P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l J a n u a r y 2 1 , 2 0 1 4 r e c o n s i d e r a t i o n d e c i s i o n d e n y i n g c o n t i n u o u s g l u c o s e m o n i t o r i n g s y s t e m b e c a u s e t h e m e e t t h e e l i g i b i l i t y r e q u i r e m e n t s f o r : • a h e a l t h s u p p l e m e n t u n d e r s e c t i o n 6 2 a n d S P e r s o n s w i t h D i s a b i l i t i e s R e g u l a t i o n ; • a n u t r i t i o n a l s u p p l e m e n t u n d e r s e c t i o n 6 7 o f • a h e a l t h s u p p l e m e n t f o r a l i f e t h r e a t e n i n g h e P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b 6 9 a n d S c h e d u l e C . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( " M i n i s t r y " ) t h e A p p e l l a n t ' s r e q u e s t f o r a n i n s u l i n p u m p w i t h a M i n i s t r y d e t e r m i n e d t h a t t h e A p p e l l a n t d i d n o t c h e d u l e C o f t h e E m p l o y m e n t a n d A s s i s t a n c e f o r t h a t r e g u l a t i o n ; o r , a l t h n e e d u n d e r s e c t i o n 6 9 o f t h a t r e g u l a t i o n . i l i t i e s R e g u l a t i o n ( " E A P W D R " ) S e c t i o n s 6 2 , 6 7 ,
PA RT E -Summarv o f Fa c ts Wi t h the consent of both part ies, the h earing w as conduct 22(3)(b) o f the Employ ment and Assistance Act. For its recons i der atio n decision, the Ministry had the follo 1 . Informat i on from its rec o r d s that the Appellant is disability a ssistance. 2. Appellant's Se p tember 3, 2013 M ed ical Equipment Req doctor f o r an insulin pum p and contin uou s gl ucos e m medical supplier for that equipment and for monthly co 3. Email corres p ondence bet ween the equipment supplier and a social wor the item s and in fo r m a ti on from the supplier advis i ng that longer sell s the equipment the Appellant was using. His continuous glucose mon itoring. 4. Let t er dat e d July 1 2 , 2013 from a doctor to the M • T h e App e llant , who is h i s pat ie nt , h as type 1 dia • The d o ctor ha s f o l lowe d th e A p pe l lant re gularly • T h e Ap pellant has signif ica nt co mplicati ons f multi p le o phtha lmolo gic proc ed ures, nephrop t r an sp lantation , neurop a thy w ith d istal pain and f or intractable vomiti ng (d iabetic gast ro p ares • Th e Appell a n t has b e en on i nsu lin pump the rapy improv e me nt in hi s A1C t es t i ng an d s ome imp • Th e d oct o r belie ves t hat the A p pellant's gly cem improvement/stabi l izati on of all di a betic c ompl glu cose monito r ing sys t e m to his in sulin pum 5. Prescrip t i on note dat e d Augu st 19 , 2013 c omp l eted b specific t ype of i nsul i n p u mp . 6. Appell ant' s request f or re c on si deration , w ith a wr • He is a bri tal diabet i c of 32 years with mu lti ple s • He suffers from frequent low bl o o d su gar wh ich d ange rous to his l if e. • He suffers from some high blood sugars that he also does not feel. • He believes the request ed i tem is medical e q • His current pump is outdated and no longer doing its • The requested equipment is a life saving piece of • There was a change to the legislation. For this appeal, the Appellant submitted a written statement, a letter dated February 18, 2014 from the same