Health Committee on May 18th, 2017

[Don Davies, NDP, Vancouver Kingsway, BC]

Excuse me, I have the floor, Ms. Harder. I'm talking about clause 2, my proposed amendment to it, and explaining it. But of course the amendment that I've raised—if anybody is following the purpose of my amendments—is an issue that has to do with the confused objectives of this bill. In order to make that argument, I've pointed to various parts of the bill that would suggest to Canadians that this is a comprehensive federal framework, and to others that suggest that it's in fact meant to be occupational. It was in the course of making that argument that I referred to this section of the bill, and there's no rule that says I can't refer to other sections when I'm speaking to my amendment.

[The Chair, Liberal, Bill Casey]

I think the committee would like to hear from Mr. Doherty, but I need to have unanimous consent from the committee to let Mr. Doherty make a presentation. Do I have unanimous consent?

[Some hon. members]

Agreed.

[John Oliver, Liberal, Oakville, ON]

And then it will come back to me?

[The Chair, Liberal, Bill Casey]

Yes, it will.

Mr. Doherty.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

Thank you to our colleagues who are here.

Mr. Davies, I appreciate fully your comments with respect to those groups you feel should be included in this bill. I said this before: in no way, form, or fashion do I want to diminish the impacts facing other groups who are suffering from PTSD, whether it is our indigenous population, refugees, or the victims of sexual assault or violence.

My bill was intended for our first responders, our veterans, and our military. Even after having the bill drafted, I realize that perhaps the term “first responders” needed to be broadened. Indeed, in the public safety committee we understand that a first responder could be called a public safety officer. Who's captured in that? This goes to the goal of the bill. We need to make sure our terminology is correct as we move forward, as to who's included in that area.

I will bring it back to some other comments Mr. Davies made, that it is a confusing bill, and that it is misleading in its terminology. I would argue that it isn't, because as you read it, it is talking about a comprehensive framework with respect to first responders, military and veterans, and those who have experienced human tragedy every day. Again, in no way was it to diminish the impact on others who are facing mental health injuries.

My hopes were that we could have a broad discussion, as we have been over the last 18 months, regarding mental health injuries. Indeed we've had a number of different groups come before us, and we heard great testimony from Dr. Sareen that it is different in the workplace versus traumatic incidents, such as those in residential schools or those that refugees face. There was also agreement that getting something in place now—and learning from this process so that we can apply it as we move forward for the greater good—is what we should be doing.

I know that we probably have representatives listening in from those groups that Mr. Davies has mentioned today. Again, I offer my apologies, but my bill was focused on our first responders, our military, and our veterans. My hope was that we would be able to do something—not quickly, but thoughtfully and measured—for those who put their uniforms on every day and make a sacrifice for you and me.

I agree that healthy debate is important. I appreciate those who have written letters. I've had conversations with folks such as the nurses' union and other groups. I have to be completely honest that again, I keep drawing it back to the intent of this bill. Whether Mr. Davies believes it's misleading or not, this was drafted by legal counsel with the understanding of what my goal was. They drafted it with the best understanding of how we could achieve the goal.

I have to believe, Mr. Chair, that they're far more educated than I am, and far more adapted at getting legislation through and writing legislation. That's not saying that it's always perfect. I appreciate the conversation here. I appreciate the opportunity to be able to come and talk about amendments, but I will bring it back to its original intent. It was an act respecting a federal framework on post-traumatic stress disorder—a comprehensive framework for first responders, veterans, and military.

[The Chair, Liberal, Bill Casey]

There are some amendments to expand it. How do you feel about expanding it to other areas?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

I think we would have to look at those amendments as we go through the bill.

[The Chair, Liberal, Bill Casey]

Okay.

Mr. Oliver, you're next.

[John Oliver, Liberal, Oakville, ON]

Thank you.

I was happy to hear that bill was really intended to be about workplaces and, in particular, first responders.

Thank you very much for identifying this issue and bringing it forward on behalf of first responders and those who are going into the military, the RCMP.

To Mr. Davies' points and the broader definition of PTSD as it relates to problems outside the workforce, I would point out that PTSD is already a recognized mental health problem in the U.S. in the DSM, Diagnostic and Statistical Manual of Mental Disorders, groupings. I haven't been able to find out whether it's part of the case mix groups in Canada, but it would go to the point that people who have terrible calamities in their lives, such as a tragic car accident, have ongoing PTSD symptoms because of it. They go into the mental health system and there are treatment protocols and processes there for them. There's clearly a triggering event. The failures of the mental health system, and the inadequacy of the funding of the mental health system, I don't think, are going to be changed by broadening the application of PTSD in this bill.

To my mind, the people who are struggling and suffering, and those committing suicide, are more the first responders, the military. I just had a mother of a soldier who had returned from, I think it was, Kuwait, who could not get treatment for his PTSD. He thought he had it. It related to the problem of causality. Was there a triggering event?

We heard as well from one of our key witnesses here that it's like the frog in the pot of water that slowly heats up; they don't even realize they're at the point of dying because of the gradual changes. In our first responders, the RCMP and the military, I think first of all there's a culture of their thinking that this is their life, that they should be tough and be able to handle these calamities as they experience them.

Then at the federal level there also seems to be a problem that if there isn't a culminating event, if there isn't a clear moment in time, then the PTSD isn't caused by someone's work. At that point, there seems to be a treatment gap. I think those who are going to benefit the most from the bill are in those groupings that Mr. Doherty identified. I think the best impact we can have is focusing on them.

