PART C -Decision under Appeal The d e cision under appeal is the Mi nistry of Social deci s i on dated August 4, 2011 which d e nied the appellant' accessory for the lnterX 5002 Neurostimulat ion Device. requ es t based on the Employmen t and As si st anc e (EAPW DR) as it rea d on March 31, 20 10, th e d ate on received. The specific bases o f deni al are as follows: Schedu le C, s. 3 [as it read on M arch 31, 2 01 0] The ministry dete rmined that not a ll o f the criter ia set out in medica l equipment an d device s were met. The m inistry the D o me a c cessory, had been prescribed by a medical pract physiotherapist (PT ) had been pro vided as required bys. 3(2)(a) and ( d eter min e d t hat th e Dome acc e ss o ry w as not a n y o 3 (1 ) and , in pa rticular, w as not a p osi t i on ing d evice param ete rs f or th e prov is i on of e lectro ther ap y in terms Sc hed u le C, s. 2 [as it rea d on July 4, 200 2] T he m in ist ry d eter m ine d that th e appell ant is not elig app ro ved f or elec t ro t herap y equ ipment u n der the legi b road er cate gory of "du r able m edi ca l equipment and ap at the t i me of t he a ppel la nt's requ e s t for th e D o me acc prev ious a p pr o val o f an electrotherapy de v ice does ministry to con t inue t o prov ide electrothe rapy d evic e the policy p a ra mete rs fo r th e prov i sion of electro ther and cost. s . 69 Lif e -thr eate n in g health need [as it rea d on March 31, 201 0] The m i nistry a l so dete rmined that the appella n t wa s of the EAPWDR [li fe -threate ning health need ] becau threate n ing need f or the Dom e accessory and (ii) the p the provision of electroth era py equipment in term s of fu PART D -Relevant Legislati on Employmen t and Assistance for Persons with Disabilities Act (EAPWDA Em ploy m ent and Ass istanc e for Persons with Dis ab C, s. 3 in effect on March 31, 2010 Disability Benefits Program Regulation, s. 2, in effect on July 4, 2002 APP EAL# I Development (the mini st r y) reconsidera tion s request to be p r ov i d e d with the Dome T h e ministry consider ed the ap pel l ant's for P ersons w i t h D i s a bi li ti es Regul a tio n which the app el lant's or iginal request w a s s . 3 of S chedule C for the provision of was sa tisf ied th at t he equipment, including i t i oner and that an assessmen t by a b ). However, th e m inistry f the me dical eq ui pme n t and d evi ces set out in s. u nd er s. 3(1)(d), and exceeded the polic y of fu nctio nal i t y , quantit y , a nd cost. ible fo r t he Dome on th e b a sis that she was slati on in effec t on J uly 4, 2002 whic h i nc l uded a pli an ces " not fo u nd in the le g is lation in ef fec t essory. F urther, th e min istry de termined that n ot establish a p re c ed ent that req u i res th e s i ndefi ni tely and t he Dom e accesso ry excee ded ap y eq ui pme n t i n ter ms of f u ncti o n ality, q u antity, not e li gi b le for t he D om e ac cessory under s . 69 se (i) t he in for mation doe s not est ablish a li f e a rameters set ou t in policy are exceed ed for nctio nality, quantity and cost. ), s. 16 ili t ie s Regul a t i o n ( EAPW DR), s. 69 and Sched ule
PAR T E -Sum marv o f F a c ts P r eli min a ry Mat ters • Th e hea ri n g w as ori ginal ly sched uled for Se ptemb 7 , 2011 a t th e writ ten re que st of the appellant w cha i r. The appel lant 's s ub m is sio n i ncludes the f the min ist ry has n ot prov i d ed the ap pe llan t with pr epare f or th e h ea rin g, h er re pre se nt ativ e is u • A resc heduled h ea rin g was to be condu cted secon d t ime on Octob er 1 2, 20 11 at the wr itt m i nistry an d the Tri bunal ch air. The ap pe ll a nt's adjournment r equ es t: t he m i nis try provi ded new r whi ch is a matter that s hou l d be r esolved by • Th e hearing wa s r esched uled t o ta ke plac e on ti me o n May 23, 20 12 at the writte n r e qu est of the appell a nd the Trib un al chai r . The a pp ell ant' s submissi adjo urnment requ est: the appell ant suff er ed a flare-u pai n and r equi r es a peri od o f reco very, as s et • Prior t o a d ate bei ng s e c u red to resch edule the he May 1 , 2 01 3 a t the w r i t ten r equest of t he app Tribunal chai r . The appel lant's subm i ssion incl reques t : t o have t ime to c ons ult with leg al cou u nab le t o work o n the ap peal and requ i res a 3 dated April 25 , 201 3, to allow t he Ombu dspe results of F O i [F r eedom o f I nformat ion] searches me m b er, si nce she cannot pr epare f o r the heari • The hearing con vene d on Janu ary 29, 2 014, appell ant reques ted an adjournment on the followi 1. Her advocate, who requires the assist anc the location for the hear ing nor manage the documents without the care worker who cancelled services for today at the last minute. 2. The appellant requires an advocate to be present and to assist due to her disability. 3 . Th e a ppellant h a s no t rec eiv ed sufficient docum 4. Th e Privacy Comm i ssione r is in t he p rocess o withholding of documents requested of the ministry by the appellant. 5 . Her doctor has said that hearings over an ho and her advocate serves to keep her focused. • The ministry objected to an adjournment on the basis of the length of time that this appea been outstanding. • The panel granted an adjournmen t of the hearing for the following reason: cancelled services for the appellant's advo cate APPEA L # I er 9, 2 01 1 bu t wa s adjourned on S ep t e mbe r i th the c ons ent of the minis try a nd t h e Tr ibunal ollo w in g bases for the ad jou r n me nt re qu es t: the do cume nts she re qu ire s in o rd er to na ble to att e nd, an d me dic al reason s; on No v e mbe r 2, 201 1 but w as adjourned for a e n requ est o f the appellant w it h t he consen t of th e sub mis sion in c lud es t he follo w i ng basi s f o r the ea son s for deni al a t the adj udicati on stage t he Om b ud sp ers on prior t o t he appeal h ea r ing . J un e 19, 20 12 but wa s adj our ne d fo r a th ird ant with the con s e nt of th e ministry on includes t he foll owing basis fo r the p of h er c hronic f atigue and my of ascial o ut in the May 11, 20 12 l e t ter from a physician. arin g, an ext en sion o f time w a s grante d o n ell ant wit h t he consen t o f the m inist ry a nd the udes t he follow ing basis for t he exten sion nsel, due to health problems she has bee n -m o nth e xtensio n ac cording to he r d oc to r's no t e rs o n to com p lete an inve stigation , to get the , an d to prepare for a nd ho st a fami l y ng at the sa me t im e . w ith t he a ppell ant attend i n g by teleph one . T he n g bases: e of a ca r e w orke r , could not phy si c al ly get to entation from the ministry. f i n vestigating her complaint regarding the ur in duration are detri mental to her health l has The care worker at the last minute, maki nq ii i mpo ssibl e for the
APPEAL# I advocate to obtain alternative assistance on short notice. The adjournment is to permit the advocate to make these alternative arrangements so that she can attend and represent the appellant on the appeal. • The hearing convened on March 20, 2014, with the appellant and the ministry attending by telephone and the appellant's advocate and her care worker attending in person. The panel chair stated a ground rule for conduct of the hearing that the parties would refrain from interrupting each other, that only one person should speak at a time, particularly since the parties were both attending by telephone, and to allow a person to complete his or her thought. The appellant would not agree to this ground rule as she stated that her disability causes her to forget important points that she needs to make so that if she does not raise the issue immediately, which may interrupt the speaker, she is not able to record the thought to raise later. The advocate agreed that it is important that the appellant not be interrupted as her brain injury will compel her to start her thought process over, from the beginning. • The panel chair pointed out that an adjournment had been granted by the panel to allow the advocate to attend the hearing so that she can assist the appellant with ensuring that all her important points are made, and reiterated that the ground rule will be enforced as part of the panel's ability to give directions necessary to maintain order at a hearing (Section 19.2 of the Employment and Assistance AcQ. The appellant asserted that she views this ground rule as a refusal by the panel to accommodate her disability. • Given the panel's decision on the ground rule, the appellant requested that she be allowed to record the hearing so that she would have an accurate record of what was said at the hearing. The panel chair referred to the Tribunal's Practices and Procedures which prohibits recording of the hearing by a party or any other person attending [Rule 5.2(e)] and to the legislative requirement that hearings be confidential [section 88 of the Employment and Assistance Regulation] and refused the appellant's request. • Given the panel's decision on the ground rule, the appellant stated that she might not be able to complete her presentation within the 3-hour time period allotted for the hearing because of her brain injury and cognitive disability and she requested a commitment from the panel that, in that case, an adjournment of the hearing will be granted to allow the hearing to be completed on another date. • The panel chair reiterated that the previous adjournment had been granted to allow the appellant's advocate to attend the hearing as the appellant had stated that her advocate is necessary to help to keep her focused, and the panel will rely on the advocate to help ensure the hearing is completed within the time allocated. The panel chair pointed out that close to 2 months have passed since the previous attendance, that the panel has received volumes of written materials, and that the hearing is an opportunity for the appellant to explain her position and to highlight the evidence that she considers important for the panel to consider in making its decision. The hearing was completed within the time allotted so that this issue was not revisited by the appellant. • The appellant pointed to the May 22, 2002 letter from the Ombudsman confirming it is not aooropriate for new mounds for denial to be raised by the ministry during the appeal process.