doctor an d a letter dated February 18, 2014 from a so In his statement , the Appellant wrote that there is no other funding source (Diabetes Association) that will cover the costs of the device. He has been working with the social worker for a kidney transplant program at a hospital and she has exhausted all potential funding resources for him the letter from her. The Appellant wrote that he has no other funding resources available to him other than the Ministry. The Appellant stated that the requested device is life saving and critical due to his <lan u eroa:;l v low-blood suqars. EAA T003(1 0/06/01) ed a s a written hear i ng pursu ant to section w i ng evidence: a Pers o n With Disabilities ("PWD") and receives uest and Just ificatio n form si gned by a o n i t oring s y s tem, together wi t h a quote from a nsumable supplies. k e r regar ding the cost of i t does not upgr ad e pumps and also no curre nt pump is not compati b le with i nist ry a d visin g that: b etes, d i agnos ed as a yout h . since 2002. r om h is dia betes, i ncl udi ng reti n o pathy wi th athy curr ent l y b e ing as s essed f or renal , auto ? Ne uropathy wi t h r e cu r re n t admis sions is). since Februar y 2010, l eadin g to some r o vemen t in hi s gast ro pare s i s . ic con t rol c oul d be better, leadin g to a n ication s i f they coul d add a continuous bloo d p. y t h e s ame doct or f or th e App ellant for a itten statemen t fro m him n oting t h at : ide effects inclu ding kid ney fai lu re. h e no lo n ger fe els and which is ex tre mely uipment not a health supplement . j ob. equipment. c ial worker. , as indicated in
I n t h e F e b r u a r y 1 8 , 2 0 1 4 l e t t e r , t h e d o c t o r w r o t e , i n • T h e A p p e l l a n t h a s h a d t y p e 1 d i a b e t e s s i n c e r e t i n o p a t h y r e q u i r i n g l a s e r p h o t o c o a g u l a t i o n , m e d i c a t i o n ; i s i n c o n s i d e r a t i o n f o r a p a n c r e a s • H e h a s f o l l o w e d t h e A p p e l l a n t a s a c o n s u l t a n i n d i c a t e t h a t t h e A p p e l l a n t h a s b e e n o n a n i n • T h e A p p e l l a n t h a s d e c e n t b l o o d s u g a r c o n t r o w a s 8 . 2 % i n O c t o b e r 2 0 1 3 . • T h e A p p e l l a n t h a s r e p e a t e d e p i s o d e s o f s e v e a n d h o s p i t a l i z a t i o n a l s o a c o m p l i c a t i o n o f h • H e i s c o n c e r n e d t h a t w i t h o u t o n g o i n g p u m p t o t h e r i n s u l i n d o s i n g e r r o r s w h i c h w o u l d h a v e d i a b e t e s m a n a g e m e n t , t h e r e f o r e , a n i n s u l i n p s y s t e m i s a m e d i c a l n e c e s s i t y . I n t h e F e b r u a r y 1 8 , 2 0 1 4 l e t t e r , t h e s o c i a l w o r k e r c o w i t h t h e A p p e l l a n t t o o b t a i n f u n d i n g f o r h i s n e w i n s u m o n i t o r i n g s y s t e m . S h e s t a t e d t h a t s h e e x p l o r e d e x A p p e l l a n t a n d t h e o n l y o p t i o n a v a i l a b l e t o h i m i s t h r o T h e P a n e l f i n d s t h a t t h e w r i t t e n s t a t e m e n t f r o m t h e A d o c t o r a n d s o c i a l w o r k e r p r o v i d e i n f o r m a t i o n a b o u t t t h e r e q u e s t e d i t e m a n d i s a t t e m p