Health and Social Services

SECTION 14.0 

Cree Health and Social Services 

14.0.1 Except if elsewhere expressly provided herein, the laws of general application respecting health services and social services shall apply to the Crees in the Territory. 

14.0.2 Québec shall establish forthwith upon the execution of the Agreement, and in accordance with the provisions of this Section, a Cree Regional Board of Health Services and Social Services, in order to exercise the powers and functions of a Regional Council within the meaning of the Act respecting Health Services and Social Services (L.Q. 1971, c. 48). 

14.0.3 The said Cree Regional Board shall be responsible for the administration of appropriate health services and social services for all persons normally resident or temporarily present in the Region described in paragraph 14.0.5, in conformity with the said law. 

14.0.4 The said Cree Regional Board shall also take over and exercise the powers and functions of the existing establishment at Fort George, as well as other establishments hereafter created. The said Board shall also be vested with the ownership of all the assets of the said establishment at Fort George. The Cree Regional Board, in the case of the creation of a new establishment, shall regulate and supervise the election of the members of the boards of directors of such establishments, if it determines that such establishments shall have a board of directors distinct from that of the Cree Regional Board. 

14.0.5 The Cree Regional Board shall have jurisdiction over that portion of the Territory comprising Categories IA and IB lands allocated for the James Bay Crees, including the Crees of Great Whale River, as well as Category II lands contemplated in Section 5 of the Agreement, and which region shall be designated as Region 10B. The jurisdiction in respect to Category II shall not preclude the jurisdiction of any other board established from time to time by Québec. For greater certainty, from the coming into force of Complementary Agreement No. 22, the Category IA, IB and II lands of the Crees of Oujé Bougoumou shall form part of Region 10B, and the Cree Regional Board shall have jurisdiction thereon. 

JBNQA, par. 14.0.5 

Compl. A. no. 22, sch. 3, s. 4 

14.0.6 Notwithstanding paragraph 14.0.2 the Cree Regional Board shall not supervise its own elections, shall not assess its own performance and shall not exercise the functions specified in Section 16 (c) of the said Act, which powers shall be exercised by the Minister of Social Affairs. 

14.0.7 In supervising or conducting elections of community representatives to the said Board, the Minister of Social Affairs shall not consider or declare an election to be irregular or invalid due to lack of formalities having been followed providing the Minister is satisfied that the election was carried out in accordance with the customs and procedures or the Native people of said communities and that such customs and procedures did not deprive any qualified individual of the right to vote or of the right to hold office. 

14.0.8 In the event that the Minister declares an election of a community representative to be irregular and invalid pursuant to paragraph 14.0.6 the chief of such community shall be the Cree representative for such community on the said Board until another representative from such community has been validly elected. 

14.0.9 The existing establishment situated at Fort George shall be part of and shall fall under the authority of the said Cree Regional Board and shall be created as a public establishment of the four classes mentioned in Section 39 of the said Act, by the issue of letters patent or supplementary letters patent, as the case may be, forthwith upon the execution of the Agreement, in accordance with the provisions of the said Act.

14.0.10 All persons normally resident or temporarily present in the said Region 10B shall be entitled to the services included within the jurisdiction and powers of the said Cree Regional Board. 

14.0.11 The Cree Regional Board should be composed of: 

a) one (1) Cree representative from and elected for three (3) years by each of the distinct Cree communities (as defined in Section 3) in the said Region existing or hereafter created by or pursuant to the Agreement, ordinarily served by or through the Cree Regional Board; 

b) one (1) Cree representative appointed for three (3) years by the Cree Regional Authority or its successor; 

c) three (3) representatives elected for three (3) years, from among and by those persons who are considered to be members of the clinical staff of an establishment in the said Region within the meaning of the said Act providing that no more than one (1) member of any one professional corporation may serve on the board at any time; 

d) one (1) representative elected for three (3) years, from among and by those persons who are members of the non-clinical staff of any establishment in the said Region; 

e) the director of the community health department of a hospital centre, forming part of the Cree Regional Board or of a hospital centre with which the Cree Regional Board has a service contract or his nominee or the professional director or his nominee. The Cree Regional Authority shall appoint such person if there is more than one such centre; 

f) the general manager of the establishment in the said Region or, if there is more than one such establishment, a person chosen by and from among such general managers. 

