j APPEAL# I PART C Decision under Appeal The decision under appeal is the Ministry of Social Deve!opment and Social Innovation (ministry) reconsideration decision dated October 1, 2013 wl1ich denied the appellant's request for a Monthly Nutritional Supplement for vitamins and minerals and additional nutritional items. The ministry held that the requirements of Section 67(1.1) of the Employment and Assistance for Persons With Disabilities Regulation (EAPVVDR) were not met as there is not sufficient information to establish that: -as a direct result of the chronic, progressive deterioration of health, the appellant displays two or more of the listed symptoms; -the appellant requires vitamins and minerals to alleviate the symptoms of his chronic, progressive deterioration of health and to prevent imminent danger to life; and, -the appellant requires additional nutritional items as part of a caloric supplementation to a regular dietary intake to alleviate the symptoms of his chronic, progressive deterioration of health and to prevE,nt imminent clanger to life. PART D Relevant Legislation --------·----------------------~·--·-·----··· ----------------Employment and Assistance for Persons With Oisahilities Regulation (EAPWDR), Section 67(1.1) and Schedule C, Seciio,, 7
APPEAL# PART E Summary c! Facts The evidence before the ministry at the time of the reconsideration decision included an Application for Monthly Nutritional Supplement (MNS) dated June 18, 2013 sign·ad by a medical practitioner and stating in part that: -the appellant's severe medical conditions are L4-L5, L5-S-1 disc·dege11eration and LS radiculopathy, with a note: "sustained post work injury" and tc, see appended CT and X-Ray Reports; -in response to the question whether as a direct result of the ci1ronic progressive deterioration in health, does the appellant display two or more symptoms, tl·:e medical practitioner indicated the symptoms of significant muscle mass loss, with a note "muscle wasting thigh and leg", and significant neurological degeneration, with a note "muscle wasting and ~hronic pain; -the appellant's height E:nd weight are recorded; -in response to a request to specify the vitamin or mineral supplements required, the medical practitioner noted multivitamins, ca!cium, iron, etc. and that he "needs these for !ong term use"; -in response to a request to describe how the vitamin or mineral supplement will alleviate the specific symptoms identified, the medical practitioner wrote "prevent osteoporosis, helps muscle strength and growth;" -in response to a request to describe how the vitamin or mineral supplement will prevent imminent danger to the appellant's life, ti,e medical practitioner wrote "prevents or slows progression of muscle wasting;" -in response to a request to specify the additional nuhtionai items required, the medical practitioner wrote "fruit and vegetables zmd protein rich foods"; -in response to the question whether the appellant l1as a medical condition that results in the inability to absorb sufficient calories to satisfy daily requirements through a regular dietary intake, the medical practitioner wrote "unsure"; -asked to describe how the nutritional items required wi!I alleviate one or more of the symptoms described and provide caloric supplementation to the regular diet, the medical practitioner noted "high protein diet will help with muscle growth;" -in response to a request to describe how the nutritional items requested will prevent imminent danger to the appellant's life, the medical practitioner indicated "no imminent danger." -the additior1ai comments by the doctor are that the appeila~t has no family doctor and was seen at a walk-in clinic and ti1e medical practitioner revie,ved "few p,,st rredical notes." As well as the following: 1) X-Ray Report dated i\ugust 18, 1986 of the appellant's lumbar spine; 2) X-Ray Report