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 r e c o n s i d e r a t i o n d e c i s i o n d a t e d J a n u a r y 2 8 , 2 0 1 4 w N u t r i t i o n a l S u p p l e m e n t ( M N S ) f o r a d d i t i o n a l n u t r i t i o o f S e c t i o n 6 7 ( 1 . 1 ) 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 P W D R ) w e r e n o t m e t a s t h e r e i s n o t s u f f i c i e n t i n t h e a p p e l l a n t r e q u i r e s a d d i t i o n a l n u t r i t i o n a l i t e r e g u l a r d i e t a r y i n t a k e t o a l l e v i a t e t h e s y m p t o m h e a l t h a n d t o p r e v e n t i m m i n e n t d a n g e r t o l i f 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 a n d S c h e d u l e C , S e c t i o n 7D 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 ) h i c h 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 M o n t h l y n a l i t e m s . T h e m i n i s t r y h e l d t h a t t h e r e q u i r e m e n t s e f o r 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 f o r m a t i o n t o e s t a b l i s h t h a t : m s a s p a r t o f a c a l o r i c s u p p l e m e n t a t i o n t o a s o f h e r c h r o n i c , p r o g r e s s i v e d e t e r i o r a t i o n o f 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 6 7 ( 1 . 1 )
P A R T E S u rn rn a r v o f F a c t s T h e e v i d e n c e b e f o r e t h e m i n i s t r y a t t h e t i m e o f t h e r 1 ) A p p l i c a t i o n f o r M N S d a t e d A u g u s t 1 5 , 2 0 1 3 s s t a t i n g i n p a r t t h a t : • T h e a p p e l l a n t ' s s e v e r e m e d i c a l c o n d i t • I n r e s p o n s e t o t h e q u e s t i o n w h e t h e r a d e t e r i o r a t i o n i n h e a l t h , d o e s t h e a p p e p r a c t i t i o n e r i n d i c a t e d t h e s y m p t o m s o s i g n i f i c a n t m u s c l e m a s s l o s s ( n o t e : " l a m o d e r a t e t o s e v e r e i m m u n e s u p p r e s s • T h e a p p e l l a n t ' s h e i g h t a n d w e i g h t a r e • I n r e s p o n s e t o a r e q u e s t t o s p e c i fy t h e p r a c t i t i o n e r w r o t e : " f o l i c a c i d , e n r i c h e d • I n r e s p o n s e t o t h e q u e s t i o n w h e t h e r t h t h e i n a b i l i t y t o a b s o r b s u f f i c i e n t c a l o r i e d i e t a r y i n t a k e , t h e m e d i c a l p r a c t i t i o n e r • A s k e d t o d e s c r i b e h o w t h e n u t r i t i o n a l i s y m p t o m s d e s c r i b e d a n d p r o v i d e c a l o m e d i c a l p r a c t i t i o n e r w r o t e : " n e e d e d t o a n d b o n e s " ; • A s k e d t o d e s c r i b e h o w t h e n u t r i t i o n a l i a p p e l l a n t ' s l i f e , t h e m e d i c a l p r a c t i t i o n e v i t a m i n s A , C , E , D , B o o s t ; " a n d t h e m e d 2 ) L e t t e r d a t e d J a n u a r y 1 4 , 2 0 1 4 s i g n e d b y t h e p a r t t h a t : • T h e a p p e l l a n t s u f f e r s f r o m D i a b e t e s 2 , D i s e a s e . W i t h t h e s e i l l n e s s e s c o m e s m a l n u t r i t i o n , s i g n i f i c a n t s e v e r e m u s c l e s i g n i f i c a n t n e u r o l o g i c a l d e g e n e r a t i o n ; • O s t e o a r t h r i t i s o f t h e c e r v i c a l s p i n e o r l u c a u s i n g s e v e r e p a i n t h a t c a n r a d i a t e f r t h e a f f e c t e d p a r t s o f t h e b o d y ; • L u p u s e x t r e m e l y t i r e d , s e v e r e j o i n t p a • I n f l a m m a t o r y B o w e l D i s e a s e t h e l o s s i n f l a m m a t i o n o f t h e b o w e l c a u s e s f e v e 3 ) R e q u e s t f o r R e c o n s i d e r a t i o n d a t e d J a n u a r y 1 P r i o r t o t h e h e a r i n g , t h e a p p e l l a n t p r o v i d e d t h e f o l l o w U n d a t e d l e t t e r s i g n e d b y a p h y s i c i a n a n d s t a t • L u p u s i s d e s c r i b e d g e n e r a l l y a s a n a u t s y s t e m b e c o m e s h y p e r a c t i v e a n d a t t a c s y m p t o m s s u c h a s i n f l a m m a t i o n , s w e l l t h e h e a r t a n d l u n g s ( t h i s c a n b e l i f e t h r • L u p u s p u t s t h e a p p e l l a n t ' s k i d n e y s , a n d a n d ' v e g g i e s ' w o u l d r e d u c e f u r t h e r d e t e • " E a t i n i:i f r e s h f r u i