Steven Fletcher

[Quarantine Act, June 14th, 2007]

Mr. Speaker, I was only a couple of minutes into my speech before members' statements and oral questions, and I was just getting to the good part of it too. As I was saying, under the leadership of the Minister of Health, the government decided to put forward two amendments to Bill C-42. One requires advance notification by land conveyance operators. The other addresses potential confusion with respect to the availability of a due diligence defence for all operators. These amendments reflect the commitment of the minister and this government to protect the health and safety of Canadians.

The first amendment would revert to the original definition of conveyance operator as found in the Quarantine Act. This means that all conveyance operators in the business of transporting cargo and passengers, including buses, trucks and trains, would need to alert a quarantine officer in advance of their arrival in Canada should they suspect a person or thing on board could cause the spread of a listed communicable disease, or if a person has died.

Land conveyance operators, like air and marine, would only be required to inform a quarantine officer of a public health problem on board as specified in section 34. They would not have to perform health assessments.

This advance notice is critically important as it permits an appropriate response to health emergencies on board conveyances and permits the minister to divert conveyances before arrival, if required, to protect the health of Canadians. This would be over and above what the international health regulations require for advance notification, as member states need only to impose this obligation on air and marine conveyances.

As a signatory to the international health regulations, Canada fully intends to meet its international obligations under the instrument. In addition, Canada is prepared to go a step further. The obligations for land conveyance operators will be the exact same as those for air and marine conveyance operators engaged in the business of carrying passengers or cargo.

For conveyances travelling to Canada, conveyance operators will be required to notify a quarantine officer in accordance with the requirements in section 34, even before they arrive in Canada. The obligation to provide this advance notification continues until the conveyance “lands”, so to speak, at its first destination in Canada. For air and marine conveyances, this will be the first airport or port at which the conveyance touches down or docks.

We will also work to make it relatively easy for industry to meet its obligations under section 34.

To implement this requirement in a simple fashion, the quarantine program will develop an information bulletin that will explain what to look for in terms of symptoms, and provide a 1-800 number to call to reach a quarantine officer 24 hours a day, seven days a week. As well, an awareness campaign will be undertaken to inform land conveyance operators of the requirements in Bill C-42. Taken together, the use of a 1-800 number and the awareness campaign will make notification as simple as possible for conveyance operators.

Further, by having early warning of communicable disease threats approaching our borders, we may be able to ease the flow of cross-border traffic. Traffic flow could be eased, as early warning would allow authorities to direct travellers who are suspected of having a listed communicable disease to areas where they could be looked at quickly, while other border traffic continues unimpeded.

This amendment therefore strikes a balance between protecting Canadians from the threat of dangerous communicable diseases, and facilitating the movement of persons and goods across our international borders.

We are also proposing a second amendment to Bill C-42 to clarify that the common law defence of due diligence applies to all conveyance operators. This common law defence was always intended to be preserved in the Quarantine Act.

When we examined the language of subsection 34(4) in Bill C-42, we realized that our intention to preserve the due diligence defence was not entirely clear. Under the charter an accused person has the right to invoke such a defence if facing the possible penalty of imprisonment.

For an offence under section 34, conveyance operators could face up to six months in jail as a potential penalty. Clarifying that all conveyance operators have access to the common law due diligence defence will ensure that the charter rights of those who have made all reasonable efforts to comply with the law are protected.

It is important that we make sure that conveyance operators who make all reasonable efforts to comply with the advance notification requirements know that the defence normally associated with such efforts remains available to them.

Consequently, the second amendment will ensure it is clear that a reasonable effort defence remains available to all conveyance operators that make all reasonable efforts to comply with the requirements in section 34.

We are constantly striving to give Canada the best public health system in order to protect the health and safety of all Canadians.

Through these amendments, Canada will have the most complete advance notification requirements in the world for quarantine purposes.

