Evidence of meeting #7 for Subcommittee on Sports-Related Concussions in Canada in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was physician.
A video is available from Parliament.
7:15 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you.
Now we go back to the Liberals and Mr. Fisher.
7:15 p.m.
Dartmouth—Cole Harbour, Lib.
If you could stop me at five minutes, as a common courtesy I'd like to give the last two minutes to Mr. Nathaniel Erskine-Smith. Thank you.
Thank you all very much for being here. I apologize for the fact that we had to step out and are going to have a shortened time frame here, so that I'm not going to get to ask you all the things I want to ask you.
One of the pre-eminent concussion advocates is Ken Dryden. We had him here at our committee. He has said:
We need only to penalize all hits to the head, because whether a blow is from a stick, an elbow, a shoulder or a fist, whether it's done intentionally or accidentally, whether it's legal or illegal, the brain doesn't distinguish. The damage is the same.
That was his personal plea to the NHL and to Gary Bettman. I know that Hockey Canada does not speak to the NHL or the NHL Players Association in that way, but you have zero tolerance.
Now, I don't know whether zero tolerance speaks exactly to what Ken said there. I'm a father of, starting tonight in his first game ever, a junior B hockey player. You can get a kid in peewee who is six foot one and a kid in peewee who is four foot eleven, and you have a head shot when that six-foot guy hits the four-foot-eleven guy regardless of whether there was intent or not. That's fine. It's not a terrible rule. Zero tolerance is a good thing.
Does it speak to the things that Ken wants it to speak to, and do you envision in the future zero tolerance at the minor hockey level through Hockey Canada organizations filtering up to the NHL level, whereby we will one day see what Ken wanted to see?
7:20 p.m.
Chief Medical Officer, Hockey Canada
I completely agree with you. What we're seeing now is the results of what Hockey Canada and many of the other minor sports leagues have done in not tolerating any head hits.
When Ken speaks about no tolerance for any head hit, that is the Hockey Canada position. It is clear. Even if it is incidental and accidental, it is still not acceptable and it is penalized.
Certainly I see that filtering up even to not only the junior leagues but the NHL. All of us watch professional hockey, and I think what has happened now is that most of the hits to the head now, even in the NHL, are not tolerated and are even penalized. You can see from two of the hits we had over the last few weeks from our star players that even they were penalized for non-intentional hits to the head.
I think the message is clear, and what we are seeing is a change in the way not only we look at things but at the professional level.
7:20 p.m.
Dartmouth—Cole Harbour, Lib.
Dr. Bauman, you talked about uptake of best practices. You said that all health care, school divisions and sports groups need to get that uptake of best practices. You said that it's not happening, and you said that there are mixed messages. Then you moved onto something else. Could you maybe just give me a minute on your thoughts of how you can get those best practices and increase the uptake?
7:20 p.m.
Medical Director, Lead Physician, Concussion North
Guidelines such as our Parachute Canada guidelines were done in conjunction with the federal government and our Public Health Agency of Canada. We developed a really strong guideline.
The challenge I see as a clinician is that I have young athletes coming into my clinic every day from various sporting organizations in our different local leagues across Ontario, and many of them have never seen our Parachute Canada guidelines. It's a very strong, well-documented guideline. We've been using it with some of our national sports organizations. My challenge is that, when I present this to the patient, I would like them to be able to take it to their sporting organizations across our province. Locally, in Barrie, this isn't happening.
What I would like to see is that this guideline we developed with federal funding gets support at the provincial level that trickles, for example, in Barrie, to our Barrie Minor Hockey Association. I would like them to use it. We could have one guideline supported across all of Canada, to which every organization would have access.
This guideline has medical assessment forms in it, medical clearance forms. It has a protocol that is a very good protocol for coaches and parents. It includes pre-season education. It outlines what to do when your son or daughter has a concussion, who they need to see at various steps of their injury and when they should be referred to a multidisciplinary concussion centre.
If we had this, and if everyone were using the same form, we wouldn't have confusion. What's happening is that individual clinics are developing their own guidelines. They're developing statements, and then these organizations don't know which ones to use. Unfortunately, our federally funded one isn't getting into the hands of the athletes who need it.
I've been fortunate enough in Oro-Medonte to use the guideline developed by Parachute Canada.
7:20 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
I appreciate that.
We're going to move over to Mr. Erskine-Smith for about a minute and a half to two minutes.
February 26th, 2019 / 7:20 p.m.
Liberal
Nathaniel Erskine-Smith Liberal Beaches—East York, ON
Thanks very much.
Just following up on that, with the federal guidelines as they are—and you mentioned that there is sort of a gold standard co-developed with PHAC—is there a province that we can hold out as having the best practice for implementing these guidelines?
7:20 p.m.
