Health Committee on March 4th, 2014

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much.

I'm very glad that my colleague raised the question of midwifery and what's going on there. I'd like to come back to that question, Ms. Gillis, and question it a little more closely, given that we have some additional time for questions.

First, there's no question that primary health services to first nations, Inuit, and Métis communities is a federal responsibility, constitutionally. There's a lot of evidence to show that midwifery does improve the health outcomes in aboriginal communities. To be quite honest I don't feel very satisfied by the answer you gave. To me, this is a key example of scope of practice where we could be doing something that is practical, effective, cost-effective, and has good health outcomes.

There's an association that's ready to go. They want to do this. As you say, it's a profession that's being more and more recognized. For you to tell us, you're focusing on nurse practitioners...by the way, I understand how important that is as well. Surely the federal government has the capacity to advance two job classification requests to Treasury Board. Are we waiting until the nurse practitioners are done and then maybe the midwives will come forward? There has to be a better answer to that. There's a lot of interest on this committee because it is so basic. It's something that would really qualitatively change health outcomes in northern and remote communities.

Please tell us if Health Canada has recommended to Treasury Board to look at this classification. Are you monitoring it? How long will it take? When do you expect to see a resolution?

[Debra Gillis]

As I mentioned earlier, we have not put forward through the first nations and Inuit health branch a recommendation around midwifery, at this point; however, what we are doing is.... Because of the recognition that midwifery services or services for birthing closer to home are really quite important, because rather than—

[Libby Davies, NDP, Vancouver East, BC]

Can I just interrupt you?

I want to get to the timing question here. I know you know how important it is, so when you say you haven't made the recommendation, does that mean that Health Canada does not contemplate doing that in the foreseeable future? Is it something that's on your work agenda? Could you give us a sense of timing, or is this just not on the radar right now?

[Debra Gillis]

I really can't provide you with the timing around that.

[Libby Davies, NDP, Vancouver East, BC]

Who can?

[Debra Gillis]

Right now we are looking at our options to provide birthing services closer to home.

[Libby Davies, NDP, Vancouver East, BC]

Surely that must require some sort of classification change. My understanding is that they can't operate unless they get that classification. I just don't understand what the obstacle here is, given the importance of this particular measure. Is it something that Health Canada is going to advance at some point?

[Debra Gillis]

That's why we're looking at our options around birthing closer to home. Some of the first nation communities, especially in the remote areas, are very small. In many cases, we operate, for example, a two-nurse nursing station. Given our ability—or lack of ability sometimes—to attract staff, we have to look at the scope and we have to look at the number of staff we can have. So we're looking at the different options available to us in the variety of communities in which we provide services.

[Libby Davies, NDP, Vancouver East, BC]

It seems to me that would be something that would come about as a result of getting a classification, because then you know what capacity you have and what resources need to go where. If you don't have the classification to begin with, then midwifery isn't even part of the review and the consideration. So really, I'm just not getting it. It seems inexplicable why this wouldn't be advancing. According to all the information we've seen, midwives would actually be assisting nurse practitioners. They would actually be extending the scope of practice. Maybe there wouldn't be one in every remote community, but they would be one of the choices there if you could get over the technical barrier of having the classification. I'm sure we'll take this up in the study, but I really wish Health Canada would advance this and see it as something that is a priority.

[The Chair, Conservative, Ben Lobb]

Okay.

Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you, Mr. Chair.

Welcome to all the witnesses here.

The first question I have is to Colonel MacKay.

As you're probably aware, the committee just completed a study on prescription drug abuse. My question to you is how serious prescription drug abuse is in the military. What is used, generally speaking, for pain maintenance? What we found out here was that there's a huge problem with opioids being over-prescribed and abused. Can you inform the committee what the scope of practice is in that field?

[Col Hugh MacKay]

I'm sorry. Could you clarify what link you see to the scope of practice in that field?

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

The witnesses who came before the committee indicated that there is not enough knowledge among doctors, and there's no clear guidance on prescribing drugs. Some witnesses told us that one of the reasons for over-prescribing opioids is the very aggressive advertising campaigns by drug companies, which was quite shocking. What do you use for pain maintenance for our troops?

[Col Hugh MacKay]

Within the spectrum of care for the Canadian Forces health services, we have a full suite of medications available which would include narcotics and non-narcotic pain medications. We also have modalities like physiotherapy, referral to chiropractors, and those types of modalities to help with pain management. Occasionally, we need to refer folks to specialty pain management clinics in order to assist members with their pain management.

In the forces you've expressed concern about problems with misuse of prescription medications. We have a survey that we do every four years called the health and lifestyle inventory survey in which we do have personnel reports on drug usage. That study would suggest to us that there is a very small percentage of personnel who are reporting anonymously whether or not they have used prescription medications inappropriately. I don't have the specific number in my head, but it was a very small percentage of personnel that reported that.

