Citizenship and Immigration Committee on Feb. 3rd, 2011

[Normand Cadieux]

There was only one request to meet from departmental officials. The goal was for us to become aware of the situation and the problems facing refugees. But we were well aware of that because we had already discussed it with them every day for a week. The situation was described to us at length. A meeting like that was a waste of time, both for CIC officials and us. I’m not sure where you are getting this from. We can document all the meeting requests we have made in writing. I am not sure the department can do the same.

[Rick Dykstra, Conservative, St. Catharines, ON]

Sure. They're coming next, so I'm sure they'll have a response to that.

Can you tell me one other private sector organization that is negotiating directly with the federal government to deliver a service on behalf of the federal government to citizens? Can you name one other organization that deals directly with the federal government in negotiating a contract?

[Normand Cadieux]

I am not sure I understood your question. You talked about private companies—

[Rick Dykstra, Conservative, St. Catharines, ON]

In your presentation, you referred to crown agencies that deal directly with the federal government. I haven't heard you name one private sector company that engages in the same kinds of negotiations that you are having with the ministry. Other than a crown agency, could you name another private sector organization that is doing what you are doing right now?

[Normand Cadieux]

Health Canada for the first nations, the RCMP, the Department of Veterans Affairs—

[Rick Dykstra, Conservative, St. Catharines, ON]

The RCMP is a crown agency—

[The Chair, Conservative, David Tilson]

We're well over, Mr. Dykstra—

[Rick Dykstra, Conservative, St. Catharines, ON]

Okay. Thank you.

[The Chair, Conservative, David Tilson]

—so we'll have to move on to Mr. Oliphant.

[Rob Oliphant, Liberal, Don Valley West, ON]

Thank you, Mr. Chair.

Thank you for joining us today. I don't know very much about this topic, and I'll admit that from the start. But we did have a family pharmacy for many years.

Can you tell me if there's a code of ethics for pharmacists in Quebec?

[Normand Cadieux]

Yes, like in all professions and in all the provinces.

[Rob Oliphant, Liberal, Don Valley West, ON]

Oui. My concern here is frankly not for the pharmacists, and it's not for the Minister of Citizenship and Immigration. It's for the people who are claiming their drugs. My greatest concern is that there could be, as a result of your actions—and you would blame the government—refugee claimants, refugees or others not being treated for illnesses that they need to be treated for. And that could also put the public at greater risk if those are infectious diseases and if a pharmacist refuses to give drugs.

What is the concern raised by members of your association about the integrity of the pharmacist as a professional?

[Normand Cadieux]

That's not an issue because pharmacists have never refused to serve anyone or to dispense a prescription. They would never do that because, as you clearly pointed out, they are subjected to ethical rules and a code of conduct. No pharmacist refuses to serve a patient.

If our members are not able to be reimbursed by CIC because they are not included in an agreement, we recommend that they ask the refugees to pay for their medication if they have the means. Otherwise, pharmacists have the obligation to assist them and direct them to a service, a hospital or a clinic, where they can get the products they need.

The third option we are suggesting to our members is to serve the patient and then send a claim to CIC. We cannot guarantee that they will be reimbursed. Under no circumstances have pharmacists in Quebec refused, nor will they ever refuse, to assist a patient without at least directing them to another service so that they can get what they need from somewhere else.

[Rob Oliphant, Liberal, Don Valley West, ON]

I think access is as important in health care as referral. The reality is that referring someone somewhere else, which may be many miles away, is not the same as giving a patient care. With all due respect, you may say that you're not refusing; you may actually be refusing. I can happily, as a politician, put the full weight of the blame on the government for not negotiating a deal, but my concern continues to be that the refugees, the claimants, aren't being taken care of.

I have a question for Monsieur Forcier. In an article I read in The Globe and Mail, you said that you don't have data on the number of people who are on this program. You say that when you don't have a deal, you don't have data. I can't believe there's a single pharmacist who's running a small business who doesn't keep data. I can't believe that when I go to a drugstore and present my drug card, that isn't stored somewhere. I simply can't believe that you don't have data on the number of people you serve on this. You may not keep their citizenship status, but certainly you know if it is a drug program administered by either Blue Cross or the previous carrier. You must know how many people are on that program, and there would be an identifying code that says client number 7,429 or something on it. A small business person, if they're going to make money, needs to know where their business is. Is it really true you don't have data?