T he a p pellant r e q u es te d th a t t he ministry ma w a s sure of the case th a t she ne eds to m e et, S u bstan tive Mat ters D oc u m e nt a ry e vi den ce before the mini stry a t recons include d: 1 ) M inistry of H u man Re source s B C B ene fits Reco st a t ing th a t t he appel lant is eligi b l e for a Cel lSt recomm e nde d by h er chir opra ctor . Docume C e llS ti m micr ocurrent un it. A t ta che d is a March 22, n eed for th e " biofeedback de vi ce" t o "esse ntial p hrase "esse ntial f un c ti ons of l ife" reflects th e B e nefits P rogram Reg ul ation, t h e legislation in e 2 ) Ministry po l ic y respecti n g Eli g i ble Health S upple 200 5 a nd Dec embe r 1, 2 003) sta ting in par t: Elect rother apy ( Medica l E q uipm ent and Device -ba sic TENS unit (cost sh ould not exceed th Su pplem e nts a nd Pr ogram s -Eli g i ble an d -g el s e lectr odes or accesso ri e s Positi o ning D e v ices -Stan ding frames a re co The po l icy inclu des the fol lowi n g state m en ts: "The foll o wi n g general guideli ne s are provided fo r co v e rage by the minis try. T his l ist i s a ge [Emph asis included] 3) M i n is try of Employment and Income Ass ista nce showing that the maximum am ount that may be 4) Letter dated March 29, 2010 f rom the appe llant's positional devices, including the lnterX 5002 device and accessories, including the Dome, to treat myofascial trigger points throughout her body, muscle imbalances, sacral-iliac joint dysfu nction and a disp laced co c cy x. T he appella treatment to enable upright positionin g through the delivery of electrical current without having to grasp electrodes. 5) Medical Equipment Request & Justification form (the MERJ) dated March 31, 2010 completed by a physiotherapist requesting the lnterX 5002 device and other medical equipment, including the Dome accessory. 6) The minis tr y's original decision dated May 14, devices and accessories are not an eliqible item .... " and the reconsideration decision dated APPEAL# I k e i t s pr e s en ta ti on to the panel first s o th a t s he a nd the mi nis tr y agreed. ide r atio n r ele vant to t h e iss u e u nd er appe al n s i dera ti on D ec isio n dated Ju ly 4, 2 0 02 i m 600 p a ti ent p or t abl e microcurre nt unit as ntat i on respect ing t he original denial and the 20 02 physicia n' s let ter w h ich relate s th e f un c ti ons of li fe." T he panel note s th a t t he legis lative la ngu a ge in s. 2(1 )(a) of th e Di sab i l ity f fe c t at th a t date. ment s dated Dece m b er 2 , 2008 (a l so M ay 1, s ) -The following are covere d: e a moun t shown in Rate T a bl e : H ealth Non-Eligible He al th Su pplemen ts ) v e red. to a s sist in dete rminin g wh i ch item s are e l igible n e ral guid e and is NO T a ll -inc l u s iv e." BC Employment an d A s sistance Rate Table s paid for a Basic TENS unit is $250. physici an stating that the app ell a nt requires nt r e quires equipment th a t all o ws for home 2010, wh ich held tha t "the requested positi onal
I APPEAL# November 10, 2010, denying the appellant's request for the lnterX 5002 device and other devices under the legislation in effect as of April 1, 201 O. A copy of the Employment and Assistance Appeal Tribunal (the Tribunal) decision dated March 23, 2011, which determined that the ministry should have considered the request under the legislation in effect at the time of the appellant's request on March 31, 2010. 7) Letter dated July 7, 201 O from the appellant's physician stating that "the following positional supports are necessary to meet her basic needs, to provide assistance with daily living activities, to make her more independent and more able to participate socially." Included in the list of requested items is the lnterX 5002 device which the physician describes as being a different technology from microcurrent. It is "a battery operated device that delivers high amplitude electrical pulses through a biofeedback interactive loop with the body. It takes a reading from the skin and delivers what it determines to be the appropriate pulse to deliver. As the electrophysiology of the tissue changes the pulses that are delivered change. The pulses stimulate delta fibers, stimulates the release of endomorphine and dopamine and activates the body's natural pain relieving mechanisms (segmental and descending inhibition) thus decreasing acute, chronic and neurophathic pain, muscle spasm and increasing range of motion." The appellant requires the Dome accessory, which allows the treatment of the contoured areas that cannot be easily reached with the flexible array pad. The Dome is designed to be easily manipulated and does not have to be gripped, therefore it does not pose the same problem as holding the lnterX 5002 device itself. 8) Letter dated October 14, 201 O from the appellant's physician described by the physician as a continuation of the MERJ. The physician writes that the appellant's upright positioning is severely restricted and she has to spend most of her day lying down. The listed equipment, including the lnterX 5002 and the Dome accessory, is necessary for treatment to enable upright positioning. 9) Letter dated November 2, 201 O from the appellant's physiotherapist to the ministry stating in part that the physiotherapist understands that the appellant " ... has electrotherapy devices to help her pain management. These however don't bring her long-lasting relief from her symptoms anymore. Her Dr. [name of doctor] therefore recommended the use of two different machines which allow multiple currents and appliances. I am not familiar with those machines myself, but I trust [the doctor's] opinion on this matter." 10) Letter dated November 9, 2010 from the appellant's physiotherapist stating that she believes the appellant will benefit from the lnterX 5002 device, ". ..a long with dome, comb and soft tissue accessories." 11)Letter dated November 9, 2010 from the appellant's physician in response to the ministry's request for additional information respecting trials and costs of the requested items (the lnterX 5002 device and two other devices). The physician describes the lnterX 5002 device as an interactive neuro-stimulation device that costs $3,995 US plus the cost of the accessories, including the Dome for $250 US. 12)Letter dated January 17, 2011 from the appellant's physician stating in part that the lnterX 5002 device is an electrotherapy device and that, like a TENS unit, delivers electric current to the body. "However the type of current varies as does its therapeutic effect and the method of
