Natural Resources Committee on Feb. 5th, 2008

[Brian McGee]

The reactor itself was designed and built in 1957 and has incredible margins. It's a very robust, very strong design. I can't tell you why that was; it's too far back in time. So the reactor itself was designed to the standards at that time.

What's important is that it's not a power reactor. What's happening in some of the dialogues, which is probably just natural, is power reactor standards are being interchanged with research reactor standards. This is a research reactor. It operates at low pressure and low temperature. It still has to be operated safely, and you still have to ensure it has the proper margins, but we need to make sure we're talking about research reactor standards and not power reactor standards in some of these discussions.

To answer your question directly, would it meet today's standards for a research reactor if it were being constructed today? It would not, but that's not uncommon. During the life cycle of any nuclear facility, standards change.

Let me give you an example. I drive a vehicle that doesn't have side airbags. When I was a kid, I rode in a vehicle that didn't have seat belts, which probably gives you an indication of my age. So over the progression of the auto industry, we've gone to seat belts and then we went to driver side airbags and then we went to passenger side airbags as well, and now you can buy vehicles with side curtain airbags.

Safety standards are always being increased, but we don't retire vehicles that don't have side curtain airbags. I still drive one, and my guess is that many of us in the room do.

So that's the way to try to rationalize these safety system upgrades. The industry is always elevating the bar and always trying to take the technology to the safest possible level.

[The Chair, Conservative, Leon Benoit]

Thank you very much, Mr. McGee.

Mr. Trost, your time is up.

Now we will go to our fourth witness, who is joining the other three at the table via video conference. We have Dr. Thomas Perry from the University of British Columbia. He's with the Department of Medicine and Department of Anesthesiology, Pharmacology and Therapeutics.

Go ahead, please, Dr. Perry, with your five- to seven-minute presentation. Then we'll open it up to questions, which could be directed to any of the four witnesses.

[Dr. Thomas Perry, Department of Medicine and Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia]

Good morning. Thank you, Mr. Chair. I thank Vancouver General for setting up the video conference so I could participate with you.

I had asked the clerk of the committee, Mr. Mariage, to circulate to you, if possible, a transcript or at least the audiotape of what I said during an interview on As It Happens a few weeks ago. I think it's more efficient if I assume the members know that content. It was fairly simple.

[The Chair, Conservative, Leon Benoit]

That has been done. They have that.

[Dr. Thomas Perry]

The only thing I could add to that is I hope your members understand I'm not an expert in nuclear medicine. I'm one of the people who requisitions nuclear medicine studies as part of my regular work as a hospital internist. I'm a reasonably senior doctor, so I have many colleagues whom I've practised with for a couple of decades, and I'm a working Joe doctor.

To prepare for this appearance I did do a little bit of background research locally yesterday. I spoke with colleagues in the nuclear medicine department and I thought I could share with you that, if I understand their perspective accurately, in British Columbia there was no crisis in December. One of them said it seemed like much ado about nothing, from their point of view.

You might not be aware that they were having daily teleconferences around the province of British Columbia to ensure the supply of radioactive molybdenum, which they obtain from Atomic Energy of Canada, was shared around the province to get the maximum benefit from it.

From my colleague's perspective, if I understood him accurately, patient procedures or tests were being scheduled according to priority, so those that were potentially the most important to patients were still getting done.

That's the same experience I had working in my hospital. For the full month of December, I was puzzled by the news reports and the middle-of-the-night sitting of Parliament, because we certainly didn't perceive any crisis out here.

I think the only other thing that would perhaps put things into perspective from our point of view, at least in British Columbia, is when I met a senior family doctor at the swimming pool last night and told him I was appearing this morning, he said there are real health crises, but this was not one of them.

With that, if there's anything I can enlighten you on by way of questions, I'd be happy to.

[The Chair, Conservative, Leon Benoit]

Thank you very much, Dr. Perry.

We will start with the New Democrat member of the committee.

Ms. Bell, go ahead, for seven minutes.

[Catherine Bell, NDP, Vancouver Island North, BC]

Thank you, Mr. Chair.

Thank you, Dr. Perry, for taking the time to appear before us today. I understand you were going to be going into surgery and that's why you couldn't come.

[Dr. Thomas Perry]

I hope I'm not going into surgery because I'd be the patient.

[Catherine Bell, NDP, Vancouver Island North, BC]

Okay, sorry.

[Dr. Thomas Perry]

I have a pager here. I'm on duty.

[Catherine Bell, NDP, Vancouver Island North, BC]

Okay, that's what it was. Well, thank you anyway.

