Selwyn Kay was alone at his cabin when his health began to give out.
It was Oct. 17 of 2020 and the rivers were freezing up. Access to the outside world was not possible by land or boat.
About 25 kilometres away in Fort McPherson, Charlotte Kay got the call from her nephew that her brother needed help right away.
SA国际影视传媒淭here was no other way of getting into town,SA国际影视传媒� she said. SA国际影视传媒淵ou couldnSA国际影视传媒檛 travel by skidoo or anything else.SA国际影视传媒�
There was only one option SA国际影视传媒� he needed to be flown out.
Her nephew first attempted to arrange a flight. A whole day later, she hadnSA国际影视传媒檛 heard back and called. She was told the flight would cost between $20,000 to $30,000, as medevacs to camps are not covered by medical travel.
Charlotte turned to the GwichSA国际影视传媒檌n Tribal Council, which owns GwichSA国际影视传媒檌n Helicopters. The GTC agreed to get Selwyn to Inuvik Regional Hospital and got him out within a few hours. He was at the hospital until midnight, when he was medevaced to Yellowknife to see his doctor SA国际影视传媒� who took one look at him and put him on a plane to Edmonton for treatment.
SelwynSA国际影视传媒檚 doctor wrote a letter to the GNWT, asking them to fund Charlotte as a medical escort; but while the request was in the system, her brotherSA国际影视传媒檚 condition wasnSA国际影视传媒檛 getting any better.
SA国际影视传媒淲e waited and waited and I kept calling medical travel,SA国际影视传媒� she said. SA国际影视传媒淭hey said the request was sent to Yellowknife and they were waiting for approval. But we couldnSA国际影视传媒檛 wait anymore, because we knew he was really sick.
SA国际影视传媒淥n my way out to the airport, I contacted medical travel again and they said they had not heard anything. So I left it at that.SA国际影视传媒�
Her family pooled their resources to get her on a plane to Edmonton.
Upon hitting the tarmac in Edmonton, the Kays made straight for the Royal Alexandria hospital, where Selwyn was admitted to the intensive care unit. Charlotte then set about getting the paperwork figured out to cover her expenses. It was then she found out her doctorSA国际影视传媒檚 request for her to be covered under the medical travel policy had been denied. Four letters to the NWT Health and Social Services Authority later, she was still on the hook for the costs of the emergency.
Charlotte says she was given multiple reasons for the denials. First the doctorSA国际影视传媒檚 request was turned down because of the wording of the letter. Kay added that even before she left she was told she would also need to get a doctor in Edmonton to sign off on her travel SA国际影视传媒� even though Selwyn had not even arrived at the time. As this was going on, her brotherSA国际影视传媒檚 health continued to deteriorate.
Selwyn Kay passed away Oct. 29 with Charlotte and her daughter by his side. But Charlotte says she wasnSA国际影视传媒檛 even able to begin grieving when the GNWT demanded she return north.
SA国际影视传媒淭hey wanted me on the plane the next day, without my brothers remains,SA国际影视传媒� said Kay. SA国际影视传媒淚 refused. I said ISA国际影视传媒檓 not leaving my brother here. My brother wanted to be cremated, and because of Covid-19 in Edmonton that took time to organize and I was not about to leave him there.SA国际影视传媒�
NTHSSA spokesperson David Maguire referred Inuvik Drum to the GNWTSA国际影视传媒檚 Medical Travel Policy, which lists seven criteria to be eligible for medical travel funding for both patients and escorts.
SA国际影视传媒淚f the request for benefits for a non-medical escort from the physician does not align with one of the escort criteria the benefits for the escort would not be approved,SA国际影视传媒� he said.
Escorts are evaluated on the patientSA国际影视传媒檚 conditions SA国际影视传媒� people under 19, breastfeeding women or women who are going out of territory to give birth, persons with physical or medical disabilities who are unable to travel unassisted or a person needing a language interpreter are listed as eligible.