c u r r e n t d e l i v e r y . 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" i o n d a t e d A p r i l 1 4 , 2 0 1 1 w h i c h d e n i e d t h e s o r i e s t o g e t h e r , u n d e r t h e l e g i s l a t i o n i n e f f e c t i n w h i c h s h e d e s c r i b e s t h e d i f f e r e n c e s b e t w e e n i b e s t h e l n t e r X 5 0 0 2 d e v i c e a s a d e v i c e t h a t l i m p e d a n c e . T h e D o m e i s " . . . a n e x t e r n a l a l l o w s c u r r e n t d e l i v e r y w i t h t h e h a n d p o s i t i o n e d o f h a v i n g t o c l a s p a r o u n d t h e r e c t a n g u l a r s h a p e d a s o f t h e b o d y w h e r e t h e f l e x i b l e a r r a y w o n ' t w o r k l l S t i m C S 6 0 0 " a c o n v e n i e n t e a s y t o u s e p a t i e n t p o r t e d t o p r o v i d e s i g n i f i c a n t a n d l a s t i n g p a i n l r e s u l t i n g i n a n i n c r e a s e i n m o b i l i t y w i t h d a y t o  o f t h e r a p y i s a m a j o r a d v a n c e m e n t o v e r b i t t h e h e a l i n g p r o c e s s . " t e r X 5 0 0 2 P a i n M a n a g e m e n t N e u r o s t i m u l a t i o n t e r X T h e r a p y ' ' i s d e s c r i b e d a s p r o v i d i n g " g e n t l e s t h e s k i n a t t h e a r e a o f p a i n o r i n f l a m m a t i o n . " i v e t h e r a p y " w i t h " U n i q u e d a m p e d , p u l s e d , i c h p r o v i d e s d y n a m i c , t a r g e t e d , h i g h d e n s i t y N S o r o t h e r E S t i m w h i c h p r o v i d e " P a s s i v e f o r t r e a t m e n t a p p l i c a t i o n s o f a l a r g e r a r e a o f s k i n e c t r o d e e a s e s t r e a t m e n t a p p l i c a t i o n o f l a r g e
1 9)Pri n t o ut of i nformation regarding the l nterX 20)Online definiti ons of TEN S (transcutaneous elect por t ab le dev ice use d to trea t chronic pain b y placed ov e r the painful a rea. 21 )O nline defi nitions of "p osit ion", " devic e", "electrotherapy'', 22) Wikipedia informati on about ele ctrothera py. 23)W rit ten submis sion on behal f of the appel lant 24)Case law, incl u d i n g the decision s in Abraha ms, Drilling , Hudson , Puskas, R i zzo Shoe s Ltd . and 25)R equest for Reco n s i d erati o n dated June 26, 20 T he following additional docume nt s wer e su b mitted re co ns ider a tion de cision bu t p r ior t o t he hearing a nd A ppeal Re cord , as well as Appendices A through P: 1) P rint ou t of th e mi ni st ry infor mati o n fo r eli gibili Canadia n En cycl o p e dic Digest for admi nistrativ print out of th e mi ni st ry reconsi de ra tio n pr o c edures; 2) On li n e de f initions of "an d . " 3 ) Ema il corr espondence dated May 26, 2 0 1 O betwee 4) Lette r dated Jul y 2 1, 22011 (sic ) from the app poin ts a re ca usin g the appel lan t to experience pa maint ai ning positi o n s. The ln t er X 5002 and th medically essenti al" to facilit ate the appellant transferring f r om dif ferent positi ons. Floor to ceiling poles equipment and slings also a re n ot a s uitable option. 5) Copy o f the ministry's reconsideration de cision request for the Enart device pursua nt to the legislation in 6) Copy of the ministry's reconsideration decision dated August 3, 2011 denying the appellant's reques t for the Dome accessory for the lnterX 5002 device pursuant to the legislati until March 31, 2010. 7) Letter dated September 8, 2011 from the appellant's physician stating, in part, that the lnterX 5002 and other requested devices "are not traditional TENS devices. They use different forms of electrical current and function differently in the body. Traditional TENS treatment worsened [ the ap pella n t's] pa in . Th erefore, a traditional TENS orovidina electrotheraov treatment to fthe anoellantl." The ohvsician continues " ...o f the APP EA L# I a c cessori es, i ncluding t he Dome. rical n erve st imulatio n ) a self-opera ted sen ding electrical i mpuls es t h rou gh e lectrodes "m a y " , "me d i cal", "positioning". received Marc h 18, 2011. Choi, Forty-Ninth Ven t ure s, Gustavson Waldoc k ; and, 11. b y the app el lan t to the Trib u na l su b s eque n t to th e are id entifi e d as a subs eq u ent subm i s sion in th e ty fo r a diet s up plement ; exc erpt from th e e l aw; email corr espondenc e w ith the Tri buna l ; n th e app e l lan t and a legal advocate. ellant's p hy sician st at in g in part th at t rig ger in an d difficulty wi th ad just in g a nd e Dome, along w it h oth e r equipment , "are : (a) adj usti ng a nd ma intai ning po si tions, and ( b) would not e li minate th e need for this dated August 4, 2011 denying the appellant's effect u ntil M arch 31, 2 010. on in effect device is not a n a p propriate manner of
d i f f e r e n t I n t e r X m o d e l s o n l y t h e I n t e r X 5 0 0 2 o f [ t h e a p p e l l a n t ' s ] c o m p l e x n e e d s : s u f f i c i e n t f e a t u r e a n d i s c a p a b l e o f a t t a c h i n g t o a l l t h e F l e x i b l e A r r a y ) 8 ) L e t t e r d a t e d M a y 1 1 , 2 0 1 2 f r o m a s e c o n d p h s t i m u l a t i o n d e v i c e a s a p o s i t i o n i n g d e v i c e f o r a n d m a i n t a i n i n g p o s i t i o n s ( e . g . s i d e l y i n g , l y i n s t a n d i n g , s i t t i n g a n d w a l k i n g ) ; ( b ) t r a n s f e r r i n g r o l l i n g o v e r ; a n d ( c ) m o v e m e n t o f e x c e s s b o d T h e p h y s i c i a n a l s o r e c o m m e n d s t h e l n t e r X d p o s i t i o n s o f l o w e l e c t r i c a l i m p e d a n c e , a r e a s t i s s u e s , a n d i d e n t i f y i n g t h e o p t i m a l t r e a t m e n t p u l s e d , s i n u s o i d a l , h i g h i m p u l s e , h i g h d e n s i t y i m p r o v i n g p o s t u r a l p r o b l e m s . 9 ) L e t t e r d a t e d O c t o b e r 4 , 2 0 1 2 f r o m a c o n s u l t a d i a g n o s e s t h e a p p e l l a n t w i t h a n u m b e r o f m e w h i c h p r o v i d e d i n a d e q u a t e p a i n c o n t r o l . T h e r e d u c e p a i n t o m a n a g e a b l e l e v e l s , r e d u c e t h T h e p h y s i c i a n n o t e s t h a t t h e l n t e r X d e v i c e a p r e g u l a r T E N S t h e r a p y a n d h a s a d d i t i o n a l f e a 1 0 ) L e t t e r d a t e d O c t o b e r 1 8 , 2 0 1 2 f r o m a t h i r d p h a p p e l l a n t ' s p h y s i c i a n w r o t e a l e t t e r t o t h e m i n o u t l i n e d a n d t h e s e w e r e r e q u i r e d t o h e l p c o n t i m e . 