National Defence Committee on Feb. 12th, 2008

[The Chair, Conservative, Rick Casson]

I call the meeting to order.

Today we continue our study of the health services provided to Canadian Forces personnel, with an emphasis on post-traumatic stress disorder.

Today we have another expert panel. We'd like to welcome you, Colonel Gerry Blais, director of casualty support and administration, and Colonel David Weger, director of health services personnel.

Gentlemen, I understand that you both have presentations to make. We'll get you both to make them, and then we'll open it up to the usual round of questions. The floor is yours. Please proceed.

[Colonel David Weger, Director, Health Services Personnel, Department of National Defence]

Thank you, Mr. Chairman.

Mr. Chairman, members of the committee, I am Colonel David Weger, the director of health services personnel for the Canadian Forces. I thought it might be useful, by way of my opening remarks, to provide the committee with some idea as to what my general terms of reference are, and more specifically, what the responsibilities of my position are.

As director of health services personnel, I am responsible for two major areas of activity: health services, individual training and education, and health services, occupational management. I would also note at this point that I deal with these areas as they pertain almost exclusively to uniformed health services personnel, that is, those health services personnel who are in the military. I play no direct role in the mental health world, nor do I work with operational stress injury or post-traumatic stress disorder.

Within the realm of health services, individual training, and education, I am responsible for the development of training and education guidance, the establishment of occupational standards, the strategic oversight of training delivery, validation of training programs, and management of our maintenance of clinical skills program.

In all, there are in excess of 300 health services related individual training and education activities. These activities run the spectrum from primary care paramedic training at the Justice Institute of British Columbia to post-graduate medical specialty education at various Canadian universities, and from basic field medical services training at the Canadian Forces Medical Services School in Borden to the joint medical planner course at the NATO School in Germany. My directorate is also responsible for the administration of the Canadian Forces first aid program.

On the occupational management side of my portfolio, I am responsible for helping to manage the 19 health service occupations found in the Canadian Forces by ensuring that the Canadian Forces has sufficient uniformed health services providers to meet its operational needs. This includes the identification of recruiting targets, the establishment of periods of service, the creation of occupational structures that foster career progression, and the attraction and retention of health services human resources.

By virtue of my position, I am also the team leader for five human resources initiatives under our major health services reform project, Rx2000. Three of these initiatives deal with the enhancement and sustainment of clinical skill sets, one with the attraction and retention of health services personnel, and the last with both these areas as they pertain specifically to the nursing profession within the Canadian Forces.

I would be more than pleased to answer whatever questions you might have that pertain to my areas of responsibility.

Thank you.

[The Chair, Conservative, Rick Casson]

Thank you.

Go ahead, sir.

[Lieutenant-Colonel Gerry Blais, Director, Casualty Support and Administration, Department of National Defence]

Mr. Chairman, members of the committee, good afternoon.

I am the director of the Centre for the Support of Injured and Retired Members and their Families, commonly referred to as the Centre, which is a joint effort of the Department of National Defence and Veterans Affairs Canada. Part of this mandate includes acting as the director of casualty support and administration for the Canadian Forces. The centre provides information, advocacy, and referral services for ill and injured regular force and reserve force members and veterans, their families, and the chain of command. All services are available in both official languages.

The Centre provides a range of administrative support measures to injured Members, manages a variety of programs and offers many services, including:

provision of a 1-800 help line; searching for service records and other information; investigating files and documentation related to pension or disability award entitlement; guidance and approval of reserve disability compensation and the extension of class C service for reservists injured in a theatre of operation; providing information and assistance on Veterans Affairs services and benefits; coordinating requests for one-time financial assistance and support to provide for aids to daily living in urgent circumstances through the use of a contingency fund; providing emergency funding for travel from isolated areas to be with sick and injured family members; approval and payment of funeral benefits and family travel to funerals, memorials, and the bedside of ill and injured members; and counselling members on their entitlement to CF transition programs, including the vocational rehabilitation program for serving members;

authenticating the eligibility of medically released members for the Public Service Commission Hiring Priority Program; assisting medically released members in finding employment through the Transition Assistance Program; facilitating the interdepartmental transfer of security clearances; providing information and applications for the National Military Cemetery in Ottawa; providing pastoral assistance to veterans and their families through the Pastoral Outreach Program.

We develop and regularly update reference material and publications such as The Death and Disability Handbook, The Commanding Officer Guide to Casualty Support and Administration and The Assisting Officer Guide. We provide training and 24/7 assistance to assisting officers of injured members and the next of kin of members who are killed or who pass away while serving. Through the operational stress injury social support program, where military personnel are suffering from an operational stress injury, we offer information and support to them and their families. And through the speakers bureau, we provide awareness training pertaining to operational stress injuries.

Thank you. I would be pleased to answer any and all questions.

[The Chair, Conservative, Rick Casson]

Thank you. We'll start the questioning with Mr. Coderre.

[Denis Coderre, Liberal, Bourassa, QC]

Thank you, sirs. It is a pleasure to have you here with us this morning.

As someone who is unfamiliar with this area, I have a question for you, Colonel Blais. In the event of a death, we must deal with the family and with loved ones. Of course, we open our hearts to these people and we help them. I am not just talking about entitlements, pensions and the like. I want to know if long-term psychological help is available to the family after the death and burial have taken place.

[LCol Gerry Blais]

Approximately six months ago, we brought in a measure that helps families a great deal. Thirty days or so after the burial has taken place, a designated officer meets with the family, along with the officer in charge of the detachment, a chaplain from the Pastoral Outreach Program and an official from Veterans Affairs Canada. Canadian Forces and Veterans Affairs Canada provide emotional support to the family. The Centre operates detachments in 11 locations across the country.

