Evidence of meeting #56 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was amendment.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Clerk of the Committee  Mr. Philippe Méla

11:05 a.m.

Liberal

The Chair Liberal Bill Casey

We will call our meeting number 56 to order. Imagine: meeting number 56.

Today we are doing clause-by-clause of Bill C-211, and then we have a bit of committee business to do after that. We will go right to Bill C-211.

Is everybody ready?

Pursuant to Standing Order 75(1), consideration of clause 1, the short title, and the preamble is postponed until the end, so I am calling clause 2.

(On clause 2)

Does clause 2 carry? All in favour?

Mr. Davies.

11:05 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Mr. Chair, I think there is going to be one major decision that the committee is going to have to make with respect to this bill. Happily, it's kind of a nice decision to make. I don't think it's a question of intent, ideology, or difference, but one thing that has become very clear through the course of this testimony is that we have two possibilities in front of us with this bill.

One is to create a bill that deals comprehensively with PTSD, or in other words, to have the bill call for the creation of a federal framework on PTSD comprehensively. Or are we talking about creating a federal framework for workplace PTSD? Both are inherently worthy objectives, and both of them I think are important.

I had not planned on moving an amendment or raising that issue at this particular clause, except now that I quickly read it, I think this may be the first time that the committee will have to determine which path we're going to take, because under the definition of “federal framework”, the bill says that it “means a framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.”

As you'll see later on, I have two suites of amendments, depending on which way we want to go. I'm content with making this a bill to create a federal framework for workplace PTSD. I'm also content to create a framework that would deal with PTSD comprehensively. I will advocate later on for the latter, for a number of reasons that I'll go into then. I think this definition is the first time that we'll have to make that decision on which path we're going to take, because the way this definition is written, it adopts the comprehensive approach.

I'm going to move an amendment at this time. In fact, I'm going to invite my colleagues to have the debate now, because I think we have to do it here. If we do not intend this bill to be a comprehensive approach to PTSD with regard to all major population groups in Canada, not just those in the workplace, then we should insert the word “workplace” in front of “post-traumatic stress disorder”. I'll make the argument why I think we shouldn't do that, but we'll make this decision.

Obviously, workplace post-traumatic stress disorder is a serious issue in Canada. As you'll see later on in the bill, there are certain specific groups that are mentioned as being the front-line victims of post-traumatic stress disorder. They are listed in the bill as veterans, RCMP officers, health professionals, corrections officers....

Am I missing anybody?

11:10 a.m.

Liberal

The Chair Liberal Bill Casey

First responders.

11:10 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Yes, first responders who are military personnel, as well as firefighters and corrections officers....

We've also heard evidence, of course, that PTSD can occur from episodic exposure: a woman who was exposed to a vicious sexual assault; refugees who are fleeing war zones and conflict zones and have come to Canada scarred and traumatized by that experience; or first nations, indigenous people. I think we can agree that those people are experiencing PTSD in much the same way as anybody else, but they didn't get that exposure through their workplace.

We heard very trenchant and powerful testimony from every witness, but in particular from our last panel, which told us about the delay that's happened in this area and how important it is to act quickly and in a timely manner for these people. We heard that it's extremely important for these victims to be heard and to be represented. If we take an approach of passing a framework on workplace PTSD, as laudable as that is, what would we be saying to those other groups—indigenous people, women, refugees, and others—who are not included in this federal framework? We would be sending one message to them, that they must wait.

I've heard a couple of arguments that it's better to get this going and not delay. With the greatest respect, Mr. Chair, that is a complete red herring, because nobody is asking for any delay. The amendments that would make this bill comprehensive won't cause any delay or difficulty whatsoever.

This bill essentially calls for the Minister of Health to convene a conference—within a year, I think—and spells out who should be around the table at that conference to begin the process of developing a framework on PTSD. The only question is who is at the table. This bill calls for the Minister of Health, the Minister of National Defence, and the Minister of Veterans Affairs to be present at that table. If we broaden that to include three other ministries, as you'll see later in my amendments, that does not delay anything. It just adds three seats to the table to develop the framework.

