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Ottawa says no way to Keewatin dental deal

Health Canada officials say they won't honour fee-for service billings submitted by dentists working for Kiguti Dental Services in the Keewatin.

JIM BELL
Nunatsiaq News

IQALUIT ­ An official with the federal Department of Health and Welfare has told the government of the Northwest Territories that Ottawa will not pay extra dental service costs created by a new contract between the Keewatin Regional Health Board and Kiguti Dental Services.

In a July 17 letter, Dr. Jay Wortman, the Ottawa official in charge of Health and Welfare Canada's non-insured health benefits program, told the GNWT that Ottawa won't pay the extra costs of having dentists replace dental therapists in the Keewatin region.

"If it is the intention of the KRHB to pass on additional costs to the NIHB program in the form of fee-for-service claims, we will hold back the current funding for the dental therapist program from the contribution agreement and apply that amount to the NIHB budget to offset those billings," Wortman said in the letter, which is addressed to Warren St. Germaine, the director of financial and management services for the GNWT's health department.

"Alternatively, if the KRHB plans to use the current dental therapist funding to provide the service through another modality, we will take measures to ensure that no additional billings are paid through NIHB for these services," the letter goes on to say.

The letter is contained in a package of documents put together by the Kivalliq Inuit Association to support their call for a public inquiry into recent activities of the Keewatin board.

Double billing?

Pierre Blais, who is acting as the director general of Ottawa's non-insured health benefits program while Wortman is on holiday, said the funding arrangement for the Keewatin's new dentists may amount to a form of double billing.

"That would be one suspicion that we would have, although I don't want to put words in anyone's mouth," Blais said.

Blais explained that the cost of hiring four dental therapists in the Keewatin region is part of a fixed budget that's included in the money that Ottawa transfers to Yellowknife every year for territorial health services.

But he said that transfer agreement doesn't provide for "fee-for-service" claims by dentists on top of that amount.

"The dental therapist is a salaried employee. Whether he sees one person in a day or 10, it matters not. They get paid the same," Blais said.

Dentists, on the other hand, get paid through "fee-for service" claims.

Since aboriginal people in Canada are guaranteed free health care, Ottawa must pay for their dental bills. In the NWT, that means every time a dentist sees an aboriginal patient, the dentist submits a bill to the GNWT's health department, which then passes it to Ottawa for reimbursement.

Blais also pointed out that dentists normally expect much higher salaries than dental therapists. The average salary for a dental therapist is normally about $40,000 a year, while dentists usually expect to be paid up to $250,000 a year.

Blais said the GNWT has yet to respond to Wortman's letter.

Earlier this year, the Keewatin health board created an uproar in the Keewatin region when they announced a plan to fire four dental therapists who had been working within Keewatin schools.

At the same time, they said a new deal with a private company called Kiguti Dental Services would create better dental services provided for Keewatin residents more efficiently.

But Ottawa health officials appear to see the Kiguti deal as a step backwards.

"The unilateral action taken by the KRHB is in direct conflict with our need to maintain the current quality and level of service in the NWT while maintaining an effective community based service," Wortman said.

Wortman's July 17 letter was sent only 16 days after Kiguti began to offer dental services under its new arrangement with the Keewatin board.

Earlier this year, hamlet councils in Rankin Inlet, Baker Lake and Arviat, the Keewatin Inuit Association, the Keewatin Divisional Board of Education, and Kivallivik MLA Kevin O'Brien all protested the KRHB's deal with Kiguti.

Forty-nine per cent of Kiguti Dental Services is owned by Rankin Inlet's Tapiriit development corporation, while the remaining 51 per cent is owned by dentists Hassan Adam and Charles Pastori.

More recently, numerous groups and individuals have called for a public inquiry into the Keewatin health board's recent activities.

Baffin board says no to private money

The Baffin Regional Health and Social Services Board has rejected an offer from the Qikiqtaaluk Corporation to build and lease back a replacement hospital in Iqaluit.

ANNETTE BOURGEOIS
Nunatsiaq News

IQALUIT ­ Baffin residents could have a new hospital by 1999.

But the Baffin Regional Health and Social Services Board has rejected an offer from the Qikiqtaaluk Corporation to build one, citing fears about the privatization of health care.

