Evidence of meeting #8 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 rowan's.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Sandhya Mylabathula  Ph.D. Candidate, University of Toronto, As an Individual
Swapna Mylabathula  MD/Ph.D. Candidate, University of Toronto, As an Individual
Gordon Stringer  As an Individual

6:30 p.m.

MD/Ph.D. Candidate, University of Toronto, As an Individual

Swapna Mylabathula

Just to reiterate, there's no need to reinvent the wheel. There are organizations that already reach the public and are already recognized. People already go there. These organizations already have an audience, so, as we were mentioning earlier, the federal government may have partnerships not just with the provincial and territorial sport organizations, but also with science communication organizations that already reach the target audiences that it is looking to reach with policy.

6:30 p.m.

Liberal

Greg Fergus Liberal Hull—Aylmer, QC

Thank you.

I want to turn the floor over to Ms. Hardcastle, in order to give her more time to ask any remaining questions.

6:30 p.m.

Conservative

The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen

Thank you, Mr. Fergus.

In conclusion, we will finish up with three minutes for Ms. Hardcastle.

6:30 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Thank you very much.

I'll try to be quick. I know this is an emerging issue, and it's quickly evolving, so I don't think we have the best template for how we would roll out these protocols that you're talking about. You mentioned the governmental concussion board in your conclusion. I envision something more like a commissioner or a secretariat with an administrative body behind it. However, the point, actually, is more about....

Because it is publicly funded, I want to go back to the Canadian concussion strategy that was developed by Parachute. In Ontario, there is Rowan's Law, which has a mandatory protocol. Could Ontario's law be implemented using Parachute's Canadian concussion guidelines, or are there some gaps? Is there a contradictory area?

6:35 p.m.

MD/Ph.D. Candidate, University of Toronto, As an Individual

Swapna Mylabathula

Certainly.

Rowan's Law is continuing to be developed in terms of exactly how it's going to be implemented across Ontario. Its predecessor, Policy/Program Memorandum No. 158, is currently being implemented across schools. It's focused on the school setting across Ontario—public and Catholic schools, elementary and secondary schools—and through that I think we can have a very good uptake of harmonized guidelines, such as those of Parachute. I don't see any contradictions in terms of that. I think where it becomes a question is with regard to implementation and relevance to the particular target audience.

6:35 p.m.

Ph.D. Candidate, University of Toronto, As an Individual

Sandhya Mylabathula

Just to add to that, we can implement the Ontario piece everywhere else in Canada, but it's important to take into consideration, for example, the particular cultural and other types of factors that are important to each province and territory, because they won't necessarily be the same as Ontario's situation in every case. It's about applying the general idea of what's going on to see how that fits within their contexts, and then sharing information as well, of course, on what works and what doesn't work and evolving from there, because this is an evolving issue.

6:35 p.m.

MD/Ph.D. Candidate, University of Toronto, As an Individual

Swapna Mylabathula

Our vision is indeed to see something like that rolled out across the country in each province and territory.

6:35 p.m.

NDP

Cheryl Hardcastle NDP Windsor—Tecumseh, ON

Perfect. Thanks.

6:35 p.m.

Conservative

The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen

Thank you very much.

On behalf of the committee, I would like to thank both of you for your excellent presentation today and for providing the information and disseminating so much important information to us. We greatly appreciate that.

6:35 p.m.

Ph.D. Candidate, University of Toronto, As an Individual

6:35 p.m.

MD/Ph.D. Candidate, University of Toronto, As an Individual

Swapna Mylabathula

Thanks so much.

6:35 p.m.

Conservative

The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen

We're going to suspend the committee for five minutes while we change panels.

6:40 p.m.

Conservative

The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen

Okay, we're going to reconvene and start the committee again.

I'd like to welcome Mr. Gordon Stringer, who is the father of Rowan Stringer, who died in 2013 after sustaining a head injury while playing rugby. Mr. Stringer is an advocate for concussion awareness and education.

Mr. Stringer, I welcome you to our committee and look forward to your presentation. Thank you very much for coming.

6:45 p.m.

Gordon Stringer As an Individual

Thank you very much, Mr. Chair.

I'd also like to thank the committee, particularly Mr. Fisher, for facilitating my appearance here.

As was mentioned, my daughter Rowan passed away in May 2013 from a blow she suffered playing high school rugby. She took a hit in a game on May 8, which was a Wednesday. She lost consciousness on the field and was transported to the children's hospital here in Ottawa. In spite of all the interventions they could do—this being the world-class facility that it is, we know that she got the very best care—she succumbed to her injuries on Sunday the 12th.

Since then, we've been involved very heavily, particularly in learning about concussion. I could probably have written on a Post-it Note what I knew about concussions before what happened to Rowan. I'm considerably more knowledgeable now.