You've said that there was no crisis in British Columbia that you were aware of. I just wondered who would determine that there is a crisis in nuclear medicine.

[Dr. Thomas Perry]

For example, I worked through the SARS crisis. I'm actually the doctor who looked after the most patients with SARS in B.C. I looked after two patients. That was a true crisis. We were very frightened of what was happening to the public and to us, as health professionals, and were even more alarmed by what was happening in Toronto and China. In that case, we all received email and paper bulletins from the hospital administration alerting us to what was going on.

Now, norovirus, or so-called Norwalk-type virus, presents a crisis in a hospital because people and staff get sick and wards have to be closed. We get a temporary crisis once every few months in which we're alerted by the hospital. We got no such alert that I'm aware of in British Columbia. And speaking with a colleague in nuclear medicine yesterday, he confirmed that the nuclear medicine specialists who were apportioning tests did not perceive any crisis. They were handling the situation.

The other intriguing thing that I guess made me send an email to As It Happens and that led to an interview, which now leads to me appearing before you, is having run into a senior radiation oncologist from the BC Cancer Agency, just while signing off records in the medical records room. I asked him, “Did you perceive a crisis in December?” and his answer was, “Well, no, we had a contingency plan at the Cancer Agency”.

I think if there had been perceived to be a crisis, senior administrative people in B.C. would have alerted us to that, perhaps even the Ministry of Health.

[Catherine Bell, NDP, Vancouver Island North, BC]

My question was who would have alerted you. So the Ministry of Health would have potentially done that?

[Dr. Thomas Perry]

The senior medical director in our hospital would have emailed me and everyone else.

[Catherine Bell, NDP, Vancouver Island North, BC]

I asked that question because Tony Clement, the Minister of Health federally, was before us and said there was a shortage in the Victoria hospital. But you weren't hearing that, and you would have been aware if that was the case, then, if you were talking with your colleagues.

[Dr. Thomas Perry]

I emphasize that if you want to pursue this, the right people to call as witnesses are the nuclear radiologists and the technicians who were really handling these issues. But a colleague informed me yesterday that the Royal Columbian Hospital in New Westminster, if I understood correctly, obtains radioactive molybdenum from a different supplier and had some that it could share as well, and that there was a daily teleconference occurring in British Columbia by the nuclear medicine specialists to ensure that supplies of radioisotopes were apportioned according to the greatest need. For example, a so-called elective cardiac scan for someone suspected of having angina might have been deferred because it's typically not a highly productive scan--it often doesn't answer questions--whereas others that were deemed to be crucial would be pursued.

There are very few nuclear medicine scans that are crucial, and the test of that is that most nuclear medicine facilities are not open at night and never on weekends. We never get an emergency scan in my practice.

[Catherine Bell, NDP, Vancouver Island North, BC]

Thank you.

One of the things that we're hearing, and I heard it again today from Ms. Gulenchyn, and I invite you to answer this question as well, is that other diagnostics were available, other treatments. My question is this. Would anyone die if they didn't receive the treatments or the diagnostics? I keep hearing from the minister that people were going to die.

I understand that there may have been delays, that definitely there was going to be a shortage, that people were managing that shortage, and I heard from Ms. Gulenchyn that if we didn't act in Parliament when we did, the crisis would have escalated or we would have indeed been in a crisis across Canada. We're hearing a different story from the east than from the west. I just wondered if we can figure out whether there were conversations across the country. Ms. Gulenchyn said back on December 6 in an interview that she didn't expect the delays to be life-threatening. I'd like her also to answer the question, because you're both saying the same thing, that this was not a life-threatening crisis.

[Dr. Thomas Perry]

Unfortunately, I wasn't able to listen to Dr. Gulenchyn's testimony, but I certainly encourage you to pursue this, because the reason I'm here before you is I had a different interpretation of the middle-of-the-night sitting of Parliament. I did not agree with your colleague who called it Parliament's finest hour. I thought it was shocking, and I wrote to a number of MPs by email to say how disturbed I was that Parliament would meet in the middle of the night and at excessive speed agree to legislation. It's not because I'm concerned about the safety of the reactor--that doesn't frighten me at all--but the overruling of a regulatory authority, if there had not truly been a crisis, concerns me enormously. So I certainly encourage you to pursue it.

To the best of my medical knowledge, I've been struggling to think of a nuclear medicine procedure that cannot be achieved by another medium, another technique. Studies of the thyroid gland with radioactive iodine would be one example where it's difficult to obtain the same information otherwise. But apparently radioactive iodine comes from different sources, according to my information.