It's a chimera and a complete red herring for anybody to argue that broadening this bill at this point slows down anything. It does not. On the contrary, broadening this bill at this point is this committee's opportunity—right now, when the bill is in front of us—to give Canadians the comprehensive PTSD framework that all Canadians have been waiting for. I would argue that not adding these other groups now is actually playing right into the exact trauma that we're warned against. We're warned against not representing people, telling some groups they have to wait while we develop a PTSD framework for others.

Mr. Chairman, I am not going to repeat this argument at each of the different opportunities the committee will have to make this choice, but I will ask every member of this committee to remember that we sit on the committee for health. This bill came to the health committee. It didn't go to public safety; it didn't go to veterans affairs. It didn't go to the committees that one would think are charged with dealing with certain occupations. It came to the health committee, where we are entrusted to make policy for the health of all Canadians.

I would urge my colleagues here and say that, right now, we have a chance—brought by the wonderful work of Mr. Doherty, who has flagged an issue that has been ignored too long, an issue that has devastating impacts on people's lives—to make sure all these voices are heard.

I, for one, am going to very strongly urge that the health committee have this bill leave committee by saying that we have improved the bill by enlarging it slightly to make sure we develop a comprehensive federal framework for PTSD not only for these vital groups that have to deal with trauma every day, but also the three other major groups that have been identified by witnesses at this committee.

It's not a floodgate. We're not talking about 10 or 20 different groups. We're talking about three major groups—women, indigenous people, and refugees—and bringing those voices to the table when we have developed the framework.

I've also heard people say, “Let's just get this done and then we can deal with the rest of the groups later. This will be a framework. Let's just get this framework done.” Do you know what message that sends to the other groups? It tells the other groups that they can wait. That's the message it sends: “We could have dealt with you right here, but we deliberately decided that you can wait.” If I heard one message from these witnesses in this hearing, it's that we cannot wait.

Waiting costs lives. PTSD sufferers commit suicide. They attempt suicide. They lose jobs. They lose family. We heard the devastating testimony. I, for one, don't want to be a member of a committee who says to any of those groups that they have to wait, all because we didn't take the time to add a few words to this bill. Also, remember, just make sure those voices are at the table when the conference is convened.

I am going to raise this now, and I invite my colleagues' comments and look forward to your thoughts on this. If we don't broaden this framework now, if we do decide we're not going to add these other large demographic groups that are cited as suffering from PTSD, then I submit that we do have to put the word “workplace” in here, because that will then be consistent with what this bill is about. I'll point out for a moment that we heard testimony that women have PTSD at double the rate of men—double the rate—so we're not talking about marginal groups; we're actually talking about the main sufferers of PTSD.

I'm going to pause for a moment and just briefly make a case for the workplace aspect. Don't mistake my remarks for minimizing the importance of having a federal framework for workplace PTSD. That's a laudable goal. I'm going to let Mr. Doherty speak for himself later on if he wishes to, but I kind of think, after listening to everything and judging what I heard from speakers, that this is what he intended. I think maybe he intended his bill to be a bill that creates a federal framework for workplace PTSD, specifically for those people in uniform, in particular, or front-line health professionals, those people who deal with it every day in an ongoing way.

I also want to state, for the record, that I understand that there may be some differences in that PTSD, as these people are exposed to PTSD as a routine and regular part of their job. I'm not sure, at the end of the day, that the symptoms that any person with PTSD suffers with are any different, or that the treatment is any different, or that they need to be recognized any differently, but there is that one occupational difference.

I will urge the committee, though, that if we do seek to narrow this bill to this, that we make the necessary changes to insert the word “workplace” where it's necessary and to eliminate the phrasing in this bill that suggests that it's comprehensive, because that is not only incorrect, it's misleading.

I'm going to refer my colleagues to the summary of the bill. This was the start of some of my confusion. It says:

This enactment requires the Minister of Health to convene a conference with the Minister of National Defence, the Minister of Veterans Affairs, provincial and territorial government representatives responsible for health and representatives of the medical community and patients' groups

—note the reference to “patients' groups”—

for the purpose of developing a comprehensive federal framework

—here I'm going to underline the word “comprehensive”—

to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of post-traumatic stress disorder.

