1 EVIDENCE Standing Committee on Health NUMBER 028 1st SESSION 42nd PARLIAMENT Tuesday, November 1, 2016 Le mardi er novembre Standing Committee on Health CANADA [Recorded by Electronic Apparatus] EVIDENCE November 1, 2016 Committee Edited Evidence * Table of Contents * Number 028 (Official Version) Official Report * Table of Contents * Number 028 (Official Version) Témoignages * Table des matières * Numéro 028 (Version officielle) 28 01 11 2016 2016/11/01 08:45:00 House of Commons Comité permanent de la santé Standing Committee on Health HESA Chair Mr. Bill Casey 42 PUBLIC PART ONLY -

PARTIE PUBLIQUE SEULEMENT (0845) [ English ] The Chair (Mr. Bill Casey (Cumberland—Colchester, Lib.)) : First of all, this meeting is public. If at any time a member wants us to go in camera, they can move a motion. I want to remind members that item number one on the agenda is to submit suggestions for the draft report on the opiate crisis to committee staff by p.m. today. Mr. Davies. Mr. Don Davies (Vancouver Kingsway, NDP) : Mr. Chairman, I was just reviewing the committee business, and unless I've missed something, we haven't set down the final day for adding an extra meeting to discuss the report.

This is the only part of the agenda where the opioid study is mentioned. I'm wondering if we should nail down now the extra meeting on Monday, November 14, that we were discussing. I think before we leave the opioid study, we should pick the time and date of that extra meeting if we're going to have one. The Chair : We're open for discussion on that. We've had members say they are not available on that date. Is there any debate on that or any comments? Will we have a meeting on November 14? Mr. Davies. Mr.

Don Davies : I don't anticipate a problem, but if we just have one two-hour meeting on the Tuesday, I think there's a good chance we will not finalize the report. Given that we want to have that in the hands of the minister.... The other option, I guess, is to extend that meeting until the report is done. I've seen other meetings do that before, where we just stay. That might mean the meeting on Tuesday the 15th goes three or four hours. On Monday the 14th, is there not a time the vast majority of people can make it?

We don't have to have unanimity; as long as the majority of people on the committee are here, we have quorum. The Chair : Mr. Oliver. Mr. John Oliver (Oakville, Lib.) : I'd like to echo Mr. Davies's comments. This is an important study. We identified it as a crisis in Canada. We dropped our committee agenda to deal with this work, and I'm surprised we can't find an extra two hours as a committee to discuss this on the 14th, and to review the report, and get material ready to be part of the national discussion. The Chair : Mr. Kang. Mr.

Darshan Singh Kang (Calgary Skyview, Lib.) : I echo both of these gentlemen's words. The Chair : All right. Let's

schedule the meeting for Monday the 14th in the afternoon. Does that work for everybody?

(0850) Ms. Rachael Harder (Lethbridge, CPC) : I understand what they are saying and that's not a problem. We can look at having an extra meeting, but I have a committee meeting on Monday afternoon already, and it feels as if I'm being discriminated against a little. I'm not choosing not to be here. I can't be here because I have another committee, so it's not fair to exclude me from the table due to my other commitments and expectations. The Chair : I wasn't aware of that, but I'll take that into— Mr. Carrie. Mr. Colin Carrie (Oshawa, CPC) : There are going to be challenges for me on that.

I would recommend another option, because we're assuming we could get it all done within those two hours as well. When I looked at the potential schedule, also a reasonable time to put in a dissenting report, because I think there could be some recommendations, for example, where Don would like to have one recommendation and we would probably not be okay with that recommendation, and vice versa. I would go to a fallback. As I said it would be easy to write a letter and go to that instead of going through a full, formal report because of the logistics of getting it done.

I see the timeline is going to be very tight anyway. The Chair : Mr. Kang. Mr. Darshan Singh Kang : I think we could have a meeting on Monday morning. As far as the letter is concerned, we had a discussion on that before, and we have passed that point. I think we should be aiming for the report. The Chair : Let's stick to the question about the meeting. Are there any other comments? Mr. Ayoub. Mr. Ramez Ayoub (Thérèse-De Blainville, Lib.) : I would like to echo all that has been said. I'm sorry for Mr. Carrie, but we already talked about the letter versus the report, and now we're talking about meetings.

