House of Commons Hansard #96 of the 41st Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was flag.

Topics

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:35 p.m.

Conservative

Leona Aglukkaq Nunavut, NU

Mr. Speaker, I will explain it again.

The provinces and territories deliver health care. The provinces and territories purchase their drug supply. The provinces and territories dispense the drugs to their patients.

Health Canada regulates and approves products for the market. We are doing our part to support the provinces and territories that are experiencing drug shortages because of the situation that occurred. Sandoz experienced a fire in its plant which resulted in drug shortages across the country.

Health Canada is doing its part to support the provinces and territories by identifying approved companies in Canada that can produce the drugs that are now in shortage. We have provided this information to the provinces and territories. It is also our responsibility to approve drugs. We have put in place mechanisms to approve alternate drugs to be made available. We have that mechanism in place to respond and support the provinces and territories.

We are also working with the provinces, territories, pharmacists and industry to come up with a one-stop shop to report drug supply shortages or anticipated drug supply shortages. That work has been going on. The process started last year, and we are accelerating it.

The challenge in this particular situation is a drug supply shortage which was the result of a fire. Obviously, we cannot anticipate a fire. The situation has caused some challenges. We are doing our part to support the provinces and territories.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:35 p.m.

Conservative

The Acting Speaker Bruce Stanton

It is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Abitibi—Témiscamingue, National Defence; the hon. member for Scarborough—Rouge River, Citizenship and Immigration.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:35 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Mr. Speaker, I will be splitting my time with the member for Toronto Centre.

I stand here today to support the motion brought forward by the New Democratic Party which calls for the setting up of a co-operative mechanism, “co-operative” being the operative word, with all of the provinces, territories and stakeholders requiring the manufacturer to report promptly to the government about the distribution, et cetera, of drugs and to expedite review of new drugs that could replace old ones.

This is a comprehensive motion and I support it, but I do not think it is enough. If we look at best practices in other jurisdictions, there are other things that could be done that would also help, but the motion is a good start and I support it.

I intend to move an amendment at the end of my speech to add something which I think would enhance the motion.

There has been a lot of misinformation and misunderstanding about this problem. I want to talk about the scope and nature of this problem, why it is so important, and why there was an emergency debate two nights ago, and I thank the Speaker for allowing the emergency debate.

This is not a new issue. In 2006 shortages began to escalate at 400% the number of shortages there were prior to 2006. As a result, many countries immediately took steps to ramp up their ability to anticipate and track shortages, and to find substitutions and ways of ensuring there was the necessary supply of drugs.

It has been mentioned that we continue to compare ourselves to the United States. Many of us who have been around here for quite a long time actually understand the way government works. We understand provincial and territorial jurisdiction. We understand the Constitution of Canada. We also understand there are parallel systems that can be looked at with regard to best practices.

We have heard the government say that the U.S. Food and Drug Administration mirrors a lot of what Health Canada is supposed to do in terms of making sure that there is a safe, reliable supply of medically necessary drugs for Canadians to use. In 2006, a drug shortage program was created within the U.S. Food and Drug Administration. The Canadian government could easily have set up a similar program within Health Canada to anticipate shortages, to work with the provinces, territories, manufacturers, et cetera, to prevent those shortages from causing risk to the lives and health of Canadians. This is what most of us are concerned about here. It is not about being political, pointing fingers and saying the government did not do this or that. The point is that because very little has been done, every single day in this country the lives of patients are being put at risk because of drug shortages.

The Liberal Party flagged this back in the summer of 2011. We suggested that the government should take a similar approach, to anticipate and to flag shortages and to ensure that there is a supply. This did not happen and we therefore took it to the health committee to investigate. We did what we thought were the appropriate things to do. We felt there was an inappropriate response from the government. We held a round table in September last year in which we brought together the stakeholders to discuss what should be done and to determine the nature and scope of the problem.

Of course, the stakeholders told us the same thing, that there needs to be an urgent investigation into the problem and a look at best practices. We were told that the federal government has a key role to play, a leadership role, in coordinating all of the stakeholders, the provinces, the territories and the health care providers in order to anticipate and identify shortages and manage the system.

