Natural Resources Committee on Jan. 29th, 2008

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

So it was just MDS Nordion you were talking about in this letter, nothing at all with the other ones.

[Linda Keen]

Yes.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

I think I'm beginning to see where some of the point of disagreement is, and it's about the interpretation of section 9 in the CNSC. I'll just give you some idea of where some of the government members--maybe not all--are coming from.

This is part of your mandate. In subparagraph 9(a)(i) of the legislation it says to “prevent unreasonable risk, to the environment and to the health and safety of persons, associated with that development, production, possession or use”. Looking through the act, nowhere does it specifically exclude being concerned about cancer patients and their treatments. As a legislator, I look at that and see that it's a risk to people when they don't get their medicine, so that's roughly where we're coming from.

I want to ask you also--

[Linda Keen]

I'm sorry, was that a question?

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

It was a statement to help you understand where we're coming from here. You seem to have completely dismissed that, and the legislation doesn't specifically exclude what you're specifically excluding.

I also want to ask why you didn't use your subsection 47(1) emergency powers, specifically in light of section 7, where it says:

The Commission may, in accordance with the regulations, exempt any activity, person, class of person or quantity of a nuclear substance, temporarily or permanently, from the application of this Act or the regulations or any provision thereof.

Section 7 is part of your powers. Subsection 47(1) of the act states, “Notwithstanding any other provision of this Act, in case of emergency”--and I think we would agree that this was an emergency--“the Commission may, without conducting any proceedings, make any order that it considers necessary to protect the environment or the health and safety of persons or to maintain national security and compliance with Canada’s international obligations.” The “health and safety of persons” is what I'm onto there.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. Trost. Your time is up.

I don't know if there's any need for a response. I don't know if there was a question there.

Ms. Keen.

[Linda Keen]

I think that would be a bit difficult to respond to in a very short manner. It comes back to the issue that this was not the mandate of the CNSC. It has been independently reviewed for seven years, and that was not the mandate of the CNSC.

[The Chair, Conservative, Leon Benoit]

Thank you, Ms. Keen.

On a point of order, Mr. Alghabra.

[Omar Alghabra, Liberal, Mississauga—Erindale, ON]

Mr. Chair, I would like you to consider the fact that Ms. Keen started ten minutes late. Could we just go on for another round of ten minutes so she can stay for the full hour? I think it's a reasonable request. She was allotted an hour and she started ten minutes late. We have a lot more questions.

Could we get one more round, please?

[The Chair, Conservative, Leon Benoit]

Mr. Alghabra, we have the Minister of Health here, ready to go. It's beyond the time that his meeting was scheduled to start. He also will be shorted some time, if you'd like to look at it that way.

Thank you very much, Ms. Keen, for coming today. We appreciate it very much.

We will suspend the meeting for about three minutes and come back with the next witness, the Minister of Health.

[The Chair, Conservative, Leon Benoit]

We'll reconvene the meeting with the third hour this morning. We have as our witness the honourable Tony Clement, Minister of Health. With him is Morris Rosenberg, deputy minister, and Meena Ballantyne, who is assistant deputy minister, health products and food branch. I thank you all very much for coming today.

Minister, go ahead with your statement, and then we'll get directly to questioning.

[Tony Clement, Conservative, Minister of Health]

Thank you, Mr. Chairman.

I do have some opening remarks.

Before answering questions, I will review the measures taken by my department when it became aware of the prolonged shutdown of the NRU reactors in Chalk River and the ensuing shortage of medical isotopes.

Of course, I'm addressing this issue, Mr. Chair, from my perspective as the federal Minister of Health and my mandate to help protect, maintain, and improve the health of Canadians.

As members know, the Chalk River reactor is a critical source of medical isotopes in Canada and indeed worldwide. Radioisotopes are used in diagnosing and treating cancer and cardiovascular disease. They are relied upon by health care facilities in Canada and around the world.