dated ,!anuary 21, 1987 of the appellant's lumbar spine; 3) CT Report dated May 25, 1994 of the appellant's lurnbar spine; 4) X-Ray Repo1i dated November 18, 1994 of the appe!!ant's lumbo-sacral spine; 5) X-Ray Report dated June 24, 1996 of ihe appE,!lant's lumbo-,acral spine; 6) CT Report dated June 24, 1996 of tile appellant's lumbar 3pine wi\11 contrast; 7) Operation Report dated Februrny 4, 1997 to a:!eviate L4-5, l.5-S1 disk degeneration and LS radiculopathy, left side; 8) Page 2 of Report dateod March 4, 2000 of" CT of the app,"dlont's lumbar spine; 9) X-Ray Report dated February ·1, 2000 of tr,e appella,1t's lumbar spine; 10) X-Ray Report dated October 30, 2002 of the appell3nt's lumbar spine; 11) X-Ray Report dc1tecl June ·12, 2003 of the appellant's lumbar spira; and, 12) Request for Reconsideration dated August 23, 2013. Prior to the heuring, !he 2,:pe!lant provided the fo:IJ,ving additional document: Letter dated October 6, 2013 from the medical practitioner who completed the Application for MNS. Requested to respond to tfi,3 point that 11uscle mass wasting in the appellant's left leg thigh and calf does not describe how much rnu3c:e mass io lost ar,d its significa1·,ce in measurements, the medical practitioner wrote "ri ht le calf 37.5 cm, left lsg calf 32 ---cm ~ , 1 -0 c m in fro m 1o . _ _i 11t line (loose)." Asked to explain how the requested -------------------------'
, APPEAL# I vitamins and mineral:; wi!i help alleviate the specific symptom cf signi:icant neurological degeneration and to prevent imminent danger to lif9, the medical pracUioner w:ote "it will definitely help." The ministry did not object to the admissibtlity of the additional letter. The panel admitted the appellant's evidence as further detail cf his conditicn 2,nd being in support of the information and records before the ministry on reconsiderntion, pursuant to section 22(4) of the Employment and Assistance Act. In his Notice of Appeal, t. 0 2 cippellant expressed his disaqreE,mert with the ministry's reconsideration decision. The appellant consentad in the att,endance of a m:nistry Dbserver at the hearing. At the hearing, the appei!rmt statecl that in 1997 he had an L-4-5, L_s-s-1 fusion operation and has had ongoing pain on the left side that radiates down his leg. He must take narcotic medications every day to relieve his pain. As a result of the chrnnic back pain, he has not workecl sir,ce 1998. This injury has "crippled" his life and he has tried to find some enjoyment despite his limitations. The medications he takes cost $150 per month and are not covered by the ministry. The ,ippellant stated thm with the vitamins and minerals and other nutritional items, he might not need to take as much medication because he will be stronger and have more energy. The appellant stated that the ministry accepted that r,e displays one of the listed symptoms, namely significant neurological de,1eneration. He also hac, significant rnu,;cle mass loss which has gotten worse over the past 5 years. He has weakness in his left side which ma~es it hard to keep his balance when he is walking, and he is concerned about fallinJ. The appellar,t stated that the doctor has set out the benefits of the multivitamins, calcium and iron ancl the ot11er nutritional items and, overall, it will strengthen his muscles and stop him from falling. Tl1e appellant statE,d ihat these ite,ns sl1ould reduce his chronic pain and also reduce the risk of organ failure du,a to use of strnng narcotic medications. Tr.e appellant stated that organ failure could happen a year from now, or it could be 10 years frdm now. The appellant stated that he has taken multivitamins in the past and these have helped with his energy level and strength. The appellant explained that, in the latter c:ated October 6, 2013, the doctor sets out the measurements of his right calf compared to his ldt