1 1 ) L e t t e r d a t e d J u l y 2 2 , 2 0 1 3 f r o m a s p o r t s m e d t h e l n t e r X 5 0 0 2 a n d i t s a c c e s s o r y e l e c t r o d e s H e b e l i e v e s t h a t a p o s i t i o n i n g d e v i c e i s n o t s o t o t r a n s f e r a n d a d j u s t p o s i t i o n s . H e b e l i e v e s b e c a u s e i t h a s t o b e a p p l i e d t o t h e a r e a s w h i r e s i s t a n c e i n d i f f e r e n t a r e a s o f t h e b o d y . 1 2 ) E m a i l d a t e d J u l y 2 6 , 2 0 1 3 f r o m t h e a p p e l l a n t p a n e l a t t h e p r e v i o u s h e a r i n g . 1 3 ) L e t t e r d a t e d J u l y 2 9 , 2 0 1 3 f r o m t h e s a m e s p o l n t e r X 5 0 0 2 d e l i v e r s h i g h a m p l i t u d e e l e c t r i c p t h e b o d y . B a s e d o n t h e r e a d i n g s , t h e u s e r i s w h i c h a r e t h e o p t i m a l s i t e s f o r t r e a t m e n t . 1 4 ) L e t t e r d a t e d S e p t e m b e r 1 0 , 2 0 1 3 f r o m t h e m i r e c o n s i d e r a t i o n d e c i s i o n a n d d e c i s i o n s u m m a 1 5 ) L e t t e r d a t e d O c t o b e r 2 8 , 2 0 1 3 f r o m t h e m i n i s p o s e d b v t h e a n n e l l a n t .A P P E A L # I p r o v i d e s t h e r a n g e o f f e a t u r e s n e e d e d b e c a u s e t r e a t m e n t p r o t o c o l s , h a s t h e a c t i v i t y r e a d i n g e l e c t r o d e s . " ( D o m e , C o m b , S o f t T i s s u e a n d y s i c i a n r e c o m m e n d i n g t h e l n t e r X 5 0 0 2 n e u r o  t h e a p p e l l a n t i n o r d e r t o f a c i l i t a t e : ( a ) a d j u s t i n g g s u p i n e , a n d u p r i g h t w e i g h t b e a r i n g p o s i t i o n s o f f r o m d i f f e r e n t p o s i t i o n s , e . g . s i t t i n g t o s t a n d i n g , y f l u i d s i n h e r l o w e r l e g s u p t o w a r d t h e p e l v i s . e v i c e " a s a p o s i t i o n i n g d e v i c e " f o r ( a ) l o c a t i n g i n t h e s k i n t h a t a r e n e u r o l o g i c a l l y r e l a t e d t o i n j u r e d l o c a t i o n s f o r d e l i v e r y o f t h e i n t e r a c t i v e , d a m p e d , c u r r e n t ; a n d ( b ) i n c r e a s i n g r a n g e o f m o t i o n a n d n t i n r h e u m a t o l o g y a n d i n t e r n a l m e d i c i n e w h o d i c a l c o n d i t i o n s a n d p a s t t r e a t m e n t i n t e r v e n t i o n s p h y s i c i a n p r e s c r i b e s t h e l n t e r X 5 0 0 2 d e v i c e t o e r i s k o f s u i c i d e a n d i m p r o v e s l e e p a n d f u n c t i o n . p a r e n t l y h a s d i s t i n c t p r o v e n a d v a n t a g e s o v e r t u r e s n o t a v a i l a b l e w i t h r e g u l a r T E N S e q u i p m e n t . y s i c i a n s t a t i n g i n p a r t t h a t i n M a r c h 2 0 1 0 t h e i s t r y a d v i s i n g o f t h e n e e d f o r t h e s p e c i f i c d e v i c e s t r o l p a i n a n d r e d u c e t h e r i s k o f s u i c i d e a t t h a t i c i n e p h y s i c i a n s t a t i n g i n p a r t t h a t h e p r e s c r i b e s [ F l e x i b l e r a y ( s i c ) , c o m b , d o m e a n d s o f t t i s s u e ] . l e l y a n e x t e r n a l d e v i c e u s e d t o a s s i s t i n d i v i d u a l s t h e l n t e r X m e e t s t h e c r i t e r i a f o r p o s i t i o n i n g d e v i c e c h h a v e t h e l o w e s t a m o u n t o f i m p e d a n c e o r r e g a r d i n g c o n d u c t o f b o t h t h e m i n i s t r y a n d t h e r t s m e d i c i n e p h y s i c i a n s t a t i n g i n p a r t t h a t t h e u l s e s t h r o u g h a b i o f e e d b a c k i n t e r a c t i v e l o o p w i t h a b l e t o i d e n t i f y t h e p o i n t s o f l o w e s t i m p e d a n c e , n i s t r y t o t h e a p p e l l a n t e n c l o s i n g t h e r y . t r y t o t h e a p p e l l a n t r e s p o n d i n g t o q u e s t i o n s
APPEAL# I 16)Letter dated January 13, 2014 from the ministry to the appellant advising the records requested are withheld in their entirety as the terms of the sanction limit the amount of time to be spent to 7 hours and it is not possible to accommodate the request within this time. 17)Copies of emails from the appellant to the Privacy Commissioner dated January 21, 2014 requesting a review of the ministry refusal to fill her FOi request and from a warehouse dated January 16, 2014 regarding the time required to locate and retrieve boxes. 18)Letter dated January 22, 2014 from a physician to the ministry stating in part that the appellant "requires the Dome electrode to support her hand in a relaxed, ergonomically correct position (that avoids having to grasp a device with her fingers) when delivering electrotherapy to large muscle areas. This is necessary because of myofascial trigger points. The Dome is also requires (sic) to locate specific sites in the body that have the lowest amount of impedance or resistance to electric current. These sites correlate with areas in need of treatment. Medical literature indicates that delivery of electric current to these sites results in maximal treatment outcomes." Should the appellant be unable to get the lnterX 5002, then purchase of the 1000 model is recommended. Although the appellant cannot attach the soft tissue electrode to the Inter X1000, she will still be able to get sufficient therapeutic benefit with using the lnterX 1000 to warrant its purchase. "In the medical field positioning equipment include devices that support parts of the body, devices that assist in transferring and devices that locate the positions in the body where abnormalities are present." Examples given by the physician included computerized tomography machines, magnetic resonance imaging devices and X ray equipment, and devices that provide electrotherapy treatment on acupuncture points including the lnterX. 19)Email dated January 28, 2014 between the appellant and her advocate regarding the appellant's trust. 20)Copies of Eligible Health Goods/Services Purchase Authorizations for TENS with a STOB of '7928' or '7929' [Medical Equipment Rentals/Repairs and Medical Supplies or Nutritional Supplements, respectively] dated December 17, 2007 to June 26, 2008 and Sample Service Line & STOB Coding Information. 21)1ndustry White Paper-Electrical Neruostimulation, Neuro Resource Group (NRG). 22)Print out of Distributor information regarding the lnterX technology. 23) Print out of an abstract regarding the electrical skin resistance method. 24) Print out of an abstract regarding the fall of impedance and bone and joint pain. 25) Print out of an abstract regarding a method of and device for determining the position of a medical instrument. 26)Print out from a Fall Protection Blog regarding learning about Fall Protection Positioning Devices.