In Canada alone, approximately 30,000 patients per week undergo nuclear medicine scans. As well, Chalk River provides isotopes for 76,000 tests per day worldwide. When the NRU reactor was shut down from November 18 to mid-December, I can tell you it significantly reduced the supply of these isotopes in Canada and around the world. In all, MDS Nordion estimates a 65% reduction of the isotopes in Canada during this period.

As soon as this fact was announced on December 5, we started taking immediate action. We began working with provinces and territories and with health system partners to determine the extent of the shortage and to assess options to respond effectively.

We communicated with nuclear medicine specialists to assess how best to manage the impacts on the health care system and on patients. We contacted 773 health care facilities across Canada, including up to 245 nuclear medicine facilities to determine the severity of the shortage. I personally communicated with provincial and territorial health ministers, and my officials kept in close contact with their provincial and territorial counterparts closely monitoring the situation as it evolved.

We also contacted other international agencies to determine the extent of the shortages worldwide. We quickly formed a group of experts from the fields of oncology, cardiology, and nuclear medicine, as well as representatives of the Canadian Medical Association and the Canadian Society of Nuclear Medicine.

I want to refer, if I may, to the information we received from this group. Some people out there seem to think there really wasn't a health crisis after all and our response was overblown. Let me say that based on the information we gained from our advisory group, such people are absolutely wrong. This advisory group made it crystal clear to our government that we certainly were in the midst of what was a growing health crisis and one that needed action. This group estimated that approximately 10% of affected patients were facing life and death decisions and another 30% to 40% were facing the risk of underequipped physicians making inappropriate diagnostic and treatment decisions. In short, Mr. Chair, the situation was not sustainable and certainly not acceptable.

In realizing the impacts of the shortage, the Canadian Medical Association issued a statement saying that nuclear medicine services were now being rationed across Canada; that patients were deprived of timely access to critical diagnostic procedures; that this was impacting diagnostic services, timely surgery, and therapy planning, placing patients increasingly at risk; and that the decision to take the reactor off-line for an extended period of time had already affected critical medical management decisions and the numbers affected would escalate every day that the shutdown was in effect.

The most severe shortages were felt in smaller rural and remote centres, particularly in Atlantic Canada. One hospital in Newfoundland told me that most of their staff in nuclear medicine had been sent home because without isotopes no work could be done. Their last generator expired at noon on December 7 and they had no backup. All appointments for patients had been cancelled and all emergency patients were being turned away. For the health of Canadians we needed production to resume to prevent even more hospitals from going without. In the short term, the situation was threatening lives. If left unchecked over the long term, the situation would have started taking lives.

Given the serious consequences to the health of Canadians, we had a responsibility to seek information from the Canadian Nuclear Safety Commission about ways to resolve the growing health crisis. We wanted to see if there could be an expeditious hearing to consider the merits of AECL's safety case without in any way directing that the commission reach a particular conclusion, but as we know, such a hearing did not take place.

Our government then issued a directive stipulating that the commission's decisions take into account the health of Canadians who are dependent upon nuclear substances for medical purposes, but that had no effect. As a result, the government had to take the decisive action on December 12, proposing C-38 to Parliament. Following all-party passage of that bill, the reactor came back online on December 19 and isotope deliveries resumed during the holidays.

I believe we acted in such a way that we balanced the likelihood of a potential incident of nuclear safety with the real certainty--the real certainty--of a serious and growing health crisis. For this action, the Canadian Medical Association and the Canadian Society of Nuclear Medicine publicly thanked the Prime Minister, myself, and all members of Parliament “of all political stripes”, to use their words, for the fast legislative action.

Some have said we could have obtained extra supply from international sources. Indeed, we moved quickly to try to obtain supply from the four other suppliers in France, Belgium, the Netherlands, and South Africa. We contacted European suppliers. They were willing to help, but they found they could only increase their output by 10% to 15%, which would not be enough to meet Canadian demand. Also during this time, French and South African reactors were going through their own routine maintenance and were unable to meet Canada's supply shortage. Furthermore, time for producing and transporting these isotopes was significant, especially given the short lifespan of these products. In short, Mr. Chair, it was not an option to meet Canada's demand from international suppliers, particularly since Chalk River produces more than half the world's supply.