14.0.12 One-third of the first members elected under sub-paragraphs 14.0.11 a) and 14.0.11 c) shall serve for one (1) year and another one-third of such members shall serve for two (2) years. The members with such terms of office shall be designated by the drawing of lots at the first meeting of the Cree Regional Board. 

14.0.13 The term of office of the members of the Cree Regional Board elected in virtue of sub paragraphs c) and d) of paragraph 14.0.11, shall not be renewed consecutively more than once. 

14.0.14 Notwithstanding the provisions of Section 24 of the said Act, the members of the Cree Regional Board shall be indemnified for loss of income incurred by them, in accordance with the regulations to be established by such Board. 

The members may also be indemnified in accordance with the said regulations for their expenses incurred in attending such meetings. 

Such regulations shall take into account the prevailing conditions in the said Region, shall be subject to the approval of the Minister of Social Affairs and shall take into consideration the following: 

a) Board meetings shall be scheduled, whenever possible, to avoid conflict with the remunerated work of Board members and to take advantage of convenient or inexpensive transport; 

b) if, in spite of the foregoing, individual members suffer loss of income, the Board may indemnify such members for such loss, upon application therefore and where: 

i) the Board member represents or normally resides in a community other than that in which the meeting is held, and 

ii) the Board member is either self-employed or employed under conditions which preclude continuation of remuneration during time absent to attend such meetings, and

iii) loss of remuneration is clear and unequivocal rather than potential. 

14.0.15 The members of the Cree Regional Board shall, in a general meeting each year, elect a chairman and vice-chairman of the Board from among their number. 

In the case of a tie-vote at a meeting of the members of the Board of Directors, the Chairman of the meeting shall have a casting vote. 

14.0.16 The Cree Regional Board shall establish, by by-law, an administrative committee and determine its functions, powers and duties. The administrative committee shall consist of the Chairman of the Board, the general manager of an establishment and four (4) other members of the said Board, at least one (1), but not more than two (2), of whom shall have been elected under paragraphs 14.0.11 c), d) and e). 

14.0.17 The Cree Regional Board shall meet at least four (4) times annually. A quorum, for such meetings, shall consist of four (4) representatives elected in accordance with the provisions of paragraph 14.0.11 a) and two (2) other representatives. 

14.0.18 

a) Those persons who are Cree, in accordance with the criteria established in Section 3, and who are entitled to vote and hold office pursuant to the provisions established in Section 10 for local government in the said Region, as well as the Inuit ordinarily resident in the community of Fort George, who are of the age of majority, shall be entitled to vote for and to hold office in the Cree Regional Board. 

b) All non-Cree persons who have been ordinarily resident for the twelve (12) months preceding any election in one of the communities served by the Cree Regional Board, shall be entitled to vote for the members to be elected pursuant to sub-paragraph 14.0.11 a). 

c) There shall be no residency requirements in respect to entitlement to vote or to hold office under the provisions of sub-paragraphs 14.0.11 c), d), e) or f). 

14.0.19 In implementing the Agreement and in dealing with the Cree Regional Board, Québec should recognize and allow to the maximum extent possible for the unique difficulties of operating facilities and services in the North: 

a) in recruiting and retaining staff, generally; working conditions and benefits should be sufficiently attractive to encourage competent personnel from outside the said Region to accept posts for periods of time ranging from three (3) to five (5) years; 

b) in providing employment and advancement opportunities for the Native people in the fields of health and social services, and in providing special educational programs to overcome barriers to such employment and advancement; 

c) in budgeting for the development and operating of health and social services and facilities to compensate for the disproportionate impact of northern costs, including transportation, construction and fuel costs. 

14.0.20 Future health and social programs and services should be applied to the maximum extent possible through the Cree Regional Board. 

14.0.21 A Cree band may continue to apply for, receive and administer funds from such direct grant programs as may be agreed upon by the Cree Regional Board and such band. 

14.0.22 The budget from Québec to the Cree Regional Board shall include funding for the support of health services, which are not included in Provincial programs for the general population, but which are provided to the Native people by the Department of National Health and Welfare or other agencies.

14.0.23 The basis for determining the amounts of the budget support in paragraph 14.0.22 should be the actual expenditures for health and social services for the fiscal years 1974-75 provided by Canada and Québec to the extent of responsibilities assumed by Québec under this Section and Schedule I thereof. Funding will be modified on the basis of changes in the Cree population, the cost of the specific services included and the evolution of provincial programs for the general population. 

14.0.24 The expenses of the Cree Regional Board shall be paid in accordance with the provisions of Sections 132 and 136 of the said Act, taking into account the provisions of this Section. 

14.0.25 In respect to the implementation of this Section, it is the intention of the parties that all health services in the said Region and social services in the said Region shall ultimately fall under the Cree Regional Board and that the assumption of such responsibility should be achieved in an orderly and deliberate manner. The initial steps towards assuming such responsibility are set out in Schedule 1 of this Section. 

14.0.26 Until such time as the Crees have accepted full provincial funding for all health services to the Crees, in accordance with Schedule 1 of this Section, the latter reserve their option in respect to the provisions of such services by Canada. 

14.0.27 Health centres, nursing stations and health stations at various locations, in accordance with the attached Schedule 2, belonging to the Department of National Health and Welfare and all material and other assets located in such buildings as part of the regular equipment shall be turned over to Québec by reciprocal Orders in Council. The time schedule for turning over the federal health facilities shall coincide with the assumption of full responsibility for administration of health services by Cree Regional Board at which time the said assets shall be transferred to the said Board by Québec at no cost of it. 

14.0.28 Québec shall take all measures necessary in order to implement this Section. The legislation recommended to give effect to the foregoing shall apply notwithstanding the provisions of Section 2 of the Health Services and Social Services Act. Québec undertakes that any future amendments to laws respecting health services and social services which are recommended to the legislator shall not derogate without just cause from the rights of the Crees to the following: 

a) the existence of a separate Board for the administration of health services and social services within Category IA and IB lands and for the Crees within Category II lands; 

b) to uniquely Cree representation from Cree communities in the Territory; 

c) the option for creating a Regional council and separate Boards for each establishment in said Region 10B; 

d) financial support for services which at least maintain existing scope, range, extent and conditions; 

e) administration of future health and social services programs to the fullest extent possible through the Cree Regional Board. 

14.0.29 The provisions of this Section can only be amended with the consent of Canada and the interested Native party, in matters of federal jurisdiction, and with the consent of Québec and the interested Native party, in matters of provincial jurisdiction. 

Legislation enacted to give effect to the provisions of this Section may be amended from time to time by the National Assembly of Québec in matters of provincial jurisdiction, and by Parliament in matters of federal jurisdiction.

Annex I 

The existing Federal and Provincial services shall remain intact during the period of time preceding the creation of the Cree Regional Board and shall be modified thereafter only by definitive action by the Board either through contract or acceptance of Province funding. Initially, the Board should assume responsibility for all services to the Fort George population by no later than March 31, 1977, and thereafter in accordance with the ability of the Board to assume further responsibilities and subject to acceptance of this by the other Cree communities, but in any event not later than March 31,1981. 

Annex II 

Section 14 (CREE) 

Land Information Sheet 

Real Property Holdings 

SECTION 15 

Health and Social Services – Inuit 

15.0.1 The Kativik Health and Social Services Council and the establishments shall be governed, mutatis mutandis, by the provisions of the Act respecting Health Services and Social Services (1971, c. 48) and all other laws of general application in the province, save where these laws are inconsistent with this Section, in which event the provisions of this Section shall prevail. 

15.0.2 The Regional Government shall be charged with promoting, by all means and measures which it may deem adequate, the advancement and development of public health in Region 10A which shall encompass the territory under the jurisdiction of the Regional Government established pursuant to Section 13 of the Agreement. 

15.0.3 There shall be a health and social services council for the said Region 10A under the name of “Kativik Health and Social Services Council”. 

15.0.4 All rights, powers, privileges and obligations of the Kativik Health and Social Services Council shall be exercised by the council of the Regional Government. 

The functions, powers and duties of the administrative committee, general manager and staff of the Kativik Health and Social Services Council shall be exercised by the executive committee, the head of the Health and Social Services Department of the Regional Government and the officers of the Regional Government respectively. 

15.0.5 The Council shall regulate and supervise the election of the members of the boards of directors of the establishments contemplated by paragraph 15.0.9 of this Section. 

Every regulation made by the Council under this paragraph must deal with the procedure to be followed in such election and provide for a voting period of at least four (4) hours for the members of each of the electoral colleges contemplated by paragraph 15.0.12. 

Such regulation must be submitted for the approval of the Lieutenant-Governor in Council; if it receives such approval, it shall come into force on the date of its publication in the Québec Official Gazette. Québec agrees to repeal Order-in-Council 1888-75 of May 7, 1975. 

15.0.6 If the Council fails to exercise the functions assigned to it by paragraph 15.0.5 of this Section, such functions shall be exercised by the Minister. 

15.0.7 Notwithstanding the provisions of paragraph 2.9 of Schedule 2 of Section 12 and paragraph 2.9 of Schedule 2 of Section 13 of the Agreement, any ordinance passed by the Regional Government under this Section shall apply within the whole territory of the Regional Government and its application shall not be limited to municipalities. 

15.0.8 For the purposes of health services and social services, Region 10A initially shall be divided into two sectors : the Hudson Bay Sector and the Ungava Bay Sector. 

Every city or town, village, county, mining town and other municipalities customarily receiving health and social services in the Hudson Bay Sector shall be included in the Hudson Bay Sector; the Ungava Bay Sector shall include all city or town, village, county, mining town and other municipalities customarily receiving health and social services in the Ungava Bay Sector. 

15.0.9 There initially shall be established by letters patent one establishment for each sector including all of the four (4) following classes : 

a) local community service centres; 

b) hospital centres; 

c) social service centres; 

d) reception centres. 

A hospital centre for general care shall be encompassed within each of the initially designated establishments in accordance with the implementation schedule set forth in Schedule 1 of this Section. 

15.0.10 All persons normally resident or temporarily present in Region 10A shall be entitled to the services included within the jurisdiction and powers of the establishment. 

15.0.11 All the powers of the establishment shall be exercised by a board of directors composed in accordance with paragraph 15.0.12. 

15.0.12 Each establishment shall be administered by a board consisting of the following members, who shall be members of it upon their election or appointment : 

a) one representative from, and elected for three (3) years by, each municipality of the sector; 

b) three (3) representatives elected for three (3) years, from among and by those persons who are considered to be members of the clinical staff of an establishment in the said Region within the meaning of the said Act providing that no more than one member of any one professional corporation may serve on the board at any time; 

c) one representative elected for three (3) years, from among and by those persons who are members of the non-clinical staff of any establishment in the said Region; 

d) the director of the community health department of a hospital centre, or agency forming part of the Kativik Health and Social Services Council or of a hospital centre with which the Kativik Health and Social Services Council has a service contract or his nominee or the professional director or his nominee. The Kativik Health and Social Services Council shall appoint such person if there is more than one such centre; 

e) the head of the Health and Social Services Department of the Regional Government or his nominee; f) the general manager of the base facility in the sector. 

Such representatives shall be elected according to the election proceedings established by the Kativik Health and Social Services Council under paragraph 15.0.5. 

If the election of a member is not held, the Kativik Health and Social Services Council shall make the appointment. 

15.0.13 The provisions of paragraphs 13 to 15 and 45 to 47 of Schedule 2 of Section 12 of the Agreement shall apply, mutatis mutandis, to the qualification of candidates and electors for the election of the members of the board of directors elected under sub-paragraph a) of paragraph 15.0.12. Persons otherwise eligible to hold office under sub-paragraphs b), c), d), e), and f) of paragraph 15.0.12 shall be exempted from any residency or domicile requirements. 

15.0.14 Any vacancy among the members elected in accordance with paragraph 15.0.12 shall be filled by following the mode prescribed for the election of the member to be replaced, only for the unexpired portion of the term of such member. 

15.0.15 Notwithstanding the provisions of Section 24 of the Act respecting Health Services and Social Services, the members of the board of directors shall be indemnified in accordance with regulations to be adopted by such board for loss of income suffered by the members as a result of attending meetings. The members may also be indemnified in accordance with the said regulations for their expenses incurred in attending such meetings.

Such regulations shall take into account the prevailing conditions in the said Region, shall be subject to the approval of the Minister of Social Affairs, and shall take into consideration the following : 

a) Board meetings shall be scheduled, whenever possible, to avoid conflict with the remunerated work of board members and to take advantage of convenient or inexpensive transport. 

b) If in spite of the foregoing, individual members suffer loss of income, the board may indemnify such members for such loss, upon application therefore and where : 

i) the board member represents or normally resides in a community other than that in which the meeting is held, and 

ii) the board member is either self employed or employed under conditions which preclude continuation of remuneration during time absent to attend such meetings, and 

iii) loss of remuneration is clear and unequivocal rather than potential. 

15.0.16 The board of directors of every establishment must establish, by by-law, an administrative committee and determine its functions, powers and duties. 

15.0.17 The administrative committee shall consist of the chairman of the board of directors, the general manager and three other members of the board of directors of the establishment appointed each year by such board. 

15.0.18 Paragraph 15.0.15 shall apply, mutatis mutandis, to members of the administrative committee when attending meetings of such committee. 

15.0.19 The budget from the Province of Québec to each establishment shall include funding for the support of health services which are not included in provincial programs for the general population but which are provided to the Native people by the Department of National Health and Welfare or other agencies. 

15.0.20 The basis for determining the amounts of the budget support in paragraph 15.0.19 shall be the actual expenditures for health and social services for the fiscal year 1974-75 provided by Canada and Québec to the extent of the responsibilities assumed by Québec under this Section and Schedule I hereof. Funding will be modified on the basis of changes in the population, the cost of the specific services included, and the evolution of provincial programs for the general population. 

15.0.21 In implementing the Agreement, Québec should recognize and allow to the maximum extent possible for the unique difficulties of operating facilities and services in the North : 

a) in recruiting and retaining staff, generally; working conditions and benefits should be sufficiently attractive to encourage competent personnel from outside Region 10A to accept posts for periods of time ranging from three (3) to five (5) years; 

b) in providing employment and advancement opportunities for Native people in the fields of health and social services, and in providing special educational programs to overcome barriers to such employment and advancement; 

c) in budgeting for the development and operating of health and social services and facilities so as to compensate for the disproportionate impact of northern costs, including transportation, construction and fuel costs. 

JBNQA, par. 15.0.21 

A. corr.

15.0.22 Every establishment may make contracts of professional services with any other establishment or body whereby one party binds itself to make services of a professional nature available to the other or by which the parties exchange such services; such a contract shall be valid only from the date on which it is filed with the Kativik Health and Social Services Council. 

15.0.23 Every establishment must, at least once a year, hold a public information meeting, in which the population of the sector served by the establishment shall be invited to participate. 

The members of the board of directors must there answer the questions put to them respecting the establishment’s financial statements, the services it provides and the relations it has with the other establishments and with the Kativik Health and Social Services Council. 

The mode of calling such meeting and the procedure to be followed at it shall be determined by the Kativik Health and Social Services Council. 

15.0.24 Québec shall take all measures necessary in order to implement this Section. The legislation to be enacted to give effect to the foregoing shall apply notwithstanding the provisions of section 2 of the Act respecting Health Services and Social Services. 

JBNQA, par. 15.0.24 

A. corr. 

15.0.25 Health centers, nursing stations and health stations at various locations, in accordance with the attached Schedule 2, belonging to the Department of National Health and Welfare and all material and other assets located in such buildings as part of the regular equipment shall be turned over to the province of Québec by reciprocal Order-in-Council. The time schedule for turning over the federal health facilities shall coincide with the assumption of full responsibility for administration of health services by the Kativik Health and Social Services Council at which time the said assets shall be transferred by Québec to the said Council at no cost to it. 

15.0.26 This Section shall be implemented gradually over a maximum Transition Period of five (5) years, in accordance with the provisions of Schedule 1, beginning upon the execution of the Agreement. 

15.0.27 The provisions of this Section can only be amended with the consent of Québec and the interested Native party. 

Legislation enacted to give effect to the provisions of this Section may be amended from time to time by the National Assembly of Québec.

Annex 1 

(1) This Section shall preserve and improve the scope, extent, conditions and availability of existing health and social services and related services, but in a way that does not inhibit mutually desirable changes in programs or in their administration; foster progressively the training and education of health and social services personnel from among the Native people; and recognize the unique needs and the problems associated with meeting such needs in northern areas. 

(2) Except as indicated below, the existing federal and provincial services shall remain intact during the period of time preceding the creation of the Kativik Health and Social Services Council and shall be modified thereafter only by definitive action by or through the Council, but in any event the existing federal services shall be terminated not later than the last day of the five (5) year Transitional Period mentioned in paragraph 15.0.26. 

(3) Forthwith upon the execution of the Agreement, a working group shall be assembled under the auspices of the Ministry of Social Affairs of Québec to review the means by which, and with the intention of expeditiously organizing, a broad range of support services, including but not limited to assistance with transportation and housing, translation, and counselling, might be made available to Inuit travelling to centers in the south or returning to their homes in the north. The working group should include representatives of those agencies currently providing or coordinating such services and two (2) representatives appointed by the Northern Quebec Inuit Association. 

The working group shall table its recommendations with the Minister of Social Affairs by May 1, 1976. In the interim, Canada and Québec shall maintain existing supportive services to the Inuit. 

(4) Agencies of Québec and Canada will immediately undertake to improve health and social services for persons residing in the communities of Aupaluk, Port Burwell, and more urgently, Akulivik. As the need arises health and social services shall expeditiously be considered for the residents of new communities that may be established in the future within Region 10A. 

(5) Québec undertakes to expeditiously review health and social services staff, facilities and equipment at Kuudjuaq (Fort Chimo) with the intention of upgrading the capabilities of the existing establishment to fulfill the sectoral responsibilities envisaged by this Section, and similarly for the community of Povungnituk, including plans for the earliest feasible construction of a hospital centre for general care.

Annex 2 

Section 15 (Inuit) 

Land information Sheet

Real Property Holdings

Summary

The Cree Regional Board of Health and Social Services will be established in Quebec to administer health and social services for Crees in the Territory. It will have jurisdiction over a portion of the Territory comprising Categories IA and IB lands allocated for the James Bay Crees and Category II lands contemplated in Section 5 of the Agreement. The board will also take over and exercise the powers and functions of the existing establishment at Fort George and other establishments hereafter created. It shall not supervise its own elections, assess its own performance, or exercise functions specified in Section 16 (c) of the Act, which powers shall be exercised by the Minister of Social Affairs. If an election of a community representative is declared irregular or invalid, the chief of such community shall be the Cree representative for such community on the board until another representative is validly elected. All persons normally resident or temporarily present in the Region described in paragraph 14.0.5 will be entitled to the services included within the jurisdiction and powers of the board. The regional board will have a representative from and one representative from each of the Cree communities within the Region 10B.

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