t s a n d v e a a i e s a l o n a w e c o n s i d e r a t i o n d e c i s i o n i n c l u d e d : i g n e d b y t h e a p p e l l a n t ' s m e d i c a l p r a c t i t i o n e r a n d i o n s a r e d i a b e t e s , o s t e o a r t h r i t i s a n d l u p u s ; s a d i r e c t r e s u l t o f t h e c h r o n i c p r o g r e s s i v e l l a n t d i s p l a y t w o o r m o r e s y m p t o m s , t h e m e d i c a l f m a l n u t r i t i o n ( n o t e : " i m b a l a n c e o f n u t r i e n t s " ) , c k o f p r o p e r n u t r i t i o n a n d e x e r c i s e " ) a n d i o n ( n o t e : " m u s c l e s p a s m s , m u s c l e w e a k n e s s " ) ; r e c o r d e d ; a d d i t i o n a l n u t r i t i o n a l i t e m s r e q u i r e d , t h e m e d i c a l b r e a d s , f l o u r s , c e r e a l s , g r a i n p r o d u c t s ; " e a p p e l l a n t h a s a m e d i c a l c o n d i t i o n t h a t r e s u l t s i n s t o s a t i s f y d a i l y r e q u i r e m e n t s t h r o u g h a r e g u l a r n o t e d : " D i a b e t e s T y p e 2 " ; t e m s r e q u i r e d w i l l a l l e v i a t e o n e o r m o r e o f t h e r i c s u p p l e m e n t a t i o n t o t h e r e g u l a r d i e t , t h e r e g u l a t e b l o o d , b u i l d m u s c l e , n e r v e c e l l s , t e e t h t e m s w i l l p r e v e n t i m m i n e n t d a n g e r t o t h e r w r o t e : " O m e g a 3 a n d O m e g a 6 , i r o n Z i n c , i c a l p r a c t i t i o n e r n o t e " p a g e e n c l o s e d ; " a n d , a p p e l l a n t ' s m e d i c a l p r a c t i t i o n e r w h i c h s t a t e s i n o s t e o a r t h r i t i s , l u p u s , I n f l a m m a t o r y B o w e l c h r o n i c p r o g r e s s i v e d e t e r i o r a t i o n o f h e a l t h , m a s s l o s s , s e v e r e i m m u n e s u p p r e s s i o n , a n d m b a r s p i n e c a n i r r i t a t e t h e s p i n a l n e r v e s , o m t h e s p i n e a s w e l l a s n u m b n e s s a n d t i n g l i n g o f i n , a l s o a f f e c t i n g n e r v o u s s y s t e m ; o f f l u i d a n d n u t r i e n t s f r o m d i a r r h e a a n d c h r o n i c r , f a t i g u e a n d m a l n u t r i t i o n ; a n d , 4 , 2 0 1 4 . i n g a d d i t i o n a l d o c u m e n t : i n g i n p a r t t h a t : o i m m u n e d i s e a s e w h e r e t h e b o d y ' s i m m u n e k s n o r m a l , h e a l t h y t i s s u e . T h i s r e s u l t s i n i n g , a n d d a m a g e t o j o i n t s , s k i n , k i d n e y s , b l o o d , e a t e n i n g ) . h e a r t a t r i s k f o r p r o b l e m s a n d e a t i n g f r e s h f r u i t s r i o r a t i o n a n d i m m i n e n t d a n g e r t o l i f e . i t h h e a l t h v e a t i n i:i w o u l d a l l e v i a t e s y m o t o m s o f a
chronic, progressive deterioration of health and to prevent imminent danger to life." • The appellant is fighting breast cancer and she is on treatment for the next 5 years. e Caloric supplementation will improve the quality of life in cancer patients; this will prevent imminent danger to life and prevent further deterioration of her pancreas, heart, kidney, eyes and nerves. Caloric supplementation should also include a balance essential amino acid supplement rich in protein and with adequate vitamin D. • Eat a wide variety of fresh, organic foods to give the appellant's system the best chance to naturally produce estrogen. A high quality protein, fresh vegetables and fruit would help prevent further deterioration of health and prevent imminent danger to life. • Type 2 Diabetes if left untreated or improperly managed can result in a variety of complications including heart disease, kidney disease, eye disease and nerve damage. The appellant is having a hard time managing her diabetes. • Caloric supplementation will improve the quality of life, this will prevent imminent danger to heart, kidney and to life. • The appellant has had Irritable Bowel Syndrome (IBS) for many years. Taking a supplement of probiotics may also help treat IBS. • Osteoarthritis is described generally as degenerative arthritis which is a progressive disease that gradually becomes more severe with time. If left untreated, the compression on the nerves from the lumbar spinal stenosis