Veterans Affairs Committee on Dec. 6th, 2016

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Okay, thank you.

The minister answered our questions regarding the decision to limit marijuana to three grams per day. Are there other drugs that the department has looked at and capped in terms of the amount that is allowed? If so, which drugs, and what was the reasoning behind that particular decision?

[Michel Doiron]

First of all, marijuana is not in the same category as the other drugs we dispense. That's why you get an authorization; you do not get a prescription for marijuana. For the other drugs that typically are on the market, there is a PIN number. I am not a doctor, so I apologize to the doctors. We have doctors who can speak to this much better than I can, but the doctors know what type of prescription to give and what quantities because they can refer to a manual that says, for pneumonia give penicillin for seven days, three times a day, 250 milligrams per—I'm just making this up, by the way.

In the case of marijuana that does not exist. The research is very limited on the benefits of marijuana. We're not saying there are no benefits. There are some benefits, but the research is limited. Anecdotally we hear it has helped people and we don't refute that, but the reality is that there are also some contraindications with using marijuana, especially for mental health issues. Some very high-level psychiatrists have come forward and noted some of the issues that marijuana may cause. Ten grams a day is a lot of marijuana. We have to be very clear. The policy we've put out is a reimbursement policy. We are not replacing the doctors. We are not replacing the medical health professionals. What we're saying is that according to the Royal College of Physicians and Surgeons, according to Health Canada, the upper safe level is approximately three grams a day.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Thanks very much, and thank you for being here today and answering our questions.

I was asking the minister about earnings loss benefit and permanent impairment allowance, in particular. I'd like to drill down on that with you a little bit. They are mentioned in the supplementary estimates (B).

With regard to the earnings loss benefit, can you explain who qualifies for that, how the decision is made, and the timelines on decisions now that the formula has been changed for the amount the person receives?

[Bernard Butler]

Thanks very much for the question, and I might say, it's a pleasure to be here with this committee.

The earnings loss benefit is an income-support benefit paid to veterans eligible for our rehabilitation program. If you have a rehabilitation need—vocational, psychosocial, or medical—while you're in that program you are eligible to receive income support. Those decisions are made at the front end of the process at the operational level, and they're made relatively quickly. You can stay on earnings loss benefits for the whole length of time you are completing your rehabilitation plan.

For example, you and your case manager will work out whether it's a vocational rehabilitation need, what your goals and plans are, and what you have to do to become re-established. During that period, which could be three years or even more depending on the circumstances, you will get this monthly income-support benefit. If at the end of that exercise you and your case manager determine that you are not going to meet the goals and objectives of the plan, that you are essentially totally and permanently incapacitated, which is the term the legislation uses, you can then go on what we call the extended earnings loss benefit at the same rate, 90%, through to age 65. At age 65, it ends and you are then qualified for our retirement income security benefit, which is a different program but provides benefits after age 65.

[Colin Fraser, Liberal, West Nova, NS]

Thank you.

With regard to the permanent impairment allowance, can you elaborate a little bit further on how qualification is determined and if there are any problems on the timeline of getting people approved for that?

[Bernard Butler]

With the establishment of the new Veterans Charter back in 2006, the permanent impairment allowance was a program designed to address the career impacts of severe disability on veterans. That was the fundamental policy rationale. In the legislation, the regulations define eligibility. It's for those most seriously disabled. The categories for permanent impairment allowance include veterans who have lost limbs, have become totally blind, have experienced a total loss of hearing, or have other very severe limitations.

In budget 2015, there was an amendment made to the regulations to try to broaden access to the program. There was an additional element added to the regulations covering veterans experiencing significant issues with mobility, whatever the cause, that had the effect of increasing the number of veterans able to access the program.

With budget 2016, however, there is an effort being made to address what is called the grade level distribution. Within the permanent impairment allowance program, there are three categories of eligibility, and it sets the pay scales from about $500 to $1,500. What budget 2016 has basically said is that we need to do a better job of ensuring that veterans are distributed more evenly across those three categories. Our ombudsman and various stakeholders criticized the program for limiting access to the higher financial benefits associated with PIA. It was simply the distribution. On April 1, 2018, you'll see the introduction of a new model trying to ensure improved grade level distribution across the program.

[Colin Fraser, Liberal, West Nova, NS]

Thank you. With regard to the disability award, could you touch on that as well, and contrast it with the permanent impairment allowance, so we understand exactly what that means and how that will be rolled out?

[Bernard Butler]

The permanent impairment allowance is considered to be an economic benefit, and it's one of the economic elements of the new Veterans Charter. The rationale was targeted at veterans who had career-limiting impacts in their employment, and it was targeted at the most seriously disabled. The disability award, under the new Veterans Charter, is a non-economic benefit paid for recognition and compensation for service-related disability. You receive that award depending on the degree or extent of disability, and with budget 2016, come April 1, 2018, the maximum amount of the award for a 100% disabled veteran will move from $310,000 to $360,000.

[The Chair, Liberal, Neil Ellis]

Very good.

Mr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you. We were talking earlier about Ste. Anne's Hospital. Will Ste. Anne's, since it has been transferred to the province, have the capacity to carry out research on veterans' care? Do you know anything about that aspect of its activities?

[Bernard Butler]

What I would tell you is that at Ste. Anne's, we'll continue to have our OSI clinic, which provides both walk-in and residential care. In terms of a centre of excellence for mental health, you know that this was part of the minister's mandate letter, to create a centre of excellence in mental health, and you know that the department is doing a lot of work with our colleagues in National Defence and at the Royal Ottawa, as a focal point for that type of research.

That would be the framework and the centre of the effort. Ste. Anne's focuses on long-term care for veterans, as well as having the OSI clinic there.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you. With the staffing at Ste. Anne's, have there been any issues in the transition with recruitment and retention policies among staff?

