Health Committee on Feb. 9th, 2017

[John Oliver, Liberal, Oakville, ON]

It's not of the amendment. The original wording of the bill stands, except for those two line items and the wording changes that I just went through.

[The Chair, Liberal, Bill Casey]

Thank you very much, but we have to deal with the amendment we have. We'll take yours as a separate amendment.

Now we are back to amendment NDP-2. I would like to know if amendment NDP-2 carries.

(Amendment negatived)

Now we have a motion from the floor, which is Mr. Oliver's motion, to change the words.

I didn't catch it. Do you want to say it again?

[John Oliver, Liberal, Oakville, ON]

Sure.

I move that in proposed subsection 56.1(2), in line 10 the word “evidence” be changed to “information” and in line 16 the word “regulatory” be changed to “administrative”.

[The Chair, Liberal, Bill Casey]

Is that in order?

[A voice]

Yes.

[The Chair, Liberal, Bill Casey]

All right. The motion is in order.

Go ahead, Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

Through you, Mr. Chair, I would be interested in knowing why the member would wish to change the word “regulatory” to “administrative”.

At first I didn't feel that there was much of a difference, and I felt that Mr. Davies perhaps made a point in terms of thinking of nurses and that sort of thing. However, the link directly to the Supreme Court decision firmed in my mind that we should stick with the original language, which is to say “regulatory structure”, and that the department should look for positive ways to make that very clear to those who are applying.

At the end of the day, those who put an application forward are not necessarily going to pull out this piece of legislation in its full form. They're going to read the application form that's put in front of them on a computer screen. That seems like the place to bring about greater clarity with regard to what that word means.

However, the direct link to the Supreme Court decision seems, on a legal front, to make a lot more sense to me. Perhaps that could be expanded on so that I understand the thinking there.

[The Chair, Liberal, Bill Casey]

Mr. Carrie is the next speaker.

[Colin Carrie, Conservative, Oshawa, ON]

Yes, I was going to elaborate on taking the word “evidence” out. We shouldn't lose the fact that what we're talking about here is an exemption for an illegal activity. We're not talking about Kool-Aid that people are putting into their veins at a consumption site. These are street drugs, purchased illegally from somebody with a nefarious background in many cases. It could be kerosene, for heaven's sake, that they're putting into their arms.

When the minister is deciding whether an exemption should be given to allow these illegal activities to take place, the word “evidence” is much stronger than just “information”. I think we should be taking this extremely seriously.

There are downsides to these sites. If you look at the evidence that we've heard.... We've had police state that there are a lot of offences—thefts, crimes to get the drugs—committed by these addicts, who usually aren't people of means, and they need to get the money somewhere.

I'm really concerned. Just to continue what my colleague Mr. Webber was saying, the government is saying that it is going to be a government of consultation, but we're moving to get rid of a lot of that consultation for these particular sites.

I know that on another committee, for Canada Post, the Liberal government is saying that they're going to give the veto to a municipality about where they put a mailbox, but they're not giving a veto or even mandatory information from a municipality or a community to give input on where an injection site is. These sites have significant criminal activity that goes with them.

Our current Parliamentary Secretary to the Minister of Justice is on the record as saying that when he was a police officer, there was no area in Toronto where this would not have negative effects.

I think that weakening the language in this bill is the wrong way to go. As I said, we're in favour of making sure that the consultation process is vigorous, and I think we should take into account what our colleagues from Health Canada said in response to Ms. Harder. They have tried to make the language consistent.

[The Chair, Liberal, Bill Casey]

Mr. Davies, go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

I listened carefully to what Ms. Mattison said, and she's quite right.

As a lawyer, I love saying this: I think the Supreme Court of Canada was wrong. What they said in the bill here—she's quite right—is “regulatory structure”. That's the wording of the Supreme Court, but the words that then illuminate what they were referring to make it clear that they're not talking about the regulatory structure in terms of regulations.