I feel very strongly that a comprehensive set of legislative tools needs to be available with the intent to protect the health of Canadians so as to avoid the human tragedy and economic and social disruption that would inevitably accompany another event such as SARS.

Consequently, I am seeking hon. members' support to provide Canadians with a greater standard of protection from the threat of dangerous communicable diseases spread via land conveyances. I am therefore asking today for members' support for Bill C-42, as reported from the Standing Committee on Health.

I want to congratulate the Standing Committee on Health for its hard work with respect to Bill C-42. The committee's work on Bill C-42 is a fine example of what parliamentarians can accomplish through the spirit of cooperation and mutual respect for one another's opinions and points of view.

I call upon my hon. colleagues in this House to support the amendments and ask for their cooperation in securing speedy passage of the bill.

Again, it was a great pleasure working with the Standing Committee on Health on this important bill. It was a pleasure to have worked hand in hand with members from across the country from coast to coast to coast, and from each party to ensure that these amendments were brought forward and ensure successful passage of the bill.

[Quarantine Act, June 14th, 2007]

Mr. Speaker, I am pleased to speak to Bill C-42, An Act to amend the Quarantine Act.

In December 2006 we brought the 2005 Quarantine Act into force. It replaces the previous Quarantine Act, which contained outdated authorities. The new Quarantine Act aims to prevent the introduction and spread of communicable diseases through points of entry into Canada, such as airports and marine ports. It is an essential tool for responding to public health emergencies that may be international in scope.

In December 2006 we also introduced Bill C-42, An Act to amend the Quarantine Act, in the House of Commons. Bill C-42 seeks to amend the wording in section 34 of the 2005 Quarantine Act in order to address certain implementation problems, which relate to the advance notification by operators of conveyances coming into Canada, such as aircraft and ships.

As enacted in May 2005, section 34 requires advance notification by conveyance operators to an authority to be designated by the Minister of Health at the nearest entry point into Canada.

There are implementation issues related to the wording of this section. One issue relates to the need to report at the nearest entry point into Canada. In the event of a public health emergency on board, conveyance operators may be unable to determine which of the many points of entry into Canada was actually the nearest to them at the time of reporting.

Another issue relates to the need to designate an authority who is situated at the nearest entry point. The most appropriate authority to designate, such as a customs or a quarantine officer, is not actually located at every entry point, including all airports and all small ports receiving international traffic. Designating an authority who is at these entry points is therefore not workable.

Bill C-42 addresses all these implementation issues by requiring conveyance operators to notify a quarantine officer before they arrived in Canada if they have reasonable grounds to suspect that: (a) a person or a thing on board could cause the spread of a communicable disease, or (b) a person on board has died.

For land conveyances, this would generally be the first customs officer who they see when they cross the border.

When Bill C-42 was developed, a decision was taken to remove advance notification by land conveyance operators, such as buses and trains, and to focus on air and marine conveyances. Advance notification by land conveyance operators is not required under revised international health regulations. As well, advance notification by land conveyances could be prescribed under regulations at a later date, if a later assessment indicated that it was necessary.

Bill C-42 was debated at second reading and referred to the Standing Committee on Health on March 29. The members of that health committee commented on the issue of advance notification and whether it should also apply to land conveyances, such as buses and trains.

We have heard the views of the committee. We are determined to take every measure possible to get advance notification of potential communicable disease risks from all conveyance operators, including those operating on land. Canadians expect no less.

Under Mr. Clement's leadership, the government—

[Health, June 11th, 2007]

Mr. Speaker, in fact, the actions of the Liberals and the NDP are threatening some projects. Here are some examples: $600 million for wait times guarantees, $400 million for the Canada Health Infoway, $100 million for Genome Canada and $30 million for the Rick Hansen Foundation. The Liberals and the NDP are showing their true colours.

[Health, June 7th, 2007]

Mr. Speaker, there is no dispute that the previous meanspirited government denied compensation for those hepatitis victims, tainted blood victims.