Escorts are also listed as eligible if the SA国际影视传媒渞eferring health care provider indicates the Eligible Person, travelling for an initial diagnosis or an initial appointment for a life-threatening illness requires a non-medical escort to assist with understanding plan of care and/or treatment options,SA国际影视传媒� or if the SA国际影视传媒渁ttending physician at the treatment facility provides a written request for a non-medical escort to participate in a treatment program in order to learn how to care for the patient following discharge. Such requests require prior approval.SA国际影视传媒�
It also notes the Health Minister can overrule the policy in extraordinary circumstances.
Larga House does the heavy lifting
Charlotte Kay is not alone.
When patients are sent to Edmonton, they often stay at Larga House, which GwichSA国际影视传媒檌n Development Corporation co-owns with Nunatsiaq Corporation and Kitikmeot Corporation.
Larga House general manager Casey Adlem told Inuvik Drum her staff are taking on the roles of medical escorts for northerners on a weekly basis.
SA国际影视传媒淏ecause there are so many people there that require some assistance during the day, there could be several people every day that need help with regular every-day living,SA国际影视传媒� she said. SA国际影视传媒淕etting food, getting coffee, tea, going to the washroom, bathing SA国际影视传媒� all of that.
SA国际影视传媒淲e have hospitality staff, which is essentially housekeepers and janitors. We have kitchen staff for the dining room. We have drivers and then we have administration. ItSA国际影视传媒檚 usually the housekeeping staff we rely on for the majority of assistance with people who need help during the day and a night. TheySA国际影视传媒檙e really going above and beyond.SA国际影视传媒�
Picking up the medical escort responsibility is putting strain on an already overburdened establishment. For the last 19 months, Larga House has had strict sanitation protocols in place to ensure the building is not a Covid-19 exposure site for patients.
Adlem added Larga was covering the costs out of pocket.
SA国际影视传媒淲eSA国际影视传媒檙e not provided the financial resources we required,SA国际影视传媒� she said. SA国际影视传媒淪o thereSA国际影视传媒檚 more work already that weSA国际影视传媒檙e not being funded for, and we have people coming without escorts. So people are tired and itSA国际影视传媒檚 a lot of pressure.SA国际影视传媒�
Costs of running the facility have escalated even further as the pandemic festers, ironically because it has meant less medical travel overall, cutting into LargaSA国际影视传媒檚 ability to keep the lights on. Adlem added the cancellation of surgeries in Alberta resulting from the pandemic cut into the organizationSA国际影视传媒檚 books even further. Eventually, Adlem said staff had to be laid off, putting even more work on the remaining skeleton crew.
Adlem said she would like to see more support from the GNWT, noting the entire experience of medical travel is stressful enough on the patient, never mind having to do it alone.
She pointed out northerners have to leave their home community for services other Canadians can get without having to travel. The culture shock of the Edmonton International Airport, navigating the big city and hospital, memorizing doctorSA国际影视传媒檚 instructions and having to rely on a stranger to bathe oneself just make an already tough situation tougher. She said medical travel patients should be able to focus on their healing.
SA国际影视传媒淭hese are basic human rights,SA国际影视传媒� said Adlem. SA国际影视传媒淪ome of the people weSA国际影视传媒檝e had to take care of are in their 80s, in a wheelchair, without an escort. There are Elders who have come down for brain surgery without an escort.SA国际影视传媒�
Maguire said he could not comment on individual cases, but said the decision for a medical escort is based on the recommendations of the patientSA国际影视传媒檚 doctor.
SA国际影视传媒淚f the clinician does not make a request for a non-medical escort an escort would not be approved,SA国际影视传媒� he said. SA国际影视传媒淎n example of a scenario may be typically, if a patient ordinarily requires a wheelchair for mobility their health care provider will make a recommendation for a non-medical escort and the request is approved by the medical travel officer.
