Citizenship and Immigration Committee on March 15th, 2012

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

One of the great things about our job is that we get to cross disciplines.

We had another doctor before us earlier this week, Dr. Cheema, who said that one of the issues was the certification of labs. He said that because many labs overseas are not certified, there may be problems with identification. In other words, the person who is giving the urine test may not be the person who is registered. He thought that if labs were certified, that might be a remedy to the problem.

Do you see as an issue that identification documents are being altered and the person who is giving the medical samples isn't the person who is actually applying for immigration or a visit?

[Dr. Eileen de Villa]

That's a difficult question. I don't know that we can speak to the frequency with which one runs into fraud in the system. But I think we can speak to the fact that not all labs are created equal, and there must be reasonable quality assurance measures. Even if you have the right person and the sample is appropriately identified, if the test is not done under appropriate conditions, the result of the test will be questionable.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Another recommendation from the same doctor, along the same line, was to try to centralize the labs. Do you have any comment on that in terms of trying to achieve that “all labs created equal” kind of standard?

[Dr. Natasha Crowcroft]

I think that's outside our.... You would have to know more about how the labs work in different countries. In some countries, it would be easy to get a lab that was fully accredited by some kind of international standard.

The other piece of it, if you're worried about identity, is to have the place where the medical tests take place accredited, because of course, there are ways of trying to ensure that people are giving specimens themselves and are not bringing them along. That's something that could be addressed not just through the lab but through the medical centre.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Moving on to yet a different idea, pre-screening is something we've talked about on this committee. Pre-screening would allow the Government of Canada to identify each person who comes to Canada by plane or by ship.

Do you have any sense of how better pre-screening might help in terms of safety on the medical side?

[Dr. Natasha Crowcroft]

Has that ever been an issue with TB cases?

[Dr. Eileen de Villa]

No, it hasn't really.

I suppose that more rigorous pre-screening would actually be more of a benefit to the travellers themselves and to the people who are on the journey with them. Clearly, if somebody is actively sick with something at that moment in time, and you could pick it up at a pre-screening just before the travel, something could be done then. The person could be treated and could recover before leaving on the journey.

I don't know that we've had particular problems specifically on that issue.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Let me give you a chance to maybe summarize what you've just told us. If you could each make one or two recommendations to improve the quality of our medical security vis-à-vis immigration, what would they be?

Natasha, maybe you could start.

[Dr. Natasha Crowcroft]

I would add a focus to protect the health of immigrants and would include a health screening on arrival. They'd have to have access to health care to do that. So one is access to a screening process on arrival in Canada.

I suppose another thing would be that the immunization records should be part of the health check before they arrive. That's something we didn't emphasize, but I would add that as well.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Eileen, do you have one or two summary recommendations?

[Dr. Eileen de Villa]

I would suggest that we look at timing and the validity of the medical examination. Right now it's valid for a year. If we're concerned about health during travel and the journey to Canada, it makes more sense to have that medical examination closer to the moment of travel.

The other thing is that there are elements of the medical screening process that are onerous, heavy, and very paper-intensive for local public health, and for minimal benefit. That is why I would suggest that we review the processes currently in place and determine whether, in fact, they serve the objectives of the current act and its regulations.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

With my last seconds, I'm going to share my time with Mr. Dykstra.

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

Thank you, Mr. Weston. I appreciate that.

Just for clarification, I was wondering if you could elaborate on the length of time from the exam to the transfer of the individual to Canada.

In other words, you had suggested perhaps 12 months was too long. What would you suggest would be a better timeframe in terms of maximum time allowed before you'd have to be re-evaluated?

[Dr. Eileen de Villa]

What do you think, Natasha?

It's hard to say, with this one. Some people have bandied about the time of three months, or six months. I think those are more reasonable, particularly for certain diseases.

[Dr. Natasha Crowcroft]

I would add that in addition, in the opposite direction, it shouldn't be repeated when the person is in Canada. The current regulation requires it to be done again when status changes, but that applies if the person's in Canada. That doesn't make any sense.

So that recommendation could be dropped.

[The Chair, Conservative, David Tilson]

Thank you.

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chairman.

I'm curious about, and would like to explore a little bit, your comment that immigrants don't have health care when they arrive and that it poses, I think, a health risk, if I had some of your testimony there.

Do you recommend that we should provide health coverage forthwith upon arrival, as a preventative public health measure, to immigrants?

[Dr. Eileen de Villa]

Yes.

[Dr. Natasha Crowcroft]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have any data or information to tell us how long it typically takes for immigrants to Canada before they acquire health coverage, on average?

[Dr. Natasha Crowcroft]

I don't actually have any data on that.

It took me three goes to get OHIP coverage, even when I was eligible, so....

[Dr. Eileen de Villa]

In theory, though, in Ontario it's three months.

[Dr. Natasha Crowcroft]

Yes; it's three months before you can start.

[Dr. Eileen de Villa]

That's correct.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Not to belabour the point, but in that three-month time, I would take it that you would.... It would be your view, would it, that this poses a public health risk not only to those people but to Canadians as well?