March 26, 1968 (27th Parliament, 2nd Session)

NDP

Thomas Clement (Tommy) Douglas

New Democratic Party

Mr. Douglas:

Mr. Chairman, it is a tribute to the social conscience of the Canadian people that I am able to point out that not for a long time have we seen such a public outcry from all sections of the Canadian population resulting from the announcement that there are to the serious curtailments of medical services to Indians. I have received telegrams from the heads of the churches, from doctors, and from those who are interested in Indian and Eskimo problems. It is quite apparent that Canadians have been disturbed by the reprehensible action taken by the Department of National Health and Welfare in contracting or reducing the health services which are available to the native people of Canada.
I do not know of any question on which the government has waffled and dissembled more. Last Friday, in the legislature of Alberta, the premier of the province read a communication he had received from the Prime Minister in answer to a wire which Mr. Manning had sent to the Prime Minister complaining about the curtailment of medical services to the Indians. I have not been able to get the Prime Minister's reply, although I asked for it to be tabled. On orders of the day the Prime Minister intimated what was in the telegram. According to press reports the telegram intimated to Mr. Manning that everything would be cleared up to Mr. Manning's satisfaction, and to the satisfaction of everybody who was protesting the curtailment, once the Minister of National Health and Welfare had made his statement, and that the minister had not made his statement because he was being held up by members of the New Democratic party who were preventing the minister from making his statement.
Every member of the house, including the Prime Minister, knows perfectly well that when supplementary estimates are before this committee the government at its discretion can call any department it wants to. At any time last week the government could have called the Department of National Health and Welfare and the minister could have made his statement. The fact is that the minister has delayed making his statement, hoping that the storm would die down and that he could allow the department to pursue its original, intended policy of curtailing these services substantially.
The minister has never come clean with the house on this matter. Having been asked questions by the hon. member for Brandon-Souris and Northwest Territories and by
March 26, 1968

myself on Thursday, March 14, the minister said, as recorded on page 7608 of Hansard in the upper left hand corner:
I should like to say that the funds available for health services in the north for the forthcoming year will be as great as in the preceding year if not slightly greater.
Of course, to some extent that statement is misleading because the minister failed to take account of three factors: first, that in that period of time the cost of providing health services had increased substantially; second, that the native population had also increased considerably and, third, that the department, as I am told, overspent its expenditures for this purpose by about $400,000. For the minister, therefore, to assure the house that nothing unusual was happening because, to use his words, "funds available for health services in the north for the forthcoming year will be as great as in the preceding year if not slightly greater", does not answer the question whether the government is planning to curtail health services to our native people. If the minister had made the kind of statement then that he has made now he would have saved the native people of this country a good deal of heartache, the members of the house a good deal of time, and many in Canada much concern.
The minister's statement needs clarifying. Let there be no doubt about what the Department of National Health and Welfare intended to do. The minister was asked to table the directives that were sent out and he said he would consider that. I do not think he has tabled them yet. If he has, I have not seen them. The directives are interesting. I have in my hand a directive dated March 6, 1968, from the Department of National Health and Welfare, medical services branch, Manitoba zone. It is signed by Dr. K. Bridge, Dr. J. P. Harvey, Dr. E. Otke and Dr. A. Y. Eng. It begins by saying:
The federal government, as you know, has been forced to reduce many of its programs and the resources available for health services for Indian people has also been greatly reduced.
It goes on to say:
-we must ask all those Indian people and bands who have a source of income to pay for their own health services, namely:-doctors, druggists, hospitals, and to pay for their own transportation. If an Indian person cannot pay for such services, he should first of all request his band for assistance; if such assistance is not available from the band or provincial welfare agencies, the Indian person must obtain a statement from the welfare agency to the effect that he actually requires assistance to pay for personal health services and present this

Supply-Health and Welfare statement to a doctor, druggist, hospital before receiving service, otherwise the Indian person will be billed for such services.
Farther down the directive goes on to say:
Indian bands that have funds must make their own arrangements for the purchase of treatment services either by paying local physicians directly or by arranging to take part in medical insurance programs.
Another paragraph says:
The bands should establish health committees whose duty it would be "to determine what Indians of the band are medically indigent". These committees should meet at regular intervals in order to keep their records of indigents up to date.
The last paragraph but one says:
Medical services branch staff will continue to assist Indian people in improving their health as much as we are able within the limits of the reduced resources allocated to us. We would be remiss if we did not point out the problems facing us today and in the future.
Another letter sent out by the Manitoba zone of the medical services branch, Department of National Health and Welfare, also under date of March 6, 1968, says:
Due to the financial crises faced by the government of Canada, it has been necessary for Parliament to curtail the funds allowed to the Department of National Health and Welfare.
This is an interesting observation to come from that department because, so far as I know, parliament has not curtailed the funds. On March 6 parliament had not even discussed the matter of funds for this purpose. So the responsibility for any curtailment of funds must be borne by the government.
I have in my hand a memorandum sent out last November 23, 1967, signed by the director of Indian health services in the Department of National Health and Welfare. It is addressed to the chief, and says:
[DOT] (3:50 p.m.)
Dear Chief:
There has been some misunderstanding as to what Indians in our zone are entitled to medical services. I would like to make it quite clear that our Indian health services are for indigent Indians only.
Farther on the letter says:
Any indigent treaty Indian who has left the reserve for a year no longer comes under our jurisdiction. He becomes the responsibility of the provincial welfare department.
The curtailment of services has not been confined to cases where no indigency is involved. It has been applied to personnel and also to the facilities which provide health
March 26, 1968

Supply-Health and Welfare services for the population. Dr. Gordon Butler, who appeared before the council of the Northwest Territories as a witness, is quoted as saying the following on February 20:
Severe cuts are necessary to make up $250,000 of wages for medical personnel. Federal grants fall into two categories-operations and salaries. A shortage of funds for salaries means money will have to be trimmed from existing operations. Every frill will have to be cut out from the program. Under the present budget I have to treat 175 T.B. patients with the same money I would need for 115. Trimming will take place through closure of a ward in Inuvik; reduction of the medical staff at Inuvik and Frobisher; withdrawal of a dental officer at Inuvik; closure of the Fort Laird nursing station; elimination of 75 per cent of visiting specialists.
I think the minister owes the committee a much more definitive statement than the one he has made this afternoon. Are these cuts referred to by Dr. Gordon Butler to be reinstated? Does the government still intend to close a ward in Inuvik? Is there to be a reduction of the medical staff at Inuvik and Frobisher? Does the government intend to dispense with the dental officer at Inuvik? Is the Fort Liard nursing station to be closed? Has the government decided to reduce visiting specialists by 75 per cent?
I can understand why the council of the Northwest Territories was thrown into consternation when these statements were made by Dr. Butler. I think the council, the members of this committee and the public generally will want some assurance from the minister this afternoon that the curtailment of services will now be reversed and that there will be no contraction of medical and other health services to the native population.
I was glad to hear the minister say that the same standard of services will continue. I want to be clear about what the minister means by this. Is he saying that the same level of services will be maintained in the coming fiscal year as in the past? This is what we need to know. The hon. gentleman told us that as much money will be spent or even slightly more. That does not answer the question. Estimates for a health service cannot be considered on the same basis as estimates for running an office; they cannot be estimated accurately to the dollar. What the department has to do is to determine the level and extent of the health services it will provide and attempt to estimate the cost of providing such a service. But if an epidemic occurs, or there is a greater amount of illness in that year than in another, the estimate must be revised.

