[English]
EVIDENCE
[Recorded by Electronic Apparatus]
Thursday, April 5, 2001
• 1539
[English]
The Chair (Mr. John Williams (St. Albert, CA)): Good afternoon, ladies and gentlemen.
Today, pursuant to Standing Order 108(3)(e), we will consider chapter 15, “Health Canada—First Nations Health: Follow-up”, of the October 2000 report of the Auditor General of Canada.
Our witnesses today are, from Health Canada, Mr. Ian Potter, the Assistant Deputy Minister, First Nations and Inuit Health Branch; Mr. Patrick Borbey, Associate Assistant Deputy Minister, First Nations and Inuit Health Branch; and also Mr. Robert Lafleur.
May I ask, Mr. Lafleur, what's your title with Health Canada? Perhaps you can tell us.
Mr. Robert Lafleur (Senior Assistant Deputy Minister, Corporate Services, Health Canada): I'm Senior Assistant Deputy Minister with Health Canada for Corporate Services.
The Chair: Thank you very much.
And from the Office of the Auditor General, we have Ms. Maria Barrados, the Assistant Auditor General; and Mr. Ronnie Campbell, Principal of the Audit Operations Branch.
So, without further ado, Ms. Barrados, we'll start with your opening statement.
Ms. Maria Barrados (Assistant Auditor General, Office of the Auditor General of Canada): Mr. Chairman, thank you for the opportunity to present the results of our follow-up audit of first nations health, reported in chapter 15 of our October 2000 report.
• 1540
With me is Ronnie Campbell, the principal who is
responsible for this audit.
We found that Health Canada had initiated action to address the observations and recommendations in our 1997 audit. However, we are concerned that it has not made sufficient progress to fix many of the problems we identified.
[Translation]
Some of the corrective action, particularly relating to funding recipients' responsibility, requires that Health Canada work with First Nations leaders and health professionals. It has more control in other areas such as designing programs and specifying contract requirements.
[English]
Mr. Philip Mayfield (Cariboo—Chilcotin, CA): A point of order, Mr. Chairman. I don't think the translation's coming through, I'm sorry.
The Chair: Okay. Let me check it.
Mr. Philip Mayfield: We're fine now. Thank you, Mr. Chairman.
Sorry about that, Ms. Barrados.
The Chair: Okay. We're all on the same wavelength here.
Ms. Maria Barrados: Should I repeat that?
The Chair: Yes. Go back to the beginning of your paragraph, please.
[Translation]
Ms. Maria Barrados: Some of the corrective action, particularly relating to funding recipients' responsibility, requires that Health Canada work with First Nations leaders and health professionals. It has more control...
[English]
The Chair: I hate to apologize again, Ms. Barrados, but I'm getting French on all my channels. I don't get you speaking French, and I get French.
Mr. Philip Mayfield: I'm getting translation.
The Chair: I tell you, this place is falling apart, I'm sure.
A voice: It doesn't matter.
The Chair: It doesn't matter that it falls apart?
Ms. Maria Barrados: Should I switch to English?
The Chair: Please. Is it acceptable to you?
Ms. Maria Barrados: That's fine, yes.
Some of the corrective action, particularly relating to funding recipients' responsibility, requires that Health Canada work with first nations leaders and health professionals. It has more control in other areas such as designing programs and specifying contract requirements.
We are concerned, Mr. Chairman, that the department's management of contribution agreements is still weak. There is still some overlap between program objectives, many of which are not clear. While there is still considerable room for improvement, Health Canada has had some success in working with first nations to improve the reporting required of them under contribution agreements.
The department continued its initiative of transferring health programs to first nations control, providing greater flexibility in how they deliver programs. However, there remain important reporting requirements, some of which are not being met. These include updating community health plans and meeting requirements for audits, annual reports, and evaluations.
Another concern is the department's management of non-insured health benefits. A point-of-service system was put in place to facilitate timely intervention by pharmacists when the system identifies potentially inappropriate prescription drug use. We found that Health Canada had not adequately monitored pharmacist override of these warnings, nor had it conducted sufficient analysis to indicate how clients were getting very large numbers of prescriptions.
The department did have some early success intervening in cases where misuse of prescription drugs was suspected. This intervention involved following up with clients, physicians, pharmacists, and professional bodies. Despite some positive impact, however, this intervention was stopped in May 1999 because management was unsure that this approach was appropriate in the absence of either client consent or specific statutory authority for the program. The number of cases of access to large amounts of central nervous system drugs started to increase again. The department needs to follow up on these cases.
At the time of our audit, Health Canada was considering options to address this situation. Your committee, Mr. Chairman, may wish to ask Health Canada for information on its progress.
We remain concerned about Health Canada's management of its claim processing contract. We observed that the department has been slow to develop an appropriate audit strategy and that there was a significant gap between the depth of the audit coverage and the overall risk of the program. In addition, the contractor had completed few of the required on-site audits of pharmacies and dental providers.
• 1545
We did find, Mr. Chairman, that the department has
resolved the problem with the system edits that
identify duplicate claims. It also has successfully
implemented a predetermination process for dental
benefits that has resulted in substantial savings.
Improving the health of first nations is a complex task. We believe that timely and complete implementation of our recommendations would contribute to improving the health of and services to first nations.
Mr. Chairman, that concludes my opening statement. I would be pleased to answer your committee's questions.
The Chair: Thank you, Ms. Barrados.
I apologize for the interruption earlier. I think perhaps I couldn't find the correct dial to find the proper channels, so perhaps the error was at this end of the table.
We're now going to turn to Mr. Potter. Mr. Potter, you have a long opening statement, and I think you were requested to make a five-minute opening statement and that you're going to summarize this. Am I correct in saying that?
Mr. Ian Potter (Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada): You are, Mr. Chairman.
The Chair: Thank you.
Mr. Ian Potter: It's a pleasure to be here, and thank you very much for the opportunity to speak to you today.
Is the translation working now?
[Translation]
I have with me today Patrick Borbey, Associate Assistant Deputy Minister, Dr. Peter Cooney, Acting Director General, Non-Insured Health Benefits, Paul Glover, Director General, Office of Accountability Implementation and Jérôme Berthelette, Special Advisor on Aboriginal Issues.
I want to thank the Auditor General for the thoroughness of the audit and the thoughtfulness that is evident in the recommendations. The recommendations of the Auditor General and the recommendations of this committee have guided our work as we take the necessary actions to improve the efficiency and the effectiveness of the delivery of our program.
[English]
I'd like, if I could, to make a few comments with respect to our business and our mandate. The branch has a threefold mandate: to assist first nations to improve their health, to ensure the availability and access to health care services, and to support greater control by first nations and Inuit over their health programs and services.
We provide these services through a branch, and these services are organized under two general headings. One is community health services; these are offered on reserves and in Inuit communities. The second is medical services that cover the cost of drugs and other medically necessary supplies and services for registered Indians and Inuit that are not covered by other public health measures. This is called the non-insured health benefits program.
In response to the Auditor General's recommendations and the public accounts committee's recommendations with respect to the management of contribution and transfer agreements, the department has taken the following steps. At the departmental level we have created an audit and accountability bureau to enhance the internal capacity and to provide a focus on accountability, ethics, and values. As well, we have taken steps to strengthen the financial management framework for grants and contributions through such actions as creating a quality assurance division, introducing a standard format for contribution agreements, creating a steering committee, providing training courses, and adopting a risk-based audit and monitoring methodology for grants and contributions.
At the branch level we have developed, in consultation with first nations and Inuit, a new accountability framework that sets out the elements and processes for an effective accountability system. We've created an accountability implementation oversight committee with first nations and Inuit. It was established in 1999 and continues to work on the new services.
I'd like to touch on a few of the achievements to date. With respect to better planning, budgeting, and reporting, the branch has adopted a formal process that defines objectives, makes the decision process transparent, and follows up on results.
Important elements of the new system, which will improve the management of contribution and transfer agreements, include a compendium of programs that clearly set out the goals and services, the elements and standards of reporting and evaluation, and the accountability requirements of each program.
There is a new management control framework that governs the monitoring of contribution and transfer agreements. This clarifies the responsibility of finance and program officers, ensures the agreements have been well developed and justified, and follows up to see that required reporting is done.
• 1550
We have new standard contribution and transfer
agreements. We introduced that starting April 1 of this
year. The new agreements reduce 16 agreements to four
standard agreements.
The agreements have been clarified and strengthened to better define the minister's right to audit, to strengthen the accountability and reporting responsibility of recipients to their community and to government, to clarify allowable costs for contributions, to tighten the provisions around the use of retained surpluses, and to strengthen the minister's remedies in case of default.
In response to the recommendations related to the non-insured health benefits program, the branch has introduced a completely automated drug claims processing system with over 7,000 pharmacies across the country. This is point-of-sale technology that allows every pharmacist, on filling a prescription, to immediately have information about whether this is duplicate or whether there are some issues of concern about that prescription.
We've also introduced a needs-based dental predetermination system with 12,000 dentists nationally.
Both of these initiatives resulted from the 1977 recommendations of the Auditor General.
Based on other recommendations, the branch has completed and enhanced a new audit framework that's made up of four parts: next-day quality assurance—we visit the claims that are submitted from all pharmacies on a next-day basis; client confirmation—we write to clients to determine whether or not they actually received the service; provider profiling—we look at the providers against the standards to see if there are differences in their pattern; and we are conducting on-site audits.
The Auditor General raised concerns about the inappropriate use of prescription drugs by certain clients. I can assure members that Health Canada takes this seriously and we have taken the following steps. We've put in place that point-of-service system I talked about with on-line warnings. We've met with the professional associations, both physicians and pharmacists, to encourage them to work with their members to put in place measures to deal with these problems. And we've put in a process to analyse the use and effectiveness of point-of-sale drug utilization messages. This identifies providers who frequently use their professional judgment to override the point-of-sale messages. These are followed up with discussions with the providers and possible on-site visits.
We're working with the Assembly of First Nations and the Inuit Tapirisat of Canada to implement a process of client consent that will allow us to share information with health care providers on specific client use of pharmaceuticals. This practice was previously discontinued due to privacy concerns.
Finally, the evaluation of the non-insured health benefits program will be completed this year.
[Translation]
I want to thank the committee for this opportunity to bring members up to date on the initiatives that the Branch has undertaken. I want to assure the members that the department is committed to fully implementing all recommendations aimed at improving the capacity to efficiently and effectively deliver services that improve the health of First Nations and Inuit communities and we will continue our efforts until the results are satisfactory.
Thank you sir.
[English]
The Chair: Thank you very much, Mr. Potter.
I appreciate the progress you tell us you're making. Also, I did notice in the appendix to the Auditor General's report that in 13 out of 21 ratings you got an unsatisfactory progress rating, and perhaps some questions will come forward on that later on this afternoon.
But we'll turn to you, Mr. Mayfield, for eight minutes.
Mr. Philip Mayfield: Thank you very much, Mr. Chairman.
I want to thank you once again for being with us in committee here today.
As I was listening first to Ms. Barrados speaking about continued needs for improvement and then you, Mr. Potter, mentioning some of the improvements you have made, the one that struck me was the improvement in determining overuse of prescription drugs and dealing with that. I'll come back to that in just a minute.
• 1555
I want to talk about accountability a little bit
and how you can assure reasonable accountability. It
seems to me that one of the difficulties encountered in
seeking this kind of accountability is that where funds
from the government and funds from a reserve's own
sources, a band and council's own sources, have come
together, there have been rules established by
the courts. I think there was a decision called the
Montana decision or something that dealt with
this, that in fact auditing was not possible where
these funds had merged together and were commingled in
this way.
I'm wondering if you have been able to stop this commingling of funds so that you can track grants and contributions of the government successfully.
Mr. Ian Potter: We are able to ask for and receive audits and accountability for the programs and funds that we provide to first nations.
You're quite right, the Montana decision prevents us from seeing those audits that were commissioned by the Department of Indian Affairs and Northern Development. But that has not limited us in this new accountability framework for setting out audit requirements for those contribution agreements that fall into the transfer category, which are these longer-term, broader category ones, and with that new system we will get the information on a regular basis, on an annual basis. The Montana decision will not affect our ability to access that information.
Mr. Philip Mayfield: Does this mean that in every instance where money from your department is being transferred you can assure that it goes to the use it was intended, that you can follow up with audits if necessary in every instance?
Mr. Ian Potter: We're trying to put into place something that will give much greater assurance that the funds are being used for the purposes they're intended.
I think it would be presumptuous for me to say to this committee that we will prevent and assure that there will not be cases when funds were not used, but we do feel we are putting in a system that will follow up on those cases so that the likelihood will be much diminished from what it was in the past.
Mr. Philip Mayfield: Perhaps you understand the intricacies of your department and the way it does its business better than I do. At least I hope you do.
At this point I'd like to turn to the Auditor General's office, to Ms. Barrados or Mr. Campbell, however you choose. I must confess, I don't find a lot of comfort in what Mr. Potter just said. They're trying. They're doing their best, but when I ask can it be done, I'm not sure this is the case. From your point of view, is it an impossible task to be able to have some certainty about where money is going, whereby if you're not satisfied about this you can go and check and see what has happened? Is it possible to do that?
The Chair: Ms. Barrados.
Ms. Maria Barrados: Mr. Chairman, we say in our audit report that Health Canada underestimated the amount of effort it would take to implement the recommendations the way they had committed to. And what we have heard from the department is a renewed commitment to work at implementing these recommendations. That provides us with considerable assurance that they are committed to doing this.
On the specific question Mr. Mayfield asks about, tracking the funds, one of the observations we had made in the initial report and again in the follow-up report is that for the transfer agreements there was a requirement for audit, not only financial audit, but also a form of comprehensive audit that looked at compliance of the direction. In other words, the audit was to examine whether the money was being spent the way it was supposed to be spent—and this wasn't done. It is a requirement for the first nations to do this kind of audit.
What was really meant there needed to be clarified, but to really get an understanding of how money is spent, for what purpose, you need a broader-based audit.
The department has taken the initiative to clarify what is required there, and in addition they have now taken the initiative to strengthen their own ability to audit. There will always have to be an element of some risk assessment here. You can't audit everything all the time.
• 1600
Mr. Philip Mayfield: What about the commingling of funds? Is that still taking place?
Ms. Maria Barrados: Mr. Chairman, this is not something we encountered here in this audit work. It wasn't a problem in our work.
Mr. Philip Mayfield: I direct the same question to you, Mr. Potter. Has this commingling, where because the funds come together accountability is lost, been stopped?
Mr. Ian Potter: It's not a problem in the contribution and transfer agreements that we manage.
Mr. Philip Mayfield: Has it been stopped, though?
Mr. Ian Potter: We're able to account for all of the funds. We require an accountability for all of the funds we transfer, irrespective of where and how, whether they're commingled or in other ways dealt with. If they're provided to a secondary party, the agreements require a full accountability for all of the funds we provide.
Mr. Philip Mayfield: And do those agreements give you the ability to go looking if need be? Can your auditors go look at the books where they were put together, which the judge said you couldn't do?
Mr. Ian Potter: Yes, they do.
We have changed the agreements to assure that we have the authority to exercise the right to audit and to take steps if we believe the recipient is in default of the obligations of the contribution agreement.
Mr. Philip Mayfield: Mr. Potter, I want to say thank you very much, because one of my frustrations in coming to committee and talking with you is that we tend to go back into the history of the Auditor General saying things were reported quite a long time ago and they really haven't been fixed up. In this instance, it seems as though there has been some progress. And I want to say personally, if not on behalf of the committee, that I find this kind of movement very satisfying.
I'm glad to hear you say that and I just want to catch my breath. I think I'll just turn it over to you, Mr. Chairman, and I'll come back later.
The Chair: Thank you, Mr. Mayfield.
I had a question on the commingling, Mr. Potter. Commingling also prevents the information being made public. Your department may go in as an auditor, and check these figures, but if it's private money mixed up with public money, we can't, as a public, get access to it. Can we get access to the programs that you fund? As the public accounts of Canada are made public, can this information be made public or can it not be made public because of commingling?
Mr. Patrick Borbey (Associate Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada): There's no problem at all. First of all, there is no commingling of health—
The Chair: So it's all public.
Mr. Patrick Borbey: Yes, it's all public funding. And there are no issues with respect to making public the audits that are performed on recipients and on programs. The only issue is we have to comply with privacy legislation, so that's the only limit to our ability to make those public. And we do. We post our audits on the website, and that also includes the actions the department takes in terms of whether there has been found to be a need for recovery of funds, for whatever reason there may be. That's also posted with the audit. So it's pretty transparent.
The Chair: Mr. Shepherd.
Mr. Alex Shepherd (Durham, Lib.): Yes, thank you.
My question is to Mr. Borbey. You were quoted this morning in the National Post in reference to the Virginia Fontaine Addictions Foundation and the loss of possibly as much as $5 million of taxpayers' money. The quote says “75 staff members to take a Caribbean cruise”. You make the comment there that you cannot guarantee another Virginia Fontaine situation won't happen again.
Why, with the new Treasury Board guidelines that are in place here, and why, with all the ability of doing checks and balances of how money is spent, can you say this?
Mr. Patrick Borbey: It goes back to what was said earlier about risk management. We cannot guarantee against mismanagement or incompetence or fraudulent behaviour. What we're doing with the new agreements in the approach for accountability is we're making the conditions much tighter under which we would have pre-control or to prevent those kinds of situations from emerging. When those situations emerge we would be able to take immediate and decisive action to be able to suspend the agreement, suspend payment, terminate the agreement, and investigate through the audit provisions immediately what the actions are.
• 1605
What I'm saying is we can't guarantee those
situations will not emerge, but we've made it a lot
harder for them to happen.
Mr. Alex Shepherd: I guess the original comment was that you've minimized. To me a $5 million misspending of taxpayers' money is a significant amount of money.
Mr. Patrick Borbey: I think that is still under review with the audits. We don't know what the conclusions are going to be with respect to the funding situation there. We'll have to wait for the outcome before—
Mr. Alex Shepherd: One of the comments the Auditor General did make as he talked about your evaluation report evaluating the programs of Health Canada in this area... I have a copy of that report here and I don't really see the concept of evaluating outcomes. In other words, of the presumed objectives of your department, which are presumably to improve native health, I don't see any direct analysis or evaluation procedure to show how you've been successful in these expenditures of money.
In fact, the evaluation report, and the Auditor General alludes to this, is quite poor. It's not really an evaluation report at all as far as I can see. It talks about some of the programs you now do, but it certainly doesn't talk about how you've spent the money or how it's had any impact on the health and well-being of native people.
Mr. Ian Potter: If I may, I will just point out the initiatives we are taking to provide that kind of information.
Within the specific programs we have clarified the requirements for accountability reports. For example, with our diabetes initiative and our prenatal nutrition initiative we've clarified the need to provide accountability reports, evaluation reports, on the outcomes.
