Evidence of meeting #129 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A video is available from Parliament.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Patel.
Mr. Thériault, you have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Dr. Patel, Alberta's health minister told the committee that addiction can go one of two ways: suffering, misery and death; or treatment. Alberta is currently making massive investments in more beds and more treatments. Safe supply is not in the picture there, and I don't get the impression that harm reduction is either. British Columbia has also pivoted to mandatory treatment.
What are your thoughts on those two models? Of course, we need more beds and more treatments. When relapse is part of the treatment, but there's no safe supply, isn't that condemning people, in a way?
Ottawa Inner City Health
The fundamental path, I guess, as you've spoken about in Alberta, is suffering and death. Sure, that's cheap. Everybody in every ministry of health in every province would like that because it doesn't cost them any money.
The treatment plan has a fundamental flaw in it. That fundamental flaw is that there's only one treatment and it works for everybody, and there's no recidivism, meaning that when you have substance use disorder, you get your treatment and you go home. That's the end of the story. You become a part of society, and you contribute like everybody else. This is a false argument. There is no such thing.
How many people do you know who can quit caffeine, cigarettes or alcohol on the first try and never go back? For sure, there are some people who do it, but the overwhelming majority relapse and then they go through treatment again. If that's your approach, you're building a foundation that's fundamentally flawed.
The second problem with that approach is that we currently have trouble staffing acute care hospitals with enough health care workers. Where are you going to get people to staff these addiction centres? Is there some magical vending machine that I'm not aware of that has the doctors, nurses, social workers and pharmacists who are going to man these addiction centres and follow patients when they fall off the wagon? There isn't one that I can see.
If that's your fundamental approach, you're doomed to fail and you'll fail miserably.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Patel.
Our last person to pose questions to this panel will be Mr. Johns for two and a half minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
I'm going to stay on that thread.
Dr. Ghosh, you've been involved in the conversations around involuntary treatment. You were on Cross Country Checkup yesterday. Do you think it's premature to have this conversation when so many people don't even have access to voluntary treatment on demand, like Dr. Patel just talked about?
Because I have only two and a half minutes, I'll ask these questions quickly.
We heard Dr. Goulão from Portugal say they don't support mandatory treatment. They say it doesn't work.
You've also talked about incentivization and paying people to get treatment.
Lastly, you're a member of the coalition called Doctors for Decriminalization. Do you continue to believe that the criminalization of people who use drugs causes more harm and creates more barriers to recovery?
You have the remainder of the minute and a half left of my time, so I'll let you speak to those.
Assistant Professor, As an Individual
For Doctors for Decriminalization, first up, yes, I believe decriminalization is the way to go. The models of decriminalization we've seen have varied. We just need to find the right model that works, so we shouldn't give up on it yet. That's number one.
Number two, in terms of involuntary treatment, I am a huge proponent of incentivized treatment in the sense that we know it works from a medical evidence perspective. We know that ideas such as contingency management have worked really well for methamphetamine use. There's a ton of evidence around this. We know that, around vaccines, incentivization has worked as well to get people to get their vaccine. I think we can create a system in which we can get people into treatment, provided that there is incentivization. We've heard this from people who use substances themselves.
The whole mandatory treatment piece is very complicated, but we still need more space for people who want to seek voluntary treatment, and we need to build a system up for that first and foremost. That is crucial, and I don't think we're there yet. We have to have standardization around treatment services as well.
There was one last part to your question, and I've forgotten it now. I'm sorry.
NDP
Gord Johns NDP Courtenay—Alberni, BC
It is to speak about the involuntary treatment being premature, given that people don't have access to voluntary treatment on demand.
Assistant Professor, As an Individual
Yes, that's the key thing.
The one last point that I want to say is that, outside of there being a lack of access, I think there's a portion of the population who will not benefit. They are people who are moderately or severely brain injured or have moderate or severe cognitive concerns. It just will not work for that population group. I think that's where we're looking when we're looking at people who have substance concerns on the streets who are talking to themselves and acting incoherently. Part of that is the substance, but part of that is also concerns around their cognition.