I changed the word—and I don't care which word it is—because under the current bill, when it says that an applicant has to include information on the “regulatory structure in place to support the site”, what does that mean? I'll tell you that as a lawyer, the first thing I would look for is the regulatory structure. I'd be looking at the municipal bylaws and the provincial structure.

That's not what the Supreme Court was talking about. To me the chance of an applicant saying, “Regulatory structure—I'm going to have regard to the Supreme Court decision to find out what was meant by regulatory structure” is pretty remote.

I'll just read for the committee what the Supreme Court said:

It is a strictly regulated health facility

—this is speaking about Insite—

and its personnel are guided by strict policies and procedures. It does not provide drugs to its clients, who must check in, sign a waiver, and are closely monitored during and after injection. Its clients are provided with health care information, counselling, and referrals to various service providers or an on-site, on demand detox centre.

Then it goes on to talk about other things. You see, what they were talking about when they said “regulatory structure” was the internal regulatory structure of Insite. That's why I thought it would be more clear to say to an applicant, “Tell us what administrative structure you have in place to support the site.” I thought it would be clearer and avoid confusion if applicants knew that this was the information they were being called upon to furnish.

I don't really believe it's necessary to respond to Mr. Webber's very strained analogy of pipelines, but I will say just a few things.

If Mr. Webber wants to leave the impression that I'm trying to ram through supervised consumption sites over the heads of communities that don't want them, he's absolutely mistaken and is misleading this committee and anybody listening. If he intends to say that I don't think the community's support or opposition to these sites is relevant, he's absolutely mistaken. My amendment specifically retains expressions of community support or opposition. I believe that's important. That's why I've been arguing that the minister should take that into account.

I was clearly just trying to say that the burden isn't on an applicant to furnish that information. If he listened to my argument, he would be quite happy, because an applicant who wants a site is quite unlikely to submit expressions of community opposition. Sorry, but he just voted against his own statement. My amendment would allow a community to put information to the minister about community opposition. He voted against my amendment to do that, so I think he's not quite clear on what we're talking about here.

Finally, I want to say here's a difference between the New Democrats and the Conservatives. We view the addiction and opioid crisis to be an issue of health, not an issue of morality or an issue of ideology. I want a proper administrative structure and application process for pipelines and for supervised consumption sites, but here's the difference. People are dying right now. People are dying today. In his province, in Alberta, Albertans are going to die today, and you know what? Their lives could be saved if we had supervised consumption sites, but he and his party are opposed to them.

The question I have for him is, why does he want to block health facilities that save Albertans' lives? He's content to let them die? Well, I'm not.

[The Chair, Liberal, Bill Casey]

Go ahead, Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

Ms. Brouillet, I want to ask you if you can just bring some clarification with regard to this terminology. If we were to change it from “regulatory” to “administrative”, what would be the repercussions?

[Miriam Brouillet, Legal Counsel, Health Canada Legal Services, Department of Health]

For me to answer that question would not be proper.

That said, I think it's useful to go back to the decision of the Supreme Court of Canada. In that decision the court was explicit in what the court understood as being a “strictly regulated structure”. If you allow me, I will read the passage that is of interest in the decision of the Supreme Court in order to enlighten your understanding of that notion that is currently in Bill C-37.

The court goes into a description, a citation, of elements that were presented as evidence in the court at the first instance. It says, “This passage describes a strictly regulated health facility.” It refers to that notion of health facility.

It says, “It operates under the authority of VCHA, and its personnel are guided by strict policies and procedures.” When it talks about a “strictly regulated health facility”, it goes back to those policies and procedures that exist within the health care service that is provided at that site.

It goes on to say, “It does not provide drugs to its clients, who must check in, must sign a waiver, and are closely monitored during and after injection.” They're describing how it operates and what circumstances and procedures are required in that particular site.

It also says, “There are guidelines for staff to follow in the disposal of used injection equipment and the containment of leftover drugs.”

Therefore, when we are using the words “a strictly regulated health facility”, we are going back to that wording of the Supreme Court of Canada. That helps the applicant understand what is meant. As my colleague Ms. Mattison has mentioned, the department will provide guidance to support the applicants in order for them to understand what is meant by these words that were carefully chosen by the Supreme Court of Canada and very carefully chosen by the government.