About two years after her death, in May 2015, a coroner's inquest was held here in Ottawa to look into all the information around what happened to her before the fatal concussive event. That inquest was called for by Dr. Charles Tator. I believe Charles has addressed you already. At the time, I didn't know Dr. Tator at all. I've learned very much since then how valuable it is that he became involved in this. He's an incredible man.

From that inquest, 49 recommendations were made by the jury—very insightful recommendations, I must say. The unfortunate thing with inquests is that things that come out of them aren't necessarily ever acted upon. I didn't know that beforehand. I naively thought, well, here we have 49 recommendations, so things are going to get done. That's not necessarily the case.

I approached my local MPP at the time and asked what we could do to get these acted upon.

A private member's bill was put through Queen's Park, co-sponsored by a member from each of the three main parties. It was unanimously passed, and we had the first concussion legislation in Canada pass through at Queen's Park. But that first piece of legislation was speaking only to the forming of a committee, which was to advise the Ontario government on how best to implement those 49 recommendations.

I served on the subsequent committee with very learned people. I felt quite humbled being around the table with these folks, many of whom have spoken here—Eric Lindros, Charles Tator, Paul Hunter, to name a few.

After one year, that committee came out with the report on the creation of Rowan's Law. It is available online. In it, there are 21 action items for the Government of Ontario. The first was creating Rowan's Law, which was passed into law last year in March. Along with the passage of the law, there was the creation of Rowan's Law Day, which will happen every year on the last Wednesday of September in Ontario.

Last September 26 was the first Rowan's Law Day in Ontario. We had incredible participation in that day from the education field, from the health care field and from the sports community.

I was heartened to hear, in the previous presentation, talk of a week. I think that would be incredible. If that moves forward, I think consideration should be given to making that week centred around Rowan's Law Day, which is in Ontario. The day that was picked for Rowan's Law Day was specifically because it's a day that no other kind of “Day of...” falls on.

Also, it is early enough in the school year that schools, sports teams, etc. have an opportunity to discuss Rowan's story, concussions, protocols and so on, so that kids get a start on the school year and on their sports with this base of education and knowledge, age-appropriately of course. It can't be the same across the board. You can't teach a grade 3 student at the same level you can teach a grade 9 student today. It has to be an appropriate base of knowledge.

What we have now is a working group that has been established in Ontario. I again have had the honour of being asked to serve on that working group, which is now working on helping the government implement the rest of the action items that have not yet been fully implemented in Ontario.

I was heartened to hear that last week a call for commentary went out from the Government of Ontario regarding regulations, code of conduct, etc., which will address some of the action items. Commentary is open on those aspects of the bill until April 14.

Other things I've learned over the last six years are things I'm sure you have already heard, but I will reinforce them.

There are gaps. There are voids in the treatment system, the management system, in Canada for people who suffer from concussions and post-concussion syndrome. Like a vacuum, those gaps and voids eventually get filled, but unfortunately they're not necessarily filled with the right things. I've heard it referred to as somewhat of a cottage industry that has popped up with respect to concussions, people hanging shingles out, claiming their expertise in the area of concussions. When people can't get access to the primary, secondary or tertiary care they need, they will go to whatever is available, and that's not necessarily a good thing.

There's a definite need for front-line health care providers, particularly clinicians and family physicians, to update their education in the concussion area. You've no doubt heard that 70% to 80% of concussions will generally resolve within—depending on who you talk to—four to eight weeks.

Those are the people who need to be seen by their primary care physician, and those primary care people need to be able to triage them. They need to have the education to be able to tell whether they can look after them or whether they need to be referred further on. When they get to the point of being referred, however, there is a huge gap out there in proper facilities they can go to, multidisciplinary clinics where they can be addressed.

Another phrase I've learned over the last six years is that when you've seen one concussion, that is what you've seen—one concussion. It's a myriad of problems and combinations. It's a constellation of issues. You don't necessarily have just one or two; you may have six or seven. You may have only one or two, but all of them, at some point, need to be addressed.

That being said, we do have excellent examples of such facilities already in Canada, such as Concussion North, in Barrie, with Dr. Shannon Bauman. It's an excellent facility. I believe Dr. Bauman has been here. There's Dr. Michael Ellis in Winnipeg, at the Pan Am Clinic. There are people out in Calgary. There are clinics in Toronto and Montreal, at McGill and Laval.

Examples do exist, but they need to be replicated. People need to be able to have access to them when they need that beyond their primary physician care. Here in Ottawa we have a CHEO clinic run by Dr. Goulet. He desperately needs to expand his capacity there. He needs support in funding for that. He's doing the best he can for the kids, but it's not enough. He doesn't have.... That's something that also needs to be addressed, the capacity issue across Canada.

