Evidence of meeting #52 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was worker.
A recording is available from Parliament.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you, Mr. Chair.
Thank you for coming, Mr. Genise.
In regard to the PTSD presumption clause for first responders, does this also apply to health care professionals such as nurses or physicians, say, for whom they're really starting to recognize that PTSD is an issue in these kinds of workplaces?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Not at this time.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Okay. Is that being looked at or investigated?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes. It is being looked at.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
The government is looking at legislation to expand the roster of jobs. I believe that nurses are part of that expansion.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
You might have touched on this. What is the process for determining a PTSD claim? If you have someone claiming PTSD in an unrelated field, such as a factory worker who's been injured in an explosion, say, or if there's no physical injury but there's a claim of PTSD because other people were hurt or whatever, what would be the process for compensating a person for PTSD?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
We still go down the same channels. I'm going to consult my notes, because there are three specific criteria that we look at.
First of all, we're looking for an event—typically a significant event—that's clearly and precisely identifiable and wasn't cumulative, but was typically traumatic and outside the normal course of their duties. Again, we're looking for the DSM diagnosis, to make sure there is a diagnosis behind that.
If a worker has significant traumatic physical injuries, we often accept the related psychological component. It could be as the result of an explosion or whatever. It's all together. We will accept that as part of their entitlement, again using the DSM-III diagnosis as our requirement for permanent benefits on that.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Yes, for sure, but if there's no physical injury?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
If there's no physical injury?
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Yes. Say, for instance, that the explosion occurred and the factory worker was standing next to the person killed in the explosion and claims PTSD.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes. That would meet the criteria. Even if they weren't physically injured themselves, but they were in a horrific event—for example, being a driver on the subway when someone jumps on the tracks, etc.—we would again go through the basics. Was this normal for them? Was there an identifiable event? Did they seek medical attention within a reasonable amount of time? Is there a medical connection? Obviously in this case, there would be. They would gain entrance to that policy.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
You touched on the fact that some people in certain locations might not have access to a regular MD. I practised emergency medicine for 20 years, and that was a challenge we sometimes had. We'd see someone in the emergency department who was injured, and we'd write down what was going on, but there would have to be some ongoing medical care and ongoing evaluation.
Let's say the patient didn't have a family doctor. They sometimes would write us letters, repeatedly, saying, “He doesn't have a family doctor, so can you assess his return to work?” We'd say, “Well, we don't do that in the emergency department.”
What kinds of delays do you have? In terms of what you can provide, how timely is the regular medical care and follow-up that someone needs? You said that you have some means of plugging in people in these cases.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes. You have a couple of things there. One is in terms of how we.... It's common, unfortunately, that many people don't have a family physician in the traditional sense, but we accept very different forms of health care, such as physiotherapists, and chiropractors.... There's a whole list of health care providers that report to us. We use their reports. As has been mentioned, we also have the nurse consultant as part of that team. They will help to facilitate this for workers who need a family physician for that follow-up. They will work with the client to try to get them a family doctor within their community.
In terms of us facilitating care, it varies depending on the nature of the injury, etc., and the type of treatment. I talked about the roster of psychologists and psychiatrists. I believe the standard is two weeks. We expect, as part of the contract, to get one of our clients seen within two weeks. That's expedited care for sure.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
The challenge I had in Manitoba—perhaps this doesn't occur in Ontario, and maybe there are different government guidelines—is that sometimes we would have a patient with a psychiatric issue and we'd want to refer them to a psychiatrist as an outpatient. Psychiatrists were generally very reluctant to take on someone as a regular patient if they did not also have a family doctor, because what would happen, then, is that the psychiatrist would be put on the hook, as it were, for all the ongoing medical care for this person. They'd be the only doctor on record for them.
Do you ever have that problem? Are you aware of that problem occurring in Ontario when you're referring someone for psychiatric care who doesn't also have a family doctor?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
I'm familiar with that challenge. There are a variety of challenges around a psychologist treating anyone, particularly someone who's injured. If, for example, the extent of our entitlement is limited, the psychologist has a duty to continue to treat this individual, perhaps without our funding it. I know there are challenges around psychologists and psychiatrists in terms of the treatment and their carriage of clients as we move through. I am familiar with that.
Liberal
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
I don't have a comprehensive answer other than that.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Thank you again.
Dr. Eyolfson asked a lot of the questions I had, so I'll take a little bit of a different bent.
I realize that you don't really deal with clients who are trained to leave nobody behind, who learn to take a bullet for their comrade. That's a bit of a different mindset when you're dealing with this.
I'd like to talk a bit about transition. Ms. Lockhart talked a little about transition. If we're assuming that we have someone who can't return to work, and now they're going from being a worker to, if I can use these words, “civilian life”, does the WSIB assist them in any way in that transition? Besides the monetary part that you might pay out, do you provide any assistance in that transition process?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Well, we are already civilians, so if you're injured on the job in Ontario, you are already a civilian; you're not within the military. Maybe I'd look at it from a different perspective. My lens is employment and employers, so who's the employer here? I guess in this case, it's the government.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
So you'd be looking more at the employer?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
I would look at the government and say if you can't work in this department of the government or you can't work on this line at GM, then why can't you work on this other line at GM? GM is paying the cost for this claim, so if you can't build tires, then maybe you can fix the radio. But it's up to you to decide how you manage your business.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
I'm not necessarily asking you to respond for the military. I'm just asking you whether, if there is a construction worker who can't go back to work and you are basically saying he is unable to return to work, there is a process through which you would assist him as he transitions? We've talked about education and things like that. There's that opportunity, but besides that, are there any services you might provide, such as counselling?
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes, there's employment counselling and planning, but we're always working on the rehabilitation side, in terms of their going back to work, and goal setting. We collaboratively set a goal. For example, if it's not going to work with their employer, if they have shut down and the worker can't go back to work in construction, now what are we going to do? What are their interests? We try to involve them. That's part of the transition. We try to involve them in the planning, so they feel that they're part of it and have a say in their own direction. There are also employment services with counselling and exploration. We assess their skills, abilities, and interests, and we provide them with their own data for them to choose their way, so to speak, rather than just giving it to them.