As part of our treatment suite, we also have addiction counsellors available to us, who work in our mental health clinics and who are certainly available to help anybody who is starting to have any issues with respect to substance abuse, whichever type of substance that may be, whether it's prescription or non-prescription medications.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

My colleague asked you about chiropractors, and we know that in many cases instead of using chiropractors, doctors would prescribe a pain medication to treat lower back pain or other pains. That's also something that perhaps should be considered for the treatment of our troops. The statistics that were mentioned here indicate that about 50% of releases are due to that problem. Is that correct?

[Col Hugh MacKay]

I believe the highest percentage of medical releases are a result of musculoskeletal injury, yes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Is this something new or has it always been that way?

[Col Hugh MacKay]

As long as I've been in, and that's for 30 years, our statistic has been that musculoskeletal injuries or problems, have been the number one reason for release. Our soldiers are asked to work in very difficult environments and do very difficult work. Unfortunately, occasionally, that has an effect when you do it over a career. So that is the case.

Our clinics have the benefit of a remuneration system that is different than some clinicians have across the country in that we have salaried physicians who are able to take the time to spend with patients and have discussions with patients. We have a multidisciplinary team that is involved with helping patients.

I believe that perhaps provides us a little bit of protection from what you may have heard from some of the other presenters to you regarding prescription drug misuse. Our model allows us to have time to work with those patients, and hopefully not see the same types of rates that are seen in other populations.

[The Chair, Conservative, Ben Lobb]

Mr. Scarpaleggia.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you, Mr. Chair.

My understanding is that what we're trying to do with this study is to see how the federal government, through its foothold in health care.... We always assume that it's entirely a provincial matter, but in fact the federal government has an important role to play by virtue of its work and its jurisdiction over aboriginal communities, the military, and the penitentiary system. So we're trying to see how we can be the leaders in terms of breaking down barriers in the medical professions in such a way that someone could practise anywhere in the country really. That seems to be my understanding of what we're aiming for here.

I'm just wondering, for example, what the Department of National Defence is doing in the area of telehealth. Are you doing that in complete isolation, the digitization of health records, and so on, for easy access? Are there any bridges with, for example, Quebec? Are they looking at your example? Are you looking at what they're doing? Because I know they're quite active in the area of telehealth. Is there some synergy here? That's the one question.

The other is this. Do you find—maybe Ms. Gillis would want to answer this—that through the examples and the standards that your department is setting, provinces that might not have the same standards and necessarily all the occupations are bringing their standards up? For example, just by way of analogy, in terms of drinking water quality, the idea is to set federal standards so that provinces that maybe don't meet those standards then have something to aim for. Do you find that you're accomplishing that?

Also, we know that through the immigration system we're trying to make it easier for newcomers to Canada to integrate into the medical profession. Are you interfacing with Citizenship and Immigration on issues of certification?

Maybe we can start with Colonel MacKay.

[Col Hugh MacKay]

Maybe I can answer the first question.

As a small health care provider, we're not actually engaged with all of the provinces in discussing what we're doing with electronic health records. We are, however, engaged certainly within the federal government. As I explained earlier, we sit on a committee chaired by the chief information officer of the Treasury Board, where we discuss where the federal government's going with electronic health records and trying to standardize applications across the federal government. That is where we have involvement with sharing the lessons that we have learned in the implementation of an electronic health record.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you.

Ms. Gillis.

[Debra Gillis]

Let me try to answer the three questions that—

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Try the best you can. I know there was a big mouthful there.

[Debra Gillis]

Absolutely.

We have been working very closely with, in particular, provinces in which first nations live, and are finding significant success in working very closely with them in a number of different areas and breaking down some of those barriers between the first nation communities and the provincial health system. In fact, the more recent and very successful example is that last year in October, through many years of work with the Province of British Columbia, the first nations in British Columbia, Health Canada, and the federal government of Canada, we have transferred all health services to the First Nations Health Authority in British Columbia, which is working very closely with the province. But you see lots of examples of that happening right now in many different ways.

In terms of standards, and you mentioned specifically water, there are Canadian drinking water quality standards, absolutely, but they are developed in a collaborative manner with the provinces and territories. So while they are Canadian drinking water standards, they are...so for the most part provinces adopt these but they may make some minor modifications depending upon their situation.

In terms of work with foreign-trained physicians and nurses, this is some work that Health Canada has been involved in for quite some years, working with Citizenship and Immigration Canada, with Employment and Social Development Canada, with the medical and nursing colleges, and education boards. We have been working very closely over a number of years to break down some of those barriers, but ensuring that foreign-trained health workers are meeting the same standards that all physicians or nurses or others in Canada must meet.