With more than $50 million spent on flights every year, the Government of Nunavut is looking to get the best bang for its buck in its next medical travel contracts.
But Nunavut MLA Joe Enook says he hopes the process will focus as much on improving services for patients as it does about money — and he's citing a recent incident where Pond Inlet residents flying to Iqaluit for treatment were bumped from a First Air flight in favour of tourists.
"My reaction was absolutely shocked, dismayed and very sad," Enook told CBC.
"When a person has an appointment either here in Iqaluit or in Ottawa, that person might have waited a long time and to have the airline take them off their flight because a tourist had to make their connecting flight is, in my humble opinion, ludicrous."
Specific details of the incident have not been released for privacy reasons, but Health Minister George Hickes confirmed patients weren't given top priority on the flight, as outlined in the territory's expensive medical travel contracts.
"There was an error. I'm sure it was unintentional but it does create challenges for the Department of Health," said Hickes in an interview with CBC.
Hickes added that he shares Enook's outrage.
Medical travel a common part of Nunavut life
Nunavut has 25 remote, fly-in communities, but only one hospital: the Qikiqtani General Hospital in Iqaluit.
"We're not able to provide all the levels of health care that our residents need," said Hickes. "So we have to rely upon outside jurisdictions."
According to a report about the territory's medical care plan tabled last year, the most common referral centres for Nunavut patients are Ottawa, Winnipeg, Yellowknife and Edmonton.
The report blames the territory's "very low population density and limited health infrastructure," which includes deficits in both equipment and human resources.
"The medical travel component is a key component of health care," Hickes said.
This fact, combined with long patient wait times, is part of the reason why the Pond Inlet situation is so infuriating to Enook.
"How much longer are they going to have to wait to see a specialist?" he said. "We have a huge contract and that should have some power as to who gets on that plane or not."
Tens of millions of dollars spent each year
In the last fiscal year, medical travel cost $50.7 million, with the territory's three major airlines — First Air, Canadian North and Calm Air — each receiving somewhere between $14 million and $18.3 million.
"Medical travel's a huge component," said Hickes. "It's almost a quarter of the Department of Health's budget overall."
And that's only going up.
Nearly a decade ago, Nunavut MLAs debated the increasing cost of medical travel, which then-regular-MLA Keith Peterson said was not sustainable.
"Costs are always going up," Peterson said at the time. "It's proven over time that the costs will increase."
And Peterson's prediction has proven true.
Ten years ago, in 2005-2006, the medical travel cost was $39.4 million. The year before that, it was $34.7 million.
The budget for medical travel and transportation has been increasing every year.
Looking for 'efficiencies' in new contract
The current standing offer of agreements with Keewatin Air, Canadian North and First Air are set to expire on Aug. 31, 2017.
Hickes said his department is working with other government officials to decide on the next steps for the contract renewals.
"When we're dealing with that size of line item out of our budget, it's a huge impact, so any efficiencies that we can identify to maximize the care, we're going to explore."
As for the situation in Pond Inlet, Hickes tempered his outrage with pragmatism while responding to Enook's concerns in the legislature.
"To err is human," he told the assembly. "I don't want to put too much pressure on the individual that may have misunderstood the policy.
"I trust that the airlines have communicated with their staff that medical travel clients are a priority on any flight in Nunavut."
Enook's words on the subject were decidedly less charitable.
"I hope [Hickes], in the strongest terms... conveys that it's just not acceptable."
CBC has requested comment from First Air, but has not yet received a response.