We're also working at the broader level, which is to try to get some of the data with respect to those communities, because, as you quite properly point out, we want to look at whether we are making a difference in the health of those communities. We have very limited data on the health of many of the first nations communities on reserve. Their general data is not picked up well in the census. We have supported and continue to support the development of a regional health survey, working with first nations organizations to do that kind of evaluation of health outcomes. That's at the broad level.
We're also putting in place what we call a first nations health information system, which is a combination of a case file or patient record system and a program record system. That's being rolled out at the moment. It would provide us with that data.
We recognize this as a difficulty. I think provincial governments that manage similar programs recognize the difficulty of showing results for their health dollars. Do we really make a difference in the health outcomes of the population?
We are obliged and are quite willing to participate in those efforts with the provinces as part of the recent agreement with the provinces to provide much better reporting on health outcomes and the performance of the health care system on whether it's working efficiently and making an improvement in the health outcomes.
Your expectations are the same as our expectations. I can tell you we are taking them very seriously. The difficulty of doing that is not only our difficulty but a difficulty that I think affects all health programs across Canada.
Mr. Alex Shepherd: When we talk about your expectations, we also have your current plans and priorities. I look at plans and priorities becoming the things that we evaluate a year from now.
Mr. Ian Potter: Right.
Mr. Alex Shepherd: The plans and priorities are also fairly vague: “health initiatives that improve the health status of the First Nations and Inuit people” and “increased awareness of health issues”, and on and on. These aren't things that we can quantify as actually improving the everyday health and well-being of native people.
How are we going to take something like this, your plans and priorities, and evaluate them a year from now?
Mr. Ian Potter: I believe we would have to look at it in the context of the reports we can produce, along with the reports we will produce on the individual program and the broader evaluations we are supporting through survey methodology.
• 1610
I think that combination will give members of
Parliament a much better understanding of the
contribution the programs are making to the health of
first nations and Inuit. We are working seriously at
developing that capacity so that we, as I said, along
with other health departments, can report on them in a
more effective manner.
Mr. Alex Shepherd: It was also noted by the Auditor General that a lot of your transfer agreements don't even include community health plans. Where are we with that?
Mr. Ian Potter: We have implemented as part of our new accountability framework a system that requires a community health plan to be developed for every transfer agreement. The transfer agreements are contribution agreements to communities where the communities have much greater control over the programs of health—
Mr. Alex Shepherd: But that was the case in the past, and what the Auditor General basically found was that you didn't do it. You transferred the money without the plan.
Mr. Ian Potter: We have now put in place a system that requires the reporting on the plans before the money can flow. The Auditor General pointed out, quite correctly, that when transfer agreements were renewed, in some cases the health plans were not renewed. We have now put in place a contributions management system, an automated system. We're rolling that out across all offices.
That is the system that will allow cheques to flow. If the officer who is responsible for managing the contributions or the health plan in that community does not have the health plan and cannot check off the box that shows the community has a health plan in place, we will not allow the funds to continue. We are building in automatic checks to make sure those health plans are prepared.
We're also working with the first nations, because it is not a simple thing to develop these health plans. We are working with them. We are developing training plans with them. We are meeting with our own staff so that these things can be rolled out in a more effective way.
The Chair: Thank you, Mr. Potter.
Thank you, Mr. Shepherd.
Mr. Moore, we're moving on to a second round of four minutes.
Before we start that, I omitted to say at the end of your statement, Mr. Potter, that you summarized your statement. Your full opening statement will be filed with the clerk and will be available should anybody actually want a copy of it.
Mr. Moore, please.
Mr. James Moore (Port Moody—Coquitlam—Port Coquitlam, CA): In May 1999 Health Canada stopped intervening in cases of suspected prescription drug abuse. The Auditor General indicated that this was done because the department was unsure of the appropriateness of the approach. Why was the department unsure of the appropriateness of the approach?
Mr. Ian Potter: We had introduced a program that followed up on cases where we thought there was over-prescription of a certain drug. These were basically cases of central nervous system drugs. We discontinued one part of that process.
We continue to have a process in place that follows up on the prescription pattern of physicians so that we can look at an individual physician's prescribing pattern. We can look at the pharmacists and at individual pharmacies to see if they're providing a high level of a certain type of drug. We're following up with next-day audits on them.
What we had to discontinue was profiling an individual's information. We were taking information about an individual's use of certain prescription drugs and sharing that with other professional health providers. Our advice was that in the absence of either clear consent, allowing us to share that information, or legislation, which would provide us with the right to share that information, we should discontinue that due to privacy concerns. We did that.
We have taken steps to reinstate that through discussions with the Assembly of First Nations so that we can get a system of consent. The intent is that we'll be looking to first nations to sign consent forms. Those consent forms will allow us to track individuals and to share individual records with the health care providers.
• 1615
Mr. James Moore: The department doesn't collect information on prescription-related drug deaths. The Auditor General recommends that Health Canada do so in all regions. It's the only recommendation that the department doesn't clearly agree on.
Will Health Canada agree to systematically gather data on prescription-related deaths of first nations in all regions? Why or why not?
Mr. Ian Potter: Gathering data on prescription-related deaths is not within our purview. This is the responsibility of the vital statistics authority, which rests with provincial governments.
Vital statistics require that the presiding medical officer fill in a death certificate, and they fill it in according to World Health Organization standards.
What we have done... There is the cause of death and there are contributing causes of death, and in some ways it's very difficult to determine whether or not it's due to overuse of a drug. If it's an automobile accident, the precipitating cause of death could be that. It could be trauma to the head or some other loss of blood, but the contributing factor could have been drugs.
What we have done, though, is we have met with the registrars of vital statistics, and we have laid this question before them. They have given us an understanding that they will try to work with us to try to identify the contribution that overuse of prescription drugs has on morbidity, on death in the population.
They need consent, though, from first nations to participate in this. We've met with the Assembly of First Nations. We've written to them and asked for them to participate with the registrars of vital statistics so that we would be able to get that kind of information.
Mr. James Moore: So you've written. Have you gotten a response? It will have to be entirely voluntary?
Mr. Ian Potter: We have not got a response yet from the AFN, but we have a response from the registrars of vital statistics that says they're prepared to work with us to try to do that.
Mr. James Moore: Therefore, the mechanism through Health Canada will be entirely voluntary?
Mr. Ian Potter: It's not our authority to do that. It's the provincial registrars of vital statistics that control the system of reporting deaths and cause of death.
The Chair: Okay. Thank you, Mr. Moore.
Mr. Bryden, please, four minutes.
Mr. John Bryden (Ancaster—Dundas—Flamborough—Aldershot, Lib.): The non-insured health benefits program applies to all aboriginals, both on reserves and off reserves?
Mr. Ian Potter: Yes.
Mr. John Bryden: So how do you get the consent, through any aboriginal organization, of the thousands of aboriginals who live, say, in Winnipeg, who aren't associated with any reserve but yet have access to the non-insured health benefits program? Who speaks for them?
Mr. Ian Potter: The intent to get consent would be a registration system.
The program applies to registered Indians and Inuit. Those are defined populations—families, names, individuals. The intent would be to have each one of those families fill in a registration form to continue their benefits. With that registration form—
Mr. John Bryden: Why do you have to go to the Assembly of First Nations? Why don't you just make that a requirement of the program? The Assembly of First Nations does not speak for all kinds of people in urban centres, as opposed to rural centres.
Mr. Ian Potter: We believe it's unlikely that we will get high compliance, unless there is an indication from the organizations that represent first nations and Inuit that this is something that's in their interest.
There's often a great deal of suspicion when we ask for people to sign documents, and this may relate to some history. But we believe that we will get, and we're positive and optimistic that we will get, their support and that we will be able to roll out a system of consent with individuals.
Mr. John Bryden: My concern is, though, that we're talking about something that is really fundamental to health.
If people on the non-insured health benefits program abuse the prescription by going around to various pharmacies or getting multiple prescriptions, it has a very negative impact on their health.
So, surely, the real way to go would be to take a responsible position on it and say that you cannot take part in this program unless you do give consent, so that there is some sort of tracking to avoid abuse of these drugs. Is this not the safer way to go, at least in the interest of the health of the clients?
• 1620
Mr. Ian Potter: We are concerned with the health of the clients, and we don't want to impose barriers to access to needed medical supplies and pharmaceuticals. We do take the issue seriously, so while we are not providing, as I said, the individual names and the individual history, we are actively at this moment doing provider profiles that look at certain druggists. We've put in place a limit on certain drugs so that if the individual is, in our view, reaching a certain limit that we would consider to be over-prescribed, there is a ceiling, and there will be a point-of-sale reference so that the pharmacist will be notified not to fill that prescription.
We're putting in place ways to deal with the issue. It's not that we have put off the issue to a time in which we can get consent to do individual records. We have put in place a number of measures that we think are relatively effective at controlling that issue.
Mr. John Bryden: Let me try it another way, then.
Set prescription drugs aside. What's to stop any aboriginal from going out and buying cough syrup, for example, at any number of pharmacies? If you're not keeping a client profile, how do you prevent that kind of abuse when it's not a prescription pharmaceutical, but it's a non-prescription pharmaceutical?
Mr. Ian Potter: I think we would face the same problems in managing that issue as the physicians, pharmacists, and other professional organizations have for the general population.