Today we heard in the news that two major hospitals that conduct open heart surgery in British Columbia, St. Paul's Hospital and Vancouver General, have actually postponed all of their elective cardiac surgery. Those are the two major centres in British Columbia. They have postponed elective cardiac surgery because they only have one week's supply left of protamine, a drug that is absolutely necessary for open heart surgery. They are holding that supply in case an emergency cardiac surgery needs to be done. Everyone is waiting.

At the heart of this problem is the fact that they do not know when there will be a supply, how long there will be a shortage, or what other drugs that are necessary for open heart surgery will be in short supply in the future. Therefore, they are concerned. It is fine for the government to say it knows that everyone will care for their patients. Yes, they can care and yes they can wish to do something, but if they do not have the required drugs for intervention, surgery, or to keep someone's chronic disease from getting worse, or to save someone's life, what will they do? Wishing will not make it happen. All the best intent in the world will not make it happen.

I have brought forward that bit of history to let members know why we are concerned about this. When other jurisdictions in other countries saw this four years ago and began taking steps, we wonder why the government continued to pretend it was not a problem.

Two years ago we found there was a rapid increase in the shortages, even from the shortages that existed four years ago. They doubled. We found that in the month of March alone there was a shortage of 250 new drugs.

The Food and Drug Administration in the United States, which has a lot of the same capability, capacity and mandate as the health department here, actually doubled the number of people working on their drug shortages program. It upped the ante in terms of making sure that it moved forward. We saw that the President of the United States and Congress were so concerned that they immediately began to bring forward three new bills to deal with the issue and to strengthen the hand of government to deal with the issue. In November 2011, we saw the president himself issue an immediate order to avert shortages and to have departments work together and do what they needed to do because, as he said, “it is the belief of this administration...that we cannot wait”.

Yet Canada's Prime Minister has shown no such leadership. Canada's Minister of Health has shown no such leadership. They waited until everything fell apart with the Sandoz problem here before paying attention. Then, instead of saying, “Let us see what other jurisdictions are doing, let us find out what we can do, let us move quickly now and say that we're sorry that we didn't pay attention earlier on, let's work with provinces and territories”—understanding that they had already got contractual obligations with other suppliers and that they could not break those contracts—“let's see what we can do to help them, let us work together with the stakeholders, and let's become very proactive”. Instead, there was blaming.

This is what bothers me. It is one thing to suggest that one now cares. It is another thing to say, “Don't look at me. It's not my fault. By the way, we're going to wait and see what we can do if something else happens”.

That is unacceptable. Canadians, physicians, and the Canadian Medical Association have all issued directives for the government to take the same kind of proactive stance in anticipation of and looking at shortages and managing them well.

There is a real problem here. If we want to talk about what the government could have done in taking a proactive stance in terms of identifying shortages really early and anticipating them, here is what jurisdictions have done within their own drug departments. I want to use the Food and Drug Administration's drug shortages program, which I think the government could have set up within Health Canada. They looked at manufacturing problems. They worked one on one with manufacturers, knowing that they could not make manufacturers make different business decisions and that they could not force manufacturers to create new jobs. Instead, what they did was to work with the manufacturers. They let other manufacturers who were making similar drugs know that they could actually speed up production, that they would help them to have the capacity to quickly produce more drugs. They looked at how some firms were only producing one drug and when they found out that the largest firm among that group was going to stop, they asked other firms, “Can you speed up production? Can you increase your capacity? What can we do?” That is called anticipation. It is a proactive management solution to a problem.

We need to look at Sandoz. The minister and the Department of Health inspect the manufacturing plant. If they had seen that the manufacturing plant was having problems with one set of drugs, they should have known that there was going to be a problem. They should have worked with Sandoz to help them deal with that.