calf, measured at the same point on his leg. The doctor drew a line on his legs to ensure the measurements 'Nere taken at the same placE. His left leg is smaller by 5.5 cm, as compared to his right leg. This was the first !ime that measurements were taken since the appellant did not realize that this sort of detail was required. The appellant s(a'ed that on his :cft Eide he has no ankle reflexes, and he experiences tingling and weakness and these symptoms are getting v;orse. His right leg is healthy and normal. The appellant stated that he is not physi:ally active comparnd to a normal person. He does things at a slow pace, with no recreational activities. He has pain and tender,-,ess in boti1 his back and his leg. The appellant stated that he has moved to a new community and h2s not yet found a family docto 0 , so the doctor who completed the MNS Application is at a walk-in c!inic. The ministry relied on its r2consideration decision which included e'Jidence that the appellant is a Person With Disabilities (PWD) in receipt of disabiiity assistance. On June 20, 20"13 the appellant submitted an application for the MNS, for vitamins and minerals as we!I as tor additional r,utritonal items. At the hearing, the ministry stated that to be satisfied !!1at the symptom of sigr ifican: mu,oc!e n1ass less had been met, there would need to be more information abo1~1 prior measurements or t,-e a 1 :pellarrt's leg in order to compare and to determine the change over a specified period of time. ------------------------------------------------------~
I APPEAL# ----------~ PART F Reasons foi· Panel Decision The issue on the appeal io vvhether the rninist1·y decision. which clenied the appellant's request for a Monthly Nutritional Supplement for additional nutritional ite•ns an,: for •1iiamins and minerals because the requirements of Section 67 ( 1.1) of the Employmont anci Assistance for Persons With Disabilities Regulation (EAPWDR) were not met, was reasonab!y supported by the evidence or is a reasonable application of the applicable enactment in the circumstcmces of the appellant. Section 67(1.1) of the EAF'WDR sets out the eligibi'ity ri;quirenients which are at issue on this appeal for providing the additional nutritional supplement, as follows Nutritional supplement 67 (1. 1) In order for a pe,son ,;,1itt1 disabilities to rec.:eiv," 3 nutriknal supplement uncler this section, the minister must receiv2 a request. in th2 form s~;t:cified by tr1e rnini~;ter, completed by a medical practitioner or nL 1 rse practitioner, in vvhi,:h the practitioner ha3 confirmed all of the following: (a) the person wirh disabilities':() whom the requsst relates is being treatecl by the practitioner for a chronic, progressi1,,·e dsterioration of h.~alth on account ot a severe meciical condition; (b) as a direct ,·ef.uit of the ci1mnic, pmqressive rleterior2tion of health, the person displays two or more of the following symptoms: (i) malnutrition; (ii) underweight sta'us (iii) significant weight loss; (iv) significant muscle ,nass loss; (v) significant r,eu,·ological degener2.tion; (vi) significant deterioration of a vital organ; (vii) moderate to s-::;vere immune suppression: (c) for the purpose o' alie1iating a symptom refm,·,,d tc in pa,-agraph (b), the person requires one or more of the items set cut in sedan 7 of Schedu!e C and specified in the request; (d) failure to obtain the itc,ms refecred to in paagraph (c) will resu!t in imminent danger to the person's !ifa. Section 7 of Schedule C of th,? E.I\PWDR pmides as foliows Monthly nutritional supplmnent 7 The amount of a nutriti:inc: s1.q:plem2,1t thal r,,ay be provided under section 67 /nutritional supplement] of this regulation is the sun, cf triE: amounts fo: t~o::;e of the fo!!owin9 :terns specified as required in the request under section 67 (1) (c) (a) for additional nutritional :terns ti12t are pat of a caloric s.1pplEmentation to a regular dietary intake, up to $165 each month: (b) Repealecl [B.C. Reg E,312,)10, s. 3 (b) J (c) for vitamins and minerci:s. up to S40 each n1onth The ministry acknowiedgeci that the med cal prac;i:icmer contirrneci that the appellant is being treated for a chronic, progressive dde i<xation o:' hec1itli on sccount of a severe medical condition, specifically disc herniation and L-5 rndiculcpathy, pusuant to Section 61(1.1 )(a) of the EAPWDR '-------------------------.. ---------