2 7 ) F i r s t p a g e o f a r e s e a r c h a rt i c l e e n t i t l e d ' B l a d T e c h n i q u e . ' 2 8 ) P r i n t o u t o f W i k e p e d i a i n f o r m a t i o n r e g a r d i n g 2 9 ) P r i n t o u t o f o n l i n e i n f o r m a t i o n r e g a r d i n g a C o A l u m i n u m C o m m o d e , a n d b e d s f o r t h e h o m e 3 0 ) C o p y o f p a g e s f r o m a r e p o r t b y t h e O f f i c e o f f o r I n c o m e A s s i s t a n c e , a n d I m p l e m e n t a t i o n o 3 1 ) C o p i e s o f p a s t T r i b u n a l d e c i s i o n s r e s p e c t i n g c h a i r a s p o s i t i o n i n g d e v i c e s . T r i b u n a l d e c i s i o D i s a b i l i t y B e n e f i t s P r o g r a m R e g u l a t i o n . 3 2 ) O n l i n e d e f i n i t i o n o f " l i m i t e d r a n g e o f m o t i o n " t h r o u g h w h i c h a j o i n t c a n m o v e . 3 3 ) W i s e G e e k o n l i n e d e f i n i t i o n o f " v e r b a l a d j e c t i v 3 4 ) O n l i n e d e f i n i t i o n o f " a m b i g u i t y ' ' a s ( 1 ) t h e p o s m o r e d i s t i n c t w a y s a n d ( 2 ) v a g u e n e s s o r u n c 3 5 ) O n l i n e d e f i n i t i o n o f " s e n s e " . 3 6 ) O n l i n e d e f i n i t i o n o f " p a r t i c i p l e " a s t h e f o r m o f a d j e c t i v e . 3 7 ) P r i n t o u t f r o m t h e U V i c W r i t e r ' s G u i d e w i t h d e v e r b w h i c h e i t h e r d o e s n o t f u n c t i o n a s a v e r b a n o t h e r v e r b t o f o r m a p r e d i c a t e . 3 8 ) A d d i t i o n a l o n l i n e d e f i n i t i o n s o f " p o s i t i o n " , " d e v 3 9 ) A d d i t i o n a l o n l i n e d e f i n i t i o n o f T E N S a t y p e o t h e s k i n a n d a l o w a m o u n t o f e l e c t r i c i t y i s s e n s e n s a t i o n . 4 0 ) C o p i e s o f s . 1 6 o f t h e E A P W D A a s i t r e a d D e v e r s i o n w h i c h t o o k e f f e c t J u n e 1 , 2 0 1 0 . 4 1 ) E x c e r p t s f r o m t h e I n t e r p r e t a t i o n A c t , i n c l u d i n g 4 2 ) E x c e r p t s f r o m t h e E A P W D R , i n c l u d i n g S e c t i o p r o v i s i o n s ) a n d S e c t i o n 6 9 . 4 3 ) P r i n t o u t f r o m t h e m i n i s t r y w e b s i t e o f t h e P e r s A P P E A L # I d e r C a n c e r D e t e c t i o n U s i n g E l e c t r i c a l I m p e d a n c e a n E l e c t r o n i c A p e x L o c a t o r . n t o u r B e d p a n , a l u m b a r c u s h i o n , a n A l l I n O n e . t h e O m b u d s m a n r e g a r d i n g B a c k g r o u n d , A p p l y i n g f P r e v i o u s C o m m i t m e n t s . a l i f t c h a i r , m a t t r e s s a n d c u s h i o n s a n d R o l l a b o u t n d a t e d A p r i l 2 8 , 2 0 0 3 a p p l y i n g a s e c t i o n o f t h e : a r e d u c t i o n i n t h e n o r m a l d i s t a n c e a n d d i r e c t i o n e " a s a v e r b t h a t i s u s e d t o m o d i f y a n o u n . s i b i l i t y o f i n t e r p r e t i n g a n e x p r e s s i o n i n t w o o r e r t a i n t y o f m e a n i n g . a v e r b u s e d i n c o m p o u n d t e n s e s a n d a s a n f i n i t i o n o f " v e r b a l " h i g h l i g h t e d , b e i n g ' a f o r m o f a b u t a s a n o u n o r a d j e c t i v e , o r c o m b i n e s w i t h i c e " , " p o s i t i o n i n g " a n d " e l e c t r o t h e r a p y . " f t r e a t m e n t i n w h i c h e l e c t r o d e s a r e a t t a c h e d t o t t o t h e a f f e c t e d n e r v e s t o b l o c k t h e p a i n c e m b e r 1 , 2 0 0 7 M a y 3 1 , 2 0 1 0 a n d t h e c u r r e n t S e c t i o n 8 . n 7 9 ( T r a n s i t i o n i n r e s p e c t o f r e p e a l e d o n s W i t h D i s a b i l i t i e s F a c t S h e e t .