I think I'll leave my comments at that for now. I welcome any questions you have regarding what was said.

6:55 p.m.

Conservative

The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen

Thank you, Mr. Stringer, for your helpful testimony. It's very appreciated. Hopefully you can add more as the questions come. I appreciate that.

Mrs. Fortier.

6:55 p.m.

Liberal

Mona Fortier Liberal Ottawa—Vanier, ON

Thank you very much for being here and sharing your testimony. Honestly, I would prefer hearing you sharing with us what else the federal government should be looking at. If you have any specific recommendations that we could look at, I would appreciate hearing that from you.

6:55 p.m.

As an Individual

Gordon Stringer

Well, I know from my career working for the federal government and 12 years at the health department that there are jurisdictional issues when it comes to health. That being said, I truly believe that the federal government, being the place where a lot of the funding, the money, originates, can have a role in influencing what happens at provincial levels.

We have Rowan's Law in Ontario now. Over the next couple of years, all of the action items are going to be implemented, things like the gaps in education for the medical areas. That was one of the recommendations, ensuring that health care practitioners have updated education, and in the curricula in universities for medical schools. This would be particularly in Ontario, but I do believe it needs to be expanded across Canada, and more education in this area needs to be provided, particularly in the ER, family practitioners and clinicians areas, those front-line people who see the kids and the people coming in the doors first.

I believe we have a template in Rowan's Law that can be replicated across Canada in each province. We've had the catastrophic event. We've had the inquest. We've had the recommendations. We've had one year of experts sitting around the table talking about how best to do this. We've had the action items presented. We have a government that is in the process of implementing all of those action items.

It doesn't necessarily have to be one-size-fits-all, as your previous witnesses said, but I think the template is there. A lot of the heavy lifting has been done. Replication of it, I believe, should be relatively straightforward, given of course the unique circumstances of each jurisdiction. That is understandable, but I think the blueprint is there, much like the blueprint is there for many of the multidisciplinary clinics that do need to be replicated across the system to improve access.

The template is there in Rowan's Law. I'm working now to try to encourage other provinces and jurisdictions to adopt something similar, be it by legislation, policy or regulation. It really doesn't matter to me, as long as the spirit of it and the force of it are there. I think the federal government can have a role in encouraging that type of adoption across the country.

7 p.m.

Liberal

Mona Fortier Liberal Ottawa—Vanier, ON

With the work that is being done right now in Ontario—I didn't go through all the documentation—are you aware of whether an evaluation of Rowan's Law will be done in a few years to see if something else should be addressed? As you say, it's a template. Is there an exercise for making sure that we review, or that there's a revision of, that law?

7 p.m.

As an Individual

Gordon Stringer

Yes. It is mandated that there will be annual reports. The initial recommendation was for every two years, but through the public commentary process it was changed to annual reports that will be done on what has been accomplished with respect to the action items and how it is functioning. I believe it can also be an evergreening process. Some of the elements that will be required, the information portals, etc., will be evergreen. They will be updated as better information comes forward.

What we really want to do is have those portals be the ones that people go to. One thing we learned through the inquest was that Rowan did Google concussions, but the information that came up was not helpful. It wasn't the stuff she needed to see. We need to ensure that the first thing that comes up when people search for the elements of concussions are things like the government portal, where the very best, the newest, and the most up-to-date information can be found. Places like Parachute need to be the ones that pop up for people to seek out information on that. There needs to be some work there with respect to ensuring that the right and most up-to-date information gets into the hands of people. It could be combined with a public service announcement program during a concussion week. There are many ways that could be done.

It's very important that they get the right information when they search for it.

7 p.m.

Liberal

Mona Fortier Liberal Ottawa—Vanier, ON

Thank you.

7 p.m.

Conservative

The Vice-Chair (Mr. Robert Kitchen) Conservative Robert Gordon Kitchen

Mr. Richards.

7 p.m.

Conservative

Blake Richards Conservative Banff—Airdrie, AB

First, I think I can speak on behalf of everybody when I say how sorry we all are for your loss. I also want to commend you for the courage you have shown in taking a horrible tragedy for you personally, and for your family, and trying to do something to help others. That takes a lot of courage, and it's something that deserves to be commended completely. Thank you for that.

7 p.m.

As an Individual

Gordon Stringer

Thank you. I appreciate it.

7 p.m.

Conservative

Blake Richards Conservative Banff—Airdrie, AB

I want to start with a question that I think will be a very difficult one. It probably won't be comfortable to answer, but I'm going to ask it. If you're not comfortable, it's okay, but I think it's an important question because it really gets to the heart of everything. Is there something that, had we known—if someone had had better education, or if something didn't exist then that should have existed—your daughter's death could have been prevented?

7 p.m.

As an Individual

Gordon Stringer

Absolutely.