N.W.T. Health Minister Julie Green addresses disappointments in health care

Residents of smaller N.W.T.communities have been raising concerns about health care after recent reports of patients paying their own way to Yellowknife for a diagnosis and treatment.

In one of those cases, a two-year-old in Hay River, N.W.T., visited the health centrethree times over four days and was sent home each time only to be diagnosed with double pneumonia in Yellowknife.

In March, Dln, N.W.T.,Elder Morris Neyelle bought his own ticket to Yellowknife after his local health centre gave him Tylenol for what he called "burning" stomach pain.

Once in Yellowknife, Neyelle hademergency surgery to treat a tumour the size of a pop can. Neyelle opted not to travel to Edmonton for radiation treatments. He later died at age 71.

NNSL Media reported incidents out of Fort Resolution, N.W.T., including one woman who visited the health centre for stomach cramps, was given an Aspirin, andunexpectedly delivered a baby once she returned home. The woman had not known that she was pregnant.

Health Minister Julie Green spoke with CBC News about thepublic concern over health care in the territory specifically in smaller communities.

The Q&A has been edited for clarity and length.

CBCNews: What goes through your mind when you hear those stories about people in in smaller communities who in some cases pay their own way to Yellowknife to get critical care?

Julie Green:I just think about how anxious it must be for them to have a sick loved one and to feel that they have to drive to Yellowknife or fly to Yellowknife in a very small location. Like Sambaa K'e, there's a nursing cabin, so there's not really much in the way of health infrastructure there. But in bigger places, in Hay River and in Fort Resolution and in Dln, there are health centres there and the staff there want to help patients. They want people to feel better. And so there's obviously a gap here in what we think we're providing to the patient and what the patient is experiencing from that care. We need to bridge that gap.

CBCNews:When things like this happen, what happens inside the department? Does that trigger a review?

JG:A review is triggered if the patient or the patient's guardian complains. We have a very robust complaint process and it's available in every region. I really encourage people to use it because it will trigger an investigation, a meeting with the family and the health professionals and some kind of resolution. The thing about complaining in the media is there is no resolution. It's a place to make your complaints known, but you're not going to get a follow-up, public follow-up, from health in that circumstance.

CBCNews:What do you see as the issue around staffing?

JG: We do have a severe nursing shortage at this point, [for] which we're releasing a plan to address in the next couple of weeks. I think the issue is around what can be accomplished in a small health centre.

So there is an X-ray machine. It's possible to do blood tests.It's possible, of course, to triage people, connect with telehealth, talk about whether a medevac is necessary with the hospital at Stanton.

So they can't diagnose cancer in a small health centre, they just don't have the expertise or the diagnostic capacity to do that. We actually don't usually do it in Yellowknife either. It usually happens in Edmonton at the Cross Cancer Institute. So I think some of it is an expectation that all the services are available everywhere. But the fact is that there's sort of a stepped approach to care from the health centres.

We're doing the best we can with the resources we have in those small communities. We could always be doing better. And that's the value of hearing people and their personal experiences.

CBC News: You're raising, for example, the cancer diagnosis isn't going to happen in a regional health centre, but the decision making ...so that they end up at Stanton or they end up in Alberta, rather than having to pay their own way. So there's what can be accomplished in a small community, but there's also that decision making.

JG: It's at the discretion of the nursing staff. And I want to say they're professional licensed staff, and they have to make a decision about how best to treat the person in front of them. And they generally start with the easiest and simplest diagnosis and work their way up into something more complicated.

I think that sometimes it takes a while for treatments that are proposed at the health centres to take effect.And I think it's that gap, which is where people start to worry that they are not receiving the appropriate treatment because they don't yet feel any better. And so then they take matters into their own hands, which is, you know, advocating for yourself is very important, but what I would like to see is that people feel comfortable talking to the health centre continuously and saying, 'I know you gave me Tylenol,that's not doing it. Could you do this for me or that for me?' And to have that interactive process at the beginning, instead of waiting to complain after the process is at the crisis point.

So I realize that some people aren't comfortable advocating with medical professionals. They feel a little shy about their lack of expertise, but that is the right thing to do. You need to tell them how you feel so that they know what they can do for you.

CBCNews:The example of somebody that went to the hospital three times in Hay River and then on their own drove to Yellowknife to get attention at Stanton. That does sound like an example of somebody advocating for themselves.

JG:It does sound like they're advocating for themselves. That was an alarming case. I'm sure the family was very frightened that their child wasn't getting any better.

My experience of antibiotics, which I know are the cure for pneumonia, is that they takea day or two to really attack the symptoms for people to feel better. So they might have been, you know, a bit of a bit of lag time there, which panicked the family, understandably.

CBCNews: Are there enough health care resources being put into these communities outside of Yellowknife?

JG:We're working with the resources we have. We have a huge budget for health. We provide services 24/7in 14 communities with nurses during the day and on call at night.

We feel like we are doing the best with the resources we have at this time.

We are interested in how we can improve relationships to expedite the expression of concerns and and finding remedies or resolutions to the concerns that are raised. I'm not sure that this is a money problem. This is a relationship based problem.

CBCNews:Morris Neyelle, he wanted some public explanation for what happened in his case. He did sign a waiver allowing health officials to talk about it. And I believe that the health department declined that. Why was that?

JG: I don't know. I didn't make that decision. But we do not generally talk about people's health in a public forum. It's their private health information.

CBCNews:Even if they sign a waiver?

JG:I don't know what the legalities of that are, but I wouldn't be comfortable talking about somebody's specific situation waiver or no waiver. I wouldn't want to turn the radio on and listen to people talking about my health.

CBCNews:Is the department willing to give any kind of public accountabilityfor any mistakes that have been made for these people that have suffered?

JG:Lots of assumptions there that mistakes have been made and apologies are required. I can tell you that when I hear in the media a story about care that is not acceptable to the patient, I usually make my own inquiry. But I once again would really encourage people to use the complaint system. That way there will be an investigation and there will be an opportunity to speak to health care providers and resolve the situation. Telling the media is only telling the media. It is not going to result in a resolution to the complaint to the individual family.