[Denis Coderre, Liberal, Bourassa, QC]

Therefore, psychological help is available, if necessary.

[LCol Gerry Blais]

Absolutely.

[Denis Coderre, Liberal, Bourassa, QC]

Fine then.

In addition to sustaining physical injuries, members may be scarred emotionally. As a Member of Parliament, I have met with several veterans and other individuals with complaints about compensation. When these persons come to see us, we get the impression that they have no one else to turn to.

Practically speaking, what recourse do these persons have when they encounter compensation problems or when they are dissatisfied with the treatment they have received, for example, when they have the impression that they have been more or less forgotten? Are the real problems on the administrative level? I am not asking you to get into specifics, but simply to explain to me how client services work.

[LCol Gerry Blais]

Veterans Affairs Canada is largely responsible for this area. I cannot get into issues that come under their jurisdiction. However, if a person has a problem, he can get in touch with us. The Centre is also staffed by people from Veterans Affairs Canada. Along with VAC personnel, we can help the member research his military records, among other things, to help him document his case and achieve a successful resolution to his problem.

[Denis Coderre, Liberal, Bourassa, QC]

I see.

Colonel Weger, when you're talking about taking care of all resources, does that include the military hospital? At Kandahar airfield, are you responsible for specific needs like bringing in more nurses? Are you in charge of that too?

[Col David Weger]

Indirectly, I am. In places like Kandahar, I generate the personnel employed by our directorate of health services operations. But the actual responsibility for staffing the facility lies with our directorate of health services operations.

[Denis Coderre, Liberal, Bourassa, QC]

That brings me to the question of retention. Of course there is the issue that we're missing some specialists and nurses. How do you proceed proactively to keep the people or to bring some and keep them inside the forces?

[Col David Weger]

There are a number of different programs we employ. The one with which we've had the greatest success thus far is actually an Rx2000 initiative dealing specifically with attraction and retention of medical officers and, to a lesser extent, pharmacists.

We have, over the last three years, brought ourselves from approximately a 45% deficit in the number of medical officers that we required to slightly less than a 10% deficit now. So we're well on the road to recovery with the general duty medical officers, the equivalent of your family physicians, and we anticipate hitting our preferred manning levels by the summer of 2009.

The medical specialists--that is to say, within the military context specifically, general surgeons, anesthetists, orthopedic surgeons, internal medicine specialists, psychiatrists—are very small groups to begin with. There are only 10 of each within the forces, with the exception of five psychiatrists. That is to say, that's our manning level. And we can be in as serious a deficit as 100%, as we are currently with radiologists, or at or over PML. In fact, we are currently over the preferred manning level for anesthetists. The ideal manning level is 10, and we currently have 12 in uniform.

They are the harder group to attract, and they have traditionally been the harder group to retain. Our retention, by way of comparison, for our general duty medical officers has gone from about 50-odd percent in 2000 and 2001 to--we're forecasting--about 65% by as early as this year.

[Denis Coderre, Liberal, Bourassa, QC]

What's your best argument to keep them?

[Col David Weger]

It's a combination of things.

[Denis Coderre, Liberal, Bourassa, QC]

You're making them an offer they can't refuse?

[Col David Weger]

It's pay. It's continuing professional education offers. To a certain extent, the operations we're engaged in--in Afghanistan currently--are an attraction factor. They certainly are for a number of the specialists, the direct entry specialists, that is, licensed and qualified specialists we've recruited over the last two or three years.

[Denis Coderre, Liberal, Bourassa, QC]

If you're staying in Canada, there's of course an issue of sensitivity, urban versus rural or regional. What's your strategy? Because, of course, if you're going to Valcartier it's going great. My colleague will probably talk about Petawawa and some other areas where there is an issue. You can have all the infrastructure you want, but if you don't have the people to work and give us the proper help and you aren't able to keep them, this is an issue.

How do you manage?

[Col David Weger]

Actually that, again, is not specifically my portfolio. The bulk of my responsibility with the military specialists is to ensure that they are working on a day-to-day basis in a way that will maintain the skill sets we need in operations. The trauma skill sets, by and large, they're not going to be able to maintain in places like Petawawa.

Most of our specialists, particularly the surgical specialists, are embedded in the trauma hospitals in places like Toronto, Vancouver, Calgary to a certain extent, and also Montreal. Basically taking care of the needs of our individual soldiers is largely done on the specialist side by either hiring or using a fee-for-service system through the civilian sector. The responsibility for recruiting and securing those services falls under the responsibility of our director of health services delivery.

[The Chair, Conservative, Rick Casson]

Thanks, Mr. Coderre.

Mr. Bachand, you have seven minutes.

[Claude Bachand, Bloc, Saint-Jean, QC]

Thank you for being here.

One question has been bothering me since I visited Camp Mirage where a morgue is located. When I toured the camp, I was informed that steps would be taken to make this morgue more functional.

Are the soldiers killed in Kandahar sent to the morgue at Camp Mirage? If so, have facilities at the morgue been updated over the past year?

[LCol Gerry Blais]

The Commander of the Expeditionary Force is the person in charge of that area.

[Claude Bachand, Bloc, Saint-Jean, QC]

I understand. Thank you. That would be a good question to put to them when they testify before the committee.

I recall reading in several specialized journals that you were making an effort to reintegrate injured soldiers. That does not necessarily mean sending them back into combat zones. For instance, if a solider has had his legs amputated, he cannot return to active duty.

At one time, when CF members were unfit to perform the duties for which they had been hired, they were demobilized and told their services were no longer needed. Is it true that now you make a special effort to reintegrate them into the Canadian forces, by assigning them to duties better suited to their physical condition?