The Conservative government has fulfilled its commitment to compensate the pre-1986 and post-1990 tainted blood victims. We put in $1 billion toward this fund. The victims will be receiving that money shortly after the courts have approved the agreement.

[Food and Drugs Act, June 6th, 2007]

Mr. Speaker, I am pleased to speak to this private member's bill. This is a very serious issue and the government takes the issue of security of supply of prescription drugs and the protection of the health of Canadians very seriously.

When, in late October, the member for St. Paul's introduced the bill, she mentioned concerns about the effect of the then recent and potentially future U.S. initiatives aimed at facilitating cross-border drug sales to the United States. These two initiatives were restricted to individual purchases rather than wholesale or bulk shipments.

As I will outline further, we have not seen any impact from these initiatives. In fact, total sales to the United States have declined.

The member referred specifically to a U.S. measure to allow Americans visiting Canada to return with up to a 90 day supply of prescription drugs for their own use. In other words, this provision affected personal physical imports only, so-called foot traffic.

Although the measure became law on October 4, 2006, it essentially endorsed the then current U.S. administration practice regarding personal imports.

Members should know that the value of foot traffic purchases of prescription drugs in Canada has remained constant in recent years.

There was another U.S. development last fall, also in October, but not specifically referred to by the member at that time.

The U.S. Customs and Border Protection Agency ended its approximately one year practice of selectively seizing individual prescription drug purchases sent by mail from Internet pharmacies in Canada. While such personal mail order imports continue to contravene U.S. law, they have been tolerated, enabling the Internet pharmacy business in the first place.

As with the measures for foot traffic, we have not noticed any increase in sales associated with this U.S. Customs decision. In fact, the latest information from Health Canada shows that Internet pharmacy sales to the U.S. dropped by an additional 20% in the last quarter of 2006, resulting in total 2006 annual sales of $211 million.

The overall sales have dropped by 75% from their peak of $850 million in 2004. Why the decline? Several factors are at play. These include: the introduction of the U.S. medicare act part D, which, for the first time, provides drug benefit coverage for millions of previously uninsured or underinsured seniors; actions by manufacturers to restrict the supply of drugs sold to Canadian pharmacies involved in cross-border drug sales; the higher Canadian dollar; and, U.S. residents pursuing imports from other countries have also contributed.

When Bill C-378 was introduced last October, the government's assessment of the situation was that the U.S. initiatives with respect to foot traffic and mail order seizures did not pose a threat to the Canadian drug supply. This assessment has been proven valid. In the case of foot traffic, that is because sales predate Internet commerce and have existed for about 20 years. They have never posed a concern with respect to Canada's drug supply and the volume of such sales has been stable in recent years at an estimated $500 million.

The halting by U.S. customs of selective seizures of drug imports did not really change anything either as such personal imports have already been tolerated for a number of years anyway.

The most recent statistics bear this out. Foot traffic remains stable and Internet pharmacy sales dropped by 50% in 2006 and likely have dropped significantly more due to the sharp appreciation of the Canadian dollar since the more recent statistics.

Over the past several years, officials with Health Canada and the Department of Foreign Affairs and International Trade have continuously monitored the value of cross-border drug sales to the United States and related developments in that country, including the U.S. measures in October. Let me assure the House that they will continue to do so.

In the meantime, the Americans face ongoing challenges posed by the world's highest priced prescription drugs, explaining their continued preoccupation with finding way to make drugs more affordable. That is why the idea of importing lower priced drugs from Canada and other countries continues to be a political issue in the United States.

Federal legislators and state and municipal governments continue to see imports as part of the solution. Individual Americans, especially those without drug coverage, are also looking to other countries for relief from high drug prices.

At the federal level, in previous sittings of the U.S. Congress, a number of bills have been proposed to legalize drug imports, including bulk imports, from Canada. These legislative proposals were not able to gain a lot of support or traction, primarily due to the Republican majority in Congress and opposition by the U.S. administration. This was the case despite the fact that some bills were sponsored by Republicans.

