Citizenship and Immigration Committee on Oct. 24th, 2017

[Dawn Edlund]

We have a snapshot of the cases we looked at—that 2014 caseload—when we were doing the analysis of the cost avoidance for the provinces and territories. We have a breakdown for 2014 of how many cases were under $50,000 and up to over $500,000. That is a very wide range.

[The Chair, Liberal, Rob Oliphant]

I'm afraid I need to end you there.

Go ahead, Mr. Tabbara.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

I'll be sharing my time with Mr. Whalen.

I wanted to clarify some things on who's exempt and who may not be. As I understand the statements, refugees who are applying to Canada would be exempt, correct?

[Dawn Edlund]

We settle refugees, yes.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

If a Canadian citizen applies for his or her family to come over with spouses, they're exempt.

[Dawn Edlund]

Yes.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

However, in the economic class, if someone is deemed medically inadmissible, they're not exempt, correct?

[Dawn Edlund]

Yes.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

I have an article here from the Toronto Star. A York University professor has been denied because her 13-year-old son has Down's syndrome. We have an individual who has a good profession, a professor at a university, but one of the children has a health condition, so the whole case is denied.

Is there not some way we can have a policy whereby we can see some changes and allow some leniency and acceptance to the family? I think we should measure the contributions of a family as a whole and not target one individual in the family and have the whole case denied.

Can you elaborate on that?

[Dawn Edlund]

Part of the fundamental policy review will cover these kinds of questions. Have we got the balance right that I spoke of earlier in trying to protect publicly funded health and social services versus the humanitarian, compassionate side, etc.? Those kinds of things will be factored in, and certainly if the committee were to make a recommendation in this regard, then that would be factored into our thinking as well.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Briefly, to add to that, you mentioned striking a balance. Have we been engaging with the provinces to strike that balance with them as well?

[Dawn Edlund]

When federal, provincial, and territorial ministers met in October of 2016, they jointly made a commitment that we would be looking at this world of medical inadmissibility because if there were to be changes and possible impacts on the provinces and territories, which administer health and social services, we wanted to make sure that we actively engaged with them. We sought their input, their feedback. That's been happening since October 2016, so that's about a year now.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Thank you.

I'll pass the remaining time to Mr. Whalen.

[Nick Whalen, Liberal, St. John's East, NL]

Thank you very much, Mr. Tabbara.

I'm trying to wrap my head around this, so thanks for teaching us.

There's a category of “a danger to public health”. If someone comes forward who could be a danger to public health, their application could be delayed, in which case they would receive treatment, or it could be denied outright, presumably.

Then there is “a danger to public safety”, and again, if it could be treated, it'll be treated, or they could be rejected.

Then there is this third category of “excessive demand on health or social services”. Under that we have a couple of different interrelated definitions. One is being above the average health care cost threshold. The other one is the demand on health or social services that would add to existing wait lists and would increase the risk of mortality or morbidity.

I'm trying to see how this could be quantified. Do you have particular metrics that you use, and how do they interplay? In the data structure you use to assess applicants, are there particular fields within that data structure that go into whether or not this person is going to increase wait times or increase morbidity or increase mortality? Are there particular line items within the data structure for the applicants that go on these things together, and would it be easy for the department to assess family by family, rather than individual by individual, or maybe just exclude the children altogether?

I know it's a long-winded question, but maybe we can talk a little about how this data is presented to the department and stored.

[Dr. Arshad Saeed]

I think this question was partially answered before as well, but I'll repeat some of it again.

We look at the reports provided by the applicant and the severity of the condition and the needs for services, the frequency they require. An individualized approach is used because courts have told us again and again that you have to review the applicant individually, not on a generic or diagnosis-based assessment. We look at the diagnosis and we look at the prognosis for the next five years and what types of services are required for that particular individual.

[Nick Whalen, Liberal, St. John's East, NL]

Again, with this category, is this a definite “no”, or is this one that could be “Wait and see; delay your application until your condition isn't as severe”?

[Dr. Arshad Saeed]

They are provided an opportunity through procedural fairness to come back and tell us if they are going to defray the cost of these services. It's only delayed in the sense that they are given the opportunity to give us the medication plan.

[Nick Whalen, Liberal, St. John's East, NL]

Okay.

Ms. Kwan asked for a lot of information. I'd like to make sure that in there we're getting information not just on rejections but also on the people who are impacted by this test. Of all the 360,000 or 550,000 medical exams you look at, what percentage will trip the threshold of an issue or additional concerns regarding rate of mortality and morbidity? I'd like to have a sense of how often this becomes an issue for the assessment and how often an interaction has to occur as a result of that, just to make sure we get there.

With regard to families, what would the department recommend in terms of regulatory change to make sure that children aren't subject to this? Is it just these definitions, or are there other regulations we would have to look at if we were going to make children exempt from this?

[Dawn Edlund]

That's getting into what I referred to earlier as the awkward situation of officials speaking to policy advice that we will give to the government, so it's difficult to answer that question.

Various mechanisms can be used in redefining some of the services, redefining what excessive demand is, and creating other exempt categories. All kinds of things could be looked at as part of this.

[The Chair, Liberal, Rob Oliphant]

I need to end it there.

Hopefully, the officials will read our report, because I suspect that's what we will be giving to you. It will be exactly what Mr. Whalen is asking from you.

Next is Mr. Saroya or Mr. Maguire.

[Bob Saroya, Conservative, Markham—Unionville, ON]

I just have one question, Mr. Chair.

We've been talking about fairness. In terms of fairness and in terms all these inadmissible people, all these rejected cases from 2014, 2015, and 2016, can you provide us with a list of what countries these rejected people were from, and the reasons? Is that possible?

[Dawn Edlund]

Yes. We've already discussed that. We have the list of the cases for which there were recommendations made by a medical officer based on services related to particular conditions. We have that list. Then we need to do the digging to see what happened next in terms of the actual cases themselves.

[Bob Saroya, Conservative, Markham—Unionville, ON]

Does any country have zero problems bringing all their citizens here for any medical or other reasons?

[Dawn Edlund]

Do you mean the nationality of the applicants?

[Bob Saroya, Conservative, Markham—Unionville, ON]

Yes.