Health and Social Services keeps inadequate health care records, has set no priorities or targets for itself and lacks a proper human resources plan, Auditor General Sheila Fraser says of the Yukon government's largest department.

And its shortcomings are not restricted to shoddy record-keeping or lack of labour strategy, Fraser said Tuesday. She was in Whitehorse to deliver her performance audit of the department, which last year cost $258 million to operate.

"We found that (it) does not prepare business case analyses on a regular basis,” Fraser writes in her report.

"(So) there is a risk that the status quo will continue and projects or programs that could reduce costs or enhance services will not be implemented.”

To highlight the importance of such analyses, the performance audit notes the department's decision to start a magnetic resonance imaging (MRI) program, in which a sound business case was made.

In the absence of similar business cases for building new hospitals in Watson Lake and Dawson City – a $50-million expense largely criticized for stretching resources and increasing health care costs – Fraser preferred to speak in general terms.

"I didn't look at the question of hospitals in this, but clearly I think it's important for any government with any program or service, to know what are you trying to achieve with that,” Fraser told journalists during a press conference Tuesday, when asked about the prudence of the government's current direction.

But her performance audit does point to Health and Social Services' lack of direction, and recommends that it rank its health care priorities, set timelines and targets to address and outline resources required to meet them.

"The department has not established either key health indicators or targets for them,” writes Fraser. "We also found that it has not established targets for health outcomes.”

Without these, Fraser continues, "the department cannot assess whether it is making progress in these areas.”

Indicators, outcomes or measurement processes are non-existent for diabetes or Health and Social Services' alcohol and drug programs, according to Fraser's report.

The Yukon is also one of four Canadian jurisdictions in which it is not mandatory for physicians to fill out International Classification of Diseases (IDC) codes on invoices to the department.

"I certainly hope they will make this mandatory so they can get better information on the prevalence of diseases in the territory,” Fraser told the media.

The auditor general also spoke to millions of dollars in overspending by the department for the previous two fiscal years that were unauthorized by the legislative assembly, and therefore in contravention of the territory's Financial Administration Act.

Fraser dismissed the department's excuse that those dollars were to pay for out-of-territory medical treatment – invoices for which can take a year to receive.

"They should not be waiting to have the invoice; they should really know who is being sent out of the territory for these services and doing an estimate for these costs,” Fraser said.

While Health and Social Services agreed to act on Fraser's raft of recommendations, she said "it's up to the department to establish what is realistic to achieve.

"It's not up to an auditor general to establish priorities of a department,” Fraser added.

The per capita cost for providing health care to Canadians in 2010 was $3,957, but in the Yukon, this amount was $6,304, compared to $7,700 in the Northwest Territories and $11,593 in Nunavut.

For the Yukon government, Health and Social Services consumed 29 per cent of last year's billion-dollar budget.

Of the $258 million spent by the department in 2010, $148 million provided health services, $28 million went towards continuing care expenses, while the balance covered social services expenditures.

Fraser's performance audit also reported some troubling statistics.

Of the 1,774 alcohol-related emergency room admissions at Whitehorse General Hospital in 2009/2010, just 22 clients accounted for 567 of those visits, or 33 per cent.

Additionally, 155 individuals accounted for 216 drug-related emergency room admissions during the same year.

See related story below.