r APPEAL Ii. l ' _____ ~-----------·-----, ___. , ______ ------··· Two or more symptoms The ministry's position is that sufficient in;orrnation has not bee,n provided from the medical practitioner to establish that as a direct resu!t of the chronic, progr,,ssive deterioraticn of health, the appellant displays two or more of the listed symptor,,s, pursuant to Section ()7(1 i )(b) of the EAPWDR. The ministry argued that the medical practitioner reported that th,, aopel!ant's ,,vmptcrns «re significant muscle mass loss and significant neurological degeneration; howevH, the comrnert "muscle wasting thigh ar,d leg" does· not describe how much muscle mass tl1e appelia;·t i12s lost and o'✓er what period of tin,e tr1is has occurred to establish that the loss is "significant." The mini3try 2cknowhsdged that the Jpps!lant di:;plays the symptom of significant neurological degeneration as a direct. result of a ~r,ronic progrm,sive detericration of health. The appellant's position is that there is sufficient information from tr1e medical pr2ctition·er to establish that as a direct result of the chronic, progressive deterioration of hi, heaith, he also clic,pl;iys lhe symptom of significant muscle mass loss and, therefore, two or more of ihe 'isled symptoms. The appellant argued that, in the letter dated October 6, 2013, the doctor sets out the 111e,1surernents of his right calf compared to hi'.1 left calf, measured at the same point on his leg and his left leg is sma!ier by 5.5 crn as compared to l1is right leg due to muscle wasting. The appellant argued that on his left side he has no ankle reflexc,s, ancl he experiences tinqling and weakness and these symptoms hav(3 been netLn:2 worse over the fJast 5 years. Panel decision Section 67( 1.1 )(b) of the t',i\P'NDR require:, that a medical practitioner confirm that as a direct result of the chronic, progressive deter:oration of heGlrh, the person oisplays two or more of the symptoms listed. Although the ministry raised an issue with a lack of detail with respect to the nature and extent of treatments to support a diagnosis of a "significant' neurological de,Jeneraiicn, tii,, ministry ultimately acknowledged that there is sufficient information from the medical practitioner, ,vith tile c'escription "muscle wasting and chronic pain," to establish that the appellant displ3ys one of the ,,ymptoms listed, beinq significant neurological degeneration. However, for the symp'orn of significant muscle mJss loss, the ministry determined that the description "muscle wasting thigl1 anci k,g" was not ceufficient to establish the symp'.0111 was "significant." In the letter from the medical practitioner cle,ed October 6, 20·; 3, in response to the p>Jint that muscle mass wasting in the appellant's left leg thigh anci calf does r,ot describE, :row much muscle mass is lost and its significance in measurements, the medical practitioner mete "right ie9 calf 37.5 cm, left leg calf 32 cm, 10 cm inferior from joint line (loose)." At the heanng, the mir,istry statn1 that to be satisfied that the symptom of significant muscle mass loss had been 1r,et, there would need to be r:iore ir-.fonr,;ition about prior measurements of the appellant's leg in order to cor,1pare and to determine the change over a specified period of time. However, the panel finds that the ;r,edrcal pr acti'.io,1er inclicatecl