However, I should point out that while some individual Republicans have supported and even sponsored drug import legislation, the official Republican Party position remains steadfast in opposing drug imports and in accepting high U.S. prices.

As the members in this place know, the U.S. legislative environment has been affected somewhat by the Democratic win in both houses of Congress last November. In this context, it is important to note that legalizing drug importations from Canada and other countries has reportedly been among the legislative priorities for some leading Democrats.

As I just noted, some Republicans have supported drug importation. In January of this year, a bipartisan group of U.S. Congress and Senate lawmakers introduced a bill that would allow importation from other countries. The pharmaceutical market access and drug safety act of 2007 would legalize both bulk or wholesale, as well as individual retail imports, including transactions via Internet pharmacies.

A democratically controlled Congress does suggest a greater potential for U.S. legalization of bulk imports. However, the overall view of Congress is that the prospects of enactment of legislation giving a clear green light to drug imports is dim at best.

To illustrate the point, let us look at developments in the last few months. In the U.S., opposition to the legalization of drug imports remains strong in many quarters. The enactment of legislation to legalize drug imports, without provisions for major impediments to such imports, is unlikely. This is especially the case given the Bush administration's opposition to drug importation.

There is potential for legislative horse-trading after such a controversial bill is introduced in the U.S. Congress. The U.S. Senators “endorsed” drug importation in early May, but included a provision--and this is very important--to disallow such imports unless the Secretary of Health and Human Services first certifies that they “pose no additional risk to the public's health and safety”, and that they will significantly reduce costs to consumers.

Proponents of importation have labelled this amendment as a poison pill, and with good reason. All observers agree, including the bill's lead sponsor, Senator Dorgan, that it has effectively neutralized the bill's drug importation provisions. This is because the actualization of those provisions would now require U.S. administration support but the president, by virtue of his past opposition to drug importation, is not expected to offer that support.

Even if the provisions were to be put into force, the administrative burden included in the bill, which is 140 pages long, is so onerous that its implementation would be significantly slowed. Its extensive administration and oversight regime includes requirements for inspections of exporting facilities and multiple procedural requirements of both exporters and importers. This suggests that there would be very slow uptake in the provisions.

I could go on but the bottom line--

[Food and Drugs Act, June 6th, 2007]

Mr. Speaker, I have two questions for the member.

It is a little ironic that the member has brought forward this bill because not so long ago the Liberals were in the power and they had the opportunity to do so. The Internet pharmacy industry actually reached its peak in 2004 at sales of $850 million per year. Last year the total annual sales were $211 million. There was a very sharp decline in the fourth quarter to 75% below its peak under the Liberal regime. It is reasonable to assume that when the next statistics come out, there will be an even further decline because of the sharp appreciation of the Canadian dollar. That is one area.

My other question deals with the fact that when the amendment was put forward in the United States there was a provision stating that no imports would be allowed unless the Secretary of State--

[National Cancer Survivors Day, June 4th, 2007]

Mr. Speaker, I am pleased to inform the House that June 3 marked the 20th anniversary of National Cancer Survivors Day. This day is set aside for Canadians to recognize the lives that have been touched by cancer. Cancer is predicted to be Canada's number one killer.

Due to research, better screening and prevention, more and more people are surviving cancer. Effective cancer control is complex and requires the collaborative effort of the entire cancer community across the country.

That is why Canada's new government recently committed $260 million over five years to coordinate Canada's fight against cancer. The Prime Minister also announced the creation of the Canadian Partnership Against Cancer, an arm's length, not for profit organization that will implement the Canadian strategy for cancer control. The partnership brings together patient survivors, cancer experts and government representatives from across the country.

Canada's new government's approach to cancer is proactive and will help revolutionize the way our society deals with chronic and deadly diseases.