Medical Director, Lead Physician, Concussion North
I really do feel that Manitoba and the work with Dr. Mike Ellis, who's one of our co-directors on the Canadian guidelines, has been doing instrumental work within the province. They have a federally funded clinic. I think that's important to note. As a physician with expertise together with a clinic that's received federal support and funding, they've been able to utilize their clinic as a means to get provincial organizations on board. They have been working with some of the first nations communities. They've been able to get full support.
When you have that kind of clinic example, which is why I say that a federally funded multidisciplinary clinic needs to be supported, I believe we can have better uptake with our guidelines, provincially and federally.
7:25 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you, Mr. Erskine-Smith.
We are going to move to our second round. We only have about two minutes in this round for each of the members.
We're going to move to Mr. Kitchen, for two minutes.
7:25 p.m.
Souris—Moose Mountain, CPC
Thank you, Mr. Chair. I appreciate this.
I'm going to ask Mr. Jackson a question.
I see that you're the director of insurance and risk management. For many years I was a hockey coach, and I had patients come to me in my practice and say, “Okay, I got hurt playing hockey. I have this Hockey Canada form.” They came to me with concussions, and as I was dealing with them and assessing them, they would ask, “How do I pay for this?” Can you explain the challenges that you have in Hockey Canada with that form?
7:25 p.m.
Director, Insurance and Risk Management, Hockey Canada
Certainly. It may be the insurance-based form that you're talking about. We require that to be completed in a claim situation, and certainly there's always the challenge of getting it completed efficiently. There's always the challenge that players have to go see a physician in order to get that completed. There is obviously the process of getting it into our offices, into the Hockey Canada offices, and the process of reviewing each of those forms, so there are many challenges around it.
7:25 p.m.
Souris—Moose Mountain, CPC
The form allows for physicians, for chiropractors and for physical therapists to fill it out and complete it. Is that correct?
7:25 p.m.
Director, Insurance and Risk Management, Hockey Canada
Yes. It is meant for physicians. There's no question that we do get other entities filling out that form, depending a lot of times on what the injury is as well.
7:25 p.m.
Souris—Moose Mountain, CPC
The form doesn't stipulate that, though, but it does allow for other practitioners to point that out.
Especially in rural Canada, where we're dealing with injuries, again, where you have a practitioner who doesn't understand the sport and will often refer to somebody who does, who might be an expert in a sports injury area, to assess that, that might be the chiropractor or the physical therapist in that community who fills those forms out. You would accept those as insurance, correct?
7:25 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you, Dr. Kitchen.
We're moving over to the Liberals now and Mr. Erskine-Smith for two minutes.
7:25 p.m.
Liberal
Nathaniel Erskine-Smith Liberal Beaches—East York, ON
Thanks very much.
My question is for Hockey Canada. I played baseball growing up, not hockey. In baseball, there are accidents that happen and concussions do happen, but it's not really in the course of regular play, so I appreciate the answers to Mr. Fisher in relation to hits to the head.
When a concussion happens in youth sports here in Canada, what is the reporting mechanism so that we have a global picture of what's happening?
7:25 p.m.
Director, Insurance and Risk Management, Hockey Canada
If a player suffers a concussion, obviously we have a very simplistic message that we teach our safety people, which is, if in doubt, you sit them out. They are pulled out for that game.
7:25 p.m.
Liberal
Nathaniel Erskine-Smith Liberal Beaches—East York, ON
Is that then reported so that there is a clear picture at the national level for Hockey Canada as to how many concussions are happening at the local level?
7:25 p.m.
Director, Insurance and Risk Management, Hockey Canada
There is no specific surveillance, and I can tell you that one of the biggest challenges is surveillance. When you start to talk about collecting that type of data, it's very difficult, a lot of times, to get people to fill out those forms, to submit that information. It's one of the biggest challenges we have.
7:25 p.m.
Liberal
Nathaniel Erskine-Smith Liberal Beaches—East York, ON
Have any efforts been made to go down this road of ensuring that where concussions do happen in youth sports, there is a central reporting mechanism to Hockey Canada and you are able to collect these statistics?
7:25 p.m.
Director, Insurance and Risk Management, Hockey Canada
Right now, we actually sit on the FPT working group on concussions. That's one of the big topics they're looking at, surveillance.
The reason for that is, just as you were saying, data is important. We need to know what's happening out there.
We're going to see what comes of those discussions and other discussions, but certainly as I say, there's no question, surveillance is one of the biggest challenges.
7:25 p.m.
Mr. Peter Fonseca (Mississauga East—Cooksville, Lib.)
Thank you, Mr. Erskine-Smith.
We're going to thank Dr. Bauman now, because we're going to lose the video feed in about a minute or so.
Thank you very much for your testimony and for your answers. If there is anything else that you would like to submit to the committee, please feel free to do so. The report will be put together and hopefully will be tabled in the House by the end of the spring.