I do not think that forced, mandated treatment would work on that population group. We need to have alternatives such as housing for that population group.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Johns.
Thank you, Dr. Ghosh.
That concludes the rounds of questions for this panel. I want to sincerely thank you both for being with us. This has been extremely interesting and will undoubtedly be very valuable to us in our study. Thank you for being with us and sharing your expertise. You're welcome to stay, but you are free to go.
Colleagues, please don't run away. There's one update I have for you with regard to the calendar going forward.
Mr. Johns, I think, is going to seek to resume a motion that had been adjourned.
In terms of updates, this Thursday we'll commence the study of Bill C-277. That's a private member's bill from Alistair MacGregor. We will have a panel of witnesses that has been confirmed for Thursday. The sponsor of the bill will appear on October 10. Unless the direction of the committee has changed, we would propose to do clause-by-clause at a subsequent meeting, likely October 24.
With respect to the opioid study, we'll resume the opioid study on Tuesday of next week. We've gone with the work plan and invited the third panel. That's by way of update.
Now I recognize Mr. Johns, and then Mr. Doherty.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you, Mr. Chair.
I would like to return to the motion that we tabled.
Do I need to read the motion again, Mr. Chair?
Liberal
NDP
Liberal
The Chair Liberal Sean Casey
Okay. That's a non-debatable motion.
Is it the will of the committee to resume the debate on the motion and the amendment that was adjourned at a previous meeting?
Liberal
The Chair Liberal Sean Casey
Do we need a recorded vote on that? Could we have a show of hands?
(Motion agreed to)
The debate is now resumed.
The motion has been circulated to the committee. When the debate was adjourned on the motion, an amendment had been proposed by Dr. Hanley. The debate was on the amendment.
To refresh your memory, this is the question before the committee. The original motion from Mr. Johns was:
That, pursuant to Standing Order 108(2), given the increasing prevalence of privatized health care across the country and the difficulty Canadians face in getting the health care they need, the committee undertake a study of at least four meetings on protecting Canada’s public health care system against for-profit corporations, and that the committee invite the Chief Executive Officer of for-profit health care providers like Loblaw Companies Limited to testify.
The amendment before the committee now is to add, after the words, “at least four meetings on”, the following: “the role of the private sector in Canada's public health care system, including”. The debate is on the amendment.
Mr. Doherty has the floor, and then Dr. Ellis.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Mr. Chair, if I can I'd like to cede my time on the floor to Dr. Ellis. I think I'll have something to say after.
Liberal
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you very much, Chair.
Here we are, nine years into a coalition government that has really done nothing but allow this public health care system that we all hold so dear, and one that I worked in for many years, to decay.
How do we know that? In this committee we've often talked about data, so the question then becomes this: What evidence is there to say that there is decay in the public health care system at the hands of the NDP-Liberal coalition? Where to begin, Chair, is probably the bigger question.
The most obvious difficulty that Canadians have is access to the system. When you begin to look at access to the system that we have, of course everybody around this table would clearly realize that it is predicated upon the fact of having access to primary care. Primary care providers, whether they be nurse practitioners or family physicians, allow folks to have that requisition for blood work or an X-ray or a referral to see a specialist.
In spite of the fact that we want to return to this grandstanding motion, which was tabled and interrupted our important witnesses related to the opioid study, what we know very clearly and very simply is that, when Canadians don't have access via a primary care provider, it doesn't matter if we have the best-formed health care system in the galaxy. I say that not to be hyperbolic or to sound foolish, but to outline the fact that without access, regardless of the system, there is nothing. There is nothing for those 6.5 million Canadians who do not have access to the health care system that has been held so dear by Canada for an incredibly long time.