Mr. John Bryden: No, I have to pursue it a little bit because this is one of the problems with this program. I did a lot of work on this program in an earlier day, and what was happening, very clearly... individuals are capable of going around and purchasing non-prescription drugs or other accessories in multiple areas. If you don't keep a client record of purchases, how can you prevent someone from using it in this fashion?
Mr. Ian Potter: I may have misled you. We do keep a client record of purchases, and we do track that. This is what I was saying: if there is a number of purchases of drugs at a certain level, for those drugs that are central nervous system drugs, they will trigger within our current system a notice to pharmacists that there is an issue here about limits. We follow that at the moment.
Mr. John Bryden: Even if it's non-prescription?
Mr. Ian Potter: That's right. We do, even if it's not a prescription.
The Chair: Ms. Barrados would like to make a comment on this, too.
Ms. Maria Barrados: I have just a point of clarification.
It's my understanding in this program that, for the over-the-counter drugs that you might purchase without a prescription, if a first nations individual gets a prescription for those, they will be paid under the program. So you have running as prescription drugs aspirins and things that we ordinarily wouldn't consider—that type of drug.
Mr. Ian Potter: We can keep a record of that—
The Chair: The situation, I think, Mr. Bryden, is that they can go in, like you and me, and buy these non-prescription, over-the-counter remedies, but if they want a prescription and the government to pay for them—which they can do but you and I can't do—then Health Canada has that information.
Mr. John Bryden: So that control is in place? Even if it's an aspirin, if they're going to buy it, they have to buy it by prescription, so you keep a record, and if it's over-bought then there's a triggering mechanism?
Mr. Ian Potter: As the chairman said, if we are paying for it—if we are reimbursing the pharmacist—we keep a record, and we keep a record against each individual. The issue that we stopped was sharing that information with pharmacists and physicians in general.
Mr. John Bryden: Okay. I've got you. Thank you.
The Chair: Thank you very much, Mr. Bryden.
Mr. Mayfield.
Mr. Philip Mayfield: Thank you very much, Mr. Chairman.
I want to ask some questions about the Virginia Fontaine treatment centre in Manitoba. There has been an outrageous misuse of taxpayers' money here. To his credit, the minister has said that it's going to be looked into, and I'm wondering if you could answer the question of when will the audit of the treatment centre be completed.
• 1625
Mr. Robert Lafleur: The audit is well underway. The auditors have not given us an indication of exactly when their report will be available to us, but we have been providing all the support the auditors have requested. As you may know, the government went to court to have the court endorse its right to audit, and for that reason the audit itself was delayed for quite a long time. It's now under way in earnest, and because it is a forensic audit, it's quite detailed and very focused. We hope to have the report soon, but we don't have a date yet for that.
Mr. Philip Mayfield: Are there any preliminary results from the audit that are available to you at all?
Mr. Robert Lafleur: There are no reports that are final. We've had some indications from part of the audit work that is being done, but we're not taking any action until the reports are made final. There are views, in some cases, of people affected by the audits, and they will have to see the audit and be allowed to speak to it before the audit is final and available to us for action.
Mr. Philip Mayfield: Is there anything you can share with us from these findings?
Mr. Robert Lafleur: Not at the moment.
Mr. Philip Mayfield: When the report is completed, will the results be made public?
Mr. Robert Lafleur: The results will be made public. The minister has undertaken to ensure that if funds have been misused, they will be sought and returned to the government. Our practice is to put our audits on the Health Canada website when they're made final, and we'll continue to do that.
Mr. Philip Mayfield: If fraud is determined, will there be recommendations for charges to be laid?
Mr. Robert Lafleur: That will be a matter for the police to consider. We will share the information with the police, and they will then follow their normal course and determine from the information whether or not a police investigation is warranted. Then at the end of that they'll determine whether or not charges will be laid. That is completely independent of Health Canada's processes.
Mr. Philip Mayfield: Would your forensic auditors be cooperating with the police on that, if the police request it?
Mr. Robert Lafleur: I assume they would. We would certainly expect the auditors who are contractors to us to cooperate with the police.
Mr. Ian Potter: I would add that the department has also filed a statement of claim in the Court of Queen's Bench, Manitoba, seeking an accounting of all funds, damages, appointment of receiver, dissolution, and the return of all funds that were not properly spent to the crown. We're pursuing this as a civil matter, aside from the possible investigation by the police.
Mr. Philip Mayfield: If there is money to be repaid—you've mentioned that there might be—who will be repaying the money? Has the money been spent or is there still some to come back? How will that money be recovered?
Mr. Robert Lafleur: To the extent that the moneys are available in accounts that have been frozen, the money would be obtained through that process.
Mr. Philip Mayfield: I see.
The question has to be asked: what steps is the department taking to ensure that this kind of thing doesn't happen again?
Mr. Robert Lafleur: We've taken a number of measures, but as my colleagues have indicated, it is impossible to absolutely guarantee that no one will use illicit measures to get at the government's money. We have certainly been working very hard in the last number of months to put into place a whole series of provisions that will allow us to monitor much more closely and to administer much more tightly the conveyance of money and to oversee the use of money by communities once they've received it through contributions and the transfer process.
We've had a major undertaking to review the administration of grants and contributions across the department, with, for obvious reasons, a more highlighted focus on First Nations and Inuit Health Branch and the administration by the branch of grants and contributions. We've designed frameworks to govern the administration of those contributions. We have put in training programs. We've revised agreements to tighten up the wording. We've ensured that all the agreements conform with the Treasury Board's new policy on transfer payment—in fact, we've gone beyond that. We've hired the firm of Deloitte & Touche, headed by the ex-deputy comptroller general of Canada, to look at the processes and procedures we follow in the handling of the contributions and transfer payments. We have started to put in the measures he has been recommending to us. So there's a lot we have been doing.
• 1630
Mr. Philip Mayfield: Yes, I appreciate that. As you are aware, I'm prompting you to give the committee a progress report. I wonder if there is any other item you would like to include in this progress report to the committee and to the Parliament.
Mr. Robert Lafleur: Not at this point, but if the committee wishes to go into more detail on this, we can certainly provide that information.
Mr. Philip Mayfield: Thank you very much, Mr. Chairman.
The Chair: Thank you, Mr. Mayfield.
Mr. Finlay, four minutes.
Mr. John Finlay (Oxford, Lib.): Thank you, Mr. Chairman.
Dr. Barrados, I want to inquire—I think I'm naive, I haven't studied this as well as Mr Bryden. On page 2, items 6, 7 and 8, I'm trying to understand what you mean. In item 6, you say:
I'm trying to relate that to myself. I got a prescription last week. I can fill it once with two repeats. When I take it to the drugstore, the druggist marks that one's gone, another's gone, another's gone, and when I take it back for the third time, he'll say, sorry, it's run out. Is that the system that identifies potentially inappropriate prescription drug use, or am I missing something here?
The Chair: Ms. Barrados.
Ms. Maria Barrados: No, Mr. Finlay, it's more than that. When the pharmacist registers that prescription, it goes into the record of previous prescriptions and looks to see how that prescription sits with others. It also looks to see whether there is drug interaction, so they can have a warning saying there's drug interaction. It could have a warning saying there's one that's been filled like this somewhere else. And there's a third type of warning.
Mr. Ian Potter: We actually have implemented, based on the recommendations of the Auditor General's report and this committee's earlier recommendations, what we call this point-of-sale system, which is one of the better systems that exists for insurers. My staff would say it's probably the best system we have in the country. It's an automatic, on-line, 24 hours a day system, so that when the pharmacist receives that prescription, they immediately plug it into an Internet hook-up that reads against the patient and the history of that patient, with respect to what drugs they've had, against the pharmacy and the prescribing pattern of that pharmacy, and against the physician. It then immediately informs the pharmacist whether this is a duplicate of a prescription, whether it is a multiple repeat of the same kind of drug, and whether there are drug interactions that might occur because the individual has received different kinds of drugs. Those are warnings. There are 19 different kinds. They have been developed in conjunction with the pharmaceutical industry. They alert the pharmacist to certain things.
Mr. John Finlay: Okay, I understand that. Am I protected by that system when I go in and fill a prescription in Woodstock?
Mr. Ian Potter: No, not likely.
Mr. John Finlay: But the first nations person is.
Mr. Ian Potter: That's right. We, as an insurance company, providing the health insurance coverage for first nations, have instituted that kind of system. Most insurance companies don't have that kind of automatic, immediate access system.
The Chair: Mr. Finlay, I think Ms. Barrados wants to make a point.
• 1635
Ms. Maria Barrados: There are some other systems like that. There's one in British Columbia, for example.
The concern we are raising in the report is these messages come up—now all the detail doesn't come up to the pharmacist; the message just comes up, and the pharmacist has to make a decision to dispense or to override. Our concern is that there wasn't enough attention being given to analysing what those decisions were, because when you look at the pattern of prescription drug use, there was some drop-off but it came back up.
There were a number of instances where a prescription wasn't filled, but we're still seeing a pattern of drug use that is not really acceptable. That's why our recommendation was that there should be more attention given to these overrides and that system to make sure it does fully what we would like.
Mr. John Finlay: Well, if the pharmacist is overriding that warning, then are they in cahoots with the client or patient or customer? The warning says this should be looked at. Then you say we found that Health Canada had not adequately monitored pharmacists' overrides of these warnings—
Ms. Maria Barrados: Right.
Mr. John Finlay: —nor had it conducted sufficient analysis to indicate how clients were getting very large numbers. Well, that's another question. Was it through medical doctors, pharmacists, or photocopying the prescription?