When you read that, it leads the reader to suggest that we're creating a federal framework on PTSD, period, comprehensively.

I want to refer my colleagues briefly to the preamble.

It starts:

Whereas post-traumatic stress disorder (PTSD) is a condition that is characterized by persistent emotional distress occurring as a result of physical injury or severe psychological shock and typically involves disturbance of sleep and constant vivid recall of the traumatic experience, with dulled responses to others and to the outside world.

That, my colleagues, is the comprehensive definition of PTSD. That applies to everybody—a first nations victim of residential schools, a woman who has been raped, a refugee, or our first responders.

But then it starts narrowing the scope:

Whereas there is a clear need for persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP to receive direct and timely access to PTSD support;

Well, now we start grappling with this. Is there not a clear need for first nations women and refugees to receive direct and timely access to PTSD support? I don't think anybody at this table would suggest that there isn't, but now we start seeing the bill start to narrow.

I won't go through the third paragraph. It just talks about the need for resources. Then the last paragraph is confusing, because I think it attempts to do both, to be comprehensive and specific.

It says:

And whereas many Canadians, in particular persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP, suffer from PTSD and would greatly benefit from the development and implementation of a federal framework....

So there it's suggesting that many Canadians would benefit, including these people, suggesting that there are people who would benefit that aren't included.

By the way, I'm only going to make this speech once, because once we get the issues out and we talk about them, I think we'll get the committee's desire and then we'll make the amendments quickly. I don't plan on speaking to each one of them, but it's the same theme throughout.

Colleagues, we're going to have to change the preamble one way or the other, and I have amendments to do that. I have amendments that will clear this up so that it will deal with workplace PTSD, or provide the opportunity to broaden it to the other groups.

It's unfortunate that I have to bring it up right now in kind of an odd place, but we have to deal with it in the order that we deal with clauses. So, colleagues, with clause 2, I'm going to move, for the purposes of debate, that we include the word “workplace” before “post-traumatic stress disorder.”

We'll begin the process by suggesting that the word “workplace” be included within the following definition:

federal framework means a framework to address the challenges of recognizing the symptoms and providing timely diagnosis and treatment of workplace post-traumatic stress disorder.

As you can tell, I don't support that addition, but now is the time to have that discussion, because if it is the will of the committee to narrow this to the workplace setting, then we should start there and put the word “workplace” in. If so, I will live with and respect the will of the majority of the committee.

I hope that we don't add the word “workplace” there, because I hope we can keep the bill comprehensive. Later on I'll be moving a couple of narrow amendments to add the ministry of women, Indigenous and Northern Affairs, and Citizenship and Immigration to the bill, then clearing up the preamble to be comprehensive, unless the committee at this stage decides to add the word “workplace.” If at this point we decide to add “workplace,” I will move those amendments, but I won't speak to them because I'll understand the direction of the committee at this point.

I will end by saying this, Mr. Chair. Once again, we have an opportunity right now to pass a comprehensive federal framework on PTSD. We have an ability to recognize that this affects a number of major groups and populations in Canada outside of those who wear the uniform, or suffer PTSD as a result of their work.

We have an opportunity to stop the delay. We have an opportunity to represent the major groups. We all know that this has taken too long. As Mr. Doherty and others testified in a very impactful way, time matters in this case. We don't want to have to come back in two, three, four, five, or ten years and then pass a PTSD framework for groups that we know from the testimony in this committee are suffering today.

I will conclude by saying that it's not a big deal to add a few ministers to this. I know I'm going to be hearing from some colleagues that this will complicate matters. It will not. Having the Minister of Veterans Affairs sitting beside the Minister of National Defence.... And by the way, we're going to have to add the Minister of Public Safety to this. I think that's an omission in this bill, because RCMP officers are mentioned, and they fall under the ministry of public safety and national security. We're already going to be adding another chair. We're talking about making sure that, as a committee, the right people are around that table. Whether there are three ministries represented or six, it will not make a difference other than to improve the process to make sure that we're comprehensive.

