Evidence of meeting #19 for Public Accounts in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was use.
A video is available from Parliament.
Conservative
Liberal
Chandra Arya Liberal Nepean, ON
Doctor, you mentioned that there's no more doctor shopping, but please refer to paragraph 4.63 in the Auditor General's report, which says that 29% of approximately 600 veterans obtained authorization from one physician. Again, in the same paragraph, it says that 53% of veterans obtained that prescription from four physicians. Is that not doctor shopping?
Director General, Health Professionals and Chief Medical Officer, Department of Veterans Affairs
With respect to marijuana and its authorization, I want to make the distinction that these are not prescriptions, but authorizations for access.
Liberal
Chandra Arya Liberal Nepean, ON
Okay, I'm sorry, it's authorization. Didn't it raise a red flag to see that one or four physicians were almost authorizing more than 50% of the marijuana?
Director General, Health Professionals and Chief Medical Officer, Department of Veterans Affairs
Absolutely.
Director General, Health Professionals and Chief Medical Officer, Department of Veterans Affairs
And this is an issue, because most of the medical community did not want to be placed in the position—
Liberal
Director General, Health Professionals and Chief Medical Officer, Department of Veterans Affairs
In one case, we did file a complaint with the College of Physicians and Surgeons against the individual whom we thought was prescribing a lot. But the issue is that many doctors are not authorizing it. For people who want it, because the courts have said they must have reasonable access to marijuana, some doctors are more willing to provide the authorization forms than other doctors.
Liberal
Chandra Arya Liberal Nepean, ON
You talk about reasonable access, but 3% of veterans are using 30% of the budget, costing $9,200 each. When 36% of veterans are over 80 years of age, this distribution of spending does not smell good to me. Are you compromising the prescriptions required by other veterans for other illnesses, like kidney failure, because of the high expenditures on, or costs of, marijuana?
Gen Walter Natynczyk
To answer your question, sir, no, not at all. Again, we provide support to the attending physician so that the attending physician who is supporting the veteran can make whatever prescriptions or authorizations they require. With regard to your concern, it's precisely for this reason that our minister, Minister Kent Hehr, has directed the department to conduct a review to look at all of the information that is out there right now in order to determine what the most appropriate methodology is and best practice in support of the well-being of our veterans going forward.
Liberal
Chandra Arya Liberal Nepean, ON
I understand that, sir, but your own departmental data shows that 46% of the 600 veterans who are utilizing marijuana for medical purposes are are also utilizing anti-depressants. Have you looked into that?
Gen Walter Natynczyk
Again, sir, in every case, it is the attending physician who is working with the veterans—
Liberal
Gen Walter Natynczyk
Again, the minister has met with medical experts, with the producers, with a group of veterans who are the beneficiaries of this program. We have met with a summit of almost 100 veterans' associations coming together to understand all the information out there. Again, a number of these veterans will lay out a number of bottles of medication in front of them. They have indicated that as a result of the medical use of marijuana, they are no longer having to take some of these other medications that affected their appetite, their sleep patterns and so on. But in each case, I just want to reinforce that our role is to support the attending physician to ensure that these veterans have the support that they need.
Liberal
Chandra Arya Liberal Nepean, ON
I understand.
Several times you indicated that your role is just to pay for the drugs. I think you mentioned this two or three times in your reports or in your statement. The federal government spends a total of $400 million on the prescriptions. Why until now have you not worked with other departments to find more cost-effective strategies here?
Gen Walter Natynczyk
Sir, we have continued to work with other departments. In this regard, we've been working very closely, as I mentioned in my opening statement, with Health Canada. We connect as well with the Canadian Armed Forces. There's co-operation and partnership not only with other federal departments, but other medical bodies as well.
Perhaps Dr. Courchesne could just expand on our partner—
Liberal
Chandra Arya Liberal Nepean, ON
Maybe the AG can explain it to us.
The AG very clearly says that “Veterans Affairs Canada should periodically review its cost-effectiveness strategies to assess whether they are up to date and are leading to reduced costs”. The AG recommends that cost-effectiveness strategies should be adopted.
Is that happening now, sir?
Conservative
The Chair Conservative Kevin Sorenson
Let me interrupt just for a moment.
Let's make sure that our questions come through the chair; that prevents the cut-off and everything else.
Conservative
The Chair Conservative Kevin Sorenson
We'll try to keep it a little more orderly.
To the Auditor General, please....
Auditor General of Canada, Office of the Auditor General of Canada
I think the only thing I can say is that in the audit report, we identified the issue of cost-effectiveness strategies and that there were some things that the department should do to improve those.
I can't really speak to anything the department has done since then or what they have in their action plan, but certainly at the point in time that we completed the audit and reported on it, we identified some things they were doing in their cost-effectiveness strategies and some other places where they needed to improve.
Liberal
Chandra Arya Liberal Nepean, ON
You mentioned in your report that internal departmental briefing documents indicated the risk of having more than five grams of marijuana per day. The deputy minister mentioned that the restrictions were removed.
Does this internal document state that usage of more than five grams per day is not recommended, even though the deputy minister says there are no such restrictions?
Conservative
The Chair Conservative Kevin Sorenson
Please answer quickly.
The question is for our Auditor General.
Auditor General of Canada, Office of the Auditor General of Canada
I'm not sure if I can give you an answer quickly. Certainly, what we identified was that the consultations the department had done indicated that the normal use of marijuana for medical purposes was at certain levels. I don't think there's really a difference between what I've said and what the deputy minister said. That was just the evidence. What we were pointing out is that the evidence at that point in time indicated that normal usage was five grams or less than that for medical purposes, but the limit was set at 10 grams. I'm not really sure I've heard that the deputy minister contradicted that. Perhaps they have collected more information since then, but that certainly was the information in the documentation that existed at the time we did the audit.