I would suggest to you, Chair, that certainly would be the first metric that we want to look at. We know it has deteriorated over time. We know that 20 to 25 years ago people would have had their pick of a family doctor. Family doctors made house calls, etc. What have we seen happen to the system under the NDP-Liberal coalition is this incredible degradation of access. As I said previously, it certainly doesn't matter what system you have if you can't access it.
I think there are a few other things that we need to outline. There's a horrific story of a gentleman in Quebec who had a long history of paralysis. The sad thing is that he waited so long for care in an emergency room that he developed horrific bedsores. I'm sure that many folks here are not quite aware that bedsores are incredibly difficult to heal. They are often open wounds, let's put it that way, that persist for a very long time. That can require significant nursing care, significant off-loading of the area to allow them to heal, which becomes very difficult if you have a problem with paralysis.
When you think of that, this gentleman developed these bedsores because he had to wait in an emergency room on a stretcher for days, in an inappropriate setting for someone with his care needs. I'm going to come back to that story in a second.
I wish I could tell folks around this table that it was the only story we heard of system failure in the emergency room.
As I return to Nova Scotia every weekend, as many of my colleagues do, I would challenge anyone around this table to tell me they have not heard a story from a constituent about how long they waited in the emergency room. Sadly, it has almost become an abhorrent badge of honour to say, “Wow, you know, I waited in the emergency room for 16 hours.” We hear these stories. As a former physician providing care, I find that unacceptable.
Even in the days when I practised in the emergency room, which wasn't that long ago, often if I worked a Friday night till 11 o'clock, midnight or one in the morning and someone was coming on the next shift, I always thought it was my goal to basically have the waiting room empty when the overnight physician came on. That way, he had an opportunity to look after the most seriously ill patients who were inside the emergency room, perhaps waiting to go to intensive care or for test results to come back, who had been in a traumatic accident or who had suffered a stroke or a heart attack, etc. That was always my goal: to have that waiting room emptied so that the person coming on overnight could have that very fresh start.
As I said, when all of us around this table go home every weekend, I would challenge you to say how many of the people who are voters in your community have come up to you and said, “I have had to wait innumerable hours in the waiting room.” I would love to do a straw poll around the room, but I know that's perhaps not something that people would like to answer. We know it affects Newfoundland. We know it affects Quebec. We know it affects Ontario, both urban and rural. We know it affects P.E.I. I know that, Chair, because people from P.E.I., when I've been there, have come and told me that it affects P.E.I. I know it affects B.C. and Alberta. Even Saskatchewan is affected by this.
As we begin to understand the difficult nature of this, this is what has happened under this coalition. It's beyond the eleventh hour of a struggling government. It's the 23rd hour of a struggling government that now wants to bring forward these motions to say Canadians should entrust them to fix health care. Are you kidding me? What credibility does the Liberal-NDP coalition have to say they can fix health care when it has done nothing but spiral negatively in the last nine years? They have no credibility.
That is not to mention a fact that somebody, who will remain nameless, told me. I had the good fortune of being home this weekend at the first annual Nova Scotia Stampede. We had a charity hockey game while I was there, and one of the hockey players, who was notable—and I will not name him, because I didn't ask his permission, although he told a great story—had been to the emergency room with his children. He said they were there with a child who perhaps wasn't that unwell, but he saw another child with a broken arm. He said, “I know I'm not a physician, but I could tell this child's arm was broken,” and that child waited 14 hours in a waiting room with a broken arm.
I realize that, yes, there's a triage system, and we could argue that everybody knew the arm was broken, etc., but as Canadians, doesn't that pull at your heartstrings? This was a child waiting with an obviously disfigured arm who didn't get the service they required for 14 hours.
I wish it was, as we say, a “once in a blue moon” occurrence, but it's not. I know people who have waited so long with a laceration that by the time they had an opportunity to see a treating physician, they didn't even require stitches anymore. Their wound had healed, basically, and I'm not talking about some miraculous healing. What we're talking about is a wound that was held appropriately and tightly, and after the terrible amount of time that had elapsed, again, the wound did not need suturing, which appears fantastical, I know. However, these are stories that everyone around this table has already heard.