[Michel Doiron]

As the deputy mentioned, a percentage of the staff did not accept the transfer, so the province had to do some recruitment. I don't have all the numbers in front of me, and I wouldn't want to give you wrong numbers. They did have some initial challenges in getting some people there, but our veterans were always taken care of and the medical staff was on site.

Some of the issues we have been hearing about are more in the realm of the culture. You know, the staff at Ste. Anne's had been at Ste. Anne's for...well, the director had been there for 35 years, I believe, or 37 years. There was a real culture of serving our veterans and the new people coming in have to learn this. The Province of Quebec is totally committed to ensuring that the veterans receive the care they deserve and they need. We're already seeing some benefits, as the deputy mentioned. Family members, and spouses specifically, can now be in the hospital with their spouse, which was not allowable under our act before. They may not be in the same room, but at least if they're not on the same floor, then they're very close, which is important to the veterans.

As with any transfer, there are always some growing pains. The transfer agreement was very clear on what they were supposed to deliver, but we do meet with them. I don't personally, but Mr. Butler and I have two of our top DGs meeting with them on a regular basis to ensure that they are meeting everything that's under the transfer agreement.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

With regard to the service available and the language service that's available, under the Official Languages Act, of course, with it being under the Department of National Defence's jurisdiction, you'd have a guarantee of service in both official languages. Have there been provisions to guarantee that now that it's under the Province of Quebec those rights will still be protected?

[Michel Doiron]

It is in the transfer agreement that they are to provide services in the language of the veteran, and I have not heard of any issue to date.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right, thank you.

You were talking earlier about the opening of the Veterans Affairs offices. I know we're still in transition. Are you receiving any feedback about the services that veterans are receiving since these offices started to open?

[Michel Doiron]

I can't say that I've heard from every location yet, but in some locations I have heard from, the veterans are quite pleased with the services they're receiving and the fact that they can now go to an office and actually talk to somebody.

I have heard from probably three of our five offices that veterans are quite pleased.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

I have no further questions.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Wagantall.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you very much.

Thanks for being here.

I have to carry on with the question about marijuana, and it's really important to me that you understand the impetus behind this. It's coming from multiple letters that I am receiving, not from veterans themselves necessarily but also from caregivers—a lot of times, family members. Their concern is extreme, and they talk very clearly of the difference between their loved one's condition on multiple pharmaceuticals versus using medicinal marijuana.

We know that this is very different from the recreational marijuana that is going to be available to Canadians. It's a totally different product. It does not provide the hallucinations; it provides painkilling. I've been studying it extensively because I want to know what the difference is. These individuals are saying, “You're taking away my loved one, who is finally in a condition where we can talk to each other again.” These are real situations. The reason they've needed the amounts they're talking about is that they don't sit and smoke it. They make creams. They use it in meals, because it absorbs better and you don't destroy your lungs.

What I'm hearing is all very rational. We're prepared to say we're lowering it, but I don't understand what process was taken to determine how that should happen.

When you compare the side effects of being on 1,000 pills a month—and believe me, these women document—we're not dealing with pie-in-the-sky ideas here. They know exactly what they're giving and how much it's costing. For some of them it's $100 per dosage per day. We're talking about the difference in side effects, difference in cost, and the difference in having their loved ones being able to work on other things in their lives because they're no longer in that level of pain.

I don't understand how we came to the decision of three grams. The minister said that he spoke to veterans, but he didn't say how many veterans who are taking medicinal marijuana he spoke to, or how many caregivers. I need more clarification on where we're at with this issue.

[Bernard Butler]

Thanks so much for that question and the evident passion behind it. I think you reflect the challenges that the department has had in dealing with the issue.

What I would tell you is that the consultations were actually quite extensive. We are very concerned and focused in the department on establishing evidence-based policy. There was extensive consultation with medical experts and the literature, and the minister commented on the fact that even the college of physicians has made it absolutely clear to its membership that three grams a day is the upper limit of what it perceives to be a safety factor for the use of marijuana.

Those kinds of considerations very much influence what we were doing. We have to be concerned, obviously, with the health and well-being of veterans. The policy was framed in that context. We wanted to focus on it if we are going to reimburse, and that's all we do. The Department of Veterans Affairs treatment program only reimburses. We do not prescribe. We do not authorize.

The issue you are raising is a fundamental challenge that we have in the Canadian context and abroad, because there is very little research to show from a scientific perspective what efficacy is achieved through this. We have to formulate a policy based on weighing the anecdotal evidence that we heard from veterans and their partners with where the scientific evidence seems to be. Those two do not necessarily map together very well.

Again, we were charged with developing a reimbursement policy rooted in the health and well-being of veterans. Given those concerns and the recommendations of numerous professionals in the field, we landed on the three grams.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Yes, I understand that.

However, I would say that we know that in Israel it has been used for 50 years. There are places in the world, again similar to mefloquine, where we seem to be way behind in getting the evidence and going beyond what we see, hear, and experience here in Canada versus what is happening in other places in the world as well.

I have to say, if they are doctors, and they have the opportunity to prescribe something, they should get the information on it and then know that it is not addictive in the same way as pharmaceuticals are. It doesn't cost these people, and it gives a better result. Why aren't we going in that direction?

In the paper the other day, the individual in charge of basically creating the OxyContin issue is now moving into running one of our medical marijuana companies.

[The Chair, Liberal, Neil Ellis]

Mr. Bratina.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

I want to ask about the data that you use to put the estimates together, because in other experiences I've had with Public Works, when you know that part of a road is going to collapse.... It's the looking forward part.

Can you, when you're working on a budget, reliably predict the near-term and long-term financial requirements for veterans services? Is that something that the graphs and the data are reliable on?