I n h e r 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 , t h e a p p e l l a n t w a p p e a l o n t h i s i s s u e , a n d a l l o f h e r d o c t o r s ' l e t t e r s o c l i n i c ' a n d M e d i c a l E q u i p m e n t J u s t i f i c a t i o n f o r m , a n d e n i a l f o r m . I n h e r N o t i c e o f A p p e a l , t h e a p p e l l a n t e x p r e s s e d h e d e c i s i o n . T h e a p p e l l a n t w r o t e t h a t t h e m i n i s t ry e r r e d e v i c e . A t t h e c o m m e n c e m e n t o f t h e h e a r i n g , t h e a p p e l l a n t j o u r n a l i s t r e g a r d i n g t h e m e a n i n g o f g r a m m a t i c a l t e r m T h e p a n e l c o n s i d e r e d t h i s a d d i t i o n a l i n f o r m a t i o n a s n e w e v i d e n c e . T h e m in i s t ry r e l i e d o 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 . f o r t h e D o m e a c c e s s o ry f o r t h e l n t e r X 5 0 0 2 N e u r o s 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 2 0 1 0 . A t t h e h e a r i n g , t h e m i n i s t r y s t a t e d t h a t t h e D o m e a c u s e l e s s u n l e s s u s e d w i t h t h e l n t e r X 5 0 0 2 D e v i c e a n m i n i s t r y s t a t e d t h a t a p r e v i o u s T r i b u n a l d e c i s i o n d a t d e c i s i o n w h i c h f o u n d t h a t t h e l n t e r X 5 0 0 2 i s n o t a n e A t t h e h e a r i n g , t h e a p p e l l a n t s t a t e d t h a t : • T h e l e g i s l a t i o n d o e s n o t h a v e t o e x p r e s s l y p r o a r e t h e r e t o a l l o w i t . • A l t h o u g h t h e m i n i s t r y s t a t e d t h a t s h e d o e s n o D o m e a c c e s s o r y i s u s e l e s s , t h e m i n i s t r y d o e s d e v i c e e l s e w h e r e , a n d s h e s t i l l h a s a j u d i c i a l r i g h t s c o m p l a i n t o n g o i n g a n d s h e m a y s t i l l b e • S h e h a s a d i s a b i l i t y t r u s t w h i c h i s w h o l l y d i s c r t o c o v e r t h e l n t e r X 5 0 0 2 a n d a l l t h e a c c e s s o r a c c e s s o r i e s e x c e p t o n e a n d i t w i l l w o r k w i t h t h t h e t r u s t e e o f t h e t r u s t w h i c h c o n f i r m s t h a t t h e s t a t e d t h a t s h e w i l l t h e n h a v e a f u l l y o p e r a b l e • W h i l e h e r d o c t o r s a i d t h a t i f s h e g e t s a l l t h e a m a x i m u m b e n e f i t a n d t r e a t a l l h e r a r e a s o f p a t h e r a p e u t i c b e n e f i t w i t h u s i n g t h e l n t e r X 1 0 0 0 f r o m a p h y s i c i a n d a t e d J a n u a r y 2 2 , 2 0 1 4 . • T h e p h y s i c i a n a l s o c o n f i r m s i n t h e l e t t e r t h a t t r e l a x e d , e r g o n o m i c a l l y c o r r e c t p o s i t i o n t h a t a v w h e n d e l i v e r i n g e l e c t r o t h e r a p y t o l a r g e m u s c l • T h e a p p l i c a b l e l e g i s l a t i o n o n l y r e q u i r e s t h a t t h i t p e r f o r m s a p o s i t i o n i n g f u n c t i o n a n d i s , t h e r e i n i t s d e c i s i o n t h a t t h e r e i s n o d e f i n i t i o n o f " p o • T h e d e f i n i t i o n o f " p o s i t i o n i n q d e v i c e " a s o u t f o A P P E A L # I r o t e t h a t s h e r e f e r s t o a l l r e c o r d s i n t h e p r e v i o u s n t h e s u b j e c t , a n d a l l l e t t e r s f r o m t h e ' p h y s i o d t h e H A B [ H e a l t h A s s i s t a n c e B r a n c h ] e a r l i e r r d i s a g r e e m e n t w i t h 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 i n s a y i n g t h a t t h e D o m e c a n n o t b e a p o s i t i o n i n g s u b m i t t e d a n u n d a t e d e m a i l f r o m a r e t ir e d s a n d a n i n t e r p r e t a t i o n o f " p o s i t i o n i n g d e v ic e . " p a rt o f t h e a p p e l l a n t ' s a r g u m e n t , c o n t a i n i n g n o T h e a p p e l l a n t s u b m i t t e d a r e q u e s t t o t h e m i n i s t r y t i m u l a t i o n D e v i c e o n M a r c h 3 1 , 2 0 1 0 . T h e b il i t i e s R e g u l a t i o n w a s a m e n d e d , e f f e c t i v e A p r i l 1 , c e s s o r y c a n n o t b e v i e w e d i n i s o l a t i o n , t h a t i t i s d w i l l n o t m e e t t h e r e q u e s t e d p u r p o s e . T h e e d S e p t e m b e r 1 8 , 2 0 1 3 c o n f i r m e d t h e m i n i s t ry l i g i b l e i t e m . v i d e f o r " e l e c t r o t h e r a p y " , a s l o n g a s t h e c r i t e r i a t h a v e t h e l n t e r X 5 0 0 2 d e v i c e a n d , t h e r e f o r e , t h e n o t k n o w t h a t . S h e m a y h a v e s e c u r e d t h e r e v i e w a p p l i c a t i o n p e n d i n g a s w e l l a s a h u m a n i s s u e d t h e l n t e r X 5 0 0 2 d e v i c e . e t i o n a ry a n d w h i l e t h e r e a r e n o t s u f f i c i e n t f u n d s i e s , t h e l n t e r X 1 0 0 0 d e v i c e c a n w o r k w i t h a l l t h e e D o m e a c c e s s o ry . S h e p r o v i d e d a l e t t e r f r o m t r u s t w i l l f u n d t h e l n t e r X 1 0 0 0 . T h e a p p e l l a n t s y s t e m . c c e s s o r i e s , t h e l n t e r X 5 0 0 2 w i l l p r o v i d e t h e i n , s h e w i l l s t i l l b e a b l e t o g e t s u f f i c i e n t t o w a r r a n t i t s p u r c h a s e , a s s e t o u t i n t h e l e t t e r h e D o m e a c c e s s o r y w i l l s u p p o r t h e r h a n d i n a o i d s h a v i n g t o g r a s p a d e v i c e w i t h h e r f i n g e r s e a r e a s . e r e q u e s t e d d e v i c e is a m e d i c a l d e v i c e a n d t h a t f o r e , a " p o s i t i o n i n g d e v i c e . " T h e m i n i s t r y a g r e e s s i t i o n i n g d e v i c e " p r o v i d e d i n t h e l e g i s l a t i o n . r t h b v t h e m i n i s t r v , o f " p r o v i d i n q a d i r e c t e x t e r n a l
I APPEAL# support when there is a deficiency in the ability to perform transfers or adjust one's position" is far too narrow since the legislation does not say that the device is limited to external support. The ministry definition also says under what circumstances the device can be used, that the device is for a certain reason, but this is an error in law to add criteria to the legislation. Items like slings, traction devices and dorsiflexion socks position the muscles and bones so they will heal but the ministry's definition of positioning device would exclude them as well. • In the letter dated January 22, 2014, the physician describes devices that locate the positions in the body where abnormalities are present, such as tomography machines, magnetic resonance imaging devices, X-Ray equipment, and lnterX devices that both located abnormalities and provide electrotherapy treatment. Another form of device is an electrical impedance device that has been used for bladder cancer detection and an Electronic Apex Locator which is used in endodontics to determine the position of the apical foramen. • The Dome accessory supports her hand because she cannot grip other devices for any length of time. Her doctor wrote in the July 7, 2010 letter that the Dome is designed to be easily manipula ted and does not have to be gripped, therefore it does not pose the same problem as holding the lnterX device itself. • Her doctors say that the Dome accessory, and the lnterX 5002 device, are "positioning devices" while the ministry is limiting the definition to the occupational therapy area. • Although the manufacturer does not describe the lnterX or the accessories as "positioning devices" specifically there are other devices that the ministry considers fall within the definition that also are not specifically described as positioning devices and can also be used for other purposes, such as preventing pressure sores or to provide relief so muscles do not tense up. • The decision of the Supreme Court of Canada in Abrahams is authority for the position that if there are two definitions that are plausible, the panel must favour the appellant's definition as any 'ambiguity' must be decided in the appellant's favour. • The dictionary definition of 'ambiguity' is the possibility of interpreting an expression in two or more distinct ways, so if the appellant's definition is plausible it must be favoured by the panel. The panel cannot simply rely on the ministry's definition but must analyze both definitions and decide if there is more than one plausible definition. 