[Vincent Forcier, Director, Public Affairs, Association québécoise des pharmaciens propriétaires]

As it was indicated earlier, each pharmacist is actually a private entrepreneur. They have data, but the data are not shared. If there is no overall program allowing the association to compile the data, the association will not have access to this information. It is possible to know that a pharmacist serves so many refugees, patients insured under a public or private plan, aboriginal patients, and so on, but these data are restricted to their pharmacy, since it is a private company. The association does not have access to these data. But, if we reach an agreement with CIC, it would be possible to generate statistics through the software developer, that is to say the company managing the program.

[The Chair, Conservative, David Tilson]

I'm sorry, Mr. Oliphant, we're out of time.

Monsieur St-Cyr.

[Thierry St-Cyr, Bloc, Jeanne-Le Ber, QC]

I think the concern raised by Mr. Oliphant is also everyone else's concern, including that of pharmacists. It is a question of ensuring that refugees have access to their medication. As I said, that is why I wanted the committee to tackle this issue right away. My colleagues agreed.

I would like to go back to Mr. Dykstra's question on whether there were other examples. It seems to me that the agreement you want is exactly the same as the agreement the federal government has with other organizations, including the RCMP, the Department of Veterans Affairs, the aboriginals and a fourth group whose name I did not have time to jot down. So these are federal departments, government agencies, that negotiate directly with a private organization, though it may be a public issue. But perhaps the word “negotiation” is not actually appropriate because you are telling me that it is not the list of drugs that are covered or the reimbursement rates that concern you. You simply want to know what is covered and reimbursed and how you are going to be reimbursed as pharmacists.

Is that so?

[Normand Cadieux]

Yes, absolutely. That's the case, and I can understand the concern about refugees. For now, the problem is taken care of because, under the interim agreement with CIC, services will be provided the same way they used to be. That doesn't mean that there won't be problems for pharmacists, but the services will be provided, and the public will be served.

All we are asking is to have an agreement that is very similar to those already in place.

[Thierry St-Cyr, Bloc, Jeanne-Le Ber, QC]

Okay. I think that's clearly a step in the right direction, and you're showing your good faith. I hope that, once the media attention on this issue has let up and people are talking about it less, the committee will still make sure that negotiations in good faith continue and that things move ahead briskly.

I want to go back to the computer system. It isn't the system itself that I'm concerned about, but I simply want to have a good understanding of how it works. Unless I'm mistaken, the 1,800 owner pharmacists in Quebec all have the same system. They all operate the same way with RAMQ, the RCMP, the Department of Veterans Affairs, and so on.

[Normand Cadieux]

The system supplier isn't always the same, but the systems are coordinated. When we negotiate an agreement, we sit down with the computer services supplier, present the agreement, explain what's involved so that the supplier can do the programming and it can be launched afterwards. In places in Quebec where there are three or four computer system developers or suppliers, we work with them together to ensure that everyone is operating the same way.

[Thierry St-Cyr, Bloc, Jeanne-Le Ber, QC]

So, once the system is in place, and someone comes to the pharmacy and hands in a prescription, you can know right away whether that person is eligible, if the coverage applies and at what rate? So, this helps you do your job, but it also helps the patient because you can tell the person if the coverage applies to this or that medication, if they need to take it in this or that format, and so on.

[Normand Cadieux]

In fact, it helps everyone. Obviously, the turnaround is quick. Medavie Blue Cross validates the transaction through the system. Once Medavie Blue Cross has validated the transaction, the pharmacist knows that the product is covered, that he'll be paid and that he'll receive his money within a certain amount of time. That's the ideal situation. The agreements that we also have with other federal organizations—this is something I didn't mention—enable those organizations to go and check the pharmacy, to go and do audits. This also allows for control over what is going on, on what is being paid, and for checking that the agreement is being respected. It's a benefit that doesn't currently exist, but that the agreement would allow CIC to get.

[Thierry St-Cyr, Bloc, Jeanne-Le Ber, QC]

Mr. Forcier, you just said that you didn't have numbers for the current program because there isn't a comprehensive agreement. Do you have data for the other programs? Do you know what it represents in terms of the amount of business?

[Vincent Forcier]

I won't be able to get you the numbers this morning, but we do have the data, since there's an agreement and some things are in place. We can provide you with the data.

[Thierry St-Cyr, Bloc, Jeanne-Le Ber, QC]

Could you send them to the committee clerk so that she can distribute them to all the committee members, unless the information is confidential?