Ms. Maria Barrados: Our concern, as Mr. Finlay points out, is there wasn't enough analysis of that. But there are cases where there could be a reasonable override. There are cases where a pharmacist could explain what the nature of the possible drug interaction is and could check with a doctor. So it is possible there is a reasonable override.
The Chair: Thank you, Mr. Finlay.
Mr. Mayfield.
Mr. Philip Mayfield: Thank you, Mr. Chairman.
Regarding perhaps another aspect of that accountability of pharmacies, I believe—and correct me if I'm wrong—the department signed an agreement with a claims processor requiring the processor to perform at least 60 on-site audits of pharmacies and 60 on-site audits of dental providers. The audit found that only 29 audits of pharmacies were done in 1998-99, and only one audit was done of a dental provider in the last two years.
The department has indicated that the processor would make up the shortfall by the end of fiscal 2000-2001. Well, we passed that milestone and I want to ask whether the claims processor made up the shortfall of on-site audits.
Mr. Ian Potter: The answer is not to date, and the department has taken steps to ensure compliance. We have held back parts of the funding to the claims processor, and we are doing that on a systematic basis. The claims processor has assured us—and we have been working with them and we have come to the sense that they have now taken this on. They have hired additional auditors. They have stepped up the rate of audits—
The Chair: I think the short answer is no. Is that correct, Mr. Potter?
Mr. Ian Potter: They have not to date, and we have taken steps to see that they will. We are withholding funds until they do.
The Chair: Thank you.
Mr. Philip Mayfield: Can you just give a very brief description of the dynamics of this large of a shortfall of a commitment by the processor? This is a huge gap. Why wasn't it done? I'm amazed that so much is not done that is supposed to be done. The consequences of these audits not being completed are in the report, but more importantly in the lives of people, and you're not able to follow up. I don't understand why. Respectfully, I'm very concerned. Why does this not happen?
Mr. Ian Potter: In order to understand the full details, I'd have to ask Dr. Peter Cooney to reply. We have a contractual relationship with that company. That company is supposed to do this. We bring it to their attention. We encourage them to do that, and we withhold funds in their contract until they do comply. But if you would like, I could have Dr.—
• 1640
Mr. Philip Mayfield: I'd like to put one more little addendum onto that. I'd like to know what you can do to insist that the contract is kept within the time limits and the costs established.
The Chair: Mr. Cooney, can you state your name and your position before you start, please?
Dr. Peter Cooney (Acting Director General, Non-Insured Health Benefit Program, First Nations and Inuit Health Branch, Health Canada): Certainly. My name is Dr. Peter Cooney and I'm the Acting Director General for Non-Insured Health Benefits.
The Chair: Thank you. Did you hear Mr. Mayfield's question?
Dr. Peter Cooney: Yes, I did, Mr. Chairman.
To give you a little bit of piece of mind, the contractor has responded to our stopping the funding for a period of time. There are now 140 audits that have been completed. Based on the numbers that you have there, that's a considerable increase in the number that was there previously.
The contractor is also basically doing 60 audits per fiscal quarter now, instead of 30, which is what's in the contract. So they have doubled the number of audits that they said they would do in an effort to catch up. They're actually meeting those requirements. As we speak, they're out auditing pharmacies and dental offices. They're actually doing that right at present.
So to answer your question, there was a delay, and the delay has partially been made up already. The delay will be completely made up by—actually they're indicating November of this year; certainly the end of this fiscal year.
Mr. Philip Mayfield: Is there a reason given for the delay? Was there something more profitable for them to be doing than doing what you had contracted with them? Why the delay?
Dr. Peter Cooney: Well, there are a number of reasons. To be honest with you, this is a very large contract. They process approximately twelve million claims per annum. So it is a very large undertaking for any new organization, which comes into being. One of the problems they had—the most immediate problem and the issue that really gave rise to this situation—was the fact that in May 1999, they were advised by Aetna Canada, which was their partner, that Aetna Canada was leaving the country and going back to the United States, where their base is. So to be honest with you, they lost their partner, and this gave rise to a considerable amount of problems within the private industry. They have picked up from that and, in fairness, they have now rallied around and are addressing the issue of audits. But that's the main issue—it was an internal, organizational issue in that they lost 50% of their strength.
The Chair: Thank you, Mr. Mayfield, and Dr. Cooney.
Madam Jennings, s'il vous plaît, quatre minutes.
[Translation]
Ms. Marlene Jennings (Notre-Dame-De-Grâce—Lachine, Lib.): Thank you, Mr. Chairman.
Ms. Barrados, you heard the witness testify about prescription drug abuse and the fact that the department has stopped sharing information of a personal nature because it questions whether it has the right to do so in the absence of legislative provisions or the express consent of each user. Do you agree with Health Canada's contention that either a specific legislative measure or clear consent is required?
[English]
Ms. Maria Barrados: Mr. Chairman, in response to Ms. Jennings' question, we are in agreement that the ministry has to have some form of authority to be able to deal with this personal information.
[Translation]
Ms. Marlene Jennings: I have not had an opportunity to read your report in its entirety, only the portion that you presented, and the notes aren't all that clear. I would have liked things to be very clear.
I have a question for Mr. Potter. If indeed we are seeing cases of prescription drug abuse, this means that doctors are writing multiple prescriptions for their patients within an unusual time frame. Have any doctors ever been prosecuted? Have any complaints ever been filed with the governing college of physicians with a view to getting medical licenses revoked? If so, how many such cases have there been since 1997?
Mr. Ian Potter: I don't know the exact number. I'm confident that we are monitoring the situation. Some doctors do write too many prescriptions, but I can't tell you exactly how many or under what circumstance exactly this occurs.
• 1645
[English]
Ms. Marlene Jennings: Do you want me to repeat it?
Mr. Ian Potter: Is there a certain situation where physicians have misused?
Ms. Marlene Jennings: Well, there are situations.
Mr. Ian Potter: Are there situations, and have we raised this with the College of Physicians and Surgeons?
Ms. Marlene Jennings: And with the police, if necessary. Excuse me, if you have all kinds of prescriptions being made out to people, in some cases those people may be addicted to that particular medication. But that's not always the case. We also know that the situation exists where that particular drug is being then resold.
As far as I'm concerned, if a doctor is giving out large numbers of prescriptions for these kinds of drugs to one individual, or several individuals, that's also a criminal activity. One could possibly call them a drug pusher or a trafficker. They're participating in that activity, albeit indirectly.
So I'd like to know how many doctors in the last five years have had criminal charges, investigations, or complaints filed against them, criminal complaints, and how many complaints have been filed before their professional corporation. It would certainly give a chilling effect if we did it a lot.
Dr. Peter Cooney: I can assure you that both physicians and pharmacists—we tend to deal more directly with pharmacists, because that's the person who deals on point of sale with the program—have been involved with us, and we in turn go to their disciplinary, their registering, bodies. There have been cases, as you probably know, that have gone through the courts in a number of provinces regarding pharmacists. There have also been disciplinary hearings regarding dentists and pharmacists.
The Chair: Do you have any numbers, Dr. Cooney?
Dr. Peter Cooney: I don't have actual numbers, but I can certainly get you numbers.
Ms. Marlene Jennings: Can you provide us with that, please?
Dr. Peter Cooney: Certainly.
Ms. Marlene Jennings: For the last five years.
Secondly—
The Chair: I think Ms. Barrados has a point to make on this.
Ms. Marlene Jennings: Okay.
Ms. Maria Barrados: I just wanted to add a point that we made in the audit report, that there is actually a difficulty with the field that identifies the doctor. That was a problem we noted in 1997. When we did our follow-up work it hadn't been corrected. Because there's difficulty with that doctor field, it is hard to do that kind of analysis.
The Chair: You can't read the signature.
Mr. Ian Potter: I think we've corrected that. If I could, I'd ask Dr. Cooney to explain.
The Chair: I'll get back to you on that in just a second.
Are you finished?
Ms. Marlene Jennings: No, I'm not.
The Chair: You're over your time, but you're on a good line of questioning.
Ms. Marlene Jennings: Given that one of our witnesses wasn't wearing the... I think you should have a little latitude.
The Chair: I have been having latitude. Please continue.
Ms. Marlene Jennings: Mr. Potter hasn't completed...
Mr. Ian Potter: That issue that Ms. Barrados raised with respect to the coding of the physician has been corrected, and we are now able to code the physician and follow up the activities of physicians.
Ms. Marlene Jennings: Great.
Another question is that the Auditor General raises a concern that the system that has been put into place to monitor the illegal use or overuse—whatever you want to call it—of prescription medicines, or any object that's been bought on prescription, because it's been noted it could be a non-prescription medicine for which a prescription is given so it will be covered by the insurance, by the program, has basically been—correct me if I'm mistaken, Ms. Barrados—ended, for one, and that it's not necessarily as efficient as it could be because it's up to the pharmacist to respect the warning that's put on certain medications. If they do that, they don't get paid, obviously, because they're not filling the prescription.
I'd like to know what if any measures Health Canada is taking to deal with that part, the actual surveillance, and the issue that the warning system may not be as effective as we would like it to be.
The Chair: I'll ask for fairly brief responses, Mr. Potter, if you could focus on the issues.
• 1650
Mr. Ian Potter: The issue is important. We do follow up and we do put in place... While, as I explained to the committee, for privacy reasons, we do not share personal information with other providers, we do follow up on them on a specific basis. We have a next-day quality assurance process that checks the files of particular pharmacists on a next-day basis. We check with clients to determine whether or not they're using or have received the prescription. We are doing provider profiling to see whether or not the kinds of prescriptions are outside of the norm, and we're doing on-site audits. So we do follow up on all those things in a fairly effective way, I believe.