t s t o o b t a i n f u n d i n g 2 2 ( 4 ) o f t h e E m p l o y m e n t a n d A s s i s t a n c e A c t , t h e P a e v i d e n c e a s b e i n g i n s u p p o r t o f t h e e v i d e n c e t h e M i T h e M i n i s t r y r e l i e d o n a n d r e a f f i r m e d i t s r e c o n s i d e r a T h e P a n e l m a k e s t h e f o l l o w i n g f i n d i n g s o f . f a c t : 1 . T h e A p p e l l a n t r e c e i v e s d i s a b i l i t y a s s i s t a n c e a s a 2 . T h e d o c t o r d i a g n o s e d t h e A p p e l l a n t w i t h t y p e 1 d i o f r e t i n o p a t h y r e q u i r i n g l a s e r p h o t o c o a g u l a t i o n , n e u r 3 . T h e A p p e l l a n t ' s d o c t o r p r e s c r i b e d a n i n s u l i n p u m p t h e A p p e l l a n t t o e n s u r e o n g o i n g p u m p t h e r a p y s o t h o t h e r i n s u l i n d o s i n g e r r o r s w h i c h w o u l d h a v e a n a d v m a n a g e m e n t . 4 . T h e i n s u l i n p u m p a n d a c o n t i n u o u s b l o o d g l u c o s e A p p e l l a n t . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )s u p p o r t o f t h e A p p e l l a n t ' s r e q u e s t , t h a t : 1 9 8 2 ; h a s c o m p l i c a t i o n s i n t h e f o r m o f n e u r o p a t h y a n d n e p h r o p a t h y r e q u i r i n g a n d / o r k i d n e y t r a n s p l a n t . t i n e n d o c r i n o l o g y s i n c e 2 0 0 2 a n d h i s r e c o r d s s u l i n p u m p s i n c e 2 0 1 0 . l a s e v i d e n c e d b y h i s A 1 C , w h i c h m o s t r e c e n t l y r e h y p o g l y c e m i a r e s u l t i n g i n u n c o n s c i o u s n e s s i s d i a b e t e s a n d p o t e n t i a l l y l i f e t h r e a t e n i n g . h e r a p y t h e A p p e l l a n t w i l l m i s s d o s e s o r m a k e a n a d v e r s e e f f e c t o n h i s l o n g a n d s h o r t t e r m u m p a n d a c o n t i n u o u s b l o o d g l u c o s e m o n i t o r i n g n f i r m e d t h a t s h e h a s b e e n w o r k i n g v e r y c l o s e l y l i n p u m p a n d c o n t i n u o u s b l o o d g l u c o s e t e n s i v e l y o t h e r p o t e n t i a l f u n d i n g r e s o u r c e s f o r t h e u g h t h e M i n i s t r y . p p e l l a n t a n d t h e F e b r u a r y 2 0 1 4 l e t t e r s f r o m t h e h e A p p e l l a n t ' s m e d i c a l c o n d i t i o n s , h i s n e e d f o r f o r t h e i t e m . T h e r e f o r e , p u r s u a n t t o s e c t i o n n e l a d m i t s t h e s t a t e m e n t a n d l e t t e r s i n t o n i s t r y h a d a t r e c o n s i d e r a t i o n . t i o n d e c i s i o n . P W D . a b e t e s s i n c e 1 9 8 2 a n d c o m p l i c a t i o n s i n t h e f o r m o p a t h y a n d n e p h r o p a t h y r e q u i r i n g m e d i c a t i o n a n d c o n t i n u o u s g l u c o s e m o n i t o r i n g s y s t e m f o r a t t h e A p p e l l a n t w i l l n o t m i s s d o s e s o r m a k e e r s e e f f e c t o n h i s l o n g a n d s h o r t t e r m d i a b e t e s m o n i t o r i n g s y s t e m i s a m e d i c a l n e c e s s i t y f o r t h e