If I might return to my story of metrics related to the gentleman who had paralysis and ended up with severe bedsores after waiting many days—not hours; we're talking about days—in the emergency room on an inappropriate surface, who then.... I can barely even say this out loud, but again, it was reported in the news. I'm not making something up here, but it's hard to speak the words. That gentleman chose MAID because of the bedsores that happened to him at the hands of a health care system in the greatest country in the world. Again, that happened under the NDP-Liberal coalition's watch. That's when it happened.
We also know that things have gotten worse over time. The system has, perhaps, been struggling for a long time, but we know that, at the current time, wait times to have treatment, from after you see a family physician to seeing a specialist, has increased to the worst it has been in 30 years. That's three-zero, not 13. The average wait in this country, after seeing a family doctor—because, of course, as we all know, you need a referral from a family physician to see a specialist—has ballooned to 27 weeks, which, of course, is half of a year.
Again, I know we have physician colleagues here, and I appreciate that. I would suggest that, in most cases, when a family physician has exhausted all of their knowledge, their training and their experience, when the tests they have ordered and when the information has been assimilated, the expectation, and I know my expectation as a former family doctor, would be that I have done all the work that's required, but now you have to wait six more months to have the opinion of a specialist whose extra training and extra experience is required to either make a diagnosis or to confirm treatment. That has now ballooned to more than six months. That's not acceptable. That just isn't. That's not the expectation of Canadians, and it is certainly not the expectation of family physicians who serve the patients inside the system.
We know that, in many communities, the wait time for getting an appointment to have blood work done is more than a month. As we begin to look at these metrics.... I think that's where our focus needs to be, as we begin to talk about allowing a motion to happen on another study from the very group of people—the NDP-Liberal coalition—who allowed the system to fall apart. It seems rather sanctimonious and frivolous to me.
What other metrics do we have to say that the NDP-Liberal coalition has failed health care in this country?
If there's anybody who would like to.... Unlike some of my Liberal colleagues, I don't have dealings with this company. I don't have a financial interest in that company. That's not how I work. That being said, there's a great website called SecondStreet.org. When you begin to look at that, some of the work it has done is based around how many people have died in this country on a waiting list, which is absolutely shocking. Does that mean you're waiting for a CT scan? Are you waiting for an MRI? Are you waiting six months, as I already spoke about, to see a specialist? Are you simply waiting for a blood test? Are you waiting for something perhaps more invasive like a bone marrow transplant, etc.?
As you begin to look at those numbers, they are absolutely shocking. The estimate is that between 17,000 to 30,000 Canadians die every year on a waiting list. I'll say that again, 17,000 to 30,000 Canadians die every year on a waiting list.
As you begin to fathom that number, remember that these are Canadians. They are not some anonymous person you don't know. These are your mothers, your sisters, your aunts, your uncles, your fathers, your brothers, all of those people. All of those people are people who can die on a waiting list.
I spoke to a gentleman just yesterday. Again, it's another unfathomable story. He has a known cancer in his tonsil. He knows he has it. It's been biopsied; it's been diagnosed. There is a robotic surgery available to him to have this cancer treated. You can well imagine you're going to treat tonsillar cancer. The hope would be that you will have a successful surgery. Perhaps you might be able to avoid the terrible radiation, the dry mouth that comes after that and disfigurement as well. His surgeon only has access to the robotic surgical assist one Thursday every two weeks.
As we begin to look at the failing system that exists before us at the hands of the NDP-Liberal coalition, as I said, it becomes a bit rich as to movement of this debate, because what have the NDP-Liberals done over the last nine years with respect to health care besides destroy it? Nothing.
