shepherd: Will that provide them with additional resources to meet some of the problems Mr. Kendall described?

Dr. Peter Cooney: You may want to direct this to Dr. Kendall. My belief is it will allow them to test their technological systems to ensure that they're compatible with this very large influx of information. They're about to go into that testing phase.

Mr. Alex Shepherd: Mr. Kendall, he commented that your system is manual, and you mentioned it may well overload. Are they saying the system in Saskatchewan is so far behind technologically that it can't encompass setting—

Dr. Dennis Kendall: No. The information database is now hosted on servers with the Saskatchewan Health Information Network. It's our government-sponsored health information agency.

I don't want to disagree that there are some technological barriers to overcome. I still can't understand today, if I have a concern about a prescribing of a doctor for a particular aboriginal person, why my body, as a statutory body, can't actually query the database at NIHB and get an answer.

That still is a privacy issue, and it seems we're having to do creative things to dance around the privacy issue. We have to deal with that head on. You can't have it both ways, folks; otherwise you'll have ten more Darcy Ironchild down the road.

The Chair: Mr. Cooney, you want to say something.

Dr. Peter Cooney: Mr. Chairman, on a slightly positive note, believe it or not, we were meeting with the Assembly of First Nations and the ITC, the Inuit Tapirisat of Canada, today to discuss this issue in Winnipeg, and I teleconferenced with them when I left this meeting. They are going to move forward with our recommendations and convene a meeting within the next two weeks. They're going to schedule a meeting with a number of chiefs and with senior management of ITC to hasten this consent issue on. So in relation to privacy issues, that clearly would allow us a major step forward.

The Chair: This was the very question I was going to ask. Is there any reluctance on the part of the first nations leadership to withhold the moving forward and releasing of the information that allows the doctors and pharmacists to monitor the system properly, as is being done in non-native communities—the population of British Columbia—and as it's going to be done in Alberta? Is there a holding back by the first nations community?

Dr. Peter Cooney: Mr. Chairman, you might want to ask that of the first nations community themselves.

My interpretation would be that there is a slight concern with what Health Canada or anybody else would do with the information. That then becomes incumbent on all of us to ensure that the patient, when they sign the consent, is fully and clearly informed with regard to what they're consenting to, and that I believe—

The Chair: My question was as follows. Is the leadership of the first nations holding back the approval process so that the first nations can be on the same basis as we've heard about that British Columbia and Alberta are going to be? Basically, real time information on every prescription will be granted right across the province on who it was written by, who received it?

Dr. Peter Cooney: The first nations need to give us a response to this, because we have asked for that, and we will get the response from them I believe imminently.

The Chair: So how long have you been asking for this information?

Dr. Peter Cooney: We have been meeting with them for just about a year now.

The Chair: And they have been holding back so—

Dr. Peter Cooney: They have had fairly major consultations on it, Mr. Chairman, because there is a concern about what may be done with the information. We have had continual meetings on this. It now appears that this issue is going to be addressed. It is coming to a head, which is a positive indication.

The Chair: So that's likely a significant reason why the Department of Justice is advising you about all this problem of privacy. Do you disagree?

Mr. John Bryden: I do. I think you're leading the witness.

The Chair: We'll come to you later, Mr. Bryden. We're going to go back to Mr. Mayfield.

Mr. Mayfield, Canadian Alliance member of Parliament.

• 1640

Mr. Philip Mayfield: Thank you very much, Mr. Chair. I think I've heard people say that the technology is available, but really technology is not the problem we're trying to solve. A couple of years ago, Health Canada said they were going to solve the problem with a new computer program, which didn't work.

I want to ask Health Canada, has your problem with this issue changed with the appointment of the new Privacy Commissioner? Is that where the roadblock is? I don't remember this privacy issue when Mr. Phillips was doing the job.

Dr. Peter Cooney: To date, Mr. Mayfield, we're dealing with the office of the Attorney General, and the Department of Justice is advising us. I would assume that discussions are taking place between the Attorney General's office and the Privacy Commissioner. But we receive our advice directly from our legal counsel with the Department of Justice, and that advice has been very consistent. It is also consistent with the advice given to the Auditor General's office when they looked at the same issue: their legal counsel gave them the same response as our legal counsel.

Mr. Philip Mayfield: Now the issue was raised this morning about ratcheting up the process for dealing with this situation, from consultations with the Attorney General to legislation by the House of Commons. In my question to Mr. Potter, I didn't get a lot of encouragement to go in that direction. But it seems to me we're at an impasse; people are dying and Health Canada can't do anything about it. The College of Physicians and Surgeons of Saskatchewan, and perhaps of other provinces too, is handcuffed because it can't get the information it needs from Health Canada.

Aside from new legislation, what resources do we have to deal with this problem?

