Health Committee on Feb. 17th, 2016

[The Chair, Liberal, Bill Casey]

I call the meeting to order.

I hope everybody had a nice week.

I'd like to pick up where we were at our last meeting. Mr. Davies had some issues of concern, and I notice you've withdrawn a motion. I'd like to hear your thoughts on this.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chairman.

At the last meeting, I had a motion that would provide the committee with some parameters about when it would go in camera. Mr. Carrie, I think quite thoughtfully, advised us to take some time to consider that motion, which we did.

I had a chance to talk to you, Mr. Chairman, and I'd like to thank you for reaching out and discussing that matter.

With regard to my main concern, it's my belief that the bulk of this committee's business should be conducted in public so that we're accountable to the Canadian public, so that there's a record of our deliberations and our votes, so that we have transparency in government. My main concern was that in previous Parliaments, it was customary for committees to go in camera when they were discussing committee business. I felt that was not an appropriate use of the in camera process. To me, in camera is used for the consideration of draft reports when it's necessary for committee members to be free to discuss things and discuss witnesses' evidence in a very free and open way. It's also for confidential matters or personnel matters or financial matters. However, the consideration of committee business should always be public.

After having a discussion with you, Mr. Chairman, I'm very pleased that you have agreed with that general thrust. On that basis, I have decided to withdraw my motion. I'm happy to leave this in your capable hands and see how it goes. I trust that you will run the committee with the appropriate regard for the public nature of it. If not, my motion hangs like the sword of Damocles over the committee's head.

[Some hon. members]

Oh, oh!

[Don Davies, NDP, Vancouver Kingsway, BC]

By the way, Mr. Chairman, while I have the floor, I also would take this opportunity to withdraw the other routine motion that I did draft and put forward on the agenda for today. It had to do with the 10 minutes allotted to witnesses and allowing eight minutes in certain circumstances. After considering the way in which this committee has allotted the time, I don't think this motion is necessary, so I'll withdraw that motion at this time as well.

[The Chair, Liberal, Bill Casey]

The chair thanks you for doing that.

I really appreciated the way this all unfolded. I appreciated Mr. Carrie making the motion to give us some time to talk about it. That gave me time to talk to some other committee chairs to understand what your concern was, and then to get back to you. We talked several times on it.

I hope we can resolve procedural issues this way, if we can. That's what my hope would be. It just prevents us from polarizing any more than we have to be polarized. We have a big responsibility here with this committee, and hopefully we can all go forward together—hopefully.

At any rate, thanks very much for that.

The clerk had sent out a memo asking everybody to consider what we might be discussing as we go forward. I guess we should listen to what everybody has to say. I don't think anybody submitted any ideas.

Did the clerk get any submissions? No.

Mr. Kang, let's start with you. Do you have any ideas or suggestions on anything we should study, and why we should do so?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

I'm not ready yet. I lost my phone, and I was just running around trying to find it.

How about if I pass for now and come back?

[The Chair, Liberal, Bill Casey]

All right.

Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Sure. There are two areas, and I'll touch on them briefly.

One of them is that we're one of the few nations with universal health care that does not have pharmacare or medicine included in that definition of “comprehensive”. When I was going door to door in my riding, I ran into many people who were now in jobs that were temporary or part-time or contract, and I saw that the historic pattern in Canada, where people were employed and had pharma insurance through their employers, is changing. The cost of pharma when you're unemployed is quite significant. In the case of twentysomethings who are living with their parents—and my riding is Oakville—if a child with diabetes returns to the home, the cost could be $1,000 a month that nobody in the family was anticipating.

There are varying stopgap measures. There are some programs that can be applied for when you can prove you're destitute, bu those are variable across Canada. Different provinces have different rules, so we don't have a universal application for pharmacare, particularly for those who are unemployed and need assistance. I think looking at that would be a very worthwhile study.

We could look at prescription medicine, to start with. What would a national drug formulary look like? How would we go about controlling costs? How would we manage it? Could we make it affordable? I think there are several ways we could study it to look at affordability. There have been a lot of recent studies about the cost of licensed drugs in Canada. Can we, by more competitive negotiating processes, lower those costs to make licensed drugs more affordable?