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e i n t h i s a p p e a l i s w h e t h e r t h e M i n i s t r y r e a i n s u l i n p u m p w i t h a c o n t i n u o u s g l u c o s e m o n i t o r i n g A p p e l l a n t d i d n o t m e e t t h e e l i g i b i l i t y r e q u i r e m e n t s f • a h e a l t h s u p p l e m e n t u n d e r s e c t i o n 6 2 a n d S • a n u t r i t i o n a l s u p p l e m e n t u n d e r s e c t i o n 6 7 o f • a h e a l t h s u p p l e m e n t f o r a l i f e t h r e a t e n i n g h e T h e M i n i s t r y , i n i t s r e c o n s i d e r a t i o n d e c i s i o n , c o n s i d p a r t s o f S c h e d u l e C o f t h e E A P W D R t o d e t e r m i n e i e l i g i b i l i t y r e q u i r e m e n t s f o r t h e r e q u e s t e d i t e m . T h e e v i d e n c e a n d w i l l c o n s i d e r w h e t h e r t h e M i n i s t r y ' s d r e a s o n a b l e . T h e P a n e l h a s r e p r o d u c e d o n l y t h o s e a p p e a l , a s f o l l o w s : G e n e r a l h e a l t h s u p p l e m e n t s 6 2 ( 1 ) S u b j e c t t o s u b s e c t i o n s ( 1 . 1 ) a n d ( 1 . 2 ) , t h e m i n i s t e r m a h e a l t h s u p p l e m e n t s ] o r 3 [ m e d i c a l e q u i p m e n t a n d d e v i c e s ] o f p r o v i d e d t o o r f o r a p e r s o n i n t h e f a m i l y u n i t w h o i s ( a ) a r e c i p i e n t o f d i s a b i l i t y a s s i s t a n c e . N u t r i t i o n a l s u p p l e m e n t 6 7 ( 3 ) T h e m i n i s t e r m a y p r o v i d e a n u t r i t i o n a l s u p p l e m e n t f o r a s u p p l e m e n t i s p r o v i d e d t o o r f o r a r e c i p i e n t o f d i s a b i l i t y a s s i s t a a s s i s t a n c e . H e a l t h s u p p l e m e n t f o r p e r s o n s f a c i n g d i r e c t a n d i m m i n e n t l i f e 6 9 T h e m i n i s t e r m a y p r o v i d e t o a f a m i l y u n i t a n y h e a l t h s u p p l e s u p p l e m e n t s ] a n d 3 [ m e d i c a l e q u i p m e n t a n d d e v i c e s ] o f S c h e p e r s o n i n t h e f a m i l y u n i t w h o i s o t h e r w i s e n o t e l i g i b l e f o r t h e h s a t i s f i e d t h a t ( a ) a p e r s o n f a c e s a d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g n e e d u n i t w i t h w h i c h t o m e e t t h e n e e d . ( b ) t h e h e a l t h s u p p l e m e n t i s n e c e s s a r y t o m e e t t h e n e e d . S c h e d u l e C G e n e r a l h e a l t h s u p p l e m e n t s 2 ( 1 ) T h e f o l l o w i n g a r e t h e h e a l t h s u p p l e m e n t s t h a t m a y b e p a e l i g i b l e u n d e r s e c t i o n 6 2 [ g e n e r a l h e a l t h s u p p l e m e n t s ] o f t h i s ( a ) m e d i c a l o r s u r g i c a l s u p p l i e s t h a t a r e , a t t h e m i n i s t e r ' s d i s c s a t i s f i e d t h a t a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : ( i ) t h e s u p p l i e s a r e r e q u i r e d f o r o n e o f t h e f o l l o w i n g p u r p o s e s : l o s s o f m u s c l e f u n c t i o n : ( C ) c a u t e r i z a t i o n ; ( D ) i n c o n t i n e n c e ; ( E ( i i i ) t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e f a m i l y u n i t t o p a y t h 2 ( a . 1 ) t h e f o l l o w i n g m e d i c a l o r s u r g i c a l s u p p l i e s t h a t a r e , a t t h e m i n i s t e r i s s a t i s f i e d t h a t a l l t h e r e q u i r e m e n t s d e s c r i b e d i n p a r a l a n c e t s ; ( i i ) n e e d l e s a n d s y r i n g e s ; ( i i ) v e n t i l a t o r s u p p l i e s r e q u i r ( i v ) t r a c h e o t o m y s u p p l i e s . ( a . 