I came out yesterday from another committee where we were around that table for six hours straight just to make sure we did the job, so I think we could find two hours on Monday, November 14, in the morning. There's no problem. We can find somewhere, I'm sure. The Chair : Mr. Davies. Mr. Don Davies : Are there any other committees that meet on Monday morning? No? So Monday morning would be the best time.

I would point out that under Standing Order 106(4), any four members of the committee can send a letter to the chair and cause a meeting to be held, and then the chair calls it, which means that meetings can be called even if not everybody can make it. Rachael, I hear you, but it's not discriminatory to call a meeting that not everybody can make—that's why we sub in—but I agree with you that we should be looking for the most convenient time for everybody to meet. I think we should call the meeting for Monday morning. That gives everybody enough time. There are no other committee conflicts.

We can take two hours then, and we have the further two hours on the Tuesday. By the way, I would also suggest there's a chance that even that meeting on the Tuesday may have to be extended in order to finish the meeting. I'm not predicting that will happen. I haven't seen the report, and it's not a long one, but I know that I have recommendations. That's how many I'm submitting, and we need to have discussion on them. If any of you have been to one of these meetings before, you know that if people want to talk to every recommendation, it can be six hours before we complete the report.

I think we really have to be aware of this,

schedule these two meetings, and be clear that on Tuesday we may have to stay extra as well to get it done. The Chair : Okay. Will it be on Monday morning? Mr. Oliver. Mr. John Oliver : Because of flights and whatnot, could I propose to on Monday morning, or to 1? Is that a reasonable time? The Chair : That's perfect. All right. We have agreement on that. We're going to have the meeting at o'clock on the morning of Monday, November 14. Mr. John Oliver : I guess we could all do to 1, because there are no other committees. The Chair : Mr. Carrie. Mr.

Colin Carrie : I do have another meeting that I'm organizing, from on, with all kinds of outside participation, so I'll be able to make part of the meeting but certainly not all of it. The Chair : We're probably not going to get everybody. I think we'll go with o'clock on Monday morning. Dr. Carrie, we hope you can be there for as much of it as you can. Is that all right? It's at o'clock on Monday morning, November 14, for a two-hour meeting and maybe longer. Mr. Oliver. Mr. John Oliver : Should we also be making plans to extend the Tuesday meeting as well? The Chair : I'd like to keep that option open.

For the Tuesday meeting, I would be prepared to stay longer for Tuesday as well. All right. That's done.

(0855) Mr. Darshan Singh Kang : Do we vote or...? The Chair : I think I can make that decision, can't I? [ Inaudible—Editor ] consensus on that, so it's at o'clock on Monday morning and be prepared to extend the meeting on Tuesday as well. Mr. Oliver. Mr. John Oliver : We had consensus last time and it changed after the meeting when people looked at schedules. I'm wondering if we should formalize it with a motion— The Chair : It's not a problem. Move the motion. Mr. John Oliver : —because we did have consensus on the 14th and then we lost it over the weekend. The Chair : Do you have a motion? Mr.

John Oliver : I would move that we meet Monday morning at a.m. Mr. Don Davies : I want to speak to that. The Chair : Mr. Davies. Mr. Don Davies : Sorry, Mr. Chair, but I do think you need to have the length of the meeting specified. We have Standing Orders on quorum and things. If the Conservatives and the NDP were to leave the meeting, you would lose quorum, so we have to actually specify how long the meeting is going to last and whether it's to or to 1. Mr. John Oliver : I would move that we meet from to on Monday morning to discuss the opioid crisis report.

The Chair : All in favour of meeting from to on Monday, November 14. (Motion agreed to) Mr. Don Davies : Mr. Chairman, to the clerk, do we need to have a motion to potentially extend the meeting on the Tuesday, or can we make that decision at the meeting? The Chair : We can make that decision at the meeting. Mr. Don Davies: Thank you. The Chair: Now, moving right along, we're going to talk about finalizing the work plan on the study of national pharmacare. I'm not clear on whether we finished at the last meeting with all the questions that the PBO wants answered, so I'm going to ask our analyst, Ms.

