National Defence Committee on March 6th, 2008

[Denis Coderre, Liberal, Bourassa, QC]

The question is on the follow-up. If you have some individuals there, and if we provide the medication and they are not taking it, we need to make sure we have some follow-up on the field for them, right?

[BGen Hilary Jaeger]

Just to get more precisely to the question you're interested in, it's people who have been deployed into theatre who have subsequently sought some assistance for some kind of problem, who have been prescribed a psychoactive medication while in theatre and then returned to duty outside the wire.

Are you interested in the number of people in that situation?

[Denis Coderre, Liberal, Bourassa, QC]

I have one final question.

You said we now have a national accreditation process.

[BGen Hilary Jaeger]

Yes.

[Denis Coderre, Liberal, Bourassa, QC]

According to my sources, doctors assessed certain soldiers without authorization. I was told about Dr. Deilgat, who apparently wasn't accredited in Quebec. We may not question his abilities perhaps, but I would like to know how a doctor can assess those soldiers in Quebec without being authorized to practise by the province.

[BGen Hilary Jaeger]

If a doctor who has a licence authorizing him to practise medicine works solely for the Canadian Forces on federal premises, on the Valcartier base, for example, wheher he has a Quebec licence is not important. For us, a licence from New Brunswick or Ontario would be just as appropriate.

[Denis Coderre, Liberal, Bourassa, QC]

So Canadian Forces doctors might not be authorized to practise in Quebec, in particular, and could nevertheless conduct assessments.

[BGen Hilary Jaeger]

Yes, if they're assessing military members.

[Denis Coderre, Liberal, Bourassa, QC]

And what if they are off the base?

[BGen Hilary Jaeger]

In that case, they need a licence from the Province of Quebec.

[The Chair, Conservative, Rick Casson]

Thank you, Mr. Coderre.

[Denis Coderre, Liberal, Bourassa, QC]

Thank you.

[The Chair, Conservative, Rick Casson]

Thanks, General.

Mr. Bachand.

[Claude Bachand, Bloc, Saint-Jean, QC]

Welcome again, general.

Sometimes we're concerned by the fact that the pace of rotations tends to accelerate. There is a lot of discussion in order to determine whether those rotations should be stretched, in view of the lack of soldiers. One might think it's tempting for the Canadian Forces to ask its psychiatrists or mental health professionals to give soldiers a drug that will keep them in combat, even if that's almost unacceptable.

We want to be assured that the situation is entirely safe for soldiers returning to the front and taking those drugs. In other words, we want to be sure that military members with a mental illness or post-traumatic stress disorder are entirely rehabilitated when they return to the theatre of operations, even if they are taking those drugs.

[BGen Hilary Jaeger]

With your permission, Mr. Bachand, I'm going to answer in English because that's a little easier for me.

You have to be very careful about what you know for certain and what the research seems to indicate that is not yet definitive. You have to be quite careful to separate those things in your head.

We believe that having had a diagnosis of post-traumatic stress disorder in the past does make you at somewhat higher risk of having a reoccurrence of this disorder if you're subjected to combat stress in the future. It's not 100%; it's not a guarantee.

What we don't know is exactly how big that difference is.

We also know that other kinds of things in your mental health background have a similar effect. I think Dr. Brunet alluded to a history of childhood abuse of any kind being a serious risk factor, which we actually don't screen for--for a whole lot of reasons.

So we know there are risk factors. It really is a matter of serious professional judgment--and they do take their responsibilities very seriously--to assess whether somebody who has been treated and has done well, has returned to duty and is performing well in their job, is well enough to go back into theatre. That's a serious decision. It is not taken lightly.

But if you come out with a blanket policy that says as soon as you have had a mental health diagnosis and have required treatment for a period of time, you can never go back into theatre, well, that's a recipe for perpetuating stigma and for driving the problem underground if I've ever heard one. So we don't do that.

It's case by case. We rely on the best judgment of our mental health professionals on whether people are or are not ready to go back.

[Claude Bachand, Bloc, Saint-Jean, QC]

There's nevertheless risk management, and you have confidence in your doctors. However, a doctor can decide that a military member should not be returned to combat, just as he can take the risk of deciding the contrary. Can it happen that the safety of those around the person who is returned to the front is jeopardized? Do you know whether there have been any cases in which things really went badly after a member returned to the front and had to be sent back to Canada for good?

[BGen Hilary Jaeger]

I'm not aware of any such situation. We have returned to the front people with mental health histories who had problems and were withdrawn from combat. However, that wasn't sudden. They decided, after a certain number of weeks, that things were not going well and that it was preferable to return to Canada.

[Claude Bachand, Bloc, Saint-Jean, QC]

So you don't deny that soldiers who were diagnosed with mental health problems and were taking drugs were returned to the front line?

[BGen Hilary Jaeger]

That has happened. It's true that that can be a risk for the individuals themselves and those around them, but it is also true that a sudden heart attack can put peers in danger as well.

[Claude Bachand, Bloc, Saint-Jean, QC]

How much time do I have left, Mr. Chairman?

[The Chair, Conservative, Rick Casson]

You have two minutes.

[Claude Bachand, Bloc, Saint-Jean, QC]

The most important question for me is the distribution of patients. I mentioned to Ms. Fraser earlier that some doctors were seeing up to 100 patients a day, whereas others were seeing 40. That problem may not just affect military members. We have to take measures in Quebec to encourage doctors to settle in the regions, so that they don't all wind up in urban areas.

Have you taken steps to distribute the number of patients more evenly so that every soldier is entitled to the same treatment as the others and so that things are fair?

[BGen Hilary Jaeger]

It's not easy to assess the number of patients that a doctor sees in a day because they're not all equal. For people who have a sore neck or suffer from a minor knee problem, it's relatively easy. For those who have diabetes or recurring cancer, treatment is much longer.

We can talk about means. In that respect, matters are not completely equal from base to base. At the start of the reform, we determined that there would be 1,500 persons per health care unit. That's a somewhat arbitrary figure.

I'll switch to English.

It was a little arbitrary, and the Auditor General has remarked on that. We know that 1,500 people in a very busy base like St. Jean produce more work than 1,500 people in a relatively quiet base like perhaps Greenwood. We also know that 1,500 fifty-year-old officers in Ottawa produce more work than either of those. So you have to look at the demographics of the base.

We also know that our system of compensating--particularly our contracted physicians--is very inefficient because they're on per diem rates. If you want to run a health care system at the lowest possible cost, you do not pay people per diems. But we're not interested in running assembly-line medicine either. I'm not going to come out with a policy that says you have to see 100 patients a day, because I'm going to get crap. Excuse me. I'm going to get not very good--

[The Chair, Conservative, Rick Casson]

You said flack, right?

[BGen Hilary Jaeger]

No. I was going to say something a little less suitable to being televised, but--