Now that production and delivery has resumed, my officials are continuing our work with the expert advisory group to examine contingency plans in the event of any future supply disruption. This work includes assessing the possibility of alternative sources of medical isotopes, along with substitute diagnostic techniques that could be used if needed. In addition, this work is also looking at opportunities for enhancing international collaboration to coordinate supply. Our expert advisory group will be preparing its initial assessment in February. At that point, I intend to convene health care professionals, provincial and territorial representatives, and other experts to assess the lessons learned and discuss the work of the expert advisory group.

Of course, one very important issue to consider in all of this is timely information sharing. Going forward to ensure timely notification of issues that may affect supply, we have developed a notification protocol among AECL, Natural Resources Canada, and Health Canada. This protocol provides clarity about who needs to be contacted and when. As well, it states that information will be shared immediately when it concerns the operations of the Chalk River reactor and, as a result, the supply of medical isotopes.

Under the new protocol, once my department receives timely information about a potential supply impact, a process will be triggered to contact provinces, territories, and relevant experts to assess the potential impact and launch strategies to respond. We will also be more closely monitoring information from suppliers, along with clinical trial and import licence applications, all of which could be early warning signals of potential medical isotope supply issues.

Let me give you an example. Health Canada receives routine requests from companies, including medical isotope supply companies, seeking special importation permits to adjust to supply shortages. This request is not unusual, and in fact we received one on December 3 from a company that had made the same request twice before in the past year.

As I mentioned earlier, when we were faced with the situation of shortages in early December, we took responsible action. I want to thank members from all parties—the Liberals, the New Democrats, the Bloc along with my fellow Conservatives—in both the House of Commons and the Senate—for passing our legislation so quickly.

In closing, I want to reiterate my central point that we had to act. Repeated requests to the regulator to see about an expeditious hearing were not met. Consequently, with all-party support in Parliament, we passed the necessary legislation, and the CMA and the Canadian Society of Nuclear Medicine thanked us.

I will leave it at that and say that partisan considerations aside, we're all here to do the utmost for human health and well-being. It was in that spirit that I believe we acted with good sense.

[The Chair, Conservative, Leon Benoit]

Thank you very much for your presentation.

We'll go directly to questioning now, starting with the official opposition and Mr. Alghabra. If there's time left, we'll go to Mr. McGuinty.

[Omar Alghabra, Liberal, Mississauga—Erindale, ON]

Thank you, Mr. Chair. You are correct that I'll be sharing my time with Mr. McGuinty.

Minister, thank you for coming here.

By the way, the more you keep highlighting the urgency of the situation and the crisis that has arisen from that situation, the more you reveal your failure in doing your job, because your job should have been to prevent it from reaching that level. Your job should have been to manage this crisis before it got to a crisis level. Your job should not have been done by Parliament, but you are taking pride in the fact that Parliament had to step in and do your job for you.

In your initial statement you say, “After I was made aware of the situation on December 5, we started taking immediate action.” Then you tell us that you had a conference call with suppliers on December 10, five days later. Is that your definition of immediate?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for the question.

I would say a couple of things. First of all, I've been a health minister in this country for close to five years. I know that the honourable member has not had that wonderful experience, but I can tell him that despite the best laid plans of mice, women, and men, there's always something that crops up where you have to respond to a situation that was not planned for. After you respond in the best interests of your constituents, Canadians, there's always a group of people who say you did far too much and overreacted and there's always a group of people who say you did far too little and underreacted. That's the price one pays.

But I am quite convinced that once we heard that this was an unscheduled shutdown that was going to occur to such an extent that it was going to have an impact on supply, we acted immediately. The first thing you do is collect information, and that's what we did. My own personal conversation with one of the European suppliers actually took place on Saturday, December 8—not on December 10, as you suggest—with the CEO of AREVA in Paris. Indeed, there were many official contacts as well by NRCan on Friday, December 7, when we learned about the extent of the issue we faced.

So the first thing you do in any potential crisis situation is collect information, and that's what we did. We started talking to hospitals, and then we created a plan.