11 is not a matter of determining which definition is the 'best', but whether that put forth by the appellant is plausible. • The panel needs to interpret the definition in the context of Schedule C of the EAPWDR which deals with medical equipment and devices. • The court decision in Rizzo Shoes Ltd. is the leading case, which applied Abrahams and held that the words of an Act are to be read in their entire context and in their grammatical and ordinary meaning. • Section 8 of the Interpretation Act requires a large and liberal interpretation of the term. • The court held in Hudson that social welfare legislation must be interpreted with a benevolent purpose in mind. The court also stated that it is patently unreasonable not to put significant weight on the appellant's evidence unless there is a legitimate reason not to do so. • The word "positioning" is not an adjective, as the adjective is "positional," and is, rather, a "verbal." The UVic Writer's Guide describes a verbal as a form of a verb which functions as a noun or adjective, In the phrase "positioning device", the word "positioning" modifies "device" and indicates the action the device can perform. The retired journalist confirmed in his email that the word "positioning" as a verb means to put in place or position or to locate, therefore, the term "positioning device" can mean a device used to position or locate something. • The appellant pointed to an image of the Dome accessory, as set out in the manufacturer's information, and described it as a ball on which the hand is suooorted so the muscles can rest,
I APPEAL# held in place by a strap, and attached to the lnterX 5002 device which is a rectangular box approximately 6" X 2" X1" in dimension, so that large areas of the body can be treated by moving the ball around the body to locate optimal treatment area. • The appellant highlighted the manufacturer's information that the ergonomic design of the Dome electrode eases treatment application of larger areas of skin tissue, like the thigh. • The ministry cannot issue electrotherapy equipment with no legislative authority for doing so. When the legislation is amended, the ministry reviews its policy to ensure that it fits with the legislation and this was done in 2003, again in 2005 and also in 2008 and electrotherapy equipment continued to be provided. The ministry confirmed with her by way of letter that prior to legislative changes effective April 1, 201 0 electrotherapy equipment was considered an eligible item and that TENS machines were being issued as positioning devices. • The advocate called the ministry department responsible for making decisions regarding this equipment and it was confirmed that electrotherapy equipment is a "legislative orphan." • Some ministry workers were issuing electrotherapy equipment under another section of the legislation but it is against human rights legislation to grant items to some disabled persons and not to others. Some workers were issuing TENS machines as positioning devices probably because it was recognized that the TENS allows people to position better. • The lnterX device was licensed by the FDA as a TENS device and the use is essentially the same. When she asked a representative of the manufacturer about this, she was told that the lnterX had to be licensed as a TENS but it is actually a much more advanced device which is able to locate areas of low impedance whereas the basic TENS machine cannot. • Her doctor confirmed in a letter dated November 9, 2010 that the Dome accessory can be obtained at a cost of $250, which falls within the parameters set out in the ministry's policy. However, there is nothing in the legislation that restricts the policy to a certain monetary limit. • In the ministry's policy, a breast pump is listed as a positioning device so a liberal interpretation of the definition and of what is included should be used. • She had 3 hot plates issued to her as "positioning devices" through a Tribunal decision in 2003, which shows the wide range of items that can be included. She could not reach the height of the stove so the hot plates could be positioned to allow her to reach the hot surface. • Section 16(1) (d) of the EAPWDA is not relevant to her request. The ministry did not object to the admissibility of the documents included in the subsequent submission in the Appeal Record and in Appendices A through P, and did not raise an objection to the appellant's oral testimony. The panel determined that the additional documentary evidence submitted by the appellant which relates to her medical conditions and the use of the Dome accessory and the lnterX 5002 device as being in support of the information and records before the ministry at reconsideration and, therefore, admissible pursuant to s. 22(4) of the Employment and Assis tance Act. The panel did not admit the evidence relating to the appellant's need for the lnterX 1000 device as this was not in support of information or records that were before the ministry on reconsideration, The panel considered additional information, such as dictionary definitions, as argument.
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 u n d e r a p p e a l i s w h e t h e r t h e m i n i s t ry r e c o r e q u e s t f o r t h e D o m e a c c e s s o r y ( t h e D o m e ) f o r t h e d e v i c e ) i 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 o r e n a c t m e n t i n 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 . L e g i s l a t i o n E A P W D A f a s i t r e a d a n M a r c h 3 1 , 2 0 1 0 1 R e c o n s i d e r a t i o n a n d a p p e a l r i g h t s 1 6 . ( 1 ) S u b j e c t t o s e c t i o n 1 7 , a p e r s o n m a y r e q u e d e c i s i o n s m a d e u n d e r t h i s A c t o r t h e r e g u ( d ) a d e c i s i o n i n r e s p e c t o f t h e a m o u n t o f p e r s o n ' s f a m i l y u n i t i f t h a t a m o u n t i s l e ( i ) t h e m a x i m u m a m o u n t o f t h e s u ( i i ) t h e c o s t o f t h e l e a s t e x p e n s i v e s u p p l e m e n t . E A P W D R f a s I t r e a d o n M a r c h 3 1 . 2 0 1 0 1 P a r t 5 : D i v i s i o n 4 H e a l t h S u p p l e m e n t 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 ) T h e m i n i s t e r m a 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 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 d u l e C t o o r f o r a f a m 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 . . . E A P W D R S c h e d u l e C H e a l t h S u p p l e m e n t s . s . 3 f a s i t r e a d o n S e c t i o n 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 ( 1 ) T h e f o l l o w i n g 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 a r e t h e t h e s u p p l e m e n t s a r e 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 e t h i s r e g u l a t i o n : ( a ) w h e e l c h a i r s , p e r s o n a l m o t o r i z e d m o b i l i t y d e v i c e s , ( b ) o r t h o t i c s a n d b r a c i n g , i f . . . ( c ) h e a r i n g a i d s , i f . . . ( d ) p o s i t i o n i n g d e v i c e s , i f ( i ) r e p e a l e d ( i i ) r e p e a l e d ( i i i ) t h e p e r s o n h a s r e c e i v e d t h e p r e a u t h o r i z a t i o n r e q u e s t e d , a n d ( i v ) 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 s u p p l e m e n t ; ( e ) b r e a t h i n g d e v i c e s , i f . . . ( 2 ) I n a d d i t i o n t o t h e r e q u i r e m e n t s o f s u b s e c t i o n ( l ) ( a ) o r o f t h e f o l l o w i n g : ( a ) a p r e s c r i p t i o n o f a m e d i c a l p r a c t i t i o n e r o r n u r s e p A P P E A L # I 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 t h e a p p e l l a n t ' s l n t e r X 5 0 0 2 N e u r o s t i m u l a t i o n D e v i c e ( t h e l n t e r X 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 s t t h e m i n i s t e r t o r e c o n s i d e r a n y o f t h e f o l l o w i n g l a t i o n s : . . . a s u p p l e m e n t p r o v i d e d t o o r f o r s o m e o n e i n t h e s s t h a n t h e l e s s e r o f p p l e m e n t u n d e r t h e r e g u l a t i o n s , a n d a n d a p p r o p r i a t e m a n n e r o f p r o v i d i n g t h e u t i n s e c t i o n 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 r 3 [ m e d i c a l 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 r o v i d e d t o o r f o r a M a r c h 3 1 . 2 0 1 0 1 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 i d f o r b y t h e m i n i s t r y i f 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 c a n e s , c r u t c h e s a n d w a l k e r s , i f . . . o f t h e m i n i s t e r f o r t h e p o s i t i o n i n g d e v i c e f a m i l y u n i t t o p a y t h e c o s t o f t h e h e a l t h ( d ) , t h e m i n i s t e r m u s t r e q u i r e o n e , a n d m a y r e q u i r e b o t h , r a c t i t i o n e r f o r t h e w h e e l c h a i r , p e r s o n a l m o t o r i z e d m o b i l i t y
d e v i c e , c a n e , c r u t c h e s , w a l k e r o r p o s i t i o n i n g d e v ( b ) a n a s s e s s m e n t b y a n o c c u p a t i o n a l t h e r a p i s t o r p p e r s o n a l m o t o r i z e d m o b i l i t y d e v i c e , c a n e , c r u t c h D i s a b i l i t y B e n e fi t s P r o g r a m R e g u l a t i o n , S c h e d u l e C , s . 2 ( a 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 b e n e f i t s t h a t m a y b e p a i d f o p e r s o n s w h o a r e e l i g i b l e u n d e r s e c t i o n 3 2 ( 1 ) o f t h e r e g u l a t i o ( a ) d u r a b l e m e d i c a l e q u i p m e n t a n d a p p l i a n c e s t h a t a r e m p o s i t i o n i n g , b r e a t h i n g o r o t h e r f u n c t i o n s e s s e n t i a l t o o f f u n d i n g a r e a v a i l a b l e t o t h e a p p l i c a n t . E A P W D R L i f e t h r e a t e n i n g H e a l t h N e e d s . 6 9 ( a s i t r e a d o n M 6 9 . T h e m i n i s t e r m a 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 d i s a b i l i t i e s , 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 p e h 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 ( a ) t h e p e r s o n f a c e s a l i f e t h r e a t e n i n g h e a l t h n e e d a n d t h e 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 u n i t w i t h w h i c h t o m ( b ) t h e m i n i s t e r d e t e r m i n e s t h a t t h e h e a l t h s u p p l e m e n t i P a r t i e s ' P o s i t i o n s a n d P a n e l ' s R e a s o n s f o r D e c i A p p l i c a t i o n o f s e c t i o n 1 6 o f t h e E A P W D A M i n i s t ry ' s P o s i t i o n T h e 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 c l u d e d t h a t t h e p a r e q u i p m e n t a r e e x c e e d e d , m a k i n g r e f e r e n c e t o s e c t i A p p e l l a n t ' s P o s i t i o n 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 s e c t i o n 1 6 o f t h e E A P t h e a l t e r n a t i v e , i f f o u n d t o b e a p p l i c a b l e , t h e c r i t e r i a P a n e l ' s R e a s o n s T h e p a n e l c o n c l u d e s t h a t s e c t i o n 1 6 o f t h e E A P W D A r e c o n s i d e r a t i o n , i s n o t a t i s s u e i n t h i s a p p e a l a n d , b a r e c o n s i d e r a t i o n d e c i s i o n , w a s n o t a b a s i s f o r d e n i a l E A P W D R , S c h e d u l e C , s . 3 [ a s i t r e a d o n M a r c h 3 A p p l i c a t i o n o f s e c t i o n 3 ( 1) / d ) m e a n i n g o f " p o s i t i o n i M i n i s t ry ' s P o s i t i o n L e g i s l a t i o n T h e a p p e l l a n t i s e l i g i b l e t o r e c e i v e h e a l t h s u p p l e m e n r e q u e s t e d i t e m , t h e D o m e a c c e s s o r v , i s n o t a n e l i a i b A P P E A L # I i c e ; h y s i c a l t h e r a p i s t c o n f i r m i n g t h e n e e d f o r t h e w h e e l c h a i r , e s , w a l k e r o r p o s i t i o n i n g d e v i c e . I t r e a d o n J u l y 4 . 2 0 0 2 l r b y t h e m i n i s t e r i f t h e s e r v i c e s o r b e n e f i t s a r e p r o v i d e d t o n : e d i c a l l y n e c e s s a r y t o p r o v i d e f o r b a s i c m o b i l i t y , t h e s u s t e n a n c e o f l i f e a n d f o r w h i c h n o a l t e r n a t e s o u r c e s a r c h 3 1 . 2 0 1 0 1 i n S c h e d u l e C t o a f a m i l y u n i t t h a t i n c l u d e s a p e r s o n w i t h 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 r e a r e n o r e s o u r c e s e e t t h a t n e e d , a n d s n e c e s s a r y t o m e e t t h a t n e e d . s i o n a m e t e r s f o r t h e p r o v i s i o n o f e l e c t r o t h e r a p y o n 1 6 o f t h e E A P W D A . W D A h a s n o a p p l i c a t i o n t o t h i s a p p e a l a n d , i n i n t h e s e c t i o n h a v e b e e n m e t . , w h i c h a d d r e s s e s a n a p p l i c a n t ' s r i g h t t o s e d o n t h e m i n i s t r y ' s l e n g t h y a n a l y s i s w i t h i n t h e o f t h e D o m e a c c e s s o r y . 1 , 2 0 1 0 ] n g d e v i c e " t s u n d e r s e c t i o n 6 2 o f t h e E A P W D R b u t t h e l e i t e m a s m e d i c a l e a u i o m e n t o r d e v i c e s u n d e r
I APPEAL# section 3 of Schedule C of the EAPWDR, including "positioning devices" under subsection (1)(d). The ministry noted that the legislation does not define "positioning devices" and submitted that, in terms of medical equipment, "positioning devices" provide a direct external support when there is a deficiency in the ability to perform transfers or adjust one's position, such as hospital beds, pressure relief mattresses, custom seating for wheelchairs, lifts, grab bars, raised toilet seats, and floor-to ceiling poles. The Dome accessory is electrotherapy equipment intended primarily for pain management and is not inherently a positioning device; it is medical equipment used to administer electrotherapy. When the appellant's request for a Cellstim 600 patient portable microcurrent unit was approved by reconsideration decision dated July 4, 2002, the Disability Benefits Program Regulation was in effect, but the decision did not reference the section or part thereof that was relied upon. Ministry information does not describe medical equipment used for electrotherapy as a "positioning device" or that it was provided to the appellant as a "positioning device", notwithstanding the ministry's March 4, 2011 letter to the appellant. Medical equipment used for electrotherapy appears to be a "legislative orphan." Appellant's Position-Legislation The requested item, the Dome accessory, is an eligible item as a "positioning device" under section 3(1)(d) of Schedule C of the EAPWDR. The appellant argued that the ministry failed to reasonably interpret the meaning of "positioning device," as the only limiting parameter set out in the legislation is that a positioning device must be a medical device. Since the ministry agrees that the legislation does not define the term "positioning device", the phrase must be interpreted according to the principles of statutory interpretation as set out in the case law in Re Rizzo & Rizzo Shoes Ltd. [1998] 1 S.C.R. 27, Abrahams v. Canada (1983), 142 D.L.R. (3d) 1, and Hudson v. EAAT(2009) BCSC 1461, and section 8 of the Interpretation Act RSBC 1996, c. 238. The appellant argued that Re Rizzo & Rizzo Shoes Ltd. is authority for the position that the words of an Act are to be read in their entire context and in their grammatical and ordinary sense. The appellant argued that the court held in Hudson that social welfare legislation must be interpreted with a benevolent purpose in mind. Case law and s. 8 of the Interpretation Act require that the term "positioning device" must be interpreted in a large and liberal manner and any ambiguity in the legislative language must be resolved in the appellant's favour. The dictionary definition of 'ambiguity' is the possibility of interpreting an expression in two or more distinct ways, so if the appellant's definition is plausible it must be favoured by the panel. The appellant argued that the ministry's definition of a "positioning device" as "intended to provide a direct external support when there is a deficiency in the ability to perform transfers or to adjust one's position" is too restrictive. The appellant argued that it is an error in law for the ministry to add criteria to the legislation since section 3 of Schedule C does not say that the device is limited to external support or restrict the circumstances under which the device can be used. The appellant argued that the Supreme Court of Canada held that words from legislation are to be read in their ordinary sense and, the appellant argued, since dictionaries provide the ordinary meaning of a word, dictionary definitions can be used to establish the meaning of a legislative term. According to the dictionary definitions of "positioning" provided, the device can be used to put something in a particular or appropriate place or position or to locate something, to determine the position