Dr. Peter Cooney: I guess our option is to proceed down the avenue of consent. That's the option we discussed in one of our other meetings with the Assembly of First Nations this morning, and they are now prepared to move forward with that option.

Mr. Philip Mayfield: We're in a situation now of people being over-prescribed for one reason or another. People are dying. So are you suggesting a prolonged period of consultation, in which people's lives will still be at risk? Is that really the tack we want to follow in solving this problem? How many lives are we prepared to let go so we can continue talking about this problem, which I have been talking about with members of your department for over two years?

Mr. John Bryden: At least six or seven years.

The Chair: Mr. Cooney.

Dr. Peter Cooney: Mr. Mayfield, I believe we're all saying the same thing around this table: we want to see the issue addressed. I guess the question is how it can be addressed. My belief is that this will not be prolonged. With the current status, I believe we will get an indication fairly quickly from the Assembly of First Nations and the ITC.

As we mentioned to you in our discussion this morning, we would like to see this moving on if we're going to proceed down the road of getting consent this year. We discussed that in the April public accounts committee meeting as well.

Mr. Philip Mayfield: Language like that causes me concern. You say “this year”. Well, there are still six months left in this year. I could understand it if you said you were going to meet in the next two weeks and would come out with the decision to provide the consent that doctors and pharmacists need, or even if you were going to take some other course of action in the next two weeks. But we've just been talking about this for long periods. Six months is a long time in the life of a drug addict.

The Chair: Dr. Cooney.

Dr. Peter Cooney: Mr. Mayfield, when I say this year, I mean that we plan to be actively enrolling patients this year. We will be meeting on this issue within the next two months; we will be discussing it and moving forward with it. When I say this year, the timeframe is there and the actual consents are being received.

Mr. Philip Mayfield: Can I take that as a commitment from you, sir?

• 1645

Dr. Peter Cooney: You certainly can, sir. We gave you that commitment in April as well.

Mr. Philip Mayfield: Thank you very much, Mr. Chairman.

The Chair: Thank you.

Now we're going to turn to a Liberal member of Parliament, Mr. John Finlay, who hasn't spoken so far.

Mr. Finlay.

Mr. John Finlay (Oxford, Lib.): Thank you, Mr. Chairman.

I find I'm getting much clearer on what our problems are here. I have a question for Dr. Kendall. As you say, the College of Physicians and Surgeons is a professional organization charged with seeing that physicians behave appropriately. Dr. Kendall, I have a quote here from section 52 of your bylaws, which deals with unbecoming, improper, unprofessional, or discreditable conduct. Paragraph 2(a) lists giving information concerning a patient's condition or any professional services performed for a patient to any person other than the patient without the patient's consent, unless required or authorized by law to do so.

I see nothing wrong with that, but it seems to me that this conflicts somewhat with what you've told us previously: that you can get this information, and that this information shouldn't be maintained privately. Yet it seems to me that your own bylaw here suggests that it should be private.

Dr. Dennis Kendall: That bylaw, sir, pertains to the practice of individual doctors. It relates to the fundamental issue of confidentiality in the doctor-patient relationship. As a doctor, you don't casually discuss information about your patients with other people, except those permitted to have the information by law or with the explicit consent of your patient.

That has nothing to do with the exchange of information between agencies that run programs such as we're talking about here. The college bylaw pertains only to the individual doctor.

Mr. John Finlay: But don't you have to get the information from the individual doctor, Dr. Kendall?

Dr. Dennis Kendall: If we're investigating the prescribing practices of a particular doctor, for instance, that doctor is obliged by law to answer any questions that we, as the regulatory body, ask him. Those questions would come under the provision of “except where required by law”.

If you look elsewhere in the statute of the bylaws, you'll see that when we ask a doctor for a copy of a patient's records, for instance, by law the doctor must provide them to us. That has nothing to do with the consent of the patient; it's law.

The point we're getting at here is that when we know we need to investigate a doctor, we need factual information.

Mr. John Finlay: I absolutely agree with you on that point. It was just the juxtaposition—

Dr. Dennis Kendall: That bylaw is intended to prevent doctors from casually passing on any specifics of patients' information to other people.

Mr. John Finlay: Thank you.

The Chair: Thank you, Mr. Finlay.

I forgot to mention that Dr. Cooney and Mr. Berthelette have to leave at five o'clock, which is in about fifteen minutes. That would only leave Mr. Hodes from Health Canada. I'm not sure it would be appropriate to continue the meeting beyond that time, so we will have to wrap it up in about 15 minutes.

We'll go back to Mr. Bryden, a Liberal member of Parliament.