Board members, who met earlier this week in Iqaluit, decided to rely on limited government funding and money raised through charitable donations to pay for a new regional hospital.

In a general discussion Monday, board members spoke hesitantly about an offer made by the Qikiqtaaluk Corporation, the business arm of the Qikiqtaani Inuit Association.

"We want to try it our way first," Ann Hanson, the chair of the Baffin board, told QC president Jerry Ell. "But we appreciate your offer."

Baffin's Inuit birthright corporation was prepared to spend $25 million ­ in combination with government funding ­ to construct the hospital and lease it back to the board through a long-term agreement.

Ell said QC isn't interested in becoming involved in the delivery of health care and said that under any agreement, health care delivery would remain the board's responsibility.

Hanson repeated the same fears about privatization that she expressed at last July's Baffin leaders' meeting in Pangnirtung.

"If we start privatizing, this could jeopardize the entire health care system," she said.

Ell said Hanson's reaction both surprised and disappointed him because at a meeting last month she agreed to recommend QC's plan to her board.

At that August meeting, which NWT finance Minister John Todd also attended, both Ell and Hanson heard that the GNWT doesn't have the money to directly fund the construction of a new hospital.

The GNWT has, however, earmarked about $47 million in capital funding for several new NWT hospitals. The Baffin region would get part of that money.

"It's always been earmarked, but it's been deferred," Ell said of the $47 million.

He warned the board that funding will be slow in coming and would ultimately delay construction of a new hospital.

Thanks, but no

But no amount of convincing could allay fears that having QC build the hospital would be the first step towards a private health-care system for Baffin residents.

"I can't see to go any other way at this time," Hanson said.

"I'm sorry that QC and the Baffin regional health board won't be working together to get this hospital built," Ell replied. "I'm sorry we're not going to see a hospital sooner."

QC has been trying to work out a deal with the health board for about a year. The corporation got involved after hearing that a private company might be contracted by the territorial government to construct a new Baffin hospital.

Ell said QC's offer may be short-lived.

"Our offer is on the table because of the political climate right now," Ell said. "The Nunavut members are willing to fight for this (government funding). But it might not be there by the winter."

According to a QC timeline presented to the board Monday, Ell said constuction could have begun on the new hospital next July and been completed in 1999. Under the board's timeline, Hanson says Baffin residents can expect a new hospital by 2000.

Will GNWT money dry up?

In the 1988 agreement that transferred responsibility for health care from Ottawa to Yellowknife, the federal government agreed to set aside money for replacement hospitals in Iqaluit and Inuvik.

Since then, the GNWT, with the help of a sweeping report done by the Med-Emerg consulting firm, has divided that money up so that part of it will also be used to build new hospitals in Rankin Inlet and Cambridge Bay.

Nunavut's MP schools her colleagues on Nunavut

Nancy Karetak-Lindell, Nunavut's newly-elected MP, says informing Canada's 300 MPs about Nunavut is a full-time job.

ANNETTE BOURGEOIS
Nunatsiaq News

IQALUIT ­ She's been on Parliament Hill for only two short months.

But Nancy Karetak-Lindell, Nunavut's new Liberal MP, is finding that educating her colleagues about Nunavut and the people who live here is already a full-time job.

"I have to give very basic information about how large my riding is, where it extends from... just the geographical information," she says as she takes a break in an Iqaluit restaurant. "That alone is a learning experience for a lot of them."

She says her colleagues ­ the other 300 members of Parliament elected last June ­ are nonetheless inquisitive about the North and the developments leading towards division of the NWT and the creation of Nunavut.

"It's a really big piece of news as far as I'm concerned," Nunavut's new MP says. "We're creating history. We're creating a new territory and people are excited about it."

Defending Nunavut

The former Arviat hamlet councillor adds, though, she's already had to defend her riding, especially when people learn that the Nunavut riding has only about 26,000 residents, yet takes a huge amount of federal money to pay for.

"Right away I have to tell them my riding is so large it has three time zones in it."

She'll have to convince any skeptics, because Karetak-Lindell will need the support of those colleagues when the Nunavut Act is opened up for changes that must be made before April 1, 1999.