can lead to increasing weakness and loss of function of the legs. It can also lead to loss of bowel and bladder control and the appellant is experiencing loss of bladder control. Calcium, magnesium, vitamin D and other nutrients are important for bone health, a balanced diet with plenty of dairy, fish, fiber fruits and vegetables. • Without the MNS, the appellant cannot afford the foods that would prevent imminent danger to her life. She wants a chance to improve her health, get stronger muscles and bone, get a better weight range and lower her risk of heart disease and help stop further deterioration to her bones and get her diabetes under control. • The physician added a handwritten note which reads: "Agree with patient's summary of her nutritional requirements." At the hearing, the appellant submitted the following additional documents: 1) Page referred to by the medical practitioner with the notation "page enclosed" on the original application for MNS, which states in part that: • Osteoarthritis-aching pain, stiffness, difficulty moving the joints (knuckles, knees, hips, lower back). A combination supplement of glucosamine, shark cartilage and quercetin was found to be helpful as a treatment. • Lupus-achy and swollen joints especially in wrists, small joints of the hands, elbows, knees and ankles; • Anemia-the appellant has a CPAP machine; • Chronic Inflammatory Bowel Disease-irregular bowel habits, fatigue, cramping, sweats; • Fibromyalgia-stiffness and tenderness of muscles, tendons and joints, chronic pain and disability. Digestive disorders, balance problems, itchy/burning skin; • Diabetes 2-it is expensive to stick to a healthy diet when the food prices are so high and keep increasing when the cheques stay the same. • Handwritten note: "Omega 3 and Omega 6, Vitamins A, D, E, calcium, magnesium for bone, protein and iron; and, 2) Surqical Patholoqy Report dated Auqust 9, 2013 which indicates diaanoses of an admixed
du c tal c ar c in oma i n situ in the right brea st. In her Notice o f Appeal, the appe llant exp ress ed her decis ion . The ap pel lan t w rot e that it is reall y h a rd putt explain her con dit ion at a n oral he a ring. In her Request fo r R e consider ation, t he appe llant wr muscle mas s l oss , s evere im mune suppre ssio n an d neurologi require men ts. T h e d octor has sig ned a no te con firm he a lt h. At t he hearing , the appellant a n d h er advocate stated th • The mi nis try ac cepted that sh e d ispla ys the s • Wi th lupus, she is at risk of a numb e r of different problems • She has b reast c an c e r which is li fe-threa tening treatme nts . It i s a hard b at tl e a n d sh e needs f fo rgot to menti on t his di agnosi s with t he medical pra applica tion for MNS. • Her si s ter g a ve h er a nutra -b u lle t to m ak e smoothie but s he need s th e fr e sh fruits and veget abl es • S h e i s on a die t for her di a betes . • With her IBS, s he needs to keep up he r n u t r i tion • Osteoarthr it is i s causi ng he r bo nes to get w eak ost eoporosi s and n ow t hat s he als o has a rthriti pai n i n her back caus es her t o be be dridden. • With he r m uscle l oss, she i s a fr a id s he may break some bon we ak er. S he needs to m ak e her b ac k stronger. • He r BMI is 32.6 because sh e is n ot a bl e to get a • The undate d letter w a s si gned by a ph y s ician • The page t hat was att ach ed t o t he appl ication d octor wh o had her writ e t he vi tami ns needed The mi ni stry did no t o bject t o the admissibi lity of the new docum documen ts and a dmitted the undated l etter signe d by a phy appl i cation as relating to the appellant's previousl y diagnosed medical condition the MNS and being in support of informat ion before the ministry Sect ion 22(4) of the Employment and Assi stance Act. Report or the information regarding breast cancer set out in the letter signed by a physician or in the appellant's test imony sinc e t his is a n e w di agno si s that before the ministry at reconsideration . For the same reasons, the panel also did not admit the references to Fibromyalgia and anemia. The ministry relied on its reconsideration decision which included evidence that the