We have also heard the Prime Minister stand in the House of Commons, and say—I remember it happened when I first came here a little better than three years ago—that he was going to provide Canadians with 7,500 doctors, nurses and nurse practitioners to this system to make it better. When you look, objectively, at the metrics, you have to understand that the system has gotten worse and worse, and the number of physicians continues to decline over time.
Of course, those out there watching will ask, “What are you going to do about it? What would a Conservative government...?” We've already announced a program for international medical graduates. We know there are at least 20,000 physicians who are here in this country. They have practised medicine, trained in medicine abroad and have come to this country, but are not able to practise their trade. It is an incredibly sad indictment on the system run by the NDP-Liberal coalition. This is a terrible joke. I'll preface my remarks with that.
Do you know what? Everybody has heard this: In Toronto, don't call an ambulance. Call a taxi, because your taxi driver will be a physician who was trained elsewhere. It's a terrible joke. Sadly, we know, as I said, that 20,000 physicians who trained outside of this country and have experience are living here but cannot access the system. As I go around the country and talk to Canadians, I say, “Conservatives have a plan.” To a person, Canadians say, “That is a very common-sense idea. Why would you not do that if someone is trained elsewhere and has experience?” As everyone says to me, the body is the same in country X as it is in Canada. I'm sure it's exactly the same. I'm sure it functions the same way. I'm sure the liver is still on the right side of the body. Yes, it is. Broken bones, lacerations and high blood pressure exist in every part of this world. We know diabetes exists in every part of this world.
Therefore, regarding folks who received their training and experience elsewhere, everybody says that, if they have that ability to practically prove their abilities, of course they should have a licence to practice in Canada and help treat Canadians. We know this is a win for the 6.5 million Canadians who need access to primary care. We also know it is a win for the physician who is here doing some other type of work and not able to practise.
I met a group of internationally trained physicians. One gentleman in particular told me a terrible story. He has not been able to practise as a physician. He was working as a security guard. Again, these are heartbreaking stories. His son said to this gentleman, “Dad, if you're a doctor, why do you go to work dressed as a security guard every day?” How do you explain that to your young child? “Well, I came to this country for an opportunity, and because of the barriers that exist here, I'm not able to work as a physician.”
Look at how Canada historically built this country. Many people came from elsewhere with training in medicine, nursing, pharmacy, dentistry, veterinary skills, bricklaying, pipefitting, etc. They were electricians or carpenters. How did we welcome those folks back when the country was being built up? We welcomed them by saying, “Hey, let's see what you can do. Show us what you can do.” It was “Oh, here, watch me build this. Watch me do this. Watch me apply my trade.” Everybody agreed. “Wow, you know what you're doing.” Surprisingly, the body is not different in country X compared with here in Canada.
That's one example of a practical solution Canadians can receive from a common-sense Conservative government, one that says, “When you can prove your skills, we will have you going to work and providing services on behalf of Canadians.”
Chair, the other metric we need to look at is the failing health care system, which happened at the hands of the NDP-Liberal coalition and is related to services for veterans. On this side of the House, we know that mental health is health. My great friend Todd Doherty, champion of the 988 suicide prevention hotline, pushed and pushed, such that, in my mind, it never would have happened without him.
When we understand that and we understand that veterans are calling Veterans Affairs for help.... They're saying that they need to access mental health supports. They've struggled, they've served their country and they've signed on the dotted line. The answer, of course, in these terrible.... I wish someone would accuse me of hyperbole in making up these stories, but everybody knows they're true.
Everybody knows that there are veterans in this country who were reaching out for mental health help and who were offered medical assistance in dying—MAID. That was the offer. I don't know what they said—that they can't access it, it's too long to access it, their case is too difficult or whatever, so have they considered MAID?
This is not only a sad testimony as it relates to the failing health care system under this NDP-Liberal coalition, but it also relates to how we treat our veterans. I'm a proud veteran.
Conservative
October 1st, 2024 / 12:55 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
You're very welcome, Todd.
I'm grateful to have had the opportunity to serve. It taught me a lot of things.