First Baffin visit

Karetak-Lindell was in Iqaluit last week with Ottawa's new Indian affairs minister, Jane Stewart. Nunavut's capital is the first Baffin stop for her since her swearing-in last June.

"As far as real constituency visits, I've done about three."

She attended a meeting in Baker Lake, a high school graduation in Rankin inlet and spent some time in her home community of Arviat. Those communities are in the Keewatin region, the area where Karetak-Lindell showed the strongest results in the June 2 federal election.

She says she's eager to visit more communities, but doesn't see that happening for several months, especially since Parliament just opened this week. Governor-General Romeo Leblanc read the new government's throne speech this Tuesday.

"It will be very difficult to travel while the House is sitting," Karetak-Lindell said.

In the meantime, she'll be sending out a constituency newletter to tell people about what's she's doing in Ottawa. Information about how to contact her at either her Ottawa or Arviat offices has already been sent out to communities.

"We were faxing it everywhere and anywhere," she said about the list of her office phone numbers. "We're trying very hard to make sure anyone who wants to can get a hold of us."

Karetak-Lindell doesn't have an office in Iqaluit and she's not sure whether or not she'll be able to afford to pay for one in Nunavut's capital.

"It's also more a budgetary matter," she added, "whether I have it within my budget to do that. It's hard to know whether I'll need one more person in my Ottawa office."

Wants communication with constituents

Karetak-Lindell wants her constituents to keep her on the right track about issues that concern them.

"You cannot do the job unless people communicate with you and let you know what they want you to do. It's like going through school and never getting a report card."

Karetak-Lindell is a rookie on the Hill and said it will take a while for her to settle ­ in fact, she's still looking for an Ottawa apartment ­ but she's ready to fight on behalf of Nunavut residents.

One issue she's monitoring is the battle between her government's Department of Fisheries and Oceans and Nunavut Tunngavik Inc. over the role and powers of the Nunavut Wildlife Management Board.

"It's kind of attacking the fundamental part of the land claim," she said about the on-going court battle over turbot quotas in Davis Strait.

"That has very serious consequences," she said. "When I get direct requests by NWMB or NTI to pursue certain things then that's where we'll take it. Right now, we're waiting to see what happens."

It's official: Baffin board switches from Montreal to Ottawa

As expected, members of the Baffin Regional Health and Social Services Board this week voted to move southern specialist services from Montreal to Ottawa.

ANNETTE BOURGEOIS
Nunatsiaq News

IQALUIT ­ The Baffin Regional Health and Social Services Board voted Wednesday morning to move their southern specialist services from Montreal to Ottawa.

The board had been looking at transferring southern specialist services from Montreal-based McGill University to the Ottawa Heart Institute for more than a year.

That decision doesn't mean that all Baffin patients must travel to Ottawa to get services, however. The board agreed that patients with long-standing relationships with Montreal doctors could continue visiting their specialists in Montreal, and that decisions would be made on a case-by-case basis.

All new patient referrals will be made to the Ottawa Heart Institute.

Ottawa promises flexibility

A team from Ottawa spent an hour Tuesday afternoon explaining how a partnership between their institution and the board would improve health-care services for Baffin residents. Dr Tim Cheung, Linda Hunter and Roda Grey brought a message of concern and co-operation.

"We would like to allay your fears and put them to rest," Linda Hunter, manager of the Baffin-Ottawa project, told board members about the move from Montreal to Ottawa.

She also brought a message of flexibility. Inflexibility was one of the main stumbling blocks between the board and the administration of the McGill-Baffin program.

"We'd like to change along with your needs," Hunter said. "We can move our management style in a manner conducive to keeping up with them."

The reluctance to change and the inability of the McGill administration to solve persistent problems ­ such as the inconsistent transfer of patient information ­ were cited as two of 50 complaints about the McGill service by a committee that studied the relationship.

The hurdle of the French language for unilingual Inuit and the large size of Montreal were other common complaints.

The committee presented only 14 strengths of the McGill-Baffin contract, including the continuity of specialist care and the low turnover of social workers.

The Ottawa team outlined a plan that would allow services to begin to be transferred from Montreal in October. That plans includes continuing the timetable already established by McGill for specialist visits to the North.

Transfer will take a year

Hunter suggested it would take nearly a year to move the entire system from Montreal to Ottawa.

"As with any new program, it will take a number of months ­ upwards of eight months ­ to take on the full services," she told the board.

The Ottawa team also suggested ways a partnership would encourage technological advances in the health system in the Baffin region. The region and the Heart Institute have been working together for several months to provide a telemedicine system of health care for patients in two remote Baffin communities.

The Ottawa hospital has already begun work on an electronic database of health information and a computerized system of patient records.

Some members against move

Some board members initially wanted any decision on a move to be delayed until they could consult their communities. Joe Arlooktoo, who represents Kimmirut, brought a petition to the meeting with signatures from people who don't want the service moved from Montreal.

Ann Hanson, the chair of the Baffin board, said she will write to everyone who expressed concerns about the move to explain the board's position and why they chose to make the move.

Whether or not transferring the service will save money or not wasn't discussed at the public board meeting, but in recent weeks, Pat Kermeen, the board's chief executive officer, said the board could save as much as $400,000 by severing its tie with the McGill-Baffin program. Most of those savings were expected in administration costs.

Kermeen had been talking with Ottawa officials since the fall of 1996 about transferring the service. In May, the board was informed that funding had been sent to Ottawa to begin organizing the process.

In July, a group of representatives from the Ottawa Heart Institute spent a week touring health facilities in Iqaluit, Pond Inlet and Kimmirut.

On September 1, the relationship between the McGill-Baffin program and the board was officially severed.

Avoid red tape disease, DIAND minister says

Indian Affairs and Northern Development Minister Jane Stewart said Nunavut planners shouldn't drive exploration companies away with excessive regulation and red tape.

DWANE WILKIN
Nunatsiaq News

IQALUIT ­ Indian and Northern Affairs Minister Jane Stewart has told territorial bureaucrats to waste no time creating simple regulations to guide Nunavut's natural resource development.

During her brief trip to Iqaluit last week, where she signed over millions of dollars worth of development and training money, Stewart suggested any delays in setting up Nunavut's regulatory machinery would be felt economically.

In reviewing the work of a number of regulators the minister cautioned Nunavut planners against sending the wrong signals to potential private investors.

"We're starting to see, as certainty evolves with the land claim being settled, new resource activity, new exploration activity. And that's positive, that's good," said Stewart, who's on her first visit to Nunavut since being named to the federal cabinet last June.

But Stewart said Nunavut leaders now need to co-ordinate their efforts to safeguard Nunavut's economic future.

"Making sure that the resource industry understands the structure and the structure is in place so that they can understand it, is a challenge for us," Stewart said.

Anawak must communicate

Stewart and her aides made several stops over the course of a busy two-day schedule in Iqaluit last week.

In several private meetings with Interim Commissioner Jack Anawak, which she described as "very constructive," the minister talked about the need for "good and effective communications" so that communities are kept abreast of all aspects of Nunavut's development.

"I think the importance of communications with all citizens is one of the underpinnings of the success of the project."

Although a great deal of work remains to be done between now and April 1, 1999, Stewart said she was "really impressed with the energy" that's going into the project.

During her stay, the minister met with directors of Nunavut Construction Corp. to review plans for new infrastructure development in the territory.

She also visited the offices of the Qikiqtani Inuit Association, Nunavut Tunngavik Inc. the Nunavut Implementation Commission and the Nunavut Wildlife Management Board.

"What's important for me was getting a sense of the importance of these structures, and how effective these structures are in managing the resources of the territory," she said.

During a stopover at Nunavut Arctic College, a student confided in Stewart that the creation of the new territory was exciting interest among even the most apolitical people.

"Talking to folks about where they're at and what their energy levels are, heartened me tremendously," Stewart said.

"There is great capability and everybody's going to have to use their expertise and potential to make this work, right from the students who are studying under the programs that have been provided for human resource development, to the commissioners and the interim commissioner and the leadership of NTI."

Although she is not directly participating in talks between Ottawa and the GNWT on formula financing deals for Nunavut and the remainder of the NWT, Stewart did say she expects a proposal for funding Nunavut and the west after division to be ready by next spring.

A special committee steered by the GNWT's Department of Finance is now discussing financial arrangements for the two new territories.

The Department of Indian Affairs and Northern Development, which is ultimately responsible for the transition costs, has been represented on the committee by Judy Tanguay of the Nunavut Secretariat.

"It's clearly a topic of discussion and one that we want to get settled as quickly as we can, because when that's settled, it'll be an important piece of the project that's out of the way," Stewart said.

Eegeesiak ousts Sillett as president of ITC

DWANE WILKIN
Nunatsiaq News

IQALUIT ­ The new president of the Inuit Tapirisat of Canada paid tribute this week to departing president Mary Sillett by vowing to continue chipping away at ITC's debt.

Okalik Eeegesiak, assistant executive-director with Nunavut Tunngavik Inc., was elected to a three-year term last Sunday by delegates attending ITC's annual general meeting in Inuvik.

"Mary has done a great job of downsizing ITC, and she started a job that I'll have to finish," said Eegeesiak, who will also serve as Canadian vice-president of the Inuit Circumpolar Conference (ICC).

If the lobby group's remaining $230,000 debt is to continue to be a priority for the Iqaluit native, so will be ITC's role in the next round of constitutional talks.

"I'll have to get myself updated on that issue, for sure, right off the bat," said Eegeesiak, who credited her victory in part to the political support she received prior to the annual general meeting from certain unnamed "key people."

"I've always had the backing and support of the organizations I've worked for," she said.

Back in Ottawa, Sillett accepted her defeat gracefully and said she leaves the national Inuit organization with a strong sense of accomplishment.

"Regardless of what the results were, I don't think anyone can dispute that I did a good job," Sillett said. "I feel good about that, no one can take that away from me."

Sillett assumed the presidency of ITC after Rosemarie Kuptana's resignation in 1995.

Both Eegeesiak and Sillett speculated that Sillett's bid for the leadership was hampered because she doesn't speak Inuktitut fluently.

"Despite all of the progress made, people will not vote for you because there is a feeling that a national leader, especially of the Inuit Tapirisat of Canada, should be able to speak Inuktitut fluently.

"That's always been an issue from day one."

After living in Ottawa for several years, Sillett said she now looks forward to resuming her life near friends and family in her native Labrador. And even after 25 years of lobbying for Canada's Inuit, she said she isn't ready for retirement.

"It's a really really good time to be in Labrador. It's a time when Labradorians are involved in land-claims negotiations, where Labrador Inuit, Labrador Innu and Métis are fighting for self-determination and having a say in how development occurs. So it is an exciting time."

In a separate meeting, also held last weekend in Inuvik, Sheila Watt-Cloutier was acclaimed to the presidency of ICC-Canada, and will serve as ITC's vice-president.

Nunavik health board signs deal with McGill

JANE GEORGE
Nunatsiaq News

KUUJJUAQ - Nunavik may pick up many medical specialists who used to work in the Baffin region thanks to a three-year deal between the regional health board and McGill University.

The Baffin Regional Board of Health and Social Services recently decided not to renew its own contract with the McGill doctors.

The Nunavik Regional Board of Health and Social Services is trying a new arrangement involving a region-to-region exchange of resources that could mean cheaper and better services for Nunavik.

The health board's $35-million annual budget includes money to hire five specialists a year, based on Quebec's system of allotting specialists to each region. But it has always been difficult to attract specialists to work and live in the North.

The deal has been in effect since April 1, 1997.

So the Nunavik health board has decided instead to trade its quota in exchange for 600 days of service a year from specialists affiliated with the McGill School of Medicine.

The contract won't cost Nunavik any more money. And because Nunavik is part of Quebec, the health board won't get slapped with the 18 per cent surcharge that the Baffin regional health board has had to pay in the past.

There still are a few glitches in the new deal to work out.

Last year Nunavik received only 300 specialist days, largely because of a lack of certain specialists in the South.

"Nunavik is hostage to shortages in the South," Dr. Normand Tremblay, an employee of the Nunavik regional health board said. For this reason, no psychiatrist, for instance, will be able to regularly visit Nunavik until 1998.

Many specialists aren't eager to travel to Nunavik, either, because they're not paid any special premium for making the trip. And because they generally see fewer patients in Nunavik, they may actually earn less money in the North than if they were to stay home.