Phillips, to tell us. Ms. Karin Phillips (Committee Researcher) : I guess it was just a bit unclear in the blues. I think I understood. For the last part, in terms of the federal role, my understanding was that you wanted both options looked at, a separate federal stand-alone program as well as the maintenance of existing provincial and territorial programs. The other thing is that I think the committee agreed we would include all the exemptions from the U.K. as well on the copayment question, zero for generics, $5 for brand name, and then exemptions for seniors, students, pregnant women, etc.

At the beginning the final decision was discussed, but I don't know whether the committee agreed to it. In terms of procedure, the next steps would be as follows: The chair will send, on behalf of the committee, a letter that I would draft reflecting the decisions made. Once we receive the terms of reference from the PBO, if there were any questions, the PBO could come in and answer them directly. The Chair : Do we have a motion, then, to authorize us to send a letter based on the decisions we've made here? Mr. Doug Eyolfson (Charleswood—St. James—Assiniboia—Headingley, Lib.) : Yes. I'd like to make said motion.

The Chair : I'd like to add a little something to it, too. If they come back with little technical questions, are the chair, the clerk, and the analysts authorized to answer those questions, or does every question need to come back to the committee? Would you put in your motion to authorize the chair to answer any small technical questions rather than coming back to committee? Mr. Doug Eyolfson : Indeed. The Chair : Mr. Oliver. Mr. John Oliver : On that question, I think we have a subgroup, a steering group. I don't want to tie things up, but it is a very complex study.

What might seem like small and technical questions might have significant ramifications when it gets costed and rolled out. I'm wondering if we could use the subgroup or steering committee to handle that. The Chair : That's a better idea. Mr. John Oliver : It's probably easier to get five of us together than it is to get of us together. The Chair : Dr. Eyolfson. Mr. Doug Eyolfson : I would accept that as a friendly amendment. The Chair : All right. Is there any debate on the motion? (Motion agreed to) The Chair: I guess we're down to finalizing the work plan for the study on pharmacare.

We've had several adjustments to this work plan, and we've already covered some of the things in the work plan. Does anybody have any thoughts on amending the work plan? I know there have been some discussions about it. Is there anything we need added or subtracted from our pharmacare program work plan? Dr. Carrie.

(0900) Mr. Colin Carrie : I'm just wondering if the clerk has a copy of our work plan handy. That's awesome. Thank you very much. The Chair : Mr. Davies. Mr. Don Davies : I have a question and a comment, Mr. Chair. Which meeting are we at? Are we at meeting four? On the work plan, we've finished the first three. The Chair : Yes. Mr. Don Davies : I know people are probably studying it right now, but as one comment, I would suggest that for meeting 11, which is the final round table discussion, we add Marc-André Gagnon. We have Steve Morgan and Danielle Martin, but it would be wise to add Mr. Gagnon.

The Chair : Mr. Oliver. Mr. John Oliver : I have two things, just to facilitate our discussions. Is it possible to find out from the PBO an estimate of when their costing would be completed? Everything else is doable within committee planning, but that's an unknown element. Perhaps we could get an estimate of the PBO time. The second is that meeting is going to be a long meeting. We may hear testimony from presenters. Then we will need to draft instructions to the analysts.

I'm wondering if we should agree now to add two hours to that meeting so we can begin to get our calendars cleared up and have time for that discussion. The Chair : Is that a motion? Mr. John Oliver : I move that we add two hours to meeting 11. The Chair : Okay. Mr. Davies. Mr. Don Davies : In that spirit, I think that's a good suggestion. What I think we should do is separate drafting instructions from that meeting, because that's going to be a very important meeting. It's the final round table discussion. By that time, all of us will have all the information.