Ms. Marlene Jennings: The on-site audit...
Mr. Ian Potter: It's increasing.
The Chair: Do you have anything to add there, Ms. Barrados?
Ms. Maria Barrados: I'm not sure, Mr. Chairman, whether what is being described was put in place after we completed our work, but when we were doing our work, the amount of checking with clients was actually quite limited and was tied to the on-site audits, and those were very limited. Now there may be other processes, but that on-site audit activity and then verifying with recipients was a very limited undertaking.
The Chair: Thank you very much, Madame Jennings.
Mr. Mayfield.
Mr. Ian Potter: If I could ask Dr. Cooney to—
The Chair: Very quickly, Mr. Cooney. We're already up to almost 10 minutes here, so I've been more than generous. I want Mr. Mayfield to have—
Mr. Ian Potter: We have taken those points to heart, and I think we have made some changes.
The Chair: Well, we said that two years ago, too.
Mr. Mayfield.
Mr. Philip Mayfield: Thank you, Mr. Chairman.
I did try to give you credit where credit was due. But as I look at the appendix at the back of the Auditor General's report about the follow-up, and then the overall assessment of progress made, I note that there are 20 categories there. Two of them are listed as fully addressed, five are satisfactory progress, and fully 13 are unsatisfactory progress. That is an astounding condemnation, indictment.
I'm aware that we've been here before and I've sung this song before. So could you please offer an explanation to the committee and to our Parliament about why the Auditor General would come back again with this kind of condemnation—“unsatisfactory progress”?
Mr. Ian Potter: First, I can assure the committee that since that report was tabled, substantial progress has been made. We could table with the committee, if you wish, a complete report on all the follow-ups that have taken place subsequent to the second—
Mr. Philip Mayfield: Would you be willing to provide this committee and our clerk with that information?
Mr. Ian Potter: I would. I will provide it through the clerk to the committee.
Mr. Philip Mayfield: I thank you for that, sir.
Mr. Ian Potter: I would hope that you would feel, after looking at it, that we have taken steps in the last six months to address these issues with much more alacrity than we've had in the past.
Dealing with these issues, though, requires collaboration and cooperation with first nations organizations and individuals. It requires the people on the ground to have the capacity to do this, because we have to interact with them. It's taken us some time to set up the framework and discussion process with first nations and Inuit so that they would feel the system we are developing, which is an accountability system, serves their interests as well as the interests of the department and the government. We have made substantial strides in that respect.
I think the long-term result of having done that work, which has taken us longer than we thought and initially was quite difficult in terms of getting the understanding, respect, and commitment of first nations organizations to work with us, will be much more effective compliance and support of an accountability regime that recognizes the reciprocal responsibilities of first nations governments to their people and to Parliament for funds provided under contribution agreements.
• 1655
Mr. Philip Mayfield: You see, the difficulty for me, as I talk about the report of the Auditor General and the difficulties that the department has, is the people in my mind—the native Indian people, the pharmacists who talk about the on-the-ground difficulties they have with insurance companies, with payment, with not being able to provide the services because of difficulties from the department. It really is much more than a bureaucratic difficulty. It affects people in their personal lives, in a fundamental way.
I encourage you, sir, to do what you can to save as many lives as possible, because your department is responsible for a lot of trouble for people. I don't like to get too emotional about this, but these are my people too.
The Chair: Thank you, Mr. Mayfield. We do recognize that you have a significant first nations population in your riding.
Mr. Philip Mayfield: I do, I do.
The Chair: So they're very much appropriate, these comments.
Mr. Bryden.
Mr. John Bryden: I don't have too many questions.
The non-insured health benefits program is worth how much now? For instance, how much has the last period cost the government?
Mr. Ian Potter: It was $550 million.
Mr. John Bryden: That's a significant improvement, I take it, because it seems to me a few years ago it was about $1 billion.
Mr. Ian Potter: No, the program has grown in each of the subsequent years, but the rate of growth has substantially diminished.
Mr. John Bryden: Now, am I right that it's open to all aboriginals, whether on-reserve or off-reserve, regardless of income?
Mr. Ian Potter: The eligible clientele are registered Indians and Inuit, and it is open to registered Indians whether they live on the reserve or off the reserve.
Mr. John Bryden: If I live off the reserve, I'm a registered Indian, and I make $40,000 or $50,000 or $60,000 a year, I'm still eligible for the program.
Mr. Ian Potter: Yes. The program is not an income-tested program. We did do a study to determine whether or not that was a reasonable initiative. Based on the incomes of the population, the results of that study indicated that to introduce a system of income testing for benefits would affect such a small part of the population that the cost of managing that system would generally offset any savings we would achieve through an income-tested system.
Mr. John Bryden: Mr. Chairman, I wonder if I could ask the witness for a copy of that study.
The Chair: You certainly may.
Can you provide that statement to us?
Mr. John Bryden: Now, I want that study—
The Chair: Is it possible for us to get that study?
Mr. Ian Potter: It is, yes.
The Chair: Okay.
Mr. John Bryden: I want to make an observation here. Are we to understand that this is not a program that's based on need? Is that correct?
Mr. Ian Potter: This is a program that provides access to medically necessary services.
Mr. John Bryden: Yes, but obviously it isn't based on need, because I've had people in your chair who worked for the civil service, who were aboriginal, who were earning, presumably, in their job category, more than $100,000 a year, and who were still eligible for this program.
I repeat, it is not a program that's based on the needs of the aboriginal clients, right?
Mr. Ian Potter: It's not based on financial need.
Mr. John Bryden: Okay. We can assume, then, that the program is based on race. Can we assume that correctly?
Mr. Ian Potter: The eligible clientele for the program would be legally defined groups, both status Indians as registered under the Indian Act and Inuit.
Mr. John Bryden: You don't need to wander around this. Is it or is it not based on race?
Mr. John Finlay: It's based on the fiduciary responsibility of the federal government.
Mr. John Bryden: No, no, we won't get into that.
Mr. John Finlay: Well, it is.
The Chair: John Bryden, you have the floor.
Mr. John Bryden: I just need a simple answer. I know how you get Indian status in this country. I know that it is based on race. All I want to establish is a simple answer to the question. Is it a program that's based only on being aboriginal, if you don't want to use the word “race”?
Mr. Ian Potter: It's based on whether you're a status Indian under the Indian Act or an Inuit.
Mr. John Bryden: Okay. An aboriginal, then.
I would make just one observation. I would love, Mr. Chairman, to do some analysis. The witnesses have indicated that they have a study, but one of the things that's always troubled me with this program is that it isn't based on need. It's based only on race.
• 1700
I would like to know how much of the
investment in the program is going to people who don't
need it financially, who are, let's say, above the
level of $40,000. Is that a reasonable thing to ask?
Mr. Ian Potter: I'm not sure I have the information. If we do have the information, we can provide it to the committee.
Mr. John Bryden: Thank you.
The Chair: Thank you, Mr. Bryden.
Ms. Barrados has a point to make on this issue.
Ms. Maria Barrados: I want to add that the policy intent was to have an insurance program that was insurance of last resort. So someone who has another insurance policy shouldn't be drawing on this particular program. This is something that the department hasn't really been able to implement and follow up on.
Mr. John Bryden: You've so correctly picked up exactly where I'm going. So there is no control on this program to prevent people who financially don't need the program from using the program—which I would consider abusing the program. Do I understand you correctly?
Ms. Maria Barrados: If someone has another insurance policy that covers it, there is no need for them to draw on this program. There is no check in the system on that. I believe there have been some efforts, but it's not being done.
Mr. John Bryden: Thank you.
The Chair: Thank you very much.
Mr. Shepherd.
Mr. Alex Shepherd: You have this enforced... and more money for internal audits today; why can't you do that? Why can't you go through your client base and ensure that people who have private insurance are not accessing the government insurance?
Mr. Ian Potter: I would ask Dr. Cooney to respond to that.
Dr. Peter Cooney: The program comes as a secondary payer. We do that. For example, if somebody has a private dental insurance, we have what we call an EOB, an explanation of benefits, at the point of claims processing, and the primary insurance carrier gets billed first. If it were Blue Cross or Great-West Life, they would pay the first component, and then if there were a differential in the bill from the dental office, we would make up the difference.
We have a similar policy for patients who are on social allowance—in other words, who are covered by provincial systems.
Mr. Alex Shepherd: I know what's supposed to happen, but what does happen?
Dr. Peter Cooney: That does happen.
Mr. Alex Shepherd: But the question is, do you actually go to the payments you're making and ensure there's some kind of follow-up that in fact the people who are receiving benefits under the system are not covered by some other plan?
Dr. Peter Cooney: Yes, we do. At the actual point of claims processing, we look at the claim and determine that the patient... The provider fills in on the claim that the patient has a co-insurance—for example, Great-West Life or Blue Cross. The first payment goes from them. We pay the difference.
The Chair: Mr. Campbell, you have something to add.
Mr. Ronnie Campbell (Principal, Audit Operations Branch, Office of the Auditor General of Canada): To add to that point, the declaration of having third-party coverage is voluntary. When we did our work in 1997, Health Canada conducted their own audit and determined through the results of that audit that there was a gap between the people who were declaring and the people who probably do have insurance. So it's self-declaration.
Mr. Alex Shepherd: Okay. I don't want to waste all my time on this, although it's a good area.