Radioisotopes are very seldom used for emergency treatment. I have not personally been able to come up with an example of how they might be used for emergency treatment. The most common use is to treat thyroid disorders, and that is never an emergency. It's not done on weekends or in the middle of the night, for example. So I can well believe as a doctor that there would have been substantial problems, and difficulties and embarrassments, or fear for patients. But to say, for example, that a patient with breast cancer metastatic to the bone is going to suffer or lose his or her life because we can't image those with radionuclides I don't think is true. There are other techniques to obtain those images, such as CT scanning, or MRI, or even plain X-rays.

I have not been able personally to think of an example where it was absolutely essential. If there were such examples in British Columbia, they were certainly all being serviced.

[The Chair, Conservative, Leon Benoit]

Thank you, Dr. Perry.

I'll now go to Ms. Gulenchyn to answer that question as well. Go ahead, please.

[Dr. Karen Gulenchyn]

Thank you.

Let me start, first of all, with the fact that there were major differences across the country. Our information led us to understand that British Columbia was handling and managing this issue the best of all of the provinces in the country. That was largely because there were a fair number of institutions in British Columbia that were contracted with a supply coming from an alternative supplier who was not dependent upon molybdenum that came from Chalk River. They then had a capacity to share and in fact ameliorate the situation that did not exist in other centres.

Secondly, let me point out that many of the difficulties that were experienced in the delivery of medical care occurred in smaller centres, where in fact they are on call at night and on call at the weekend to provide nuclear medicine services, unlike the major downtown institutions in Toronto, Ottawa, Vancouver, and Edmonton, where there is relatively good access to CT and MR, which provide for alternative imaging for many of these problems. Therefore, the problems were actually occurring in the smaller centres; the issues of lack of access to care were much more acute in those centres than they were in major urban centres.

It is absolutely true that therapy was not an issue. Therapy for using radionuclides in most cases is elective, and at no point was there an issue with respect to supply of radiopharmaceuticals that are used for treatment. However, therapy depends upon accurate diagnosis, and it is my belief, and certainly the belief of most of my colleagues, that nuclear medicine plays a pivotal role in making an accurate diagnosis.

In the case of Ontario, Cancer Care Ontario in fact met on an emergency basis to consider the lack of isotopes. There was in fact a central directive that came from Cancer Care Ontario, co-signed by the University Health Network and supported by the Government of Ontario, directing that the various nuclear medicine facilities should place priority upon doing bone scans, because it was viewed that there was no good alternative to bone scanning for the diagnosis of metastatic disease and the staging of treatment, and that the lack of access to bone scanning would lead to delays in staging and delays in treatment.

Finally, I think we need to understand that the health care system in Canada is a relatively constrained system. There is not a lot of extra capacity within the system. We don't have a lot of extra beds; we don't have a lot of extra CTs; we don't have a lot of extra MRs; we don't have a lot of extra high technology that's sitting unused. Therefore, when any portion of the system is withdrawn, its withdrawal has the potential to create backlogs that could take weeks and months to resolve.

[The Chair, Conservative, Leon Benoit]

Thank you very much, Ms. Gulenchyn.

We now go to the official opposition for a second round of five minutes.

Mr. St. Amand, go ahead, please.

[Lloyd St. Amand, Liberal, Brant, ON]

Thank you very much, Mr. Chair.

As expressed by my colleague, Mr. Alghabra, we appreciate your candour, Mr. McGee.

You wrote on December 7 to Linda Keen and said:

Let me say at the outset that I fully appreciate the concerns you expressed at the December 6, 2007 meeting respecting AECL's performance under the licence. AECL is committed, on an urgent basis, to the connection of the emergency power supply to pumps 104 and 105.

It rather sounds, Mr. McGee, that you were agreeing with Linda Keen that she was in fact doing her job, pointing out legitimate concerns to AECL, and you were going to immediately, on an urgent basis, react to her concerns.

In your professional relationship with Linda Keen—and I would appreciate just a short answer, because I have another area—did she at any time fail to show leadership, in your view, or act in any way that would be considered not competent?

[The Chair, Conservative, Leon Benoit]

Go ahead, Mr. McGee.

[Brian McGee]

You've asked a number of questions there, so I may not be able to keep the answers short.

The letter I believe you were referring to was not written by me; it was written by Dr. Torgerson. It was intended to try to move us toward a one-pump start-up solution. By the time we got to the December 7 point, a number of things—

[Lloyd St. Amand, Liberal, Brant, ON]

Excuse me, Mr. McGee. With respect, the letter was just a preamble. The direct question—and there was only one—was did she at any time demonstrate a lack of leadership or incompetence? That's the question.