Health Committee on Oct. 5th, 2009

[Dr. John Maxted]

I certainly agree, and meetings have been occurring. But an overall answer to a lot of the questions you've been asking here is to recognize the patchwork in our health care system and the fact that within our health care system we deal with the same FPT issues that you deal with here in government. That's why I stressed in my presentation that we have to get to the local level.

We can meet all we want and do all we want at the national level, but if it doesn't get translated into what the realities are of health care providers at the local level interacting with providers and the public health authorities within that local level, I'm afraid we're not going to be very good in our delivery of health care and public health.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Is that a problem that your members have raised?

[Dr. John Maxted]

Absolutely, and what we see is a patchwork. Earlier somebody was asking about discrepancies, resources, and the availability of resources. As we go across the country and ask our members—the college has 10 different chapters—there's a variety of responses as to whether resources like N95 masks are available, whether they have to pay for them, and whether they're readily available.

In my own area, where I happen to practise part-time, I've been told that they've been fitted for their masks but no masks are available at this time. So if the pandemic were to hit next week or within the next few weeks, as we're supposed to expect to some extent, there could be some severe implications from that.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Have you gotten any answers about the lack of masks? That is the issue you raised.

[Dr. John Maxted]

We continue to work at the national level to try to push some messaging into the local and regional areas and to deal with our regional counterparts in trying to achieve the best outcomes for them. But it's also important for us to support the kind of interaction that has to happen at the local level.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Monsieur Malo.

We'll now go to Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you, Madam Chair.

Thanks to all of you for being here, and especially Dr. Maxted for being here again. You were here on August 12, and I don't hear much of a change in your presentation. You warned us then of a multi-vehicle pileup. You talked about problems in communications--you said that was key and there needed to be a coordinated communications strategy. You talked about having directives foisted on you without consultation, and you talked about confusion in the system.

Has anything changed since August 12?

[Dr. John Maxted]

The messages you've just outlined have been heard, and some activity is taking place right now.

Would we have liked to see that activity occurring three to six months ago? Absolutely. But there is some activity that shows a light at the end of the tunnel in the kind of availability of resources, the communication we think needs to be reinforced, and the fact that we need a better communication network than we have right now. We're seeing some action. We hope it's not too little, too late. We hope this will become reality, because as much as we can talk about it, it has to become a practical reality for those on the front line.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Well, I guess the question is that if this really hits next week or the week after, it's not likely that we're going to be ready with that nationally coordinated, communicated plan that's so necessary to protect people in the event of a pandemic.

Linda, in your presentation you mentioned some of the same problems. And in previous correspondence that you sent to committee members you talked again about guidelines being developed in terms of occupational health and safety--or in the case of the federal government, it uses the words “safety” and “hygiene”. You talked about your concerns about the different standards in this country, a hodgepodge, a patchwork of systems. And you talked about the need for the precautionary principle and for nurses to have access to the N95 respirator.

I raised those concerns with Dr. Butler-Jones, the head of the Public Health Agency. He basically said that we don't need the masks, that there's no evidence to suggest you're better served by them. And he did not suggest that there were any problems with the national guidelines.

Can you comment?

[Linda Silas]

With all due respect to David Butler-Jones, I'm sure if he were to go on a unit where 100% of the patients were affected with H1N1, he would be wearing an N95--well-fitted. That I guarantee.

The evidence is not clear. We've been working on this with the agency for three years. No one can say 80% or 90% that the evidence is clear on what to wear. We do not believe safety should be put into jeopardy here.

We urgently went to the Standing Committee on Health on the safety issue because it was urgent. The Minister of Health urged us in May not to go public with this, not to create a public outcry. It is early October, we still don't have any results, and the pandemic could hit anytime. What governments, provincially, are telling us is that any health care worker who asks for an N95, regardless of where he or she works, can get one. That means every health care worker will have to defend himself--look for the mask, get a fit test. That is not appropriate in this country, and we will not stand for it.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

What you're saying is that in some provinces there's a commitment to provide the--

[Linda Silas]

Just one, the province of Ontario, which lived the SARS experience. They have the Justice Campbell report. Let's also be clear, the fact document did not even quote Justice Campbell. That in itself should be a red flag for everybody around this table.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Well, maybe the question to both you and Dr. Maxted of the College of Family Physicians is whether the mushroom syndrome is still at work. That was the report coming out of SARS, based on the lack of consideration to some of the obvious recommendations. That's a rhetorical question, but if you want to answer it, let me just finish. My time is probably coming to an end.