Finally, there are issues around people misusing some drugs because they can't afford them. They'll take antibiotics for a few doses and then go off them to save them for the next time, and that's leading to inappropriate use of antibiotics. Some people don't use the drugs they're supposed to be using at all because they can't afford them. It would also give us, I think, a national picture of prescription practices, so we could look at over-prescribing, under-prescribing, and how drugs are being used effectively across Canada.

That's one area.

My second one—and these are my top two—is that I really do feel it's time for a comprehensive seniors care strategy. The CMA is calling for it. Most of the medical community is calling for it. It's looking at how we link acute care, primary care, home care, and community services together to provide a comprehensive basket of services focused on seniors.

I have a really good quick story that I'll share with you just to give you an idea of how that might work.

About 12 or 15 years ago, I was down in Rochester, New York. There is a program down there that delivers all-inclusive care for the elderly. It links all of those services together for clients or residents who would be in long-term care facilities here in Canada. These are quite frail, quite compromised people. We went down there in the morning. A call came in from a caseworker—not a nurse—who was working with a woman who was clearly in distress, with trouble breathing. She had chronic obstructive pulmonary disease as a diagnosis, and she couldn't breathe. It was late August and it was about 85 degrees, and she was living in an apartment with one bedroom and no air conditioning. It was a stifling environment. The call came in, and within about an hour a nurse was dispatched to see her in her home. The nurse confirmed the COPD was worsening, and about three hours later—I'm trying to remember the sequence of this—the woman had an air conditioner. A community team came out and installed a $600 air conditioner. By the time we left at around 4:35, a call came back in from the caseworker, who said the woman was fine. Her lungs were clearing up. She was restoring and she was back on track, and they signed off on her for the day.

In other words, for them it was the cost of a caseworker, a nurse's visit, and some calls to some doctors and others at the main headquarters. They averted a very major acute COPD episode for about $600 and maybe another $600 of staff time for the people who were there in the residence with her.

In our system, that woman would have been left on her own and could have had a very serious COPD crisis. When the COPD exacerbated, she would have had to call 911 to have an ambulance bring her in to the emergency room. Usually after an ER stay and an ICU stay, those kinds of elderly, fragile people need time in the in-patient unit to recover before they're sent home. In our system, it would be hundreds of thousands of dollars, but that acute episode was resolved by that interaction as it was happening, through a community team and a home care team.

How do we get that kind of flexibility and responsiveness to seniors, particularly the very frail seniors, in our system? I think that's worthy of study as well for us.

Those are my two thoughts.

[The Chair, Liberal, Bill Casey]

What was your role there?

[John Oliver, Liberal, Oakville, ON]

We were looking at different models of how to provide that kind of uniform care. We were watching and observing how they ran that program.

[The Chair, Liberal, Bill Casey]

Who paid for the air conditioner?

[John Oliver, Liberal, Oakville, ON]

It was part of the budget of this organization. It was a comprehensive care model. They had a community care element, a home care element, home services, and primary care all situated under one umbrella funding model, and one coordinated service delivery.

[The Chair, Liberal, Bill Casey]

Well, I think those—

[John Oliver, Liberal, Oakville, ON]

It's a long way from our models here, I have to tell you.

[The Chair, Liberal, Bill Casey]

Well, those two subjects could take us a couple of years.

[John Oliver, Liberal, Oakville, ON]

Yes. Anyway, those are my two.

[The Chair, Liberal, Bill Casey]

Mr. Webber is next.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair. I appreciate the opportunity to be the second person to talk about what we think we should be discussing here.

First, here is a little bit about me and my background, because it leads to what I would passionately like to bring to the table here.

As a provincial minister and an MLA for a number of years in Alberta, working alongside my honourable colleague Darshan Kang, I was involved in a lot of areas with respect to aboriginal relations, and also international relations. I focused for many years in those areas.

For about the last three years of my MLA career, I was focused on a particular issue in health. I met a young lady who approached me one evening at an event, indicating to me that she was dying of liver disease. She saw no way of getting a liver transplant in the near future, and her life was going to be cut very short. It had quite an impact on me. She was asking for help. Of course, what do you do as a politician? You look into the issue when you feel strongly about it. That had a huge impact on my life.

