National Defence Committee on Nov. 27th, 2006

[The Chair, Conservative, Rick Casson]

Thank you very much.

[David Christopherson, NDP, Hamilton Centre, ON]

Thank you again for today.

[The Chair, Conservative, Rick Casson]

Ms. Gallant.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman, and through you to the witnesses.

Equally important to battlefield medical services is proper attention to soldiers in training, and upon returning from deployment the psychological services are needed to deal with PTSD, which has been mentioned. With successive back-to-back deployments in the order of 2,500 troops per rotation, how prepared is the CFHS to properly treat soldiers in need of care?

[Cmdre M. F. Kavanagh]

We are certainly better off today than we were five years ago. Five-plus years ago, in 2000, we began a project called Rx2000, and part of that project involved a massive undertaking of refurbishing and improving the services we deliver at home.

To give you some examples, in the past on many of our bases all there would be would be uniformed personnel. There might be a base surgeon and two or three physicians and uniformed technicians. The vast majority of our facilities now have over 50% civilians in them, and there are two to three times as many personnel in there, nurses, nurse practitioners, physicians, psycho-social supports, whether it's psychologists, social workers, etc., to meet the needs of our personnel. That's all a direct result of the project that we've been putting in place in the last five and half years.

I say putting in place--it's still actively engaged, still ongoing, and we're enhancing the improvements to it all the time. It still has a few more years to go before it's completely in place. But just like the competition for uniformed health care providers, the competition for civilian health care providers in many of our locations is just as difficult. However, it's vastly improved from where it was in the days when the general and I here were actually seeing patients.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

You stated that the Constitution Act of 1867 assigned sole responsibility for all military health matters to the federal authority. As you know, one of the first actions the current Ontario premier took upon gaining office was the implementation of health premiums. Now both B.C. and Alberta also have health premiums, but soldiers are exempted from paying them. Yet the Ontario Liberals are deducting health premiums from our soldiers' paycheques. What steps has the CFHS taken to recoup these inappropriately collected premiums in order to apply them to funding at your priorities?

[Cmdre M. F. Kavanagh]

We actually haven't done anything about it because it's a pay and benefits issue. It's not in my lane.

I'm sorry, I can't answer the question, because that's the chief of military personnel. It's under compensation and benefits requirement to resolve, and they would have to give you the answer. I don't know the answer.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

CFHS could use more funding, though?

[Cmdre M. F. Kavanagh]

Everybody could use more money. Couldn't you?

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

During the course of this committee's study on the mission in Afghanistan, we listened to the stories of soldiers injured in theatre. We were told that despite doctors' orders of lighter duties until injuries are healed, soldiers are forced to return to full duty prematurely. Are mechanisms or safeguards in place to prevent doctors' orders from being disregarded?

[BGen Hilary Jaeger]

Doctors' orders ought not to be disregarded. In fact, there was a shift made, and I'm sorry I can't tell you the exact year. It was somewhere around 1998, 1999, or 2000—my memory is failing—but before that, physicians used to make recommendations to the chain of command on employment limitations or on the awarding of sick leave, which the chain of command was at liberty to either accept or ignore.

A policy shift occurred in either the late 1990s or very early 2000s, whereupon the chain of command did not have the latitude to make those distinctions any more, but what was written by the physician would in fact be followed. If the chain of command wanted to discuss something or had any difficulty with the limitations, they were to take that up with the physician or the base surgeon and not play that little tension out through the member.

This doesn't, of course, mean there aren't instances across the country, because we can't be everywhere all the time, where things don't get either misinterpreted or forgotten about, or the employment limitation of people is not respected in some way. But if this were brought to the attention of the treating physician or the base surgeon, there would be intervention from the base surgeon to the unit commanding officer, saying, “We heard that you've been making Corporal Bloggins go out on morning PT, and he's not supposed to be running and not supposed to be lifting weights for another two months.”

It's certainly very easy for us to intervene if we know about these instances, but we're not the secret police going out to look at units.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So the onus is on the injured member to tell the doctor that they're being forced not to comply with doctor's orders.