2 ) c o n s u m a b l e m e d i c a l s u p p l i e s , i f t h e m i n i s t e r i s s a t i s f i e d t a r e r e q u i r e d t o t h i c k e n f o o d . ( 1 ) ( c ) t h r o u g h 2 ( 2 ) a c u p u n c t u r e , c h i r o p r a c t i c , m a s s a g e t h e r 2 . 1 , o p t i c a l s u p p l i e s , 2 . 2 e y e e x a m i n a t i o n 4 d e n t a l s u p p l e m d i e t s u l e i n e n i s , l _ . r Y , o r , l h l n u t r i t i o i i a l · s o · · i e r t , e n i , G m , l a l E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )s o n a b l y d e n i e d t h e A p p e l l a n t ' s r e q u e s t f o r a n s y s t e m b e c a u s e t h e M i n i s t r y d e t e r m i n e d t h a t t h e o r : c h e d u l e C o f t h e E A P W D R ; t h a t r e g u l a t i o n ; o r , a l t h n e e d u n d e r s e c t i o n 6 9 o f t h a t r e g u l a t i o n . e r e d t h e p r o v i s i o n s o f s e c t i o n s 6 2 , 6 7 ( 3 ) , 6 9 a n d f t h e A p p e l l a n t ' s r e q u e s t m e t t h e l e g i s l a t e d P a n e l h a s r e v i e w e d a l l o f t h e l e g i s l a t i o n a n d t h e e t e r m i n a t i o n u n d e r t h e s p e c i f i c p r o v i s i o n s w a s r e g u l a t o r y s e c t i o n s a p p l i c a b l e t o t h e A p p e l l a n t ' s y p r o v i d e a n y h e a l t h s u p p l e m e n t s e t o u t i n s e c t i o n 2 [ g e n e r a l S c h e d u l e C t o o r f o r a f a m i l y u n i t i f t h e h e a l t h s u p p l e m e n t i s p e r i o d o f 3 c a l e n d a r m o n t h s t o o r f o r a f a m i l y u n i t i f t h e n c e o r a d e p e n d e n t c h i l d o r a r e c i p i e n t o f d i s a b i l i t y t h r e a t e n i n g h e a l t h n e e d m e n t s e t o u t i n s e c t i o n 2 ( 1 ) ( a ) a n d ( f ) [ g e n e r a l h e a l t h d u l e C , i f t h e h e a l t h s u p p l e m e n t i s p r o v i d e d t o o r f o r a e a l t h s u p p l e m e n t u n d e r t h i s r e g u l a t i o n , a n d i f t h e m i n i s t e r i s a n d t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e p e r s o n ' s f a m i l y i d f o r b y t h e m i n i s t e r i f p r o v i d e d t o a f a m i l y u n i t t h a t i s r e g u l a t i o n : r e t i o n , e i t h e r d i s p o s a b l e o r r e u s a b l e , i f t h e m i n i s t e r i s ( A ) w o u n d c a r e ; ( B ) o n g o i n g b o w e l c a r e r e q u i r e d d u e t o ) s k i n p a r a s i t e c a r e : ( F ) l i m b c i r c u l a t i o n c a r e : e c o s t o r o b t a i n t h e s u p p l i e s . m i n i s t e r ' s d i s c r e t i o n , e i t h e r d i s p o s a b l e o r r e u s a b l e , i f t h e g r a p h ( a ) ( i i ) a n d ( i i i ) a r e m e t i n r e l a t i o n t o t h e s u p p l i e s : ( i ) e d f o r t h e e s s e n t i a l o p e r a t i o n o r s t e r i l i z a t i o n o f a v e n t i l a t o r : h a t a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : ( i ) t h e s u p p l i e s a p y , n a t u r o p a t h y , n o n s u r g i c a l p o d i a t r y , p h y s i c a l t h e r a p y . e n t , 4 . 1 c r o w n a n d b r i d g e w o r k , 5 e m e r g e n c y d e n t a l , 6 s u · l e rn e n t , 9 i n f a n t f o r m u l a .
