A contract to provide dedicated on-site medical support for users of the day shelter and sobering centre expires Sept. 30 and the territorial government will not be extending it.

Sean Ivens, president and chief executive officer of Advanced Medical Solutions (AMS), said this week that his company has been providing a range of medical services at both locations for street vulnerable people since 2015 under contract by the Northwest Territories Health and Social Services Authority (NTHSSA).

However, within the past month, Ivens said he was notified when seeking a contract extension that the GNWT will no longer be needing the company’s service.

“We are fairly proactive with our contracts so we always want to ensure that our extensions are in place prior to the end of an existing contract,” he said. “This contract was set to expire Sept. 30, 2022. We notified the government that it was going to expire and that we would request a six-month extension. We were notified shortly thereafter that there would be no extension or further need for medical service.

“I’m just a little surprised it came to this.”

Ivens said he was notified the service would be terminated and another program would be providing check-in service for clients.

Since the facilities have been in operation, users have been required to go through a check-in process which has involved AMS providing a general medical support assessment.

But that role has evolved, Ivens said, to meet the needs of clients.

Treating cuts or scrapes or assessing different types of impairment is important to ensure safety for each individual when entering, as well as other users and workers.

However, AMS medical staff have also been providing more ongoing and dedicated care, as needed, such as with diabetes management or help with medication intake.

“There is also really an immeasurable category that slips under the radar,” Ivens said. “When working with this clientele there is support we have been providing where if clientele become agitated or frustrated or even at times potentially violent, our staff would work with that individual to defuse the situation and treat them as humans and provide support.

“There have been many cases where staff would take them for a walk, buy them lunch, bring them back and things would settle down. It is a preventative piece that you can’t really measure.”

Fire and ambulance and emergency response

Ivens said that over the years of operation, the company has been working with other emergency organizations and law enforcement to try to reduce ambulance calls to both the sobering centre and day shelter and to lessen demand at the emergency unit of Stanton Territorial Hospital.

“We started seeing a fairly significant reduction in those types of calls with the fire department since we started service.”

The City of Yellowknife was provided a list of questions as to what the discontinuation of AMS services might mean for the municipality, including the impact on the fire division’s ambulance response and any input the city might have had in the decision.

All questions were referred to the GNWT because the territorial government contracts the service.

Ivens said he doesn’t want to be seen as a business owner complaining about revenue but rather is concerned as a dedicated Northerner that a segment of the population may be negatively affected.

“I’ve grown up in the North around this population from childhood on and I felt that some of the initiatives that we put in place were working and beneficial,” he said.

NWT Disabilities Council

Denise McKee, executive director with the NWT Disabilities Council, stated on Sept. 29 that a lack of medical services on site will impact the homeless population and broader community. The disabilities council was operating both the day shelter and sobering centre up until earlier this year.

“Provision of 24-hour medical services is a key component of the harm-reduction model, which is the ideological foundation for the Day and Sobering Shelters,” McKee stated. “It goes far beyond ‘checking people in.’ Often, the homeless population accessed the medical on-site professional to attend needs, as they arose, because they could not access any other services while intoxicated. This was a proactive measure to meet their health needs and keeping them safe.”

She added that whenever there have been “sudden health emergencies” on site that it has been important to have a professional medical person to provide immediate care.

“The homeless population has self-identified, through evaluations and interviews, that having on-site medical professionals is one of the most profoundly impactful services provided as they often have no other option for medical care,” stated McKee.

She said she expects there will be significant impacts and increases in use of non-emergency care at the hospital by the street vulnerable population as a result of this decision.

“This will likely cause delays in response times to medical emergencies in the community at large,” she stated. “We saw the trend in the past, prior to health professionals being available at the Day and Sobering Shelters, of these services bring utilized to attend non-emergencies and, at times, utilized for the purpose of transportation, minor health issues or intoxication.

“This was the very rationale for introducing the on-site service in the beginning.”

McKee said she has difficulty envisioning how the facilities might operate given the risk and insurance liabilities associated with not having a medical person on site.

“In our research regarding sobering centres across the country, if they did not have a medical professional on site then they were connected to a medical provider, in the same location, to allow for immediate response,” she started. “The potential for this to have negative outcomes is significant.”

Yellowknifer’s questions submitted to the NTHSSA on Sept. 26 and 29 did not elicit responses as of noon on Sept. 29.

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