Those who provide health service for Indians and Eskimos in the northern part of Canada cannot say to applicants: We are sorry, we have used up all the money the government has allocated; you must help yourselves.
I notice that in the Winnipeg Free Press of March 11 Mr. Shaun Herron, in one of the articles he wrote on this matter, said:
The word is out to officers of the service that anyone responsible for exceeding budget figures will be in serious trouble. It should be understood what this means in human terms.
I agree with Mr. Herron. If it is true that the word has gone out from the department to the government's health services in the north that people will be in trouble if they exceed the amount of money allocated, then the government will find itself in serious difficulty having jeopardized the lives of many of the people who are committed to its care. The government may allocate certain funds to this service and it is true they may be as large as they were in the previous year. But if a child is sick, if a community needs increased medical services, if a greater amount of hospitalization is required, then the medical officers of the department cannot say to the Indian and Eskimo people: We are sorry but we have used up our allotment for the year; you will have to get along as best you can.
Allocations for health and medical services must be flexible. They must approximate what the department thinks is needed, but I wish to get an assurance that apart from any sums of money the minister may be asking parliament to approve today there will be no diminution in the level of service, no reduction in the standard of service, no discontinuation of any of the health services which have been in operation in the past.
The directive I read a few moments ago raises a much more fundamental question, one which we have no time to discuss fully today. It is: what is the responsibility of the federal government with respect to medical care for Indians? The right hon. member for Prince Albert raised the matter yesterday on the orders of the day when he spoke of treaty No. 6 under which the Indian people consider they were given a commitment. This commitment was that a medicine chest would be kept at the house of each Indian agent in case of sickness among the Indians. They have taken this as a commitment that all treaty Indians are entitled to the health services which they require.
March 26, 1968

[DOT] (4:00 p.m.)
I know there has been a great deal of dispute as to the legal obligation which rests upon the federal government with respect to medical care for Indians, but I submit, that there is also a great deal of legal dispute with reference to land claims, and these have not been settled. I reject the federal government's right to settle either of these legal questions unilaterally. Until the matter of land claims has been settled and the people of this country are satisfied that the Indians have been treated fairly and equitably with reference to their land claims, the government has no right to change the rules with respect to health services for the Indian people.
We all hope the day will come in Canada when the Indian people will have received sufficient education and will have been absorbed into the mainstream of Canadian life, will have jobs and incomes and will have health services like other people by being able to make their contributions to a provincial or national medicare plan. Until that is true, until the Indians are able to earn wages comparable with those received by their fellow Canadians, until they are able to finance their way, I maintain that the federal government has a very definite responsibility with respect to health services for the Indian people.
If the government is hard pressed for money it seems to me the last place that there ought to be any curtailment or any cheeseparing is in carrying out our obligation to provide health services for the Indian and Eskimo people. The government, of course is trying to curtail expenditures, and that is understandable. Last night the Minister of Transport said that those who voted against the tax bill automatically voted to cut expenditures. I do not want to get into a debate on that but I remind the government that the members of this party put proposals before it which could have raised more money than it is raising at the present time without increasing taxes on the income tax payer. We said that by implementing some of the recommendations of the Carter report the government could actually have cut income taxes by making some of the freeloaders pay the taxes from which they are now exempt.
If the government has to curtail expenditures there are other places it might look than at this rather meagre sum which we are spending on our native people. The other day the government indicated that we are going

Supply-Health and Welfare to overhaul and re-equip four destroyers at a cost of some $50 million apiece. This is an item that might be re-examined in the interests of economy. Further, one strongly suspects that some of the military planes we are purchasing from the United States will be obsolete when we get them. The government might re-examine these purchases. Some $215 million is going into that expenditure.
The point I want to make is that if the government must reduce expenditures, in the name of decency and in the name of justice the last place we ought to reduce them is in our expenditures for the most defenceless and helpless group in our society, the Indians and the Eskimos whom we have treated shabbily enough in days gone by. Let us not make them the first victims of any economy measure the government must carry out.
Therefore, Mr. Chairman, when the minister is replying I ask that he give us the assurance his statement this afternoon means that there will be no reduction in the level of services or the standard of services and that there will be no closing or discontinuance of any of the health services and health centres that are now in operation. If we can get that kind of assurance then I think all the furore that has been kicked up over this problem will have been worth while. I think that the people in all parts of Canada who have protested against this proposed curtailment in health services for our native people will feel their protests have not been in vain.

Topic:   DEPARTMENT OF NATIONAL HEALTH AND WELFARE
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