I could go on. There are lots of incentives that could be provided to help create a proper supply chain, but at the end of the day, the problem has occurred at Sandoz. There is a crisis. There are some good ideas coming forward here from those of us in the House. We want to work with the minister. We want to make sure that patients are not harmed or hurt. If that is the bottom line and if the government agrees with us that this is in fact something we should care about, let us come together and pass this motion and move on. Let us work together to find the right kinds of solutions.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:45 p.m.

Conservative

Mark Strahl Chilliwack—Fraser Canyon, BC

Mr. Speaker, I would like to correct the record on the fearmongering today about cancelled surgeries. A news story said:

Nine elective cardiac surgeries were cancelled...because physicians erroneously feared they could run out of a critical drug and not have enough for emergencies.

However, Vancouver Coastal Health has said:

—the cancellations were unnecessary because there was a five-week supply of the drug protamine available in B.C. and the manufacturer Sandoz has committed to increasing its shipments of the drug to B.C. later this month.

Certainly the information and fearmongering is incorrect.

Does the member see any problems with Sandoz having 95% sole-sourced contracts to the provinces and could she perhaps explain how further regulation would have prevented the fire at that plant?

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:45 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Mr. Speaker, one can be very cute and glib and try to make imaginary statements, but the point is that no one in the House has ever suggested that the government could anticipate a fire. However, knowing that there was a sole-source provider of 90% of the intravenous medications used in ICUs, ORs and emergency rooms, the government could have done what the drug shortages program of the Food and Drug Administration has been doing with these shortages in the United States. It could have asked Sandoz to report the beginning of the shortages and mandate that it do it. That is what the FDA has just done, issuing a mandatory directive for all sole-source providers to report immediately.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:50 p.m.

NDP

Libby Davies Vancouver East, BC

Mr. Speaker, I know that the member for Vancouver Centre has been very concerned about this issue for a long time and has raised it on numerous occasions, so I appreciate her being part of the debate today. I want to ask her about the global situation, because she has certainly made the point in the past that these shortages are a global question. She is probably aware that Canada is now negotiating a trade agreement with the European Union.

I wonder what her and her party's position is on this agreement, particularly how it would impact the cost of drugs in Canada, because that is an issue for the generic market. We know that the Conservative government is forging ahead in trade negotiations and there is an issue about whether or not generic drugs will be protected in Canada or whether the government will open up the marketplace in terms of longer patents.

What is the position of the Liberal Party on this question and is it opposing the CETA agreement, because it is a very serious issue with an impact on the cost of medications?

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:50 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Mr. Speaker, one of the things we need to remember is that Canada as a country does not have very many drug manufacturers. We are a very small producer of drugs. We are very dependent on the rest of the world, and because drug production is a private sector industry, there is very little that one can do to force companies to move their prices up or down, or to interfere in their business decisions.

However, what one can do is to look at ways in which we can assist with the buying of generic drugs, providing incentives to generic companies in Canada to help them to continue to produce drugs because we know that it is generic drugs that are actually in shorter supply.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:50 p.m.

Liberal

Dominic LeBlanc Beauséjour, NB

Mr. Speaker, members will know that the member for Vancouver Centre has long experience not only in the practice of medicine in Vancouver but also in leadership positions within the medical society. I share her concern that the drug shortages will have a direct impact on the health of Canadians, but does she have an idea perhaps of what it means in smaller regional centres? She talked about Vancouver, but what about some of the smaller centres, either in her province of British Columbia or other regional hospitals where they would need access to these drugs, where the cascading effect of these shortages would be even more harmful than perhaps in a large urban centre?

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:50 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Mr. Speaker, it is obvious that when the large centres cannot get drugs, the trickle down effect of small centres not getting them at all is going to be a big problem. We need to be worried about that.

This is why we are calling for the federal government to take a leadership role, to set up a drug shortage program and to start looking at how it can work with provinces and territories, anticipating the need for supplies, helping provinces, many of which cannot afford to buy drugs and are looking for cheaper generic drugs, which are the ones that tend to be in short supply. The government needs to look at how it can help anticipate this and help provinces to fast forward other drugs and bring in imported drugs if it needs to do so before the problem actually occurs.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:50 p.m.