With that, Mr. Chair, I'll move the motion to add the word “workplace”, and I urge my colleagues to defeat it—

11:25 a.m.

Liberal

The Chair Liberal Bill Casey

I can help you out there.

11:25 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Okay.

11:25 a.m.

Liberal

The Chair Liberal Bill Casey

It's out of order. I'm advised that you can't make a change in the interpretation section of the bill that's not reflected in the bill. We're going to run into that same thing when we get to the changes to the preamble. There have been some amendments that propose changes to the preamble, but those changes aren't reflected in the bill.

I think we all know where you want to go, and probably most of us agree, but we have a process we have to follow. We have to follow the rules, or it won't work. I think—

11:25 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Mr. Chair, I have to challenge that ruling, and I'm going to make a strong argument. That is absolutely incorrect. I can point to sections in this bill that make it quite clear that the bill is related to workplace PTSD. Absolutely: it's right in the bill itself. This bill, as I pointed out, has double features. In fact, I will argue it's poorly drafted. It's confused. The summary of the bill does not correspond to what the bill is calling for.

As I pointed out, it has a dual feature to it. I can't tell when I read this bill whether it is a comprehensive framework for PTSD that involves everybody, or if it is only calling for a federal strategy on PTSD relating to certain specified occupational groups. I refer, Mr. Chair, to the ministries that are singled out in the bill.

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

No, I agree, but you mentioned the wording of paragraph 4 of the preamble, “whereas many Canadians”, which includes all Canadians who might be affected. If you then put the word “workforce” in the interpretation section, that section would then contradict the preamble. You've restricted it in one place, so I have to rule it out of order.

11:30 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

But, Mr. Chair, if I might say, I agree with that. The paragraph in the preamble very clearly suggests that this is a comprehensive framework.

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

For everybody.

11:30 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

Mr. Chair, point of order.

11:30 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

No, I have the floor. Thank you.

But the second paragraph of the preamble contradicts that. It says:

Whereas there is a clear need for persons who have served as first responders, firefighters, military personnel, corrections officers and members of the RCMP to receive direct and timely access to PTSD support.

The other groups don't?

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

I'm going to take the point of order from Ms. Harder.

11:30 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

I want to make one more point, if I can, and then I'll cede the floor.

11:30 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

Chair, you have—

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

No, I'm going to go to the point of order.

11:30 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

—to direct this meeting.

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

Yes. A point of order.

11:30 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

Thank you.

With all due respect, Mr. Davies, I understand what you're saying. You've spoken for 30 minutes now. We all understand what you're saying. But you're talking with regard to the preamble, and we all know that changes to the preamble can only be made if substantive changes are made to the body of the bill. We have not discussed the body of the bill, and therefore it is inappropriate to be discussing the preamble at this point in time.

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

Actually, we have a speakers list.

Mr. Oliver.

11:30 a.m.

Liberal

John Oliver Liberal Oakville, ON

I guess I would like to hear from Mr. Doherty about what his intent was with the bill. He was the drafter of it. What was his aim in this? Then after I've heard that, I would like to say a few words related to Mr. Davies' distinction here and offer some different perspectives on it.

I would like to hear from Mr. Doherty, if that's permissible.

11:30 a.m.

Liberal

The Chair Liberal Bill Casey

I need the consent—

11:30 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

On a point of order, Mr. Chair, I'm happy with that, but technically what we're talking about right now is the ruling of the chair that my amendment is out of order. Are we to be directing our comments to that?

What I would ask my colleagues to do is to overrule that ruling of the chair, so at least we can have the discussion about that. We can't really get into the merits of what I was talking about until we determine whether what I said is outside the scope of the bill, I think. For the purpose of continuing debate, I would ask that we overrule the chair so at least we can consider the merits of what I've said.

I just want to say one thing. Ms. Harder is incorrect. I'm raising my amendment at clause 2.

11:30 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

Then why are you not waiting—