M edic al equip ment and devices 3(1) Subject to s ubs e c tio ns (2) to (5 ) of t hi s sectio n , the me di of this S chedule are the healt h supplements t h at may be prov ( a ) th e supp le men t s a r e provided to a fa m ily unit th a t is elig ibl re g u latio n, a n d (b) all of t h e fo llow in g requi rem en ts are m e t: (i ) the family unit medi c al eq uip ment or devi ce requested: (ii ) there a re n o reso th e medi cal eq uipm ent o r device ; (ii) th e m edica l equi pme nt or d eq u ipment or de vic e. 3.1 -c an es , crutches an d w alkers, 3.2 whe el chai r s, 3.3 w h eel t o ileti ng se at s , 3. 6 h ospital bed, 3.7 pres sure relie f matt r esse o rthoses , 3 .11 hearing in s t rum ent s, 3 .12 Non-con vent ional m eters ( 1) I n t h is s ectio n , "non-co nve ntional glu cose met er' ' inc l ude s (a) a co ntinuo us glucose monitor ing me ter, an d (b) a talk in g gl (2) A no n-c o nventio na l g lucos e m eter is a health s upp l eme nt i s s a t i s f i e d t h a t (a) the g l ucos e meter is medic a l l y ess ential t o test blood g l u c c o n v enti onal glucose mete r ha s be en prescr i b e d i s u nabl e t o The App e llan t's p o sitio n i s that h e i s e l ig ib le for funding f medical nec ess i ty a nd he has n o o ther w ay to p ay for it. H wh o ha s been working w it h hi m and who confirmed that f or him. The Min istry i s the last re s or t. He subm itt ed from t h a t c ondition, as co n firm e d b y his doc t or. F or e pisodes o f sever e hypogl y cemi a resultin g in unconsc is pot e n tially life t hre aten i n g. The do ct o r also e x pre the Appell a nt will m iss doses or ma ke o t her i n sulin dos on h is long-an d sho rt-ter m diabete s m a nagem ent. re q u est e d it em is medical eq u ipme nt not a hea lth su l onger d oing it s jo b. For him, t h e re quest ed equ ipment Eligi b i lity under S che dul e C S ection 2(1 )(a) First the Mi nistry consi d ere d w he ther t h e requested item could Schedule C; that is, as a disposable or reusable medical or surgical supply The Ministry determined that the requested ite m is no t a dispo sable o r reusable medical or surgic i nfor mation about t he A ppella nt's medical co n ditions, the Ministry determined that the requested item w as not nece ssary for any of the condi tions listed in section 2(1) (a)(i). It al requested ite m is not listed among the medical or surgical supplies which it may authorize under section 2(1) (a.1) or 2(1) (a.2) of that Schedul e . . The Panel's Findings Under section 62 of the EAPWD R, the Ministry may authorize general equipm ent/ de vices t o re ci pients of disability as sistance, eligibility requirements in Schedule C are met for the specific health supplements or medical equipment/devices listed in Schedule C. Therefore, the Ministry may provide the general health supplements under section 2(1) of Schedule C only if the suppli purposes itemized in s ec tion 2( 1 )(a), or if t he req u e s o r 2(1 )(a.2). T h e Pa nel finds that the doctor prescribed a specifi Appellant to manaae his diabetes. This is not one of the purposes listed in section 2i1) nor is the . ·. EAAT 003(10/06/01) cal equ ipment an d devices d esc rib ed i n s ection 3 .1 to 3.12 ided by the m inister if e unde r section 62 [g ener al health suppl e ments] of this has rec eived t he pr e a uthoriz ation of the m in i ster for th e urce s available to t he family u nit to pay the cost of or obta i n e vice is the lea st ex pensive ap propriate me d i c al chai r seat i n g s ystems , 3 .4 s co oters, 3. 5 b at h ing and s, 3.8 flo or or c ei l i ng l i f t devic es, 3.9 brea thing d e vi ces, 3 . 1 0 uc os e me ter. f o r t h e purposes o f s ec tion 3 of t his Sc hed ul e i f t h e mi n i ste r o s e le vels, and ( b) the p e rson fo r w hom t h e n on use a con v entiona l gl ucose me ter. or t he req uested ins u lin pump becau s e it i s a e subm itted a letter fr o m a social w or ker she ha d e xplored d iff er ent fundi n g sources that h e h as ty p e 1 d iabetes a n d co mplic a tio n s e x a mpl e, the d octor re fer red to rep eated ious n es s and ho s pitali zation, a condit ion w hich s se d concer n tha t witho u t ongoing p ump th era py i ng er rors which would ha ve an adverse ef fect T he Appel lant su b mitte d th a t he believe s that the pplement . Hi s cur rent pump is out da ted and no is a life s avin g pi e ce of equipmen t. be aut h orized unde r section 2(1 )(a) o f a l su pply. Also, b a sed o n the so determ in ed th a t t he health suppleme n ts or medical such as the Appellant, but only if al l the es are needed for the specific ted item is specifically liste d in section 2(1 )(a.1) c type of insulin pump for the I I
