Health care in the Keewatin: like a wound left untreated
After the resignation of Keewatin health board chair Elizabeth Palfrey, and the firing of its CEO, Jim Egan, the GNWT is now scrambling to restore many basic health services in the region.
RANKIN INLET – Like a wound left untreated, the continuous mismanagement of the Keewatin’s health care system has now made it impossible for medical staff to provide many basic services to residents.
But NWT Health Minister Kelvin Ng didn’t apologize for that situation during a four-hour meeting with Keewatin leaders in Rankin Inlet last Friday.
He said instead it was his attempt to loosen Yellowknife’s traditionally tight reigns that may have contributed to the problem.
“I recognize that with the regional health board, as I’ve said in the past, we may have gone a bit too far in giving them too much autonomy and not questioned enough some of the decisions that were being undertaken,” Ng told about 40 people who had crowded into the Sakku building’s board room to hear what the minister had to say.
Last summer, the Keewatin Regional Health Board laid off four dental therapists to make way for a deal it struck with the private company Kiguti Dental Services to provide dental care in the region.
The board also severed its long-standing relationship with the University of Manitoba’s northern medical unit. Both decisions brought an outcry from Keewatin residents.
Since July, pleas from mayors and Inuit leaders for change in the system – most notably the removal of KRHB chair Elizabeth Palfrey and a full public inquiry into the board’s activities – fell on deaf ears in Yellowknife.
Until last week.
Palfrey finally gave in to her critics and resigned amid the growing outcry about the chronic shortage of nurses in the region. Her departure was one of many.
Deputy chair Percy Kabloona stepped in as interim chair and he, after consulting with board members, fired Jim Egan, the board’s chief executive officer, last Thursday. A senior bureaucrat within Ng’s office will fill the position until a new CEO is hired.
Only full-time doctor quits in frustration
The region’s only full-time physician also called it quits earlier this month.
Dr Ken Hedges, the only full-time physician the health board was able to hire through an arrangement with Med-Emerg International, began work as the Keewatin’s medical director last November for a five-year term.
He resigned in frustration after only seven weeks on the job, citing no confidence in the KRHB leadership.
“As a newcomer my professional credibility has been exploited… and I have been rendered powerless to advance any meaningful change within the Keewatin Regional Health Board,” Dr Hedges stated in a letter in the Jan 14 issue of Kivalliq News.
“I don’t mind if the minister of health and social services doesn’t agree with me, but I shall pray that he will exercise the personal sensitivity and political tenacity to place a strong helm at the KRHB and provide a fair allocation of resources to secure a viable health service. He must turn a nightmare into a dream.”
“Grave” shortage of nurses
Nurses at the Rankin Inlet health centre, the largest in the region, called the shortage of staff at the centre “extremely grave.”
“The health centre has been in crisis management for an extended period of time, only to come to the breaking point around Christmas time by functioning with two nurses and one midwife,” staff wrote in a Jan 12 letter to the KRHB.
“The health and well-being of the community can no longer tolerate this continuous lack of direction from the health board; neither can the front-line staff of the health centre who are trying desperately to provide appropriate health care.”
This month announcements on Rankin’s community radio urged people to seek medical attention at the centre, which services about 2,200 residents, on an emergency only basis.
The community, which should have nine nurses, is currently served by two or three. Two doctors in the community for short-term stays are leaving at the end of the month. One doctor is expected to arrive next month, also for a short-term stay.
Similar staffing shortages exist in other Keewatin communities. In Arviat, for example, the community of 1,700 operated for nearly a week during the Christmas holidays with only one nurse.
Virus outbreak in Baker Lake
Reduced staff at the health centre in Baker Lake are currently dealing with a virus outbreak in that community.
The crisis could have been avoided, Kivalliq Inuit Association President Paul Kaludjak says, if Ng had listened and acted months ago, instead of criticizing the KIA for raising red flags.
“In your November 19 letter you said, ‘I believe the service available to NWT residents, including those in the Keewatin, is consistent with the Canada Health Act and can be favorably compared to services in other similar parts of Canada,’ ” Kaludjak reminded Ng during the Friday meeting.
“You went on to condemn us for, as you put it, ‘creating a destructive focus on a very small part of the health and social services system.’ ”
KIA asks Ng to resign
With the support of Nunavut Tunngavik President Jose Kusugak, who flew in on a Thursday evening charter to attend the emergency meeting, Kaludjak asked the minister to resign.
“We can no longer have any confidence in your ability to live up to this responsibility,” Kaludjak said. “I am asking you to do what any honorable, respectful minister in any other jurisdiction in Canada would do in this case. I am asking you to step down.”
Breaking the strained silence in the room that followed Kaludjak’s request, Ng said he would not voluntarily resign.
“If I wasn’t concerned about the well-being of health, I wouldn’t be sitting here talking to you,” Ng said. “I’ve dealt with issues that have come forth and I’ve made decisions that you haven’t liked. Don’t say I haven’t made decisions because we have and we have acted when we thought it was appropriate.”
Kaludjak first demanded Ng’s resignation at an Oct. 20 press conference, shortly after a legal opinion supported KIA’s assertion that the KRHB doesn’t have the legal authority to provide physician’s services in the Keewatin.
“Just tell us you’re incompetent”
“Just tell us you’re incompetent,” Kaludjak challenged Ng. “You had ample time to correct these things and you didn’t. You did nothing.”
Ng said he may have been slow to react, but “that was to give the benefit of the doubt to the (board) trustees.”
The sparring left not only tension in the air, but also surprised expressions on the faces of Rankin Inlet’s hamlet councillors, who had invited Ng to the meeting to discuss ways they could work together to find a solution to the problem.
Kivallivik MLA Kevin O’Brien, who was disappointed that NWT Commissioner Helen Maksagak turned down a request for a full public inquiry into the KRHB last fall, said he isn’t prepared to ask for Ng’s resignation when the legislative assembly reconvenes this week.
“I’m not going to say the minister should resign or not resign – that’s really his decision at this point in time,” O’Brien said after the meeting. “He has to do what he thinks is right and myself or nobody else, except for the premier, is going to force that on him.
“That’s not really my concern right now,” he added. “My concern is that they start rebuilding the health system as quickly as possible.”
Should the health board be dissolved?
KIA suggested dissolving the existing health board and replacing it with a working committee until stability and confidence is renewed in the system, at which time a new board could be appointed.
Ng said, however, that he and his staff will work with the existing board. Though no firm decisions were made during the meeting, it’s expected a management committee will be set up to find short-term solutions to the crisis.
A nursing recruitment strategy, currently being developed by the GNWT and the territorial nursing association, is expected to be presented to the minister in mid-February.
The board may also re-establish it’s relationship with the University of Manitoba.
“Right now there’s a willingness to take another look at possibly opening up negotiations with the northern medical unit,” Ng added, “to see, at least on a short-term basis, what services can be reinstated.”>>