I would like to see our moving federally to what the Province of Ontario did, which was a presumptive ruling that if you have PTSD and you've served in these areas, it is presumed to be workplace-related. I think this is the first step of this bill, to get to presumption of work-related injury. I think broadening it will take us away from that ultimate goal that I think we've all shared.

I would like to stay with the workplace. I don't know that it needs to be defined. I guess it will come down to what other groups we would ask the minister to include when she's doing the work. I would respect Mr. Doherty's advice to us on that without necessarily having to amend the bill to limit it to the workplace.

[The Chair, Liberal, Bill Casey]

Mr. Ayoub, you're next.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I will speak in French, just to to be quicker and clearer.

I appreciate Mr. Davies' comment. We received some letters. There are even amendments. We're talking about people who provide healthcare. We talked about including certain nurses.

When we try to be more specific, we end up forgetting certain people. If we don't name them, we forget them. We may feel that they're excluded, when this is likely not the case.

The written word remains, but the intentions don't remain. The initial intention will disappear if it's not written. As Mr. Doherty said, the initial intention was to address issues concerning first responders. I think that's what it says.

Ultimately, the bill requires a number of provincial and federal ministers to focus on the issue, participate in a conference, and table a report. I don't think this excludes the addition of people who feel affected by mental health and, in particular, by post-traumatic stress disorder. I think, around the table, we all have the same intention. There is general agreement in this area.

If we intend to broaden the scope of the bill, I think we must carefully choose the sentences, words and terms to amend it. I don't think this will change the essence of the bill. In my view, we don't prepare a bill for only one category of people. We prepare a bill for all Canadians. Currently, some people are more affected by post-traumatic stress issues. However, this doesn't exclude the others.

Unless we say it's exclusively for this category of workers, which isn't the case, we can only agree to include other people and broaden the scope of the bill from the start. I think we need to find a way to do so.

My question is for the clerk, since it's a technical question. Actually, it's a legal question. Would this create obstacles? Can the committee pass amendments, proceed with the legal amendment of a bill, move in the direction suggested by Mr. Davies, and ensure that no one is excluded, but without delaying the process?

I want the clerk's view. What steps must be taken to broaden the group of people concerned and include as many people as possible in the bill without delaying the process?

[The Chair, Liberal, Bill Casey]

Would you care to take a crack at that?

What we're talking about here is this. We have two issues. We have a bill that focuses on first responders and military. Do we want to have a bill that applies to all PTSD across the population? They are two different things. We have to decide what we want to do.

[John Oliver, Liberal, Oakville, ON]

Mr. Chair, I'd like to make a motion that we move to clause-by-clause review and deal with this clause-by-clause. We'll be here all day on this debate, and we're not doing the clause-by-clause review that we're supposed to be doing. I would move that we proceed now with clause-by-clause review.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

May I have the answer from the clerk? Is there no way to have the answer to my question?

[The Chair, Liberal, Bill Casey]

Can you answer that or do you feel comfortable answering that?

[The Clerk of the Committee, Mr. Philippe Méla]

I can take a crack at it if you want.

I will answer in French.

I must point out that my comments about the bill will be those of a legislative clerk and not those of parliamentary or legislative counsel.

This bill applies to everyone, that is, to all Canadians suffering from this condition. As Mr. Davies said, the second paragraph of the preamble states that there is a certain category of persons whose need for services is more pressing. That means that those people should have direct and timely access to services.

The fourth paragraph of the preamble says that many Canadians suffer from this condition, in particular those working as first responders, members of the RCMP, military personnel, and firefighters. It clearly says that many Canadians are affected, especially certain groups of people, but that it applies to everyone. These provisions can apply to all Canadians, but we are referring here to a particular group for whom additional measures should be taken. I am not sure if Mr. Doherty agrees with me.

As you said, if there is a conference, certain points could very well be raised because they pertain to these categories, while others might be addressed because they are included in the bill. I am not sure if I have answered your question.

In any case, it is a general bill that applies to everyone.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

My question was more technical. What you are giving us are your impressions of the bill's preamble.

What I want to know is what the technical and legal implications are of adding or clarifying a word in a bill in order to expand the group of people affected.

Is it possible to do that in the preamble?

Would that delay the tabling of the bill?

[The Clerk]

In my opinion, it all depends on the word you are referring to.

If I may make a suggestion regarding Mr. Davies' amendment, I would suggest that the committee look at the direction its consideration of the bill is taking. As a rule, it is not possible to propose major changes to the definitions in a bill.

The committee can, however, put those definitions aside and see what happens with the rest of the bill. Should the committee decide that the bill must pertain to first responders, military personnel, and other categories only, that could be clarified elsewhere in the bill. It would then be possible to go back to the definitions and to the preamble and add those clarifications where necessary.

On the other hand, the bill could become much more restrictive if it were to apply to those kinds of workers only.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

As I understand it, if a further amendment is made to expand the group of persons affected, that would not change the bill, but rather would improve it. That might address Mr. Davies' request without changing the bill as introduced by Mr. Doherty.

[The Clerk]

The change would nonetheless have to be made to the text of the bill before it is made in the preamble.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Okay. Thank you.

[The Chair, Liberal, Bill Casey]

Mr. Kang, you're on the list.

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

Thank you, Mr. Chair.

My question is about the first responders. What is your definition of a first responder, Mr. Doherty?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

A first responder would be police, fire, ambulance, paramedic, corrections officers, dispatch, RCMP, and in some instances, it could even be classified as emergency response.