But the contract between the Nunavik regional health board and McGill is already starting to be felt at the two health centres in Nunavik, which have to organize client appointments for specialists.

The new arrangement could bring significant savings in patient travel, too.

Until recently, even minor surgery had to be performed in Montreal.

More than $100,000 has been spent outfitting Nunavik's two health centres to give specialists the equipment they'll need to perform their work in the region. Patient services are also being upgraded. Surgeons have since performed more than 100 minor operations at the Inuulitsivik Health Centre in Puvirnituq.

The number of costly transfers to Montreal hospitals is already down by 15 per cent from last year. "There's an increase in expertise and at the same time we're giving proper treatment to clients," Harry Tulugak, Inuulitsivik's interim director said. But the new plan also has its critics who wonder whether specialists, used to working in an urban setting, will look for reasons not to come to Nunavik. "Right now we have to treat them like spoiled babies," said one health worker. Cut-backs in health services in the South, including many hospital closures, also means more specialists are going to be leaving Quebec. There may be even fewer specialists available in the future.

My Little Corner of Canada

by JOHN AMAGOALIK

Rodents leaving a sinking ship

There was a time when working for the GNWT was actually a desirable and worthwhile thing to do. It was when it was led by reasonably good people who were honourable and who had good intentions. But in recent times, it is very difficult to use the word "honourable" when one is talking about the leadership in Yellowknife.

One should not condemn all those in positions of power because there are still some good people in the upper echelons of the Northwest Terrified Government. But the most powerful ones have tainted the barrel of apples. They have done this either through questionable intentions or just plain incompetence.

The executive branch of the government has sometimes behaved like some dictatorial regime in a banana republic. They have unilaterally changed some decisions made by the legislative members to suit their own objectives. A lot of money has been moved around to benefit some members at the expense of others.

Many senior bureaucrats have recently left the GNWT under some suspicious clouds. These senior civil servants are highly capable people who apparently do not want to be around when the proverbial crap hits the fan. The ongoing RCMP investigations into some of the activities of the GNWT contributes to the atmosphere of nervousness throughout the government.

Are the rodents leaving a sinking ship or are they afraid to challenge the king rats who occupy the wheel house of a rudderless ship which is adrift on an increasingly windy sea?

This corner quotes

"To kick each other's tires."

­ Zebedee Nungak describing the purpose of the first meeting he had with Lucien Bouchard, which took place in July 1997.

Letters to the Editor

Montreal gave excellent care to infants

As the medical director for Skyservice and chief of the Department of Emergency Medicine at the Montreal General Hospital, I have had the good fortune to work with many different health care groups in the Baffin region.

Since 1991, we have been transporting your sickest citizens, primarily tiny babies, to intensive care units in Montreal

For 30 years, the Montreal medical community has done its very best to serve the Baffin population by trying to offer the best medicine possible. The medical relationships with the patients are deep and longstanding and have taken many years to evolve and be refined. It is at this level that the physicians are very concerned about the pending move of all medical services to Ottawa due to begin September 30, 1997.

It is a fact that your population has a birth rate 2.5 times greater than the Canadian population and, very often teenagers and younger women are the mothers. This, by the force of nature, results in a higher premature birth rate and serious sickness requiring a high level of medical expertise only found in the major cities of any country.

We are transporting, on average, 35-60 babies per year and, given the expected growth of your population, there is a reasonable possibility that this number either will at least remain the same or even slightly increase in the coming years.

We now know from our transport experience that by sending the Montreal Children's Hospital mobile intensive care unit to Iqaluit to stabilize these sick babies and then transport them safely to one of these major hospital centres, it does make a difference in both saving lives and making these babies live better with less medical complications.

Everyone agrees that many improvements can be achieved in the administrative and political arrangements between the Montreal hospitals and the Baffin region, but, by far the most important part of our relationship is with the two medical communities and the patients themselves.

There is good objective evidence that we are making a positive difference to the health of your community, particularly with your neonatal population. I have had the opportunity to visit many different transport systems and I can assure you that our neonatal intensive care unit located in the air ambulance is of the highest standard found anywhere.