in the :v1NS application that there has been an ongoing process of "wcisting" of the muscles in the appe!!2m's thiql1 and leg, cather than a completed process of 'wasted' muscles. The appe'iant stated the wat;ti119 has 9otten worse over the past 5 years, and the left leg is now 5.5 crn smaller ths,n t:ie left With ti,e new info1n1.Jt,:"1 frcrn ;he rnedical practitioner in the October 6, 2013 letter, the panel fincls that t:·'" ministry's c·:,,1cl'.Jsior, that ;:;ere s 11ot sdficient information to establish that as a direct result of the chronic, progressive de'erioral!"n of health tile) appellant displays two or more of the symptoms listed, pursuant to Sectior, 67(1. I )(b) of the Ei\[>VVDR. 1vas not reilsonable. Vitamins and Minerals The ministry's position is \h:,,t 3ufficic1nt information has nut bu,n urnvided fro:n the medical practitioner to establish that the appei!an\ r8quires specif1,.: 'Jitam1ns 1ml ,ninc.,ra!s t~1 alleviate the symptoms of his chronic, progressive dete,'ioration of hE'alth a1;d to r,rev1nt irnmin,,r.t d,mf,,or to Ue, as required by Section 67 (1.1)(c) and (d) of the EAPWDR. Thf mir,.istry arg'Jed tlic: 'he 1reJdic,,i practit1on9r specifies that the appellant requires multivitamins, calcium ~nd iron on a long tcerm bas 1 s ano these will he!p muscle strength and growth, but there is not a sufficient expi2nati,:in for how thes.c, i1err-s ·Nid hep alleviale tne symptom of neurological degeneration. The ministry also argu0d that the rne.dica! prnctitio 1er in•:iicates that r,ultivitamins, c=1lciu111 and iron will prevent imminent danger to t:1e apprc!!ant's IJe as tr.ese ib:~s 'fvi,! "slc,w p,og1essio11 of muscle wasting" and there is not the immediacy p,eser;t in tile appellant's circL·rnsta:·,.;.ss ,/ the present time to show an "imminent" danger to life. The ministry argu2d that the ihm2:L; ofeve Et.;al;-1uscl,c;wasting_may er rna)I not occur at unspecified
APPEAL# -----------------------------------future times. The appel!ant's positon is thcit sufficicint irforma!ion !ias been provided to establish that the multivitamins, calcium ari,:! iron suppk,rnen\3tion is r,2qLirecl to ai!e•Vi3te, one of his symptoms of his chronic, progressive deterioration of health ;;ind to prevent i:T1i-riinr;11t dt:1nq,ar to l:fe. Panel decision Section 67(1.1 )(c) of the EAPWDR rsquires that ti1E, mec'ical pra:~:iticm,r confirm that. for the purpose of alleviating one of the svmptoms referred tc· in sub-sectio,1 (b), tile appellant requires the vitamins and minerals as set out in Section 7 of SchCJdule C In the Appli,;c,tion :'or MI\JS dat,,d ,June 18, 2013, the medical practitioner reported th,,,t tne vitamins or rninerai supp'e.,rnent~ r2qui,ed by the ,ippel!ant sre muitivitamins, calcium, and 11 iron for long terrn use", anci that these itr~ms vviil 2!k~vic;tc:.; the specific symptoms ic 1 entified by preventing osteoporosis and helping muscle Eirength and groN!h_ !nth£, letter dated October 6, 2013, when asked to explain how the reque';ted vitarnim and ,rir,era:s wiil heb al:Ccv[aie tie specific symptom of significant neurological degeneration ard to prevent irnrnlner.t dang;::r tc i!fe, th12 medical practitioner wrote "it wl!I definitely help." \Nith the new inforni:::tion from ii1e 1re,:JP-:8I pr 0 ;ctilione;in the October 6, 2013 letter, the panel finds that the ministry's conclusion that \he•e is not suffie:ent i,·,formation to establish that the appellant requires multivitamins, ca 1 dum ancl iron for the purpose of c:lieviaUr:g an id,entifiecl symptom, pursuant to Section 67(1.1 )(c) of the EAPWDR was not rea,,o;,ab!e Section 67 ( 1.1 )( d) of the EAPWDFZ require'" further that the rn~:clical practitioner confirm that failure to obtain the vitamins a1d rnnerals will resL,lt ,n im,;-::nent d,n,ger :o the appelLrnt's life. In the application for the MNS, in response to the request to describ2 how the