requested insulin pump one of the supplies listed in section 2(1) (a.1) . The Panel further finds that there is no evidence that the insulin pump falls within the provisions of section 2(1 )(a.2). Therefore, the Panel finds that the Ministry reasonably determined that the Appellant is not eligible for the requested insulin pump under Schedule C section 2(1). Eligibility under Schedule C Section 3 Next the Ministry considered whether it could provide the insulin pump with a continuous glucose monitoring system as medical equipment under the provisions of section 3 of Schedule C. The Ministry noted that, if the eligibility requirements in section 3(1)(b) are met, it is authorized to provide only the specific medical equipmenVdevices listed in section 3.1 through 3.12. The Ministry determined that the specific item requested by the Appellant is not listed as one of the eligible types of medical equipment under sections 3.1 through 3.11. It further considered the definition of a non conventional glucose meter, which can be authorized under section 3.12. The Ministry determined that the continuous glucose monitoring system the Appellant is requesting is part of the requested insulin pump and an insulin pump is not an eligible type of medical equipment under section 3.12. The Ministry also determined that the Appellant did not establish that he had sought other options to pay for the requested equipment as required under section 3(1 )(b)(ii). The Ministry stated that it is the last resort. The Panel's Findings As the Panel noted in its previous findings, the Ministry can only authorize what is specifically provided for in the regulations. The Panel further notes that insulin pumps are not among the authorized types of medical equipmenVdevices in Schedule C section 3.1 through 3.11. Section 3.12 refers to a non-conventional glucose meter as an authorized type of medical equipment and states that such a meter includes a continuous glucose monitoring meter and a talking glucose meter. Based on the specific equipment prescribed by the doctor, the Panel finds that the Ministry reasonably determined that the continuous glucose monitoring system requested is part of the requested insulin pump and insulin pumps are not provided for under section 3.12. With respect to the requirement to establish that there are no other resources to pay for the requested equipment, the Panel finds that the evidence demonstrates that the Appellant receives disability assistance, that the Appellant stated that he had tried other funding sources such as the Diabetes Association and that the social worker confirmed that she extensively explored other potential funding resources for the Appellant. The only option available to him is through the Ministry. Therefore, the Panel finds that it was not reasonable for the Ministry to determine that the Appellant had not satisfied the requirements of Schedule C section 3(1)(b)(ii). Eligibility under Section 67(3) and Schedule C Sections 2 to 9 The Ministry determined the requested equipment does not qualify as a nutritional supplement under section 67(3) of the EAPWDR as therapy under Schedule C section 2(1)(c), 2(2) and 2(2.1), or as one of the health supplements listed in section 2.1, 2.2, 4, 4.1, 5, 6, 7, 8, or 9. The Panel's Findings The Panel finds that the evidence from the doctor establishes that the requested insulin pump with a continuous glucose monitoring system is a specific type of medical equipment needed by the Aooellant to manage his diabetes. Therefore, the Ministrv reasonablv determined that the reauested -· .. -... ' , ·:.· EMT003(10/06/01)
equipment is not a nutritional supplement under EAPWDR section 67(3), not a therapy under Schedule C section 2 and not one of the health supplements specifically identified in Schedule C section 2.1 through 9. Eligibility under Section 69 The Ministry stated that the information provided by the Appellant demonstrates that the Appellant may face a direct and imminent life-threatening health need for the insulin pump with a continuous glucose monitoring system. However, it noted that under section 69 it can only provide the health supplements in Schedule C section 2(1)(a) and (f) and section 3. The Ministry determined that the requested item is not one of the health supplements set out in Schedule C section 2 and section 3 through 3.12. Therefore it could not approve the Appellant's request under section 69. The Panel's Findings Section 69 of the EAPWDR imposes the same limitation on Ministry approval of supplies or medical equipment/devices as section 62; that is, the Ministry can only provide the specific supplements, therapies, or equipment/devices listed in Schedule C section 2 and 3. As discussed in the Panels' previous findings, the requested insulin pump with a continuous glucose monitoring system is not listed in any of those sections. Therefore, the Panel finds that the Ministry reasonably determined that that the Appellant's request did not meet the legislated criteria under section 69. Conclusion The Panel finds that the Ministry's reconsideration decision was reasonably supported by the evidence and was a reasonable application of the applicable legislation. Therefore, the Panel • . confirms that decision. . •: . -'-'· EM T003(10/06/01)
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