appellant is a Person With Di s a bilities (PWD) in receipt of disa bility diabetes at the rate of $35 per month as well as the vitamin and mineral supplement in the amount of $40 per month. di sagreement wit h the mi nistry's r e c o nsid era t ion ing everyt hing on paper . Sh e wil l be able t o o te th a t she suf fer s fro m m a l nutriti on, s evere c al de gen erati on a n d sh e meets t he ing h er il lne ss and progressive dete rioration o f a t : ymp tom of malnutrition. . and she will hav e t o u n dergo 5 year s of r e sh fru its and veg etabl es to ke ep healthy. She cti tioner when h e was c omple ting th e s t o give he r ext ra nut r i e nts and energ y, t o u se, w hich are expe ns i ve . . er. She had os teope n ia, the n it de velo p ed into s, so it is c a l led o steo art h r i t i s. Som etim es the S he take s medic a ti ons f o r t he pain . es be cau s e the y are getting prop er diet. on Feb r uary 1 8, 2 0 14. for MN S was p r e pared by her and gi ven to her on th e bott om of t he page. ents . The panel reviewed the sician and t he page at tached to the s and her need for on reconsideration, pursua nt to The panel did not admit the Su rgical Pathology is not in support of inf ormation or records assistance and a dietary supplement for
A t t h e h e a r i n g , t h e m i n i s t r y h i g h l i g h t e d t h e p o l i c y f o a s s i s t a n c e m u s t h a v e a s e v e r e m e d i c a l c o n d i t i o n c a h e a l t h w i t h s y m p t o m s o f w a s t i n g . T h e s u p p l e m e n t p e r s o n ' s l i f e b y p r o v i d i n g e s s e n t i a l , s p e c i f i e d i t e m s m i n i s t r y p r o v i d e d a d e f i n i t i o n o f " i m m i n e n t " a s ' l i k e l y s t a t e d t h a t e v e r y w o r d i n t h e l e g i s l a t i o n i s i m p o r t a n t i n t h e s p e c i f i c fo r m p r e s c r i b e d a n d t h e m e d i c a l o r n l i s t e d i n t h e s e c t i o n a s p a r t o f t h i s r e q u e s t .r M N S w h i c h s t a t e s t h a t a r e c i p i e n t o f d i s a b i l i t y u s i n g a c h r o n i c , p r o g r e s s i v e d e t e r i o r a t i o n o f i s i n t e n d e d t o p r e v e n t i m m i n e n t d a n g e r t o t h e t o s u p p l e m e n t r e g u l a r n u t r i t i o n a l n e e d s . T h e t o o c c u r a t a n y m o m e n t . ' T h e m i n i s t r y a l s o a n d s e c t i o n 6 7 r e q u i r e s t h a t t h e r e q u e s t m u s t b e u r s e p r a c t i t i o n e r m u s t c o n f i r m a l l t h e e l e m e n t s
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 o n t h e 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 d e c M o n t h l y 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 d d i t i o n a l n u t r i t i 6 7 ( 1 . 1 ) 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 P e r s n o t m e t , w a s r e a s o n a b l y s u p p o r t e d b y t h e e v i d e n c e e n a c t m e n t i n t h e c i r c u m s t a n c e s o f t h e a p p e l l a n t . S e c t i o n 6 7 ( 1 . 1 ) o f t h e E A P W D R s e t s o u t t h e e l i g i b i l f o r p r o v i d i n g t h e a d d i t i o n a l n u t r i t i o n a l s u p p l e m e n t , a N u t r i t i o n a l s u p p l e m e n t 6 7 ( 1 . 1 ) I n o r d e r f o r a p e r s o n w i t h d i s a b i l i t i e s t o r e c e i v e a n u t r i m i n i s t e r m u s t r e c e i v e a r e q u e s t , i n t h e f o r m s p e c i f i e d p r a c t i t i o n e r o r n u r s e p r a c t i t i o n e r , i n w h i c h t h e p r a c t i t i o ( a ) t h e p e r s o n w i t h d i s a b i l i t i e s t o w h o m t h e r e q u e s t r e l a c h r o n i c , p r o g r e s s i v e d e t e r i o r a t i o n o f h e a l t h o n a c c o . ( b ) a s a d i r e c t r e s u l t o f t h e c h r o n i c , p r o g r e s s i v e d e t e r i o o f t h e f o l l o w i n g s y m p t o m s : ( i ) m a l n u t r i t i o n ; ( i i ) u n d e r w e i g h t s t a t u s ; ( i i i ) s i g n i f i c a n t w e i g h t l o s s ; ( i v ) s i g n i f i c a n t m u s c l e m a s s l o s s ; ( v ) s i g n i f i c a n t n e u r o l o g i c a l d e g e n e r a t i o n ; ( v i ) s i g n i f i c a n t d e t e r i o r a t i o n o f a v i t