Liberal

Bob Rae Toronto Centre, ON

Mr. Speaker, I want to thank my colleague from Vancouver Centre for very generously sharing not only her expertise but also her time with me this afternoon.

This is an important subject. I wish the resolution had been a little stronger, and I will explain why. I do not think the resolution goes far enough in setting out what the legal requirements really are for both hospitals and insurance plans across the country and the federal government with respect to access to what are necessary health services. When we look at the drug shortage, this is the context in which we have to see it.

It is absolutely no accident that this crisis is happening on the watch of this particular government, a government whose philosophy does not include support for the Canada Health Act. It campaigned hard and long against the Canada Health Act when it was first introduced in 1984. It campaigned against medicare when it was first introduced in 1968. The Prime Minister's vision of the responsibilities and jurisdiction of the federal government is the most limited view that we have ever had in the history of the country. The members opposite repeat over and over again that the federal government has no responsibilities in health care, that the provision of insured services is in the exclusive jurisdiction of the provinces. The only problem with that is it is not true, because it ignores the clear statements in the Canada Health Act that are set out as follows. Section 3 of that act states:

It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.

The provision of medication in a hospital for the purposes of an operation is a necessary health service. The fact there is not sufficient access to medication required for anesthesia and the control of pain, because those drugs are not available due to a shortage, or for whatever reason, is as much the responsibility of the federal government as it is of the provinces.

The hon. member for Mount Royal has always told me that it is not true that the federal government has no responsibilities in the area of health. Nowhere is it written that health falls completely within the jurisdiction of the provinces. Yes, the provinces are responsible for managing hospitals and for health insurance. Yes, the provinces have a huge responsibility in the area of health. Health care represents between 35% and 60% of their budget. Yes, it is their responsibility. However, the federal government has its own responsibilities. That is why we have the legislation against which they fought. I can say this on behalf of the Liberal Party of Canada. We think that the government has obligations in the area of health. It is clear and the government cannot deny it.

Section 12 says:

In order to satisfy the criterion respecting accessibility—

Which is one of the five key criteria that is set out in the Canada Health Act:

—the health care insurance plan of a province

(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons...

Everyone has to understand that, yes, the provinces have a responsibility, but the federal government has a responsibility for enforcement as well. To suggest that the federal government has no responsibility in this area is the old Reform ideology. It is so deeply ingrained in the heart and mind of the Prime Minister that he is not prepared to accept responsibility. I almost feel sorry for any minister of health in his administration. He is constantly going to be asking the question, “Why are we getting involved? It is not up to us. It is all about sole suppliers. It is all about the provinces. It has nothing to do with us. It's not our problem”.

We can look at other jurisdictions around the world: the federal government in the United States, issues in the European Union, countries in Europe. This shortage issue is not simply a matter of sole suppliers. This shortage issue is caused, as much as anything, by the fact that the generic producers are constantly telling the authorities that the more the authorities negotiate tough on price, the more the generic producers are going to say, “Sorry, we are not making that drug any more”.

There are issues of collusion worth analyzing, which is why President Obama asked that it be done. This problem did not arise last week. It did not arise because of a fire in Boucherville. It did not arise because of one incident. It is a general problem that has become increasingly serious. The government's response is to simply repeat the mantra that it is all about sole-source suppliers, it is not its problem and some of the provinces were wrong. If the government believed in 2006, 2007, 2008, 2009, 2010 and 2011 that the provinces were wrong to have sole-source contracts, why did it not say so over the last five years? Where was it? I can say where it was. It was asleep at the switch and hiding behind the fact that it did not have any responsibility. It did not want to own this problem.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

March 14th, 2012 / 4:55 p.m.

Liberal

Kevin Lamoureux Winnipeg North, MB

It is the problem.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

4:55 p.m.