When I raised this concern about respirators with Dr. Butler-Jones, he basically suggested that I didn't know what I was talking about and, by implication, that you didn't know what you were talking about. He said we're not talking about tuberculosis or smallpox, and if we were, then we'd talk about N95s. He said we're talking about a virus that is transferred when we cough. We handle it. We rub our noses and our eyes, hands in our mouth. He says that's the problem and that N95 respirators won't help at all.

What do you say to that? How do we get a better national standard to protect nurses on the front line?

[Linda Silas]

My question to him would be, how come when his own report of December of last year from the council of executives recommended the N95, they didn't support that recommendation? It was supported with their own report.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Dr. Maxted, is the mushroom syndrome still at work, or are we getting out of the dark and into the light?

[Dr. John Maxted]

I don't think we have time to cover that entire area, but what that reflected was the difficult relationship between public health and primary care, and the fact that the interface wasn't as strong as it should be. I think it is stronger than it was at that time. Is it strong enough to address the current pandemic and what we might anticipate? That's our concern, and I think that's why we're sitting at this table.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Do I have time for one more question of Dr. Doig?

[The Chair, Conservative, Joy Smith]

Very briefly, Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Dr. Doig, you seem to be saying as well that there's a lack of communication on what's happening. You're not even sure if there is a prioritization list for when the vaccine is available. I'm just wondering what this committee could say to Health Canada that would help in that regard.

[Dr. Anne Doig]

The answer is to tell Health Canada that you will give it the authority to roll something out without waiting for the multiple layers underneath. If there was a clear directive, and if the Public Health Agency had the authority to make a decision that would be acted on by everybody, then we would get rid of some of the confusion around the supply and the guidelines for immunization.

[The Chair, Conservative, Joy Smith]

Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair, and my thanks to all the witnesses for coming here today and talking about this very important issue.

To summarize some of the comments I've heard, we now have some pretty good systems and processes in place between the Public Health Agency of Canada and your organizations, both in communication and consultation. That would be my first important take-home message. I don't think this has always been there. I am also hearing, however, that as it translates down through provincial and territorial systems, down to where it matters most, at the front-line caregiver level, there are still some gaps.

My first question is to Dr. Maxted. Confidence and knowledge on the part of clinicians and primary care physicians is critical. We also know that family physicians are busy and inundated with information from all sources. Are there plans for a multi-pronged strategy with the local health authorities, with the provincial health agencies, to support our physicians, whether it be through medical advisory committees or through various techniques?

[Dr. John Maxted]

We get the kind of information we've brought to you from our members, who are at the local level and who are experiencing the patchwork of communication. And communication is essentially the problem. The Public Health Agency of Canada has produced some excellent guidelines, but they are roughly two to three pages apiece. I don't know how many of them there are right now, and they're coming out at a rate of two or three a week. They're not necessarily of practical value to front-line providers; they're not the one-page, easy-access, and readily available information that they need.

Dr. Doig and I referred to the meeting we recently had with Dr. Butler-Jones and the agency. We tried to develop some of the one-pagers we need, and we are working on that. I'm hoping it wasn't too little, too late. We need something that's easier to read and much more accessible to a family physician who is seeing 30 patients a day.

I recently received a document from one of the regions for infection control—it was 111 pages long. You're going to find very few front-line providers reading 111 pages to figure out how to control infection, which has become a highly important issue in primary care.

[Dr. Anne Doig]

To give you an example, I will quote my colleague Dr. Shortt, who told me this afternoon that he was trying to find the clinical adult dosage for TAMIFLU and could not find that information anywhere in the published material now available. Actually, it was buried somewhere in the document on prescribing for pregnant women, and he eventually found the information he was looking for. But if my normal patient volume is roughly six patients an hour, and I'm now asked to see perhaps ten patients an hour, plus triage people on the phone, I can't be taking my time to run around and look for information. I need to have something at my fingertips.

I have non-registered nurses staffing my telephone. I need something that is quick and easy for a layperson to understand, because it will be a layperson on the phone talking to another layperson, trying to decide if that person needs to come into the office or not. Those are the kinds of practical tools that we need nationally. Something as simple as that doesn't require a lot of inter-jurisdictional consultation.