[Omar Alghabra, Liberal, Mississauga—Erindale, ON]

Thanks.

I'll hand it over to Mr. McGuinty.

[David McGuinty, Liberal, Ottawa South, ON]

Thank you, Mr. Chairman.

Minister Clement, we are all well aware of your background, your experience and your achievements as a former minister in Ontario. You were part of a government that closed 29 hospitals and laid off 8,000 nurses in the province. So if I were you, I wouldn't be so quick to tout my past achievements.

Mr. Minister, I am asking you outright what exact role you played in this sorry business. Ms. Keen clearly told us this morning that Prime Minister Harper personally authorized her dismissal. She stated that she received a letter from the Privy Council that was authorized by the Prime Minister. What role did you play in her dismissal, Mr. Minister?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for the question.

I would say, Chair, that some of his earlier partisan comments on my record in Ontario are factually incorrect, but I'm not going to go over that well-trod ground. I know the honourable member thinks he's an expert on Ontario politics, but he's not.

I would say in response to the honourable member's question that of course I agree with the government's decision. Parliament rendered its decision. Parliament said that of the--

[David McGuinty, Liberal, Ottawa South, ON]

Mr. Minister, that is not what I'm talking about.

Mr. Chairman, with all due respect...

[The Chair, Conservative, Leon Benoit]

Mr. McGuinty, let the minister answer the question. Give him a reasonable amount of time to answer.

Go ahead, Mr. Minister.

[David McGuinty, Liberal, Ottawa South, ON]

That is not at all the question that was asked.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Naturally, I would prefer to answer your question.

Please give me some time to do that.

I would say that Parliament made the right decision. The decision Parliament made was that Linda Keen, as president of the commission, got it wrong when she failed to balance the risks to the health and safety of Canadians, many of whom required treatment for cancer and cardiac therapies. She failed to balance their needs against the potential for some form of nuclear accident. I think Parliament got it right.

It was clear to us in government that after Parliament made its decision there needed to be a change of leadership at the top of the Nuclear Safety Commission. I'm not going to get into all the details that may be subject to legal battles in the future.

I can tell you that I agree with the decision. I think it's the right decision. I think it protects Canadians in the future. It's not a decision you take lightly. You don't fire heads of commissions every day of the week or every month in the year, but when it is for the health and safety of Canadians, you have to make those kinds of difficult decisions at times.

[David McGuinty, Liberal, Ottawa South, ON]

Are you expecting legal action to be taken, Minister? Are you now telling Canadians that legal action will be taken against your government? Or are you going to launch a lawsuit? What exactly are you telling us?

Please do not try to tell us that the vote in the House of Commons to authorize 120 days of repair work is unrelated to Ms. Keen's dismissal. Stop spouting such nonsense, Minister. Canadians know full well that you are spinning a yarn to defend what is becoming increasingly indefensible.

Let us be clear and frank. What was your role in all of this? Do you have any evidence? Have you sought a legal opinion to support your decision, as a member of cabinet, to back Mr. Harper's decision to personally sanction Ms. Keen's dismissal? What was your role in all of this?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I approved of the decision. It was a decision made by the executive council, so that's answering that question.

I can tell you that in terms of the evidence needed for a change, I gave you the evidence in my opening statement.

There is no question in my mind that if this crisis were allowed to continue--which was certainly the desired option of the then-head of the Canadian Nuclear Safety Commission--we were literally days away from huge human health impacts, not only in Canada but around the world, which would have led to deaths. I can't say it more plainly than that, Mr. Chair.

I think we made the right decision. I think the Canadian Nuclear Safety Commission got it wrong.

When we sought a way to get the parties together, there was resistance by the commission in that regard. I'm sure my colleague, Mr. Lunn, has gone over that ground.

All I can tell you as health minister is that my responsibility in cabinet is for the health and safety of Canadians. I think Parliament made the right decision, and I think we've got better protocols in place now and a better relationship with both the commission and with the new management at AECL so we can respond better in future situations.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. McGuinty and Mr. Minister.

We go now to the Bloc Québécois, Madame Gagnon.