Mr. John Bryden: I'd like to direct my question to Mr. Cooney, or anyone else with Health Canada. I'd like to have his opinion on who is first and foremost responsible for the health and safety of aboriginals, of first nations Canadians. Is the first nations leadership responsible, or Parliament?

You've repeatedly said that you're waiting for consent from the first nations on whether you can disclose this information electronically. But if the Assembly of First Nations says no, where does that leave Parliament? Surely the final decision on whether this information should be shared between care providers is really with Parliament.

I take Mr. Mayfield's point: people are dying. In fact, this decision should be made by Parliament on the recommendation of Health Canada—quite apart from the sensitivities of the first nations leadership.

• 1650

The Chair: Dr. Cooney.

Dr. Peter Cooney: Mr. Bryden, I appreciate your point; it's a valid one. I guess the issue here is one of logic. We have found that if you try to actively enrol 700,000 people, it's a lot easier if they want to enrol. That's why we have first taken the route of getting the support of their leadership. I appreciate your point, but we want to have the first nations leadership support us in this endeavour.

Mr. John Bryden: May I make an observation, Mr. Chairman? I served for a long time on the Indian and northern affairs committee, and I can tell you that the first nations leadership does not speak for the majority of urban aboriginals—who, as we learned this morning, are the ones most vulnerable to this problem.

You don't need to reply to this, because it's not fair to ask you, but it seems to me that we're waiting for a response from a leadership that doesn't speak for the people most injured by the situation we're trying to resolve.

The Chair: It also seems to me, Mr. Bryden and Dr. Cooney, that the system developed for the non-native population of British Columbia—which is soon to be proposed in Alberta—doesn't require enrolment. I get the impression that these prescriptions are going to be registered, and nobody's going to ask the patients for their opinions or whether they want to enrol.

So why this enrolment issue? Are you getting back to this concept of consent, and are you going to follow through on that?

Dr. Cooney.

Dr. Peter Cooney: Mr. Chairman, what you're saying is correct. The B.C. plan isn't a legislated plan—if we had one, we wouldn't need enrolment, as we discussed this morning. But this is not legislated, so we do need some type of consent.

The Chair: Well, it might be that some legislation is better than 700,000 consent forms.

Mr. Bryden.

Mr. John Bryden: I may sum up my impression and offer some comments. It seems to me that Health Canada is advising the people of Saskatchewan that prescription providers can't share patient names among themselves, because the justice department has advised Health Canada that it's not proper; they can't do it. And that's correct.

So what this really boils down to is that Health Canada is acting on advice from the justice department. Justice has interpreted the privacy issue for you, and that's your decision-making challenge. Is that not correct?

Dr. Peter Cooney: That's correct.

Mr. John Bryden: If I may have your attention for just two seconds, Mr. Chairman, I would heartily recommend that we ask the justice department or the Minister of Health to provide this committee with the legal advice that the justice department is giving Health Canada on this privacy issue. He has the discretion to do it, and in the access to information bill, so once and for all, we can get to the bottom of this log-jam.

The Chair: Thank you, Mr. Bryden. We don't have a quorum at this time—you can't make a motion—but perhaps when we have nine people present you could move that, and we could request the information from the justice department.

Mr. Philip Mayfield: In the same manner, Mr. Chairman, I would like Health to come back to this committee in the not-too-distant future to explain what progress has been made. I regret that this session of Parliament is about to recess for the summer, but the early fall would not be too soon.

The Chair: Last word, Mr. Bryden.

Mr. John Bryden: One other very small point. We will see anon, but it would appear to me that Health Canada is acting on advice from the justice department based on legislation that has not yet been passed. We have the ultimate conundrum: people are dying in Saskatchewan, and people in Saskatchewan want to help them, but we have a problem right here at home in Ottawa.

The Chair: Thank you very much for that closing comment, Mr. Bryden.

I would like to thank our witnesses from Saskatchewan who have come forward today and been very candid and quite enlightening for the committee. We appreciate it very much.

• 1655

Dr. Dennis Kendall: Thank you for the opportunity of meeting with you.

The Chair: Thank you so much, and thank you, Health Canada.

Just before our visitors from Saskatchewan leave, we normally close with some comments from the Auditor General's office. Mr. Campbell, do you have any closing comments?

Mr. Ronnie Campbell: Thank you, Mr. Chairman.

I just want to briefly reiterate that we are deeply concerned with some aspects of this program. We hope we've been clear in our reports what those concerns are.

We do welcome the commitments made on behalf of Health Canada to implement the recommendations we've spoken about today, and also the issues they have implemented since we did the audit last fall. I'm sure you'll appreciate that those solutions will require continued and sustained effort on their part. As well, we will be following up on that in an effort to provide assurance on the department's progress.

The Chair: I think Health Canada will appreciate that point as well, Mr. Campbell.

The meeting is adjourned to the call of the chair.