[Rachael Thomas, Conservative, Lethbridge, AB]

Can you further clarify whether those actions are taken by staff? Are they regulated by the province, or by an external health authority, or are they just internally regulated?

[Miriam Brouillet]

What is important to understand is that each site will be unique and will have its own reality. The minister has the duty to evaluate all the applications on a case-by-case basis. There's no one answer to that. It will be a case-by-case evaluation.

[Rachael Thomas, Conservative, Lethbridge, AB]

Let's look at the one example that we do have, which is Insite in Vancouver. Are they regulated by an external health authority or are they just internally regulated?

[Miriam Brouillet]

The answer is that they exist within a health facility that exists within a provincial structure. Therefore—

[Rachael Thomas, Conservative, Lethbridge, AB]

So would it be B.C. health that is overseeing them?

[Kirsten Mattison]

Insite exists within the Vancouver Coastal Health Authority, so it's within a provincial regulatory structure. It's functioning within its local municipal structure, so municipal bylaws, for example, apply to Insite, and it follows them. In addition, it develops its own internal policies and procedures.

The government, in evaluating the application for Insite, evaluated the layers of that. It would be a similar situation in most jurisdictions across Canada. There would be a provincial framework and a municipal framework, and it would be expected that there be internal policies and procedures.

In saying that it would be a different answer for each site, my colleague is indicating that the balance between those three may be different for each individual situation. One of the things the minister, in making that case-by-case assessment, would evaluate is whether the structure in place as a whole across the different layers is sufficient to support public health and public safety as the objective of the CDSA.

[The Chair, Liberal, Bill Casey]

Okay. Time's up.

We have one more speaker, and that's Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

I won't be able to add much to this, but I was asked these questions.

First, why move from “evidence” to “information”? I think the issue here is that the language has been taken right from a Supreme Court decision that actually rebuked the previous government's model and the efforts they were working on to restrict these kind of sites, but gave direction to the minister on how she could proceed with safe consumption sites.

I want to say here that this isn't advice to a minister, but an application. It's requesting information from an applicant. Sources give the minister information. The information is then looked at. Evidence is drawn by the minister from that for her decision, in this regulation. I think that for an application, it makes sense to talk about “information”; it is the minister who draws evidence.

Second, I think my colleague Mr. Davies said it exceptionally well, so I won't say much more about it. With regard to “regulatory” versus “administrative”, everything that is in that Supreme Court frame is administrative structures and processes, not regulatory ones. I think it has to do with translating the Supreme Court decision, which is issued to a government, taking that, and then writing a bill that deals with the application of it.

I think changing from “regulatory” to “administrative” is right, and I want to thank Mr. Davies for picking up on both of these two wording points. I think they're important clarifications.

[The Chair, Liberal, Bill Casey]

All right.

Mr. Carrie, please make it short, just because of the time.

[Colin Carrie, Conservative, Oshawa, ON]

I think it's important to correct the record, because of a few things that Mr. Davies did say. I think everybody around the table realizes that addiction is a health condition that needs to be addressed, and I think detoxification treatment has been the best option.

As for his attack on my colleague Mr. Webber, who was just trying to point out that pipeline applicants have to do all the work, Mr. Davies was saying that for site applications, perhaps they don't need to do the work. We hear over and over that these sites save lives. Well, pipelines create jobs, and the suicide rate in Alberta is going up because of the unemployment rate. I think he cares about his constituents, so I don't think we should be playing that type of game and going down that road, especially with an important piece of information like this.

At any rate, I think I need to correct the record on that.

[The Chair, Liberal, Bill Casey]

Thank you very much.

I want to know if this amendment to change the word “evidence” to “information”, and then to change the word “regulatory” to “administrative”, passes.

(Amendment agreed to [See Minutes of Proceedings])

Now we will move on to amendment CPC-1.

Would you like to address this?