Going back to the evaluation of what we've been doing here, the response you gave to me about better evaluation reporting in the future is very similar to this one, which says:
I'm sure if I could read back Hansard, that's kind of what you told me. Unfortunately, this response is dated 1997. So you're giving us the same response to the Auditor General's complaint today as you did in 1997, which leads me to the inescapable conclusion that four years from now we're going to be here asking the same question and getting the same response.
We've put more money into your department, and you people sit on the audit committee. You have to come with some kind of a procedure to evaluate your spending in these areas.
• 1705
So is it appropriate that when you get to that point
of saying these are our evaluation measurements, this
is what we're going to measure as societal
indicators—reduction in fetal alcohol syndrome,
whatever those things are—you should bring those
indicators to us? When do you think you would be at a
point to determine that?
Mr. Ian Potter: We are doing that, and I think we've made progress since that 1997 report. As I said, we have implemented the first nations health information system, and it's gathering the information that's rolling out across the country into the different communities.
We are building into all our programs the evaluation of those specific programs such as the aboriginal head start initiative and the aboriginal diabetes initiative. We are doing those things, and we are working with the provinces and other national organizations to identify those indicators.
I believe the timetable for the production of those national indicators is 2002 for the reporting, and we will be able to report on our programs in that same time period.
Mr. Alex Shepherd: But can you give us some kind of an interim report of the societal indicators that you intend to use and the ones that would appear in your next evaluation report?
Mr. Ian Potter: Yes, we could do that.
Mr. Alex Shepherd: When do you think you could do that?
Mr. Ian Potter: I'm not sure exactly.
Mr. Alex Shepherd: Before the end of the year?
Mr. Ian Potter: Yes, before the end of the year.
Mr. Alex Shepherd: Okay, so you'll report that to the committee.
The Chair: Thank you, Mr. Shepherd.
As Mr. Shepherd said, it's disappointing that in 1997 we asked these questions and had a response that you were going to look at it, and we have the same thing again.
We have Ms. Jennings saying perhaps the doctors are participating in an illegal activity where they're writing multiple prescriptions for central nervous system drugs, which I take to be narcotics, and you're paying the bill and you really don't seem to be on top of it.
We raised this the last time you were before the committee. I don't see any progress at all. Mr. Mayfield made reference to these 13 unsatisfactory progress reports. I hope this is a wake-up call to you, Mr. Potter, that we don't want to see this any more.
First, I'm going to ask if we can get a commitment out of your department that in the annual performance reports, every year here on in, you report your progress systematically so that we know what is going on in that department. Is that possible?
Mr. Ian Potter: Is that with respect to the Auditor General's report?
The Chair: No, I'm talking about the fact that your department is providing services to a clientele in this country, and you're required to provide in your annual performance reports a report to Parliament on how well you're doing. I would like to see an unbiased assessment of your progress every year in these annual reports. Is that possible?
Mr. Ian Potter: I can ask—
Mr. Robert Lafleur: If I may, Mr. Chairman, we will certainly provide an unbiased statement of our progress to the extent that we can and to the extent that we have adequate indicators to signal our progress.
We've made a commitment, as Mr. Potter has indicated, to indicators for 2002, and we'll provide the committee with information—
The Chair: But it's a lot more than societal indicators. I'm talking about these 20 different recommendations that the public accounts committee has made, that the Auditor General has made, and that you've agreed to. Then we find there's no progress being made at all.
A performance report by a department to Parliament should provide detailed assessment of your progress in the way you're servicing your clientele. Every department should be doing that, and I would hope that your department does it too. I'm asking for that commitment.
Mr. Robert Lafleur: If I may, Mr. Chairman, I think the testimony of my colleagues today is evidence of that commitment and is in many respects a report on the progress that has been made in implementing those recommendations.
We've also undertaken to table with the committee, which we will do, a full report, an action plan and the actions we have taken against those outstanding recommendations signalled by the Auditor General. So we will be providing that.
I think there has been, as described by the testimony you've heard, a lot of progress—
The Chair: You're going to give that to us in annual reports so that when we look at these annual reports, we can see the progress being made.
Mr. Robert Lafleur: We'll provide the report that we have, which is a progress report specifically on the Auditor General, and with respect to the reports on—
The Chair: We're going to leave that issue alone since you don't seem to be able to give me a categorical commitment that the annual report, which is your report to Parliament, will demonstrate the progress you're making in your department in servicing your clientele. I thought it would have been a simple yes.
• 1710
Ms. Barrados, I want to ask you a question regarding
exhibit 15.5, which deals with the number of clients
going to three or more pharmacies, the number of
clients getting over 15 different drugs—this is per
quarter—and the number of clients getting at least 50
prescriptions per quarter. Did you have to analyse
data in the department, or was that data that they had
available to themselves?
Ms. Maria Barrados: We drew this information from the data systems in the department.
The Chair: Was the department aware of the magnitude of this problem of repeat prescriptions?
Ms. Maria Barrados: We had done a similar table in 1997—
The Chair: I know.
Ms. Maria Barrados: —and there was, as we put in the report, the development of this drug utilization review protocol, where some of the regions were doing a lot of monitoring and intervention. They had to stop that. Whether the department had a table like this themselves, I think that's a question for the department.
The Chair: Did the department have this information for analytical purposes or was it just part of the raw data that you didn't analyse?
Mr. Ian Potter: I would ask Dr. Cooney to respond.
Dr. Peter Cooney: We run a series of what we call ad hoc reports, in other words reports at various points, and we analyse this type of data. We then compile these and we review them. If you look at the specific information—for example, clients accessing three or more pharmacies—it may look as if there's something unusual, but in reality, when you actually start auditing these particular cases, people often may use three pharmacies in a three-month timeframe for reasons associated with one is close to home, close to work, or close to the physician's office. So when we do what we call random audits on these numbers, you may in many cases—and you do in many cases—find that because somebody accesses three pharmacies—particularly now, when there are multiple franchise pharmacy chains—it's not as it may appear.
The Chair: Okay. But I see here 4,522 people in Alberta had gone to three or more pharmacies, but 259 people had obtained at least 50 prescriptions in a 90-day period. This is more than one every two days for a full three-month period. Are you tracking this type of information?
Dr. Peter Cooney: Mr. Chairman, yes.
The Chair: And what are you doing about it when you find out about it?
Dr. Peter Cooney: When we look at that, part of the 50 prescriptions, Mr. Chairman, is due to some of the recommendations in previous reports, where physicians give out shorter supplies of drugs for medical reasons—
The Chair: One every two days or more frequently than one every two days.
Dr. Peter Cooney: First of all, you have to remember that patients may have multiple health problems. Secondly, with cases of narcotic drugs, if patients are mentally unbalanced, they often get very short prescriptions from providers. In other words, they won't give them a three-month supply.
The Chair: But they don't have to go to the pharmacy every day.
Dr. Peter Cooney: No, but they often go for a three-day supply.
The Chair: A three-day supply.
Dr. Peter Cooney: And that is included in these numbers. And that's intentional on the part of the prescriber who won't prescribe—
The Chair: Then my question was... We've talked about Ms. Jennings' point that perhaps doctors are over-prescribing. Here we have a table that the raw data would suggest there's some potential for over-prescribing. Are you investigating to find out if these prescriptions are legitimate or are you not?
Dr. Peter Cooney: Yes, we are.
The Chair: And what are you doing about it?
Dr. Peter Cooney: When we look and we see that a patient only had three pills intentionally prescribed by a provided—
The Chair: I asked what you are doing about it when you identify a problem.
Dr. Peter Cooney: When we identify a problem, we have a series of audits. We go from a desk audit to a next-day audit to a desk audit to an on-site audit. If it is a case of misuse, we report the provider. If it's incorrect prescriptions—if it's a case of a pharmacist—then we report the pharmacist to their governing body.
The Chair: But never to the RCMP or to the police.
Dr. Peter Cooney: Yes, there are cases that get reported to the RCMP, as well.
The Chair: Okay. Now, getting back to these consent forms, you ran into a problem of privacy—and I can understand privacy. So you either have a consent form or you have to deal with a legislative change. Now, if somebody is intentionally abusing drugs through a prescriptive process, I cannot imagine why they would sign a waiver form. I can't imagine that at all. Yet four years ago you identified this problem, and you still haven't brought forth legislative change. How long are we going to wait? By your own admission, the individual waivers aren't going to work and you're abandoned that process. So when are you bringing forth legislation?
• 1715
Mr. Ian Potter: We believe the consent process will work. In order for people to be—
The Chair: Didn't you say you had abandoned that?
Mr. Ian Potter: No. We are seeking to get consent from individuals. We believe people will give us consent, because it will be essential for being reimbursed. If we move to a system that requires registration, people will register in order to receive payment.
The Chair: But I thought the drugstore billed the department directly, that there was no payment and reimbursement to the client. So how are you going to get them to sign a waiver form? And, in the situation where they go to the pharmacist with a prescription and say they need it today, are you going to say, you're not getting it unless you sign a form? I don't believe so.
Mr. Ian Potter: I would ask Dr. Cooney to explain how we would manage the situation.
Dr. Peter Cooney: Mr. Chairman, these are discussions we're involved in at the moment with the AFN and ITC.
The Chair: There goes another four years.
Dr. Peter Cooney: No, that's not correct. We will not be waiting four years. What we intend to is target band offices and first nations offices for people on reserve, and we will also use the pharmacy chains as the point of enrolment in the program.
The Chair: If they don't enrol and they need the drugs, are you going to say, no, not until you sign? How are you going to deal with a difficult situation? The abuser is not going to do it voluntarily—let's be reasonable. How is a drug abuser going to voluntarily sign a waiver?