[Hepatitis Awareness Month, May 29th, 2007]

Mr. Speaker, May is Hepatitis Awareness Month. This serves as an opportunity to promote awareness and understanding of the impact of hepatitis on Canadians affected by and living with this disease.

We can reduce the risk of hepatitis A by proper handwashing before preparing and eating food. Hepatitis B and C can be spread through direct contact with infected blood and the risk can be reduced by not sharing items that may be contaminated.

In July 2006, the Prime Minister demonstrated leadership and compassion when he announced compensation for the forgotten victims of hepatitis C. The forgotten victims are individuals who were infected through the blood system before 1986 and after 1990, and were denied compensation by the previous Liberal government.

The government also supports the long term funding of the hepatitis C prevention, support and research program and we have been investing $10.6 million per year toward this effort. We look forward to continued collaboration with all stakeholders in the area of hepatitis C.

[May 14th, 2007]

Mr. Speaker, this government is upholding the principles of the Canada Health Act.

An important aspect of the Canada Health Act is that services provided by physicians who are not enrolled in their provincial or territorial health insurance plans, or “non-participating physicians”, are not considered ensured health services under the Canada Health Act, so the government is in fact upholding the principles of the Canada Health Act.

The Canada Health Act is an important piece of legislation. It ensures that Canadians have access to medically necessary services. It provides flexibility in how those services are delivered, be it not for profit or publicly or privately delivered, provided that they are publicly funded.

I think I have addressed the member's concerns. This government will uphold the Canada--

[May 14th, 2007]

Mr. Speaker, I thank the hon. member for Surrey North for raising the issue of the reopening of the False Creek Urgent Care Centre and also for the very strict timelines in answering her very interesting questions.

First, let me emphasize the federal government's desire to work in collaboration with the provinces and territories to ensure that the publicly funded health care system is strong, universally accessible and equitable and that Canadians have access to the care they need when they need it.

The Canada Health Act is Canada's federal legislation for publicly funded health care insurance. The Canada Health Act establishes criteria and conditions related to insured health services and extended health care services that provinces and territories must fulfill to receive the full federal cash contribution under the Canada health transfer.

The aim of the Canada Health Act is to ensure that all eligible residents of Canada have reasonable access to medically necessary services on a prepaid basis without direct charges at the point of service for such services.

The Canada Health Act requires that all medically necessary services provided by participating or enrolled physicians be covered by the provincial or territorial health insurance plan.

As the hon. member for Surrey North noted, on April 9 the False Creek Urgent Care Centre reopened to the public after recruiting doctors from out of province to work at the clinic. These physicians are not enrolled in British Columbia's medical services plan and, as a result, operate completely outside the provincial health insurance plan.

In this situation it is important to note that services provided by physicians who are not enrolled in their provincial or territorial health insurance plan, or who are non-participating physicians, are not considered insured health services under the Canada Health Act.

The right of physicians to practise outside of provincial or territorial health insurance plans was recognized by provinces in the 1960s and 1970s when they created their own medical health insurance programs.

Since the inception of the Canada Health Act in 1984, the position of the federal government has been that non-participation by physicians is acceptable under the Canada Health Act provided the physician is fully opted out and the patient is not entitled to a reimbursement from the plan for the services provided.

In addition, the right to opt out should never impede reasonable access to insured health services for provincial residents.

Therefore, in situations where physicians do not participate in the provincial or territorial health insurance plan, neither they nor their patients can recover the costs of the services rendered or received from the provincial health insurance plan.

These physicians may therefore establish their own fees, which are paid directly by the patient.

As noted, the provision of insured services by non-participating physicians is acceptable under the Canada Health Act as long as reasonable access to insured services is paid for by the province and is maintained.

While most provinces and territories allow for physician practice outside the plan, some provinces have chosen not to allow physicians to opt out of the public system.

With this in mind, let me assure the House that this government will continue to work collaboratively with the provinces and territories to uphold the principles of the Canada Health Act and the integrity of our publicly funded health care system.