I focused in the last three years of my career on that particular area. I introduced a private member's bill in the Alberta legislature. It was Bill 207. I have the bill right here. I'm quite proud of it. I introduced it as a private member's bill.

I served my last few years as a private member in the Alberta legislature, and I introduced this bill. It was the Human Tissue and Organ Donation Amendment Act, 2013. Mr. Darshan Kang knew it very well. He supported it, along with his caucus colleagues. It was unanimously supported throughout the assembly.

It was a bill that would incorporate a human organ and tissue donation agency in the province of Alberta, which would entail the inclusion of an electronic organ registration system. It incorporated a driver's licence. Anytime you renewed your driver's licence, they would ask whether you would like to be an organ donor. There was an awareness campaign with it as well. It was quite an intense bill. It took a lot of work by a lot of passionate people with whom I worked on this bill.

I was very happy to see it pass and a number of the issues implemented. Of course, there was a change in government, with the NDP Notley government coming into power. I have to give Premier Notley some credit, in that she continues to move forward with progress on this agency. I am very pleased with that.

What I would like to ask the standing committee today is to undertake a study to examine evidence related to the state of the human organ and tissue donation procurement system in the country, to study and focus on the level of awareness by the people of Canada and the level of preparedness of our health care workers throughout the country, in every hospital, to react at a moment's notice when there is an opportunity.

I hear of many, many instances of opportunities that could not be taken advantage of because the infrastructure was just not there. The training of the staff is just not there, and we continue to not do a whole lot about it. Right now, 4,500 people are waiting on organ transplant lists in this country, and, on average, 256 people a year die waiting for transplants. Kidney disease is on the rise. Baby boomers are getting older. I expect there will be many more demands on our infrastructure.

We have 2,000 people waiting for cornea transplants right now. Every year, 1,600 more people are included on that waiting list here in Canada, so the demand continues to increase. I would ask, humbly, that we put together a study on this issue and bring in experts.

I have lists of many experts who can come here to talk to us and to indicate to us the needs and what we need in order to have a robust procurement system here in the country. I think it's very important. I would humbly ask my colleagues around the table here to take a serious look at it. I would be the first to give the chair a list of names of people to come here to speak to us.

Thank you.

[The Chair, Liberal, Bill Casey]

First of all, congratulations on your private member's bill. What could be more important, really? All the numbers of people you're talking about.... Do we know of countries that have successful programs where they have a good response on this?

[Len Webber, Conservative, Calgary Confederation, AB]

We lag behind countries such as Spain, Portugal, the U.S., France, Belgium, Italy, Australia, Ireland, and the United Kingdom. We lag behind these countries with regard to our human organ procurement and our transplant success.

I have to give a lot of credit to the Province of Ontario, though. They have the Trillium Gift of Life organ donation and procurement system in place here. What they are doing here is a model that other provinces should be encouraged to follow and implement. Here the role of a federal government is to encourage other provinces to get on board, to develop positive systems to put it in place, and to have perhaps an overarching umbrella. The federal government should help these provinces and these silos—basically, these transplant silos—work together in order to have a robust system throughout Canada.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chairman.

I'll give the committee a wish list of broad issues that I think the committee should look at. Then I will narrow that down and zero in on a few things that I think—

[The Chair, Liberal, Bill Casey]

Just a second, please. I'm sorry. I thought you wanted to comment on Mr. Webber's idea.

I didn't ask. Does anybody want to comment on Mr. Webber's idea at this point?

Mr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Yes. I practised medicine for 20 years and could not agree more on what I think we need to do.

I'm sorry. You might have made mention of this point, and I apologize if I missed it. There are jurisdictions that actually have presumed consent. If you don't want your organs donated, you actually have to carry something that says no. That might be something I would be willing to explore to even expand this.

I think you're right. In my own clinical experience, there were numbers of patients that would have been ideal organ donors, but due to systematic shortcomings, we lost organs, and that's a tragedy.

[The Chair, Liberal, Bill Casey]

Thank you.

Dr. Leitch.