I think part of our reasoning there was to end where we began, in a way, by having these experts—Dr. Morgan, Dr. Martin, Dr. Gagnon, and the other representatives—to kind of tie up any loose ends or ask any final questions. I think the drafting instructions almost need to have their own meeting. The Chair : What's your proposal? Mr. Don Davies : I would add a meeting that is just on drafting instructions. We have a final round table discussion and drafting instructions. Make meeting just the final round table discussion, and then

schedule another meeting after that for just pure drafting instructions. It would bump the consideration of the draft report to meetings and 14. Mr. John Oliver : I don't disagree. I'm just worried that.... I don't know what the timing of this is. I would hate to see a decision to have an extra meeting lead us into a big break. Let's agree that we need an extra two hours for meeting 11, whether it's on the same meeting date or whether we add a meeting 12. Let's agree there are two more hours needed on top of this to do our committee work, and we'll

schedule it when we see our timing. Without knowing when the PBO is coming back.... I don't know what their costing turnarounds are. The Chair : The round table discussion and the drafting instructions are two completely different processes, really, so if we do need extra— Mr. John Oliver : I wouldn't want to see them separated by a big gap. I really do think they'll be relevant to our drafting instructions. The Chair : Your proposal is to add two hours to meeting and continue right through if possible or.... Mr.

John Oliver : Just recognizing that we need two more hours added to the schedule, whether they are added to a meeting or in a separate meeting I think we can determine that when we get to that point in time, but I agree that we need two more hours for drafting instructions. The Chair : Are there any comments or debate on that? Dr. Carrie. Mr. Colin Carrie : I think it's a good idea to split them, but I also wanted to mention that, for that final round table discussion, perhaps we should be open to adding a witness there, because we are really not through with the study.

There may be other people who might be of benefit to have at that final round table discussion.

(0905) The Chair : That meeting is quite far away. As we get closer, any member can propose additional witnesses that we can add to it. The motion on the floor is to add two extra hours to that meeting. (Motion agreed to) The Chair: Okay, so we'll either add two hours to that meeting or have another two-hour meeting subsequent to that. Are there any other thoughts on witnesses or the work plan? Mr. Davies. Mr. Don Davies : Mr. Chair, I will move to add Marc-André Gagnon as a fourth witness in meeting 11. The Chair : Mr. Kang. Mr. Darshan Singh Kang : In meeting 5, I would like to add Mr. Peter MacLeod.

He has completed the CIHR-funded Citizens’ Reference Panel on Pharmacare in Canada. The Chair : Whom do you want to add? Mr. Darshan Singh Kang : Peter MacLeod, on the consultation about the Canadian perspective on pharmacare.... We will send the details to the clerk. The Chair : Mr. Davies, go ahead. Mr. Don Davies : The motion on the floor is about Mr. Gagnon in meeting 11. I think we should take it one witness at a time. The Chair : Oh, I'm sorry. I didn't realize you made a motion. We just agreed.... Mr. Don Davies : Oh, did we? The Chair : We did. Mr. Don Davies : Oh, okay. I didn't realize that.

Sorry, who is Mr. MacLeod? Mr. Darshan Singh Kang : It says he has completed the CIHR-funded Citizens’ Reference Panel on Pharmacare in Canada. The Chair : Dr. Carrie. Mr. Colin Carrie : Mr. Chair, I do appreciate our being in a public meeting right now, but I thought that if we were talking about specific witnesses, who we would invite and not invite, that would be something we would do more in camera. We're starting this debate a little bit back and forth. I appreciate the conversation, but perhaps we should do it in camera if we do want to debate specific witnesses for specific reasons. The Chair : I agree.

An hon. member: I so move. The Chair: We have a motion to go in camera. Mr. Darshan Singh Kang : Before we do that, is this passed for Peter MacLeod? The Chair : I think the analyst just agreed to.... Mr. John Oliver : I think we're done, actually, with the names. We could probably stay.... Maybe we're not. The Chair : We have a motion to go in camera. Are all in favour of going in camera while we have this discussion? (Motion agreed to) The Chair: We need to suspend for seconds while we go in camera. And then, Mr.

Oliver, you'll be recognized next. [ Proceedings continue in camera ] (0905) (0930) [ Public proceedings resume ] The Chair : Mr. Oliver. Mr. John Oliver : I think Bill C-233 is a very important bill that we should give full time and attention to as a committee. We need to make sure we get it onto our work plan. It seems to enjoy the support of many people in all parties in the House. I would like to recommend that we dedicate at least two meetings, if required, to hear witnesses.

November and 24, Thursdays, would be dedicated to Bill C-233 for witnesses, if required, and we would do our clause-by-clause study on either November or December 1. We've only done one bill to date, so I don't know how much time is required between witnesses before we do the line-by-line consideration, and whether there's any work to be done by the analysts after the witnesses do their piece. If there's no time required for the analysts, then I suggest we do the line-by-line consideration on November 29. If time is required, then I suggest we target December for the clause-by-clause review.

My understanding is that we need to have our work completed by December or the bill will go back to the House unamended.

(0935) The Chair : It's important that everybody understand that we have to be done by December or the work won't matter; it won't be included, and the House will assume that we've returned the bill with no amendments or no discussion. We have a proposal to have two meetings with witnesses, and then clause-by-clause study, and then report back by December 8. Mr. Don Davies : Which are the two? Can you go over the dates again, John? Mr. John Oliver : I was proposing that we use November and November 24, which are Thursdays, to hear witnesses. Some have already requested time to discuss the bill with us.

We haven't done enough of these, so I don't know how much time is required after witnesses before clause-by-clause consideration. We could do the clause-by-clause consideration on either November or December 1. The Chair : Mr. Webber. Mr. Len Webber (Calgary Confederation, CPC) : Mr. Chair, I'd just like to remind the committee that a few months ago we did pass a motion on doing a study on the MSM blood donation, and it was to be done in the fall. If we look at your dates, Mr. Oliver, that's going to put us into some pretty tight timelines with respect to that study on MSM blood donation.

I think it's an important issue that we need to look at as well, with at least a meeting and possibly two. I have some witnesses I'd like to propose on that. I know it's on the agenda for later, so I won't dwell on that, but with regard to your motion and your dates, I just want to remind the committee that we do have this commitment regarding the MSM blood donation as well. The Chair : As a committee, we have an obligation to either deal with the bill or return it unamended. I think it's important. I think Alzheimer's and dementia and all things related are really important. The bill's very simple.

It's proposed by an opposition member and seconded by a government member, so there should be quite a bit of consensus, but I do think we should study it. Mr. Davies. Mr. Don Davies : I agree completely. I like the dates. We will have to have a bit of time to submit possible witnesses. I don't think there should be a lot of witnesses, but there should certainly be the national Alzheimer Society and some seniors groups. I can see us needing to hear from four to six witnesses, so I think two meetings would be fine.

I think the dates you proposed for the two meetings for witnesses and two meetings for clause-by-clause consideration will be fine. We should do that. It's our job as a committee to review the legislation. I also think that Mr. Webber's quite right. I was just looking at the motion. We did pass a motion to do a study this fall of the current restrictions. Fall ends December or something, so I would suggest that maybe we can turn to that next, and we would have some time after December to

schedule a meeting or two, between December and December 20, for Mr. Webber's motion on the ban on blood donation by men who have sex with men, so that we can respect the motion that's been passed already as well. This also is important. We then have to fold in all those other meetings on pharmacare with these two things. The Chair : Dr. Carrie. Mr. Colin Carrie : I am going to agree with my colleagues.

There are many things on the table that are extremely important, but perhaps the analyst can get back to us with potential witnesses for Bill C-233 because we might be able to get the whole thing done in two meetings. I think we are all in agreement on moving forward on that. The Chair : All right, Mr. Oliver. Mr. John Oliver : Mr. Chair, I move: That the Committee dedicate the meetings of Thursday, November 17, Thursday, November 24, Tuesday, November and December 1, 2016, to study Bill C-233 ,

An Act respecting a national strategy for Alzheimer’s disease and other dementias. (Motion agreed to) The Chair : That's excellent. We'll talk about MSM right now. We were talking about the 22nd as a possible date for the meeting. That's one or two days beyond fall, but does that work for you?

(0940) Mr. Len Webber : Mr. Chair, I do have a list of names of organizations and individuals I'd like to see come to present to us. I don't know if you want me to read out these names or not. It may take more than just one meeting. It may require a second meeting. It's hard to determine how long it's going to take to do this but with the names I have. There's Canadian Blood Services, for example. We could bring in Dr. Graham Sher. There is Rick Prinzen, who is the chief supply chain officer. Mr. Don Davies : Mr. Chair, on a point of order. This is a good time for us to go in camera. Mr. Len Webber : Oh, yes.

That's right. The Chair : Thank you. We'll go back in camera. [ Proceedings continue in camera ]