a l o r g a n ; ( v i i ) m o d e r a t e t o s e v e r e i m m u n e s u p p r e s s i o n ; ( c ) f o r t h e p u r p o s e o f a l l e v i a t i n g a s y m p t o m r e f e r r e d t o m o r e o f t h e i t e m s s e t o u t i n s e c t i o n 7 o f S c h e d u l e C ( d ) f a i l u r e t o o b t a i n t h e i t e m s r e f e r r e d t o i n p a r a g r a p h ( l i f e . S e c t i o n 7 o f S c h e d u l e C o f t h e E A P W D R p r o v i d e s a M o n t h l y n u t r i t i o n a l s u p p l e m e n t 7 T h e a m o u n t o f a n u t r i t i o n a l s u p p l e m e n t t h a t m a y b e p r o v i d e d t h i s r e g u l a t i o n i s t h e s u m o f t h e a m o u n t s f o r t h o s e o f t h e f o l l o u n d e r s e c t i o n 6 7 ( 1 ) ( c ) : ( a ) f o r a d d i t i o n a l n u t r i t i o n a l i t e m s t h a t a r e p a r t o f a c a l o r i c s u $ 1 6 5 e a c h m o n t h ; ( b ) R e p e a l e d . [ B . C . R e g . 6 8 1 2 0 1 0 , s . 3 ( b ) . ) ( c ) f o r v i t a m i n s a n d m i n e r a l s , u p t o $ 4 0 e a c h m o n t h . T h e m i n i s t r y a c k n o w l e d g e d t h a t t h e m e d i c a l p r a c t i t i o f o r a c h r o n i c , p r o g r e s s i v e d e t e r i o r a t i o n o f h e a l t h o n a s p e c i f i c a l l y d i a b e t e s , o s t e o a rt h r i t i s , l u p u s , a n d I n f l a m 6 7 ( 1 . 1 ) / a ) o f t h e E A P W D R . S e c t i o n 6 7 / 1 . 1 \ ( b ) o f t h e i s i o n , w h i c h 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 o n a l i t e m s b e c a u s e t h e r e q u i r e m e n t s o f S e c t i o n 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 ( E A P W D R ) w e r e o r i s a r e a s o n a b l e a p p l i c a t i o n o f t h e a p p l i c a b l e i t y r e q u i r e m e n t s w h i c h a r e a t i s s u e o n t h i s a p p e a l s f o l l o w s : t i o n a l s u p p l e m e n t u n d e r t h i s s e c t i o n , t h e b y t h e m i n i s t e r , c o m p l e t e d b y a m e d i c a l n e r h a s c o n f i r m e d a l l o f t h e f o l l o w i n g : t e s i s b e i n g t r e a t e d b y t h e p r a c t i t i o n e r f o r a u n t o f a s e v e r e m e d i c a l c o n d i t i o n ; r a t i o n o f h e a l t h , t h e p e r s o n d i s p l a y s t w o o r m o r e i n p a r a g r a p h ( b } , t h e p e r s o n r e q u i r e s o n e o r a n d s p e c i f i e d i n t h e r e q u e s t ; c ) w i l l r e s u l t i n i m m i n e n t d a n g e r t o t h e p e r s o n ' s s f o l l o w s : u n d e r s e c t i o n 6 7 [ n u t r iti o n a l s u p p l e m e n t ] o f w i n g i t e m s s p e c i f i e d a s r e q u i r e d i n t h e r e q u e s t p p l e m e n t a t i o n t o a r e g u l a r d i e t a r y i n t a k e , u p t o n e r c o n f i r m e d t h a t t h e a p p e l l a n t i s b e i n g t r e a t e d c c o u n t o f a s e v e r e m e d i c a l c o n d i t i o n , m a t o r y b o w e l d i s e a s e , p u r s u a n t t o S e c t i o n E A P W D R r e q u i r e s t h a t a m e d i c a l p r a c t i t i o n e r
confi rm that as a direct result of the ch ro n ic, p rogressi two or more of the symp t om s liste d . The mini stry ackn from the med ic al pra ctitioner to e stablish that the appe namely malnutrition and signi ficant n eu rologica l dege of signi ficant musc le mass loss and moderate to severe immune s Section 67(1.1)(c) and Sect io n 7 of Sche dul e C of the EAPWDR-Caloric Suppl The min is try's position is that it is not satisfie d t h at the appellant req as par t of a ca l o ric suppleme n t a t i on to a regu lar dietar progressive de teriorat io n of hea lth. The ministry arg the appellan t req uires folic acid, enriche d breads, flours, cere r epres ent components of a regular d ie tary i n ta k e and addition to a re gular dietary int ake. The ministry argu that the appe llant is displaying unde rw e i g ht st atus or significan demonstrate that she r equires ca lori c s upplementation to a regul a rgue d that th e s ymptom of sign i f icant muscle mass exercise. T h e mi n i stry ar gued that the a pp el lant's h ind i cate tha t h er BMI [bo dy mass i ndex] is 32.6, w h ich The a p pella nt's posit ion is tha t sufficie n t informati o n h