rm.dt:v:t2r:1ins. ca'.cium. and iron w!II prevent imminent danger to the appellant's life, the IT.Edk:al practitioner indicatc,d that it "preven:s or slows progression of muscle wasting." In the letter dated October l\ 2013. wrier: "~;keel tc, exp!a'n hcM the requested viLm1ins and minerals will help alleviate the specific s:1mptom of si,:snificrn1t r,'"uroiogica! ,1egeneration and to prevent imminent danger to life, the medical practitioner wrote "it wii. c,efo,iteiy heip." \Ni.i1e th,, s·vidence demonstrates that the multivitamins, calcium and iron would be benefici2,I to tha appeil,mt's hualth and prevent or slow progression of muscle wasting and help alleviate the n2uroiofJica: degenr,rs,io,\ there was no information provided to establish a rapid rate of muscle rnass loss or neurolog,c.al deJenerJtion tliat wouid indicate a rate of deterioration in the appellant's health such that a failure to obtciin the v:ramirs and minerals will result in an imminent danger to the appellant's life. Therefore, the panei finds ,:hat the rninis'fy rearnnabl; determined ti1at there is not sufficient information currenUy available to estcbFsh that faii•Jm ::o obtain the, vitamins and minerals will resu!i in imminent clanger to tiie appel,ant's life, pu,,;uarrt tc, :3e2:io;, 61(~ 1)(di of the i::APVVDR. Additional Nutritional Items The ministry's position is th3t ;tis ;,c,t sats(,ed thzt th,3 appeLJ,-,t, ,.quires 2.dditional nutritional items as part of a caloric supplerr,enta,ion :o a regular dietary intake to 2, levia,e tr:e symptoms of a chronic, progressive deterimation of health and lo preve,·,t an irnrninent da,1r;er to t;,e appellant's :ife. The ministry argued that the medical practitioner reported that the addliicnal nu"tritior,a! ite1n r(:quir~0d to alleviate symptoms is fruit and vegetables and prote,r, rich fo,)ds ar,d th:c; reque,t ;s for ;1ealti1y ·'ood:; sugge3ting a specific dietary complement rather than a need For rnore calories. -:he niiilistry arguc,C ti1at the medical practitioner does not report that the appeliant has c, rnedicc1l cor,di:ion that r2,;u1ts in rhe inability to absorb sufficient calories to satisfy daily requirements through a r.egu:a diet,li-\' ':-,tJ!"e ss h s -espo-1se ici the MNS application was "unsure." The ministry argLed that the ,-,,ec:ic31 p; ;c:ti::[crer inclicz.tecl the app,ellant's height and weight and that his Body Mass Index (BMIJ 's calc~L1tec! ·it 30 and, '.'~erfifore he s not in need of caloric supplementation. The ministry argued that the n-;edicai pr:at:titoner n~puriJYl th~_i\. ~here is ' 1 no iir:rninent danger" in the MNS Application anci, therefore, !-1~1s riot ,~iJnt!r·-n,3d that failurr: :t o::!:::.in the nutritional items will result in Imminent danger to life The appellant's positicn is d,'.lt suffi.::iem !,i°';xn;ation r12:; bser', p1cvickd by the medical practitioner to establish that he requir2s additional i;u\cit,ona! ,ter,-,s :;3 par; c,f a calxic. s1_;ppl.,,,re,1taii)n to a reqular dietary intake to alleviate the symptoms of a chronic, prO(FessiJe deteric11·atio,1 ,Jf ;-,ec::r and to prevent an imminent danger to his l,fe Th_(,_ appE_lic!,t a_rg_t.;.:,d_u-,,;t the J;;_ctc,r ha, se_t_,)l,Uhe oc-ir-,s_f:ts oi thEonutritio_n_al items in the_~M=N'-''S'------~
---·----. -------------Application and in tile Ociober 6. 2013 1e:ter and, ,1vera'i it w:!i strm·,r1ti1f,n his musC:es and stop him from falling. The appsllant argued tilat these rtr"i'lS should reJ,:ce '·,is chronic pa'n and also reduce the risk of organ failure due to use of strong nacotic medications. aced ti::< orga:1 hilure cou!d happen a year from now, or it could be 1 0 year:, from now. Panel decision Section 67( 1.1 )(c) of the E/,PWD~~ requ're•; chat \f;e mn. alleviating a symptorn referre,J to in sub-,.ection (b}. l!1G ,1ppel!ant req.1ires the additional nutritional items that are part of a caloric s:Jpplenientation to a rsgular dietary intake. a•3 Application dated June 18, 2013, in response to a reque:;t to ;•pecify the additional nutritional items required, the medical practitioner inc1iceted "fruit and veget,i::,12s and pi-otE'in ric', foode." identified a diet whic:1 inc!udas fruit and ve 8 etablE\, e,-,d -c>xtra pro:ein ,Ethe additional nutritional item, and the pane! finds that the ministry reasonably (!e-;_en~inE~d :hat that involves appropriate food clioi:,es for"' regula,-dietc:.