Liberal

Bob Rae Toronto Centre, ON

It is the problem because it is not addressing the problem. The federal government cannot hide behind its lack of jurisdiction. It has jurisdiction, but not exclusive jurisdiction because the provinces have their responsibility. Of course the provinces have responsibility. However, what does it tell us when the health minister of the Province of Ontario says, for example, “The federal government knew about a problem and did not tell us for a matter of weeks”? It tells us there is a regulatory failure. There is a regulatory issue that is not being addressed. I do not think it is good enough for the federal government to simply say it is now going to provide some kind of early warning system. It has to go further than that.

The federal government could establish a task force. It could get the provinces together and ask how to address this issue, how to solve the problem and how to deal with it more effectively. The federal government has had a long time to do all of those things. When we try to understand why it has not acted, the answer is very simple. It has not acted because the Prime Minister does not want, in any way, shape or form, to own any aspect of the health care issue.

Let us not forget the federal government is the fifth largest provider of direct health care services in our federal system. The federal government is a player, bigger than New Brunswick, Prince Edward Island, Nova Scotia or Manitoba. It is a big provider of services to aboriginal people, veterans and others. The government has now decided it can beat up on Sandoz because it is the one company everybody is singling out as being the problem, People might like to know that Sandoz is also a major supplier of drugs to the federal government. The company provides over 100 drugs listed on the first nations drug benefit list.

First nations people who are receiving cardiac surgery or cancer care surgery or other serious surgery, by and large, do not receive it in hospitals that are run by the federal government. They receive it in hospitals that are in the provincial jurisdictions that are then paid by the federal government for those services.

If first nations people are being denied health care services because of a drug shortage, that is the responsibility of the federal government. If it knew about this problem, as a party that is paying millions and millions of dollars to the provinces to provide health care to aboriginal people who are receiving serious surgery, that is a responsibility of the feds.

When the federal government and this minister turn around and say that it is all about sole-sourcing and provincial responsibility, that is an abdication of responsibility on the part of the administration.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

5 p.m.

Simcoe—Grey
Ontario

Conservative

Kellie Leitch Parliamentary Secretary to the Minister of Human Resources and Skills Development and to the Minister of Labour

Mr. Speaker, I think the government actually does know its role. We know that we cannot and will not dictate to the provinces where, when and what they buy. This is a provincial and territorial responsibility. I know that. As a surgeon, I stood in a hospital. It was amazing, I actually did not phone the federal Minister of Health to ask, “Do you have this drug?” I worked with the people in my province and in my hospital to make sure that we had the things I needed to provide for my patients.

Does the member opposite understand provincial jurisdiction? Does he understand how a hospital is run? Obviously, he does not.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

5:05 p.m.

Liberal

Bob Rae Toronto Centre, ON

Mr. Speaker, I am not sure that is a serious question.

It is simplest just to say that in addition to some other political responsibilities I had that the member may know about, I also served for three years on the board of the University Health Network and was chairman of the quality committee of the hospital.

I have said all the way through that of course the provinces have a responsibility. If the member would stop interrupting, she might want to hear what the answer is.

Of course the provinces have a responsibility. What I take exception to, and will continue to take exception to, is the notion that the federal government has no responsibility. The federal government has a key responsibility. The drugs are traded internationally. The federal government receives the warnings from the companies with respect to shortages. The federal government approves the drugs. It has a regulatory responsibility for the drugs, and it has responsibilities under the Canada Health Act. All of those things just happen to be true.

Opposition Motion—Drug Shortages
Business of Supply
Government Orders

5:05 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Mr. Speaker, I would like to thank the hon. member for Toronto Centre for his speech and his very clear explanations.

I would like to get his opinion on something. Right now, the federal government is boasting that it is proactive and that it is taking action, when its reaction has been to find a hasty solution to a problem that has been recurring for a number of years.

Rather than working with the provinces to find solutions that will get to the root of the problem, the Conservatives are saying that they have established a working group. However, this group has not tabled any reports since it was created. We are still waiting for long-term solutions since the ones proposed by the government are ineffective.

What does the hon. member think of these claims and the way the Conservatives are shirking their own federal responsibilities?