both th e or igin al app lica tion and t h e add itional letters and pag add iti o n a l nut r i ti o n a l items a s part of a caloric supplementati the sym ptoms of a chro ni c, p r o gr essi ve det eriora t ion confirm ed in the app licat io n that s he needs "f o lic acid, prod uct s" and also c onf i rmed in the letter signed F ebrua magnesium, vitamin D and ot h e r nutri ent s t h a t are i plen ty of dair y, fish, fiber frui ts and veg etab l es. The sh e d i splays the sympt om of maln utri tion. T h e app ella nutri tio nal i tems requ ir e d w il l all eviate o ne or more of t supp le m e ntat ion to th e r e gula r die t b y regulating her b bone. Panel d ec ision Section 7 of Schedule C and Section 67(1.1)(c) of the EAPWDR must confir m that, for the purpose of alleviati n g a symptom appellant requires the additional nutritional ite ms that are part of a caloric supplementation to a regular dietary intake as specified in the request. In the original application, in response to a request to specify the additi ona l nutritional items requ i r e d, the needs "folic acid, enriched breads, flours, cereals, grain products" and the panel finds that the minist ry reasonably determined that these ite ms are components of a regular dietary intake sup pl em ent of calories i n add ition t o a r egula r dietary intake. form, in the sect ion relating to an immi n ent danger to life, the medical practitione vitamins and also included "Boost," which is a nutritional drink which can in some forms provide a caloric supplementation to a regular dietary intake. appellant has a medical condition that results in the inability to absorb sufficient calories to satisfy daily requirements through a regular diet a ry intake, the medical practit 2, and this respon se was not disputed by the ministry. ve deterioration of heal th , the person di splays o wledged that t h e re is sufficient in for ma tion llant displays two or more o f the symptoms, n eration. The ministry found t h at the sy m ptoms uppress io n w er e not e stablished. emen tation uires additional nutritional item s y intake to alleviate the sym ptoms of a c hronic, ued t hat the medica l pr ac t i t i oner reported that al s and g r ain products and these item s no t items n e eded for caloric suppleme ntation in e d that t he medica l pr a cti tioner di d not co nfirm t weight loss, which would ar dietary intake. The mi nist ry loss i s at tri bu t ed to l ack of pr oper nut r i tion a n d eig ht an d we ight r eco r d ed in the applica tion i s in the ob es e range. as been pro vided by t h e m edi cal practitioner, in e, to e stab li sh t h a t she requires o n t o a regu lar d iet ary intake to alle via te o f he a lt h. T he app e l la nt a rgu ed t hat h er d octor e n r ich e d breads, f lours, cereals, gr ain ry 18, 2014 t h at s he need s calcium, m por t ant for bone hea lth, a ba l a n ce d di et with app ella nt argued that the minist ry acc e pted tha t nt argued that her do ctor confi rm e d that the he symptoms descri b e d and p r o v ide ca lo ric lood, building muscle , nerve cel ls, teeth a n d stipula t e that the medical pra cti tioner re f e r re d t o in sub-section (b ), the med ical practiti oner wrote that the ap pellant and not a However, at the end o f the applicatio n r listed various In response to the question whether the ioner referred to Diabetes Type
T h e m i n i s t r y a l s o a c c e p t e d t h a t t h e m e d i c a l p r a c t i t i o e s t a b l i s h t h a t t h e a p p e l l a n t i s d i s p l a y i n g t h e s y m p t o o u t t h a t t h e a p p e l l a n t ' s B M I i s i n t h e o b e s e r a n g e a n o f m a l n u t r i t i o n i n t h e a p p l i c a t i o n a s a n " i m b a l a n c e o a b s o r p t i o n o r i n t a k e . W h e n a s k e d t o d e s c r i b e h o w t h e s y m p t o m s a n d p r o v i d e c a l o r i c s u p p l e m e n t a t i o n " n e e d e d t o r e g u l a t e b l o o d , b u i l d m u s c l e , n e r v e c e l l s s u p p l e m e n t i n g c a l o r i e s . T h e p a n e l f i n d s t h a t t h e m i n f o r m a t i o n f r o m t h e m e d i c a l p r a c t i t i o n e r t o c o n f i r m r e q u i r e d b y t h e a p p e l l a n t a s p a r t o f a c a l o r i c s u p p l e r e l a t e d s y m p t o m , a s s e t o u t i n S e c t i o n 6 7 ( 1 . 