Dr. Peter Cooney: You're looking at two issues. For a drug abuser who may not want to sign, there is an option to give them an emergency supply for four days, after which they get cut off, or else there's an option for the individual to sign the consent. These are what we're actually discussing with the AFN at the moment.
The Chair: When do you expect this to be completed?
Dr. Peter Cooney: We are hoping to get this whole enrolment issue on the road by the fall of this year.
The Chair: By the fall of 2001, so it's up and running by the end of the year, so that it will show up in your annual performance report next year, 2002, that you've accomplished this?
Dr. Peter Cooney: Remember, we're on approximately a 70% utilization rate, so in any one given year we should have, if it's only through the pharmacies, 70% of the total population on board.
The Chair: Then you'll report in your annual report what success you've had and how many people have signed on. Is that possible?
Dr. Peter Cooney: We can certainly report the degree of success, yes.
The Chair: I appreciate that.
Dr. Peter Cooney: It will take a timeframe though.
The Chair: But on an annual basis, you can put it in the annual performance report—70%, 74%, 78%—and it's no big deal. We just want the information.
Mr. Ian Potter: We can provide that, Mr. Chairman.
The Chair: I was concerned about your vital statistics and the fact that these are public records. You're all into negotiations about collection of data and so on. Why is it a problem when vital statistics are public records?
Mr. Ian Potter: Vital statistics fall under provincial legislation. They describe the responsibility of the presiding medical officer to fill in a death certificate. We can deal with them, we can negotiate with them, but we can't tell them what to do.
The Chair: But you can collect the data.
Dr. Peter Cooney: We have started to collect data from them, and obviously, we want agreement from them as to how we want to analyse the data, because again you get into the issue of confidentiality in relation to provincial legislation vis-à-vis the consent issue, which we wish to work under. But we do have a system where our medical officers are now working with the provincial jurisdictions to start collecting these data.
The Chair: It seems rather strange to me that we run into a confidentiality problem, when Mr. Mayfield points out that not only are people's lives at risk, but we're dealing here with death certificates, where the lives were not at risk, but they were terminated for whatever reason, and you can't collect the data to do your job properly, so more lives are at risk and so on.
I hope we don't come back in two more years... I do note that the Auditor General has planned another follow up, which is not normal, but I'm glad they're doing it on this one, because we've had comments from both sides of the table today that show they're quite unhappy with the progress so far. The issue of the Fontaine health care centre in Winnipeg is absolutely disastrous, where we're paying $50,000 a month to rent stuff we've paid for with taxpayers' dollars. That's incredible. I look forward to the audit.
Ms. Barrados, do you have some closing remarks?
• 1720
Mr. Philip Mayfield: Mr. Chairman, before Ms. Barrados comments, it seems to me we've been using the term “four years” that the Auditor General has been bringing this forward. But if I'm not mistaken—I'd like Dr. Barrados to clarify this—when we discussed this in 1997, this was brought up from a previous AG report ten years before that.
Is that correct?
Ms. Maria Barrados: We had done a report in 1993. The focus of that report had been more on the authority structure. We had been making recommendations at that time about the need to deal with the status of this program, because it is a policy program. It doesn't really have a piece of legislation under it. We did not address the issues of prescription drug use in that audit.
Mr. Philip Mayfield: Okay.
One other concern arises out of the questioning. If we're not able to get the data from vital statistics, which is under provincial jurisdiction, how is the department able to determine when a person has died, for whatever reason, so that you can keep your records current and correct?
Mr. Ian Potter: I may have been misunderstood. We can get records. The issue was, can vital statistics develop records of deaths due to overuse of drugs related to status Indians? At the moment, they do not, I believe, keep identifier records on status Indians on the death certificates. In many cases, the death record does not indicate that the individual died from overuse of drugs.
The Chair: So you're saying that the death certificate for status Indians does not include the cause of death, or contributing factors?
Mr. Ian Potter: It does, but sometimes you would find that the use of drugs is somewhere behind the initial reasons for death. So it's working with the registrars to try to collect that information in terms of identifying first nation or Inuit individuals and trying to find, through the data, the difference between what precipitated the death and some of the contributing factors.
The Chair: I'm sure you're going to work on it and will get back to us on that. We'll see that in the annual report too, I hope.
One final thing just came to mind—namely, Davis Inlet. I meant to ask this earlier. The Auditor General's report says that after eight years—it was in 1992 that we had the gas-sniffing problem up in Davis Inlet—we've spent $108 million, approximately, fixing the infrastructure and the physical problems, but very little has been done to deal with the societal pathologies surrounding that issue.
Then we had the Sheshatsheits native situation back in the headlines this past year, which brought back to mind people's thoughts on Davis Inlet. I know people said to me, “Why can't we do with Sheshatsheits what we did with the people in Davis Inlet, and help them?”
But the point is, we really haven't helped the people of Davis Inlet. It just disappeared off the front pages of the news.
So is it eight more years for the people of Sheshatsheits? And when do we deal with the social pathologies of these issues? When? Eight years is too long.
Mr. Ian Potter: I can tell the committee that we have been dealing with social pathology in those communities, but perhaps not adequately to deal with the fundamental difficulties those communities face. We put in a youth solvent addiction centre in Sheshatsheits. We have built in health funding for clinics and services to deal with drug and alcohol addiction. We have provided services.
We must admit, the results have not been completely satisfactory. Certainly a number of children are sniffing gasoline. The government has made a commitment, along with the Government of Newfoundland and Labrador, to redress and deal with that situation. We've been working with those communities, both Davis Inlet and Sheshatsheits, to put in a plan.
Perhaps I could ask Mr. Borbey, who has been managing that on a day-to-day basis, to bring you up to date as to where we are at this moment.
Mr. Patrick Borbey: You're absolutely right; both communities are facing some very serious situations and conditions that have been in the media—
The Chair: Is Davis Inlet still facing problems?
Mr. Patrick Borbey: Yes.
• 1725
The Chair: So these social pathologies still have not been addressed, even though you've transplanted the community to another location?
Mr. Patrick Borbey: The community of Davis Inlet has not yet been transplanted. The move to Little Sango Pond is planned for October 2002. The infrastructure is currently being completed—housing units, etc.—including better facilities for health, recreation, and everything that a good, sound community needs.
As I said, there are very serious problems in both communities. The department started intervening very vigorously in the mid-nineties, remembering that we did not have responsibility for those communities from the health perspective or from a perspective of other Indian and Northern Affairs programs, for reasons related to Newfoundland's entry into the Constitution—in other words, they did not have status.
We have been treating them as status Indians since the mid-nineties, and have instituted the programs that Mr. Potter alluded to. There have been a number of children removed from both communities. In the case of Sheshatsheits, there were 20-some children removed, who have now been placed in treatment and foster care and are being dealt with in terms of the medical and psycho-social needs that they have.
Davis Inlet was a little bit more complicated. The children, approximately 35, were flown into the Grace Hospital in St. John's. They have been detoxed and have also been through social-medical assessment there. We now have the results of that social-medical assessment and we have a treatment plan that has been agreed to by the leadership of the community and the parents, and those children are now being placed, as we speak, into the treatment they require.
We also are dealing with young adults, because there are some people between 17 and 25 who are also chronic gas sniffers. We also have a plan to deal with the parents of those children who are going to be going through detox and treatment.
As much as possible, we're trying to develop solutions that will be endorsed by the community, that the community will buy into—not only the short-term solution but also the commitment to long-term healing. It is a process that's going to take some time. We have determined that a large number of the children, for example, have fetal alcohol syndrome and fetal alcohol effects, which means we are talking about generations that we have to focus on.
So I think we will be doing a much better job than perhaps we did in the past. The key is to work with the community and ensure that solutions are community driven and community bought. We have to be realistic in terms of what kinds of programs we can achieve over the next five years, for example.
The Chair: Thank you very much.
It's a sad tale, I'm afraid.
Ms. Barrados, closing remarks.
Ms. Maria Barrados: Mr. Chairman, I'd just like to point out, in our 1997 report we carried an example of one of the regions under Health Canada that had actually worked with provincial people and got an estimate of the number of deaths related to prescription drug misuse. So this is something that is possible to do and that Health Canada has done in the past.
In conclusion, Mr. Chairman, I think, as we say in our report, the department does recognize that they underestimated the effort required to put in place the corrective actions we identified in our 1997 report.
These are very serious issues we're dealing with that impact on the health of first nations people. We certainly welcome the commitment on the part of the department to make improvements. I would encourage them to pay a great deal of attention to the processes underlying what it is they're doing and staying the course.
As they make the changes and improvements, it's important the processes they put in place be followed and implemented, so that things like audits, evaluations, and community health plans are asked for, but also that they're looked at, evaluated, and that appropriate action is taken on the results of these things.
We will be following up again in two years to provide assurance to Parliament on satisfactory progress in this area.
The Chair: Perhaps you could include in that follow-up the Davis Inlet and the Sheshatsheits situation as well.
Ms. Maria Barrados: We'll try to do that, Mr. Chairman.
The Chair: Okay. Thank you very much, Ms. Barrados.
• 1730
The next meeting is scheduled for Tuesday, April 24, at
3:30 p.m., at which time we'll consider the main
estimates and report on plans and priorities of the
Office of the Auditor General for the 2001-2002 fiscal
year. At the same time, we'll consider the performance
report of the Office of the Auditor General for the
period ending March 31, 2000.
This meeting stands adjourned.