SA国际影视传媒淗owever, patients who do not ordinarily use a wheelchair sometimes request wheelchair assistance in the Edmonton Airport due to the long distances travelled within the airport. In these cases the airline staff provide wheelchair assistance through the airport.SA国际影视传媒�
Subsidizing the GNWT
When the Covid-19 pandemic first hit Canada in March of 2020, GTC Grand Chief Ken Kyikavichik said Larga House took immediate steps to ensure they were within Covid-19 safety measures. This included stopping the practice of shared accommodations and bathrooms, expanded sanitation and hiring security.
He said those decisions were entered into in good faith that a funding agreement could be negotiated out with the GNWT. However, as the pandemic carried on those talks stopped. Over the past year, Kyikavichik told Inuvik Drum the GTC and its two partners have spent at least $1 million trying to make up for the shortfall in medical travel approvals.
He said he felt the GTC was effectively subsidizing the GNWT through Larga, adding it was costing the GTC between $50,000 to $80,000 a month to maintain the level of service in compliance with public health orders.
SA国际影视传媒淪ince the fall of 2020 we have been raising this issue with the department of Health and Social Services, indicating that this is a problem and it needs to be addressed immediately,SA国际影视传媒� he said. SA国际影视传媒淲e had an initial meeting with Minister Green in March, and thatSA国际影视传媒檚 been followed by a number of letters indicating the financial exposure for Larga House. What has also risen to the surface is this issue has been exacerbated by the medical travel issue, whereby the stretched resources of Larga House are now being required to deal with NWT residences arriving in Edmonton arriving with no travel escort.
SA国际影视传媒淲e are seeing a systemic denial of medical travel escorts.SA国际影视传媒�
Kyikavichik said since the onset of the pandemic, Larga House has hosted over 3,000 medical travellers from both the NWT and Nunavut. From November of 2020 to May of 2021, Larga House counted 160 unescorted Elders over the age of 60 from the NWT. During the same time, there were two from Nunavut.
Even when medical travel is approved, Kyikavichik said many times people are not getting sufficient notice to be ready for the trip, adding it was not uncommon for patients to receive less than 24-hours notice of approval.
SA国际影视传媒淚tSA国际影视传媒檚 even less than five-hours notice,SA国际影视传媒� he said. SA国际影视传媒淚SA国际影视传媒檝e heard cases of people being advised between 10 and 11 a.m. that they were going to be on the Edmonton flight at 1:30 p.m. for medical travel.SA国际影视传媒�
Kyikavichik said the policy spells right out that medical travel should not be a burden on patients, but suggested the GNWT was under budget constraints.
He said from his observations, the GNWT simply doesnSA国际影视传媒檛 have the money to cover everyoneSA国际影视传媒檚 medical expenses.
SA国际影视传媒淲hat it certainly appears to be is a financial issue, in that thereSA国际影视传媒檚 inadequate budget for NTHSSA thatSA国际影视传媒檚 resulting in this systemic denial of non-medical escorts for patients,SA国际影视传媒� he said. SA国际影视传媒淭hat is part of the reasoning behind why the criteria is being interpreted in this manner.SA国际影视传媒�
Charlotte Kay eventually turned to the federal Department of Indian and Northern Affairs for support and got medical travel approval. Altogether, the ordeal took three weeks.
She said the approval from Ottawa took roughly a week and covered her costs of the trip and the flight.
SA国际影视传媒淚t really caused a hardship on my family,SA国际影视传媒� she said. SA国际影视传媒淭hey hire staff here to deal with medical travel, why arenSA国际影视传媒檛 they capable of making that decision of approving it. Why does it have to go to Yellowknife and you have to wait hours or sometimes days? If the doctor says you need an escort, they should be going by that. Why wait to get to Edmonton? God forbid my brother passed away while ISA国际影视传媒檓 still here SA国际影视传媒� or passed away in the bush waiting for $30,000 to pay for a medevac?
SA国际影视传媒淣o Elder should be travelling by themselves. They should have a medical escort to explain the medical terminology thatSA国际影视传媒檚 being told to them.SA国际影视传媒�
