National Defence Committee on March 6th, 2008

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you, sir.

I have just a couple of quick points for clarification. First, do we ever send anybody out to do an operational job, medicated or otherwise, if we're not confident in their ability to conduct the task and do it safely--for their own safety and for the safety of the people around them?

[BGen Hilary Jaeger]

No, we never do that. The issue is, though, that we're not completely...[Inaudible--Editor].

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Okay.

With respect to doctors' qualifications and licensing--again, sort of a value statement--do we have any doctors treating Canadian Forces people who we don't think are qualified to do that?

[BGen Hilary Jaeger]

Not any more, sir.

Everyone must have seen the newspaper articles about the fellow we found in Petawawa. For us that was not a good--

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Yes. I was shocked.

[BGen Hilary Jaeger]

It was mitigated by the fact that he had graduated from medical school, he had completed a family medicine residency, and he had passed the examinations. But he had not received his licence from the College of Physicians and Surgeons of Ontario, and there was some misleading of the recruiters as to what his status was. We found out about two weeks after he had started actual work in Petawawa. We reviewed all the patients he had seen and sort of suspended him, and he's been released from the forces. He's now the College of Physicians and Surgeons of Ontario's problem.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Okay. That's good.

You mentioned, in terms of certification and so on, that 100% of doctors are now certified, all but one pharmacist--

[BGen Hilary Jaeger]

All but one pharmacist.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

--and 79.9% of nurses. That's obviously moving to 100% on the nursing side?

[BGen Hilary Jaeger]

There are more nurses. They're taking a little bit longer to get through.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Okay.

[BGen Hilary Jaeger]

It's just a matter of getting through the paperwork.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

You or someone else talked about deployability screening and better data management. That's one thing the Auditor General hit on fairly significantly, the ability to screen effectively pre-deployment, or screening out problems as they arise.

Have we seen improvements in that? Do you see more improvements in that just with better data management? What do we have to do to make it better?

[BGen Hilary Jaeger]

I think our post-deployment screening is hugely improved. That's the most important one for us, because that's the one that gets people into treatment. It's actually something we didn't do before 2002, which I think was the very beginning of what we call enhanced post-deployment screening. It's actually a whole bunch of scientifically well-justified standard screening instruments that are administered to everybody who comes back. Or it's supposed to be administered to everybody who comes back; we need the cooperation of the chain of command and the people themselves to actually come. So compliance is less than 100%, but it's pretty good.

It's made mandatory for a reason: to help break through the stigma. People can't point at others who are going in for screening and say, for instance, “Oh, you think you have something wrong”, because everybody is going in for screening, not just those who might think there's something going on.

So we've made huge strides with post-deployment screening. Pre-deployment is less structured, but there is still lots of screening opportunity formalized for members--including their families--to be interviewed at various levels by such people as the social worker and chaplain before they go overseas.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you.

[The Chair, Conservative, Rick Casson]

Thank you.

That completes the first round, a five-minute round to start.

Mr. Rota.

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

Okay, very good.

I'll be brief because I'll be sharing my time with Mr. Murphy.

I was looking at the Auditor General's report, and one of the areas that concerns me is the contracting out of services and how you choose those people. I'll state one case. I don't want to base everything on one case, but it's something that repeats itself quite often. In this case in particular, an individual went for psychological assessment and help, and the person who was giving him treatment, who was a registered psychologist, basically said, “I don't know how to treat post-traumatic stress disorder. I've never done it before, but let's see what we can do, and we'll see what comes out of it.” This is a young kid, about 22 years old. He has his life ahead of him, and he's being told he's going to be used as a guinea pig. I really have a hard time with that.

The question I have is two-pronged, or maybe even three-pronged. He doesn't live near a Canadian Forces base. So what is the treatment for individuals who live outside the range of a CFB? Second, how do we choose these people who are going to treat our young men and women when they come back? And third, who determines, after the treatment is over, whether they can go back into theatre?

This individual has a number of conditions. The psychological affliction is probably one of the biggest things affecting him right now, because it's stopping him from going ahead with the others. He's a soldier. That's what he wants to do for a living and what he's dedicated to doing. Who determines when it's time for him to go back into theatre? Is it the psychologist in the field? Is it someone at the base?

It is a three-pronged question, if you don't mind.

[BGen Hilary Jaeger]

I will try to start from the end first.

The authority for sending them back into theatre, medically speaking, would be the base surgeon of the base he's affiliated with. That is normally a general practitioner, but he or she would never--not never, but it would be extremely rare--act against the advice of a specialist. It's probably more likely that the general practitioner, the base surgeon, based on military experience, would be more reluctant. We frequently have specialists who say they think the person is fine, and the general practitioner isn't comfortable with it. We always put ourselves in this position: if I'm the only doctor for an operating base or in Kandahar, do I want to be responsible for what might happen to this guy? So that's the easier part.

How you provide services in remote areas and....

[Anthony Rota, Liberal, Nipissing—Timiskaming, ON]

I'm in North Bay. That's not that remote. There's a base there, and it's close by. Petawawa's the nearest, and that's where he was based.

[BGen Hilary Jaeger]

Petawawa's the nearest, and it is underserviced, from the point of view of mental health resources as well.

It's a very fine line, and it really is a matter of professional judgment. The primary care physician is very important in deciding. There's a difference between our contracted physicians, who are working for Joel and who are on contract permanently, and the fee-for-service providers, who are used for a variety of things. In some areas we still, for mental health, have fee-for-service providers. It sounds like this psychologist was probably one of the fee-for-service providers, not part of our collaborative practice team in our health setting.

It's very unfortunate that he would say something like that, because, of course, PTSD is not that rare across the Canadian population. He didn't happen to be comfortable treating it. I give him points for identifying that, but that should have been communicated not to the patient but to the referring physician so he or she could perhaps make a more appropriate referral.

We often find ourselves—I'll be honest—in the position of asking about the point at which any resource is better than no resource. We can't create the perfect mental health system out of thin air. If there aren't resources in the area to tap into, then you have to ask whether we should move the patient. That has pros and cons. We know we can find the right resources in Ottawa, but that's not necessarily an attractive option either.

Again, on a case-by-case basis, all these pros and cons have to be looked at, and you try to find the right resources for the patient.

[The Chair, Conservative, Rick Casson]

Thank you. That's smack on.

We'll have time to get back to you in the next round.

Over to the government, for five minutes.

[Jacques Gourde, Conservative, Lotbinière—Chutes-de-la-Chaudière, QC]

Thank you very much, Mr. Chairman.

Post-traumatic stress disorder troubles me very much. Roughly 10 years ago, I employed a former military member who had suffered from that disorder. Another young person employed by me enrolled in the Armed Forces.

During their training, are our military members made aware of post-traumatic stress disorder? During a mission, a military member may feel that he is starting to have mental problems. Sometimes the disorder arises afterwards. Let's suppose that a military member leaves for six months and that, at the end of four months, he is no longer mentally able to endure the mission. Can he withdraw or must he absolutely stay until the end of the mission?

[BGen Hilary Jaeger]

As regards your first question, there is basic training on stress problems, which includes post-traumatic stress disorder. That's part of the basic training of all military members at the base in Saint-Jean.

Basic military training includes training in the effects of stress and post-traumatic stress disorder.

When you're on a mission, if you think you're having any kind of health problem whatsoever, you are not obliged to continue. You, yourself, can't decide that you're going home. What you do is present to your.... If you're out of the forward operating base, you would go to see your medical technician or your physician's assistant. If you were back at Kandahar airfield, you would go to the primary care clinic associated with the hospital at Kandahar airfield and describe the symptoms you're having: for example, I can't get to sleep; my heart is pounding all the time; I feel sick to my stomach; I'm having nightmares. Describe any of the symptoms you want. There's no law that says you came here four months ago and you have two months left to go and you're not getting out of here until then. The health care staff will make the judgment as to whether you can be treated in theatre and supported there or whether you need to go somewhere else.

[Jacques Gourde, Conservative, Lotbinière—Chutes-de-la-Chaudière, QC]

Thank you.

[The Chair, Conservative, Rick Casson]

Go ahead.