1 ) ( c ) o f S e c t i o n 6 7 ( 1 . 1 ) ( d ) o f t h e E A P W D R I m m i n e n t D a n g T h e m i n i s t r y ' s p o s i t i o n i s t h a t i t i s n o t s a t i s f i e d t h a t t t o p r e v e n t a n i m m i n e n t d a n g e r t o t h e a p p e l l a n t ' s l i f e n u t r i t i o n a l i t e m s r e q u i r e d w i l l p r e v e n t i m m i n e n t d a n g o f v i t a m i n s a n d m i n e r a l s f o r w h i c h t h e m i n i s t r y i s a l r m i n i s t r y a r g u e d t h a t t h e a d d i t i o n a l i n f o r m a t i o n l i s t s a i n f o r m a t i o n a b o u t s y m p t o m s a n d r i s k s t h a t a r e n o t s h e a r i n g , t h e m i n i s t r y a r g u e d t h a t t h e w o r d " i m m i n e n a n d t h a t , e v e n c o n s i d e r i n g t h e a d d i t i o n a l l e t t e r s a n d e s t a b l i s h t h a t t h e m e d i c a l p r a c t i t i o n e r h a s c o n f i r m e d r e s u l t i n i m m i n e n t d a n g e r t o t h e a p p e l l a n t ' s l i f e . T h e a p p e l l a n t ' s p o s i t i o n i s t h a t t h e i n f o r m a t i o n f r o m o b t a i n t h e a d d i t i o n a l n u t r i t i o n a l i t e m s w i l l r e s u l t i n i m t h a t s h e h a s a n u m b e r o f s e r i o u s h e a l t h c o n d i t i o n s a D i a b e t e s w h i c h , i f l e f t u n t r e a t e d o r i m p r o p e r l y m a n a i n c l u d i n g h e a r t d i s e a s e , k i d n e y d i s e a s e , e y e d i s e a s s h e i s h a v i n g a h a r d t i m e m a n a g i n g h e r d i a b e t e s . T d i a g n o s e d w i t h o s t e o a r t h r i t i s , l u p u s , a n d I B S a n d s h t h e y a r e g e t t i n g w e a k e r d u e t o h e r o s t e o a r t h r i t i s , a n s y m p t o m s o f l u p u s a n d I B S . P a n e l d e c i s i o n S e c t i o n 6 7 ( 1 . 1 ) ( d ) r e q u i r e s t h a t t h e m e d i c a l p r a c t i t i o i t e m s t h a t a r e p a r t o f a c a l o r i c s u p p l e m e n t a t i o n t o a d a n g e r t o t h e p e r s o n ' s l i f e . I n t h e o r i g i n a l a p p l i c a t i o q u e s t i o n h o w t h e n u t r i t i o n a l i t e m s w i l l p r e v e n t i m m i n " " O m e g a 3 a n d O m e g a 6 , i r o n Z i n c , v i t a m i n s A , C , E , " p a g e e n c l o s e d . " T h e a d d i t i o n a l p a g e w h i c h t h e a p p h e r h e a l t h c o n d i t i o n s a n d r e l a t e d s y m p t o m s b u t n o i d a n g e r t o t h e a p p e l l a n t ' s l i f e i n p a r t i c u l a r . T h e p a n e l f i n d s t h a t t h e m e d i c a l p r a c t i t i o n e r s p e c i f i e r e s u l t s i n t h e i n a b i l i t y t o a b s o r b s u f f i c i e n t c a l o r i e s t o a r g u e d t h a t s h e i s h a v i n g a h a r d t i m e m a n a g i n g h e r c o m p l i c a t i o n s c a n i n c l u d e h e a r t , k i d n e v a n d e v e d i s e n e r h a d p r o v i d e d s u f f i c i e n t i n f o r m a t i o n t o m o f m a l n u t r i t i o n . H o w e v e r , t h e m i n i s t r y p o i n t e d d t h e m e d i c a l p r a c t i t i o n e r d e s c r i b e d t h e s y m p t o m f n u t r i e n t s " r a t h e r t h a n a d e f i c i e n c y i n c a l o r i e t h e n u t r i t i o n a l i t e m s w i l l a l l e v i a t e o n e o r m o r e o f t o t h e r e g u l a r d j e t , t h e m e d i c a l p r a c t i t i o n e r w r o t e : , t e e t h a n d b o n e s , " w i t h n o r e f e r e n c e t o i n i s t r y ' s c o n c l u s i o n t h a t t h e r e i s n o t s u ff i c i e n t t h a t s p e c i f i e d a d d i t i o n a l n u t r i t i o n a l i t e m s a r e m e n t a t i o n t o a r e g u l a r d i e t a r y i n t a k e t o a l l e v i a t e a t h e E A P W D R , w a s r e a s o n a b l e . e r t o L i f e h e a p p e l l a n t r e q u i r e s a d d i t i o n a l n u t r i t i o n a l i t e m s . T h e m i n i s t r y a r g u e d t h a t i n d e s c r i b i n g h o w t h e e r t o l i f e t h e m e d i c a l p r a c t i t i o n e r l i s t e d a n u m b e r e a d y p r o v i d i n g a s u p p l e m