[BGen Hilary Jaeger]

The onus is first of all that we communicate directly with the unit to tell them what employment limitations to impose. But then the best arbiter of whether those employment limitations are being respected is the member themselves.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you.

Do the Canadian Forces hire foreign doctors to treat soldiers in theatre?

[BGen Hilary Jaeger]

We do not hire foreign doctors to treat soldiers in theatre; we have collaborative arrangements with some of our major allies—particularly our NATO allies and the Australians—to use their uniformed physicians in a collaborative way.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

So civilians are not hired from nearby countries where our soldiers are deployed to treat them, then?

[Cmdre M. F. Kavanagh]

No, they are not. The facility in Kandahar is a multinational unit of which we are the lead nation, with the command of it. There are Danes, there are Dutch, there are Aussies and Brits and Americans working there, who are uniformed, but we do not hire.... If we hire civilians, they will be hired meeting Canadian standards.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

And do wounded enlisted soldiers receive as high a quality of care as officers, if they're injured either in training or in theatre?

[Cmdre M. F. Kavanagh]

Absolutely.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you.

[The Chair, Conservative, Rick Casson]

Mr. McGuire is next, and then it's back over to the government.

[Joe McGuire, Liberal, Egmont, PE]

Thank you very much, Mr. Chair.

There is a lot of data coming out of Petawawa about the impact of soldiers coming back to this country and to the base they left, concerning domestic violence, divorce, drug addictions, alcohol addictions, and so on. Why are we so slow off the mark in getting ready...? We had to know this was going to happen, from people coming from a theatre of war. In Petawawa, which is where most of our soldiers leave from and come back to, why aren't we better prepared for the human dimension when they come back from a theatre?

[BGen Hilary Jaeger]

Sir, you have me at a bit of a disadvantage, because I haven't seen the statistics you're referring to. If they pertain to a psychosocial issue, I can research them through my social work staff and perhaps I can be as well-informed as you are.

I don't want to dispute the challenges people face in Petawawa, because amongst our army bases it is the largest concentration of troops you'll find in a relatively small centre. Of the other big army bases, Gagetown is a little bit in the same boat, but Valcartier's in close proximity to Quebec City, and Edmonton of course is in Edmonton. Those are the other large army bases, and social support services and a variety of mental health referral services are all more readily available in that kind of place.

[Joe McGuire, Liberal, Egmont, PE]

Why isn't the facility there? If most of the people who are in the theatre of war come back to Petawawa, why aren't there more people there to take care of them?

[Cmdre M. F. Kavanagh]

Well, they don't all come back to Petawawa. It depends on the brigade that's being deployed. When there are 2 Brigade soldiers, they come out of Petawawa. The most recent rotation were 1 Brigade soldiers, and they all came predominantly out of Edmonton or Shilo, Manitoba. As the surgeon general said, the resources are a little better when you're in an urban centre than when you're in rural Canada. It's the same in the civilian sector.

The project I alluded to earlier, Rx2000, has a very large mental health component to it. It's going to expand the number of personnel to look after mental health issues. The reality is that Petawawa is lagging behind in the implementation of that project, for a number of reasons. There are infrastructure challenges, there are challenges of recruiting professionals to work in the Ottawa Valley. That's simply a reality of today. It's considered underserviced in the civilian sector. It's difficult to attract professionals to more remote areas, and only two hours up the river is considered remote.

We're not neglecting it. We are trying to address it, and we have a very robust plan in place to do that. They are also supported by everything we have here in Ottawa. I know that's not in Petawawa, and it does not meet their wishes. We have a plan to fix that, but there are fairly significant resources here in Ottawa that do address and can be deployed to meet them--and/or the patients come to Ottawa--to assist with their requirements.

Again, the data that you have, I don't believe I've seen either. As they say, there are statistics and then there are damned statistics, so it depends on how you interpret the statistics. We have a very robust electronic health record that's in the process of being implemented, which will also be able to give us better analysis of all the epidemiological data on all sorts of health care issues when it's fully implemented. Again, it's not there yet, but it's under way. Until we have a chance to kind of analyze all the stats, I would be hesitant to draw too many conclusions from them.