Evidence of meeting #55 for Environment and Sustainable Development in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was amendment.
A recording is available from Parliament.
Conservative
Mark Warawa Conservative Langley, BC
In the interest of moving this along in an efficient way—I think we have consensus on almost everything from this point on—if Mr. Cullen were agreeable to withdrawing amendments NDP-13.2, NDP-13.3, and NDP-13.4, we could move right on to amendment G-15.2 and amendment G-15.3, and I think we could progress more quickly.
Conservative
Mark Warawa Conservative Langley, BC
We could, but I think there is very close consensus and I would ask, through you, whether he would be interested in withdrawing—
Conservative
NDP
NDP
Nathan Cullen NDP Skeena—Bulkley Valley, BC
I have not understood the 33 months under paragraph (d). This is the one concerning health professional associations and hospital associations. Thirty-three months seems like an awfully long time, and a strange kind of date that I've not seen used before. Is there any particular reason why the government has that in?
Director, Risk Management Bureau, Department of Health
It's important to realize that this particular issue of bringing together hospital associations and health practitioners' professional health associations—doctors, nurses, people who work in critical care areas—is somewhat beyond the jurisdiction of the federal government. We would be playing, really, a leadership role. We feel we would probably need about nine months to bring all the right players to the table and then another 24 months to actually proceed with the rather complex task.
Yes, the 33 months is a rather odd choice of number of months, but it's really to bring the diverse players to the table and start working, giving them a two-year period to get their work done.
Conservative
The Chair Conservative Bob Mills
Mr. Bigras, I think you had a question. Then we'll go back to Mr. Cullen.
Bloc
Bernard Bigras Bloc Rosemont—La Petite-Patrie, QC
I was wondering if the federal government was in the business of, and feels responsible for, writing guidelines for clinical practice. It seems to me that we are beginning to significantly infringe on provincial jurisdiction. We are talking about hospital associations. As far as I know, hospitals are provincial. So I was wondering if Health Canada always worked like this.
Director, Risk Management Bureau, Department of Health
I probably misspoke.
It's something that we very often do. It's just something that is not a legally binding kind of thing. So you ask people to come to the table and you hope that they get there, but you might have to encourage them along. So it's the issue of giving some time to do something where we don't have a regulation or something else behind us to force people to come to the table with us, to be able to work with them to bring them to the table.
So it's not a legally binding event, but yes, it is very much the kind of thing that Health Canada does on a regular basis.
Bloc
Bernard Bigras Bloc Rosemont—La Petite-Patrie, QC
Are the provinces at this table? Are they usually present? Are they stakeholders?
Director, Risk Management Bureau, Department of Health
I'd actually like to defer this question to the director general of medical devices, who's here today. She has a lot more experience with this, and I'd ask her to come to the table and respond to that question.
Conservative
Dr. Supriya Sharma Associate Director General, Therapeutic Products Directorate, Health Products and Food Branch, Department of Health
My name is Supriya Sharma. I'm the director general of the therapeutic products directorate in Health Canada.
Maybe I'll just address the issue of clinical practice guidelines and what we do and don't do.
As a regulator, it is a bit unusual that we would be stepping into the area of facilitating clinical practice guidelines. Ms. Milburn-Hopwood is correct in that as Health Canada, especially around the public health area, we do often step into those, but very rarely do we really move to clinical practice guidelines for specific products. However, in unusual situations, where there's a leadership role—in this case, around a specific category of product—we do take a leadership role in terms of bringing people to the table.
When we do that, it would depend on the individual issue. So if there are implications for provincial heath authorities or for individual hospitals or for individual practitioners, we would basically look at the issue and then bring the appropriate people to the table.
For some of the medical device issues, absolutely, we've had people from the various ministries of health at the table, along with certain health professional organizations and certain individuals as well.
NDP
Nathan Cullen NDP Skeena—Bulkley Valley, BC
I have two things, and we're getting prepared to withdraw our amendment.
In proposed clause 6 here, on page 15.2, there are just two places, maybe three, where I think some words can be taken out to strengthen the language.
I guess what I'm looking for is some sort of consideration from government before we withdraw: in paragraph (c) where it says “that within 24 months after the coming into force of this Act”, to say “the government requires the labelling of medical devices”, rather than “takes steps”; and then in paragraph (d), “take steps to facilitate”.... It may seem like a small thing, but I've noticed in the drafting of laws that if you're not very specific and tight with the instruction in the law, then there's lots of room for open interpretation. Three years down the road, you can say, “Well, why haven't you done this thing?” and the government can claim, “Well, we took steps to”, but still haven't done it. And we saw that very much through the CEPA review.
The only other piece that I would look for is in paragraph (e). This one is talking about preparing a list of medical devices that don't have DEHP in them. All we would ask is that there is a corresponding list of what they're able to replace. So if there's a specific tube that's come on line that we know is DEHP-free, it is meant to replace this apparatus, and vice versa, just to make it easier for hospital administrators to have a list so that they know what's being replaced and by when.
That's all.
So if we can get that feeling from government that we're willing to just tighten up the language, be more directive, talk about a replacement list, then I'll withdraw NDP-3.3, or whatever it is now.
Conservative
Associate Director General, Therapeutic Products Directorate, Health Products and Food Branch, Department of Health
I think there are probably two separate issues there. One is the interest of tightening up the language, talking about taking steps, and I don't think we have a problem with that. That seems fairly straightforward.
In terms of the list, I would go back to seek some clarification about what a replacement list would entail. In general, we wouldn't be making recommendations on the use of an individual medical device over another individual medical device. That really is the practice of medicine. So an individual practitioner would make that risk assessment based on the patient they had in front of them.
So I just need some clarification on what a replacement list would really entail and what the implications of that would be.
Bloc
Bernard Bigras Bloc Rosemont—La Petite-Patrie, QC
I am coming back again to paragraph 6(d). What do you mean by “hospital association”? For example, do you think that a public health department in Quebec is one? I think that with paragraph 6(d), we are leaving out an important player. It bothers me deeply to see the extent to which the federal government can deal directly with hospital associations without feeling the need to go through provincial health authorities.
I would like your opinion on that. What are hospital associations? They are certainly not provincial health authorities.