Health Committee on June 3rd, 2014

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

I think we do need the mechanisms and the opportunity to engage stakeholders as the minister sees fit. There are going to be ample opportunities in the next year where she might be able to put this forward, and that's why we're proposing this amendment.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I think that “otherwise engage” gives too much weasel room. It isn't at all what was intended, so I won't be able to support that amendment.

[Libby Davies, NDP, Vancouver East, BC]

Can we maybe hold for a minute because there is a suggested wording that might bridge the government amendment and I think what's wanted. We have a wording there, so if we could just....

[The Chair, Conservative, Ben Lobb]

I think we're going to suspend for one minute and confer with our legislative clerk.

[The Chair, Conservative, Ben Lobb]

We're back in session, live, here.

The first two amendments were pretty smooth sailing here, but we're just going to do some stick-handling here on the third one.

We have the amendment to the amendment that Ms. Davies would be prepared to present here. Ms. Davies, would you like to read it as best as possible? Go ahead.

[Libby Davies, NDP, Vancouver East, BC]

I will. Looking at the government amendment G-3, it says:3. The Minister must, no later than 12 months after the day on which this Act comes into force, convene a conference or

My amendment after that would read:for the development of a comprehensive federal framework with stakeholders, including representatives of the medical community and patient groups and engaging with the provincial and territorial ministers; the federal framework that includes

If I could just speak to the amendment, basically it would allow the minister some leeway to engage separately with the provincial and territorial representatives, but it's still keeping the idea that there has to be engagement with the patient groups with a conference. I'm hoping that this amendment bridges where the government amendment is and where Ms. May wants to go with the bill.

[The Chair, Conservative, Ben Lobb]

Okay, thank you for that.

Is there any comment on the amendment to the amendment?

We'll just give that back to our legislative clerk.

On Ms. Davies' subamendment we'll do a vote.

(Subamendment negatived [See Minutes of Proceedings])

All right, next up, Ms. Davies, you had a separate point earlier in this discussion on amendment G-3, which had to deal with the portion at the bottom about the management of Lyme disease. Would you like to—

[Libby Davies, NDP, Vancouver East, BC]

Yes, I'd like to move an amendment to paragraph 3(d) of amendment G-3, so that after the words: management of Lyme disease,

the following words would be inserted: including a recommended national standard of care,

Then it would continue on to the rest of the government amendment, which says: and the sharing of best practices throughout Canada;

Basically my amendment is to add the words, “a recommended national standard of care”.

[The Chair, Conservative, Ben Lobb]

Okay.

Mr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Just briefly, the challenge with that is the whole diagnosis and treatment is developing. So it's premature to expect that we're going to be able to come up with national standards of care at this stage. It's an evolving diagnostic and treatment milieu. In spite of the allergic reaction, if I can use that language, of the foundation to the use of the term “best practices”, that is probably the most relevant way to address it at this time. Best practices apply to what we know today and a framework for getting the knowledge we need to establish. Standards of care are provincially mandated. I think you're going to give terrible indigestion to the provinces and territories, and create an obstacle to moving ahead on the file.

[The Chair, Conservative, Ben Lobb]

Ms. Bennett, and then Ms. Davies.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I think what we're asking for are clinical guidelines that would be widely disseminated, as developed by professionals. Whether you're in the College of Family Physicians or whether you're a hypertension specialist, it's perfectly reasonable to ask the profession to develop the clinical guidelines and have them continually evergreened and updated.

I'm not sure what standard of care really means unless it's capable of being continually updated, as in these things where the science will be always emerging. I don't know what Libby feels, but we would love to have clinical guidelines for the country because the more that patients understand what they're to expect, the better questions they ask of their professionals, and the easier it is on the provinces and territories. It's a job that all of the health quality councils are working on, the six that exist, but it is a matter of disseminating expectations and min-specs.

[The Chair, Conservative, Ben Lobb]

Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

I appreciate Mr. Lunney's points, but I think if you read subclause 3(b) in total, it does begin by saying, “the establishment of guidelines regarding the prevention, identification, treatment and management of Lyme disease”. So I think it flows to then go on to say, “including a recommended”. It's not saying that this would be done unilaterally by someone. You read it in the context that this is being established and you read it in the context of the earlier clause 3, before paragraph (a), which we just debated, which is about the conference bringing everybody together, having the consultations with provinces and territories. So it's really laying out a process as opposed to saying there is a national standard of care and we're adopting it. No, it's saying we're recommending that should be developed.

I do think there's a nuance there and if we leave it out we're unfortunately dismissing a pretty major point that was made by the Lyme Disease Foundation. They were pretty strong about this idea that we should include the need for the development of a national standard of care, as well as best practices. So I would still leave my subamendment.

[The Chair, Conservative, Ben Lobb]

Thank you.

Ms. Adams.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thanks, Mr. Chair.

I think there might be some redundancy. I think Dr. Bennett might be correct here. It does read in it's entirety “the establishment of guidelines regarding the prevention”. So this would all come out of the conference and the engagement of stakeholders, provincial and territorial ministers. So we would be establishing those guidelines.

We then go on to say, the “sharing of best practices”, and if we recall Jim Wilson's testimony from the Canadian Lyme Disease Foundation, we were really clear with him about this. What he found deeply disturbing or had great concern about current best practice. So we're not saying current best practices, but simply the term “best practices”, and the sharing of best practices would all come from that conference. This is an evolving issue.

So we would not be able to support your amendment.

[The Chair, Conservative, Ben Lobb]

Okay.

[Libby Davies, NDP, Vancouver East, BC]

Could we have a recorded vote, please?

[The Chair, Conservative, Ben Lobb]

Yes.

This is the subamendment to G-3.

(Subamendment negatived: nays 5; yeas 4)

Now, on to the amendment G-3, as presented by Ms. Adams. All those in favour of amendment G-3?

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Before that, I'd just like to move one amendment. We've been conferring. I'd like to move a subamendment to G-3, and that is to delete the words “or otherwise engage”.

[The Chair, Conservative, Ben Lobb]

And here I thought all of this would take about five minutes. So here we go.

Mr. Wilks, I understand you may have something here.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I may. Would you like to guess what it is?

[The Chair, Conservative, Ben Lobb]

Yes, let's go.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I move the subamendment that we remove the words “or otherwise engage” from clause 3.

[The Chair, Conservative, Ben Lobb]

Is there any debate?