No Indian status card, no coverage of medical transportation by Ottawa

The family of a 7-year-old boy from the community of Deer Lake was denied medical transportation coverage because he did not yet have an Indian status card. She is calling for changes to be made to the federal Non-Insured Health Benefits (NIHB) program for First Nations and Inuit.

Jordan Harper was seriously injured and his grandmother died last January in a head-on collision with another vehicle on a winter road near his community in northwestern Ontario.

The second-grade boy was flown to Hamilton Health Sciences Centre, where two metal rods were implanted in his leg.

Last month, he was scheduled to have the rods removed, but his family was waiting for hospital staff to SSNA reserves a scheduled medical evacuation of Deer Lake has Thunder Bay.

His leg was all swollen from the rodsdescribes Aretta Meekis, the young boy's stepmother.

Family says they were told Jordan Harper was not covered by SSNA because he did not have an Indian status card, which his deceased grandmother – who was his primary guardian – had tried to obtain for him.

I cried that day because they refused – they refused medical evacuation again and he was suffering, his mother-in-law said. He had just turned 7 years old. How can you refuse a child?

Around 1100 people live in Deer Lakean isolated community that can only be accessed by plane or winter road.

After waiting more than a week to get him out of the community, the Oji-Cree First Nation Keewaytinook Okimakanak Tribal Council paid to send him to Thunder Bay so that he can undergo the stem removal operation.

This type of scenario is unfortunately very widespread, deplores the vice-president of regional services of the Sioux Lookout First Nations Health Authority (SLFNHA), Monica Hemeon.

We hear stories like this all over the place – community leaders paying for things, health directors paying for things.

The SLFNHA provides health services to 33 First Nations, 28 of which are remote, including that of Deer Lake.

For its part, the program of SSNA provides Canada's First Nations and Inuit with coverage for a number of health services that are not covered by social programs, private insurance plans, or provincial or territorial health insurance plans.

This includes medical transportation to access services that are not accessible in their communities.

To benefit from it, the customer must live in Canada and meet at least one of the following criteria:

• Be a First Nations member registered under the Indian Act, also called a “registered Indian”.

• Be an Inuk recognized by an Inuit land claim organization.

• Be a child under the age of two whose parent is eligible for the SSNA.

Jordan's mother-in-law wonders why, given the urgency of the care Jordan needed, an exception couldn't be made while her family finished filling out their application for a Registered Indian card. The process is still ongoing – the family's efforts to obtain the card have been delayed due to the accident.

A spokesperson for Indigenous Services Canada (ISC) told CBC by email that the organization is working diligently to improve medical transportation services for SSNA in the region of Sioux Lookout.

Jordan's family, however, said change can't come fast enough.

Poor communication and missed appointments

Brad Meekis is an advisor to the community band council of Deer Lake. He manages the health portfolio in his community. According to him, the communication problems between the staff of the SSNA and Deer Lake Nursing Center are causing trips to go unbooked and appointments to be canceled.

When references [médicales] are made to SSNAthey say they are not receiving referrals from our nursing center.

Amanda Meekis works at the nursing center in Deer Lake. She is responsible for managing requests for transportation for medical reasons and sending the requests to the personnel of the SSNAwhich involves a lot of bureaucracy and steps to defend the interests of community members.

She relates that she often spends hours waiting for a response from employees of the SSNA and that their interactions can be negative.

Sometimes they hang up on meshe illustrates.

She explains that the staff of SSNA often asks her detailed questions about why clients need medical transportation, but that she cannot release the information due to the confidentiality requirement.

Some of our patients miss crucial appointments, like this one. They sometimes wait many years before being seen again.

When members of isolated communities miss an appointment, the impact is potentially catastrophicsouligne Monica Hemeon.

Indigenous Services Canada strengthens its workforce

Jennifer Cooper, spokesperson for SAC, indicates in an email that an initial meeting had taken place between the service and the SLFNHA in July for discuss the concerns of community members regarding the program of SSNA.

Since then, a number of meetings have taken place, and SAC stated that several measures were taken to resolve the issues raised and increase the capacity of the office Sioux Lookout.

The measures are as follows:

• Increase in the number of employees, for a total of 20 employees in the office SSNA of Sioux Lookoutto provide additional telephone support to reduce wait times.

• Created a new senior management position to lead the team and manage capacity.

SAC also adjusts internal processes and governance structures, and streamlines forms and documentation to improve our ability to meet medical transportation demandsadds Jennifer Cooper.

A bilateral table was also created with the SLFNHAto foster regular discussions about gaps and challenges, as well as steps that can be taken to improve the operations of SSNA in the region of Sioux Lookout.

Need for increased support in urban centers

When clients fail to show up for their appointments, providers are more reluctant to schedule follow-ups for them, Hemeon says, even when the situation is beyond their control – such as not having booked a trip or flight cancellation due to bad weather.

In addition to taking people out of their communities for treatment, there is a need to provide them with support once they arrive at their destination.

The SLFNHA manages three accommodation centers in Sioux Lookout to accommodate people who go there for medical appointments. The organization also offers transportation, translation and navigation services for patients, as well as other forms of support.

“It's when they have to leave Sioux Lookout that clients tend to have a little more difficulty navigating the health system, particularly in large urban centers like Thunder Bay, Winnipeg and Toronto,” notes Ms. Hemeon.

Often, staff SSNA doesn't book lodging, and patients who don't have credit cards have trouble booking taxis and hotel rooms, she says.

The SLFNHA seeks to expand its presence in these urban centers; it has already implemented a transportation program in Thunder Bay.

However, we received a very negative response from Indigenous Services Canada and SSNA regarding our desire to move into these urban centers to better support our customersindicates the vice-president of regional services of the SLFNHA.

Back to Deer LakeJordan feels much better, said Aretta Meekis.

He is so happy to be able to move around freely, she describes. They did a really good job on his leg. He is very happy with the nurses and doctors.

Jordan has a follow-up appointment at Thunder Bay. When CBC spoke to Aretta Meekis, she wasn't sure how this trip would be covered.

With reporting from CBC's Sarah Law