e n t . A t t h e h e a r i n g t h e n u m b e r o f m e d i c a l c o n d i t i o n s w i t h g e n e r a l p e c i f i c t o t h e a p p e l l a n t ' s c i r c u m s t a n c e s . A t t h e t " i s d e f i n e d a s ' l i k e l y t o o c c u r a t a n y m o m e n t ' p a g e , t h e r e i s n o t s u ff i c i e n t i n f o r m a t i o n t o t h a t f a i l u r e t o o b t a i n t h e n u t r i t i o n a l i t e m s w i l l t h e m e d i c a l p r a c t i t i o n e r c o n f i r m e d t h a t f a i l u r e t o m i n e n t d a n g e r t o h e r l i f e . T h e a p p e l l a n t a r g u e d n d h e r d o c t o r s i g n e d t h e l e t t e r s t a t i n g T y p e 2 g e d , c a n r e s u l t i n a v a r i e t y o f c o m p l i c a t i o n s e a n d n e r v e d a m a g e . T h e a p p e l l a n t a r g u e d t h a t h e a p p e l l a n t a r g u e d t h a t s h e a l s o b e e n e i s a f r a i d s h e m a y b r e a k s o m e b o n e s b e c a u s e d s h e n e e d s p r o p e r n u t r i t i o n t o a l l e v i a t e t h e n e r c o n f i r m t h a t f a i l u r e t o o b t a i n t h e n u t r i t i o n a l r e g u l a r d i e t a r y i n t a k e w i l l r e s u l t i n i m m i n e n t n , t h e m e d i c a l p r a c t i t i o n e r r e s p o n d e d t o t h e e n t d a n g e r t o t h e a p p e l l a n t ' s l i f e , b y w r i t i n g D , B o o s t ; " a n d n o t i n g i n t h e a d d i t i o n a l c o m m e n t s e l l a n t s u b m i t t e d a t t h e h e a r i n g i n c l u d e d a l i s t o f n f o r m a t i o n s u p p o r t i n g t h e f i n d i n g o f a c u r r e n t d D i a b e t e s T y p e 2 a s t h e m e d i c a l c o n d i t i o n t h a t s a t i s f y d a i l y r e q u i r e m e n t s a n d t h e a p p e l l a n t d i a b e t e s a n d h e r d o c t o r c o n f i r m e d t h a t a s e a s w e l l a s n e r v e d a m a a e . 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t h a t a l t h o u g h u n t r e a t e d o r u n c o n t r o l l e d d i a b e t e s c o u a p p e l l a n t ' s l i f e , t h e r e i s i n s u f f i c i e n t i n f o r m a t i o n p r o v r i s k o f c o m p l i c a t i o n s f r o m d i a b e t e s i s c u r r e n t l y h i g h d e t e r i o r a t i o n i n t h e a p p e l l a n t ' s h e a l t h t h a t w o u l d i n d t h e u n s p e c i f i e d n u t r i t i o n a l i t e m s i s " i m m i n e n t , " o r l i k t h a t s h e i s c u r r e n t l y i n r e c e i p t o f a d i e t a r y s u p p l e m e $ 3 5 p e r m o n t h , a n d t h i s i s d e s i g n e d t o h e l p h e r m a n m i n i s t r y r e a s o n a b l y c o n c l u d e d t h a t t h e m e d i c a l p r a c t h e r e q u e s t e d a d d i t i o n a l n u t r i t i o n a l i t e m s w i l l r e s u l t r e q u i r e d b y S e c t i o n 6 7 ( 1 . 1 ) ( d ) o f t h e E A P W D R . C o n c l u s i o n T h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s r e c o n s i d e r a t i o n d M o n t h l y 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 d d i t i o n a l n u t r i t i S e c t i o n 6 7 ( 1 . 1 ) o f t h e E A P W D R w e r e n o t m e t , w a s p a n e l c o n f i r m s t h e m i n i s t r y ' s d e c i s i o n .l d p o t e n t i a l l y p o s e a s e r i o u s d a n g e r t o t h e i d e d b y t h e m e d i c a l p r a c t i t i o n e r t o c o n f i r m t h a t t h e f o r t h e a p p e l l a n t o r t h a t t h e r e i s a r a p i d r a t e o f i c a t e t h a t t h e d a n g e r t o t h e a p p e l l a n t ' s l i f e w i t h o u t e l y t o h a p p e n s o o n . T h e a p p e l l a n t a c k n o w l e d g e d n t f r o m t h e m i n i s t r y f o r d i a b e t e s , a t t h e r a t e o f a g e h e r d i a b e t e s . T h e p a n e l f i n d s t h a t t h e t i t i o n e r h a s n o t c o n f i r m e d t h a t f a i l u r e t o o b t a i n i n i m m i n e n t d a n g e r t o t h e a p p e l l a n t ' s l i f e , a s e c i s i o n , w h i c h 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 o n a l i t e m s b e c a u s e a l l o f t h e r e q u i r e m e n t s o f r e a s o n a b l y s u p p o r t e d b y t h e e v i d e n c e a n d t h e
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.