Health Committee on May 11th, 2023

[The Chair, Liberal, Sean Casey]

Okay. In English, the Canadian Institutes of Health Research is the wording in the motion.

We have Mr. Jeneroux, please.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thanks, Mr. Chair.

With regard to the Canadian Institute for Health Information—in English, for Mr Thériault—if the sponsor of the motion is open to it, in light of a lot of evidence we've heard over the course of the last little while, having a submission on whether this is something they've taken some extra steps on maybe since hearing from a lot of the patient advocates, but also a lot of the surgeons as well, I'm not sure if it's within the committee's right to...I don't want to say “demand” any sort of information or whether to politely ask them if they could submit something.

If there is a way to do that, getting more of their information on the record will help us have a better report. That would be beyond their first intervention, when they came and didn't have a lot of the information that we have today.

[The Chair, Liberal, Sean Casey]

Go ahead, Dr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

I'm agreeable to that, because when we heard from them before, we did not get that information to know exactly what the registry entails, what questions were being asked, what questions they may be asking of the patients.

That can be done in writing. I'm agreeable to that, as opposed to having them attend another meeting, if that would be the case.

[The Chair, Liberal, Sean Casey]

Are there any further interventions?

The motion is to invite the Canadian Institutes of Health Research to appear. Are we ready for the question?

Go ahead, Mr. Jeneroux.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I am sorry to complicate things, Chair, but can I make an amendment to have the Canadian Institute for Health Information provide its response to testimony when it comes to the registry?

I am looking at the clerk on whether this is in order or whether we can do that. I've never, I guess compelled somebody to testify before, so I'm not totally sure whether that's right.

In essence, it's that the Canadian Institute of Health Information provide, in light of testimony that's happened over the course of the set number of meetings, additional information on the capabilities of a registry within their organization.

[The Chair, Liberal, Sean Casey]

The amendment so substantially changes the motion that I'm going to suggest that the original motion either be withdrawn or defeated. The original motion was to invite the Canadian Institutes of Health Research to appear. The amendment is to invite the Canadian Institute for Health Information to submit a brief.

I see it as being so different that it isn't really an amendment. It changes the whole character. I know we're trying to get at the same information, but the manner is so different.

Can we have unanimous consent to withdraw the original motion?

(Motion withdrawn)

Everyone is okay with that.

Now we have a new motion to invite the Canadian Institute for Health Information to provide a written response to the testimony that's been given. Is that it, in essence?

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Yes, I think that exact wording.... We want them to focus on the housing of the registry within their organization.

[The Chair, Liberal, Sean Casey]

Does everyone understand the question?

Go ahead, Mr. Jowhari.

[Majid Jowhari, Liberal, Richmond Hill, ON]

MP Jeneroux, are you specifically asking what the current capabilities of the CIHI are as they relate to the registry?

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Through the chair, yes, because they house the orthopaedic joint registry. We've heard so much testimony on this that people say, “Well, if you can do that, why can't you do this?”

I hope that's clearer.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you for the clarification.

[The Chair, Liberal, Sean Casey]

Is there discussion on the motion?

All those in favour of requesting that information from CIHI?

(Motion agreed to [See Minutes of Proceedings])

The floor goes back to Dr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair. I appreciate that.

I apologize to all three of you for that, but it's procedure, and we need to get it done.

We've heard a lot of conversation about the report from Health Canada. We've heard that patients are to report issues to Health Canada and that surgeons are to provide that information such that we have that safety, that approval and those warnings that they could possibly put out.

What I'm hearing from you is that Health Canada isn't the organization that should be doing the registry. Am I correct in that?

I'll start with Ms. McGregor.

[Terri McGregor]

The political infrastructure of this is beyond my scope. If I can simplify it, if Health Canada's mandate is the safety of our population, their mandate is oversight. We get called in to state the problems, and we have solutions, but unfortunately we never seem to be invited to the discussion table.

I'll use the CSPS. I've been called in the media Canada's leading expert on BIA-ALCL, and whoops, I forgot to go to medical school.

I say that because it's fantastic to stand in front of a podium and speak at a medical conference. I have co-authored two articles with Mark Clemens. When I heard that there was a working group for BIA-ALCL at Canadian plastic surgeons, I asked if I could simply attend a meeting and share the real-world evidence, because these Canadians were finding us on social media and in our cancer support groups. To be denied....

I don't want to just present; I want to be part of it. The CSPS national BIA-ALCL committee of physicians won't even invite us to the table, but I want to let you know what's happening with these 60 Canadians.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Ms. McGregor.

Ms. Elliott, do you have any comments on that?

[Julie Elliott]

If I have time, I will leave it to Terri, if you don't mind.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Okay, thank you.

Ms. Pratt, do you have any comments?

[Nancy Pratt]

I'm not an expert on this.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you very much.

As a practitioner, when I first started out in practice and patients came to see me, the fact that they came was consent. Then, over time, it came to a point where I had to give consent to my patients in a written form. I would show them in writing that this is consent for treatment. Then it became informed consent; not only would I show that to them, but I'd also have them sign it.

As you see, there's been a progression over the years, going back 30-odd years of practice, but ultimately we see those things. Ultimately, when we talk about practitioners providing that information to patients and who are receiving the service, I'm assuming that we're still seeing that aspect, that same progression.

Is that correct? Would you agree with that?

[Terri McGregor]

As for informed consent, I would remind everyone that this is an elective surgery, not a life-saving device. The other place that we're seeing these patients having to give consent is with our reconstruction patients, who are making these decisions in the middle of active breast cancer.

I'll defer to Julie for the rest of that.

[Julie Elliott]

Right now, if a patient goes into a surgeon's office to get a breast augmentation, the informed consent that they have in front of them is about the surgical part of it, most of the time. Rarely, it's anaesthetic. Do you know that you may have systemic symptoms or that there's a slight chance that you can get BIA cancers? Rarely. Most of the time, it's about surgical complication outcome, mechanical complications, the part about anaesthesia and that's it. That's the informed consent that patients have these days.

[The Chair, Liberal, Sean Casey]

Thank you.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Could I, very quickly—

[The Chair, Liberal, Sean Casey]

That's all you have.