Here we are not offering veterans help. We're not saying, "Here's a hand, grab hold. I don't want you to die.” Not us.
The NDP-Liberal coalition government is offering medical assistance in dying to veterans who need incredible amounts of mental health support because of what we as a country have asked them to do. We have asked, "Will you sign on the dotted line? Will you serve? Are you willing to give the ultimate sacrifice for doing what we believe as a country is right?" They answered that call. They said yes. The NDP-Liberal coalition government failed them.
Chair, if it were only one veteran who was failed, maybe someone could call it a mistake, but it was not only one veteran. There were multiple veterans. This was a pattern of behaviour that, to me, could only come from where all the decisions come from in the NDP-Liberal coalition, and that is straight from the Prime Minister's Office. That is where it would appear all the decisions come from. That is a sad state of affairs.
We've been debating opioid therapy. I found it very rich today that nine years have passed and the only argument that the NDP-Liberal coalition has come up with is so-called safe supply. Let's give out free drugs. I find it absolutely fascinating that suddenly colleagues on the opposite side are now saying that we need comprehensive treatment.
We've been talking on the Conservative side of a common-sense solution of comprehensive treatment for years now, ever since I came to this place three years ago. Those are the things that we have been talking about on this side of the House. We do not believe that giving out an endless supply of high-powered opioids is what is going to enable this crisis to end.
We do believe that there is a possibility for rehabilitation and treatment for every person that is affected by the opioid crisis. We do not believe in just giving them opioids, which is palliative care. That is saying to them, "Guess what. You are never going to get better. Just take these drugs.” I believe that the costly coalition wants them to take drugs and be quiet, because then they're not a problem to them. That, of course, is an absolutely ridiculous thing to do.
As we begin to understand what the NDP-Liberal coalition has done to destroy health care in this country, it is an incredibly rich and—and perhaps unparliamentary for me to say—ridiculous argument to say that they want to talk about the health care system as it suddenly becomes a ballot-box issue. We begin to see what's important to Canadians.
First of all, for the people I visit whose doors I knock on, it's the cost of living. That's the important thing. They say, “I cannot put gas in my car. I cannot put food on my table. I cannot put a roof over my head.” Those things are what we hear every single day. If all of you who sit around this table are not hearing that, I suggest you have your hearing checked.
Then, suddenly, health care becomes a ballot-box issue. We should address health care.
Why don't you get rid of the carbon tax and address the cost of living? We know that one of the determinants of health is the ability to go ahead and put good food on the table so that you can have a healthy life. Those are things that are incredibly important. Those are the changes, the blue seal program, getting rid of the carbon tax, fixing the budget, building houses and stopping crime. Those are things that those of us on this side of the House are seized with.
We're not seized with fanciful notions of suddenly having a wake-up call to now treat people with opioid addiction properly. After not doing it for nine years, we're suddenly going to fix the most revered public health care system. That's not what we're seized with on this side of the House.
Chair, as you well know, there are many more things I could go on about, but seeing the clock at 1:05, I suggest that we adjourn this meeting at this time and pick it up later.
I move to adjourn.
(Motion negatived)
Liberal
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Let me start by asking what the order is after me.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Clearly, the Conservatives are filibustering. They don't want to have a vote on this motion. They don't want to study the increasing privatization of health care. Why is that?
They know very well that the Canadian public does not agree with this. You see one survey after another asking Canadians what it is to be a Canadian. What's the most important thing that distinguishes us as Canadians? Invariably, it comes down to two things: hockey and our public health care system.
I think the vast majority of people don't believe in the privatization of health care. I think the Conservatives' filibustering clearly indicates the fact that they don't want to talk about this, because they don't want to publicly show their support for the privatization of health care since they know it is not a winning issue among the Canadian public. That's why they're filibustering.
With that said, I see there are a bunch of Conservative speakers afterwards.
I move to adjourn the meeting.
(Motion agreed to)