-y ir,t,A;e, ,·,;Hier thai! caloric supplementation to a regular dietary intake. In the fJ!NS ,1pplic,,ticn, in n,;;po,1c,e to the qtmstion whether the appellant has a medical condition that results i11 the it"8!)iii(y to ab;;c:rb et.fficiert c::,iori,,s to satisfy clai!y requirements through a regular dietary intake, the rnedical prac~itic-ner indicetxl ··uns1.1re'· and that the "high protein diet will help with muscle growth." Tlvi medical practitii:m0cr ,nckatHi ti,e :.,ppe!isr/,; hei;Jht and weight in the App,ica!ion and this facilitated a rnlcuiaiior, of his SM: at .c; i;core of 30, ~ hich ir,c!icates a wei!;Jht wei! above the normal range and suggests, as the ministry ccnc!udec!, ti1at the appell,int is no• i:1 regular dietary inta!,e. Therefore, the p::.nel finds th:.,t the: minist,-y reasonably concluded that there is not sufficient infow1ation from :he rnedical practitione." to co; ,firm t:·,2t aclcUional nutritional items are required as part of a caloric supplerner·,tation to 2 requi.::it diet;;i--; intoke to altt:·'s1ia1·1; 67(1.1)(c) of the E/\P\NDF< Section 67(1.1 )(d) requires tha'. the, ,T,edicc-l pracVton,3t ,;onfi,-,n '.hcil fc,ilure to obtain the nutritional items that are part of a caioric suppletTif;ntation -~o Ci 1·enula1-Jieta(y ;r1tcti{r! v1;:1 life. While the evidence de,nonstrntes tha, the prr,Lin r:.J; diH wculd be beneficial to tha appellant's health and help w'ih musc!e growth, 'n the appi:cation for the G/\JS. question how the nutrition,d items will prev'crit ir,w:i:~ent .!anger t,:; the appellant's life, by stating "no imminent 11 danger. At the heai"ing, the c1ppelian~ .::1ruiled that 1.he muscle wa:;fo19 in his left leg interferes with his balance and he risks falling and th,:it his hea'JY Lise of narcotic rnc,dicat!nn; cou:d cause organ failure, which could happen in a year or ·i O year:; from !TJ"N, ·r112 panr_:J fimfo that tnt:.67(1 . 1 )(d) 1 ... d , 1 e · is h · , -, • c ~ nl ' . H nnn -:· -;( ~ ): , c . ; . _ Cy : · : · : -L.1 · ., · ,1 ' 1 , u , 1 .. c , _ ,1 . • d ,. i , e J C -! -!! -:;j2l ·" u ministry reasor,abiy concluded that !he n,ec:ica! p: ,ictitio.,er i"ff, not ,;onfirmed thai failure to obtain the requested addiUcna! nutrit/01·1.::i! i·~eri·1s \•V'.li r_:.;sL:lt in ·rnrninunt danrv::r to the appei!anfs !ife, as required by the legisl2tion. Conclusion Tho panel finds that th2 rnir:isl:/s r-::,cor1:;:c-2rcd·ior; decis1-::1"1, l\lutritional Su9piem2nt for ad·iitionLli nutrtonai itt;ms end vi·(,3r,1t,1.s and rtlinerais because an of the requirements of Section 6~,..(1 1) ef Uic E,.-:\FV\/Di-t -..vc:(0 not rnst, v,<is r~)asonab!y supported by the evidence and the panel confirms the rni,i-st1-y's dc:·ci.;:iu1. ~--------------------------------! /\PPEI\L # " --------··-·----"·----------·-------1 ical prac•:ition,2r confirm that for the purpose of set out in Section 7 of Schedule C. In the The medical practitioner 1 J1e rnedic:3.i practitioner makes a cliet recommendation r1-3ed 01' caloric supplementation to his related symptoms, as set out in Section re3ult in i1nminent danger to the person's t,1e medi•~al practitioner responded to the use of the word ' 1 imminent'' in the Section l ,! " C f- ; ' Q ' '· w · , · ,.I ; · ,y i.L I 1 --: -app · en ~ --uon an, c l· 1 " i llU ·' ~ -th a ·t th e VJhic.!·1 ck-nied the appellant's request for a Monthly
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.