Our medical community is very concerned about negative effects on morbidity and mortality rates (or, in other words, the quality and quantity of patients' lives after the move to Ottawa takes place.

Medical relationships take a long time to develop and we do not want to see any deterioration to the health of your community. I genuinely believe that it is worth reconsidering the move to Ottawa.

On the whole, there is excellent medicine being practised here, and, to my way of thinking, this aspect of our relationship is far more important than adminstrative and political arrangements that can almost always be sorted out by people of good faith.

Michael J. Churchill-Smith
MD FRCP(C)
Montreal

Editorial

Wanna buy a consultant?

Pssst!

Wanna buy a consultant?

That's what the GNWT did back in 1996, apparently, when they handed an untendered sole-source contract worth $500,000 to an Ontario-based outfit called Med-Emerg International.

Around that time the GNWT was setting out to reconfigure the NWT health care system in light of skyrocketing costs.

And they also needed a big pile of paper signed by long list of "experts" bearing various alphabet-soup acronyms after their names to justify using Baffin hospital money for new hospitals in the Keewatin and Kitikmeot regions.

Early in 1996, Iqaluit's newly-elected MLA, Ed Picco, had been lobbying loudly for the resumption of plans to build a replacement hospital in the Baffin region. The money for that project ­ at least $42 million of it ­ had been committed by the federal government in an amendment to the 1988 agreement under which Ottawa transferred responsibility for health care to the GNWT.

At the same time, Picco's newly-elected counterparts in Keewatin Central and Kitikmeot, Finance Minister John Todd and Health Minister Kelvin Ng, had each stood for election on platforms that promised improvements to health care facilities in their respective communities.

In Todd's case, that meant a new hospital for Rankin Inlet, and for good reason. People in the Keewatin region have been demanding that for years, along with a birthing centre and other services now only available in either Churchill or Winnipeg.

There are legitimate and compelling reasons, therefore, for dividing up Ottawa's new hospital money in a way that provides at least some money for new hospitals in Keewatin and Kitikmeot.

Those reasons existed long before the GNWT decided to fork out half a million dollars to Med-Emerg. Political goodwill, reasoned negotiation and a respect for consensus decision-making could have achieved an open, fair agreement for sharing new hospital money among Nunavut's three regions.

Picco, Todd and Ng all could have showed off their trophy buildings in time for the next election.

But the GNWT poisoned the process even before it started. First, they revealed that they had already spent their promised contribution for a new Baffin hospital. Second, they handed a sole-source contract to Med-Emerg, simply to provide information that already ought to be available within the territorial health department.

Third, they launched their own behind-closed-doors capital planning process that no one understands ­ perhaps because the GNWT doesn't want anyone to understand it.

In any event, the GNWT's planning process contains another idea that has received virtually no public debate.

That idea is the use of private money to help pay for those new hospitals. It's no surprise, then, that Med-Emerg's bloated, jargon-filled report eventually lumbers towards recommendations on the use of private money. That's what the GNWT likely wanted to hear, and likely paid for ahead of time.

"What role can the economic development corporations play in the financing, project management and provision of other services for these projects?" the Med-Emerg report's authors ask in their report. There are also various references to "economic development corporations" and "investment funds," as possible sources for that private money.

The report provides the GNWT, therefore, not only with a rationale for divvying up the Baffin's hospital money, but also a rationale for sneaking privatization into the territorial health care system with no public debate.

Unfortunately, they never counted on the possibility that members of the Baffin health board may be capable of thinking for themselves on that issue. This week, the Baffin board rejected the idea of having a replacement hospital in the Baffin built with private money.

Perhaps Baffin board members have acted too hastily. Perhaps their suspicions are justified. It's too early to say what their decision means, mainly because the GNWT has said nothing about how much health care privatization they're planning for. And Med-Emerg's long-winded report doesn't contain any advice about what to do in the event that health boards don't toe the GNWT's line.

It does seem likely that the Baffin's long-promised hospital may have to be paid for out of a fraction of what's left of the $42 million or so that Ottawa first promised, plus whatever the Baffin board can scrape together in charitable donations.

As for those MLAs who have been wondering out loud about why the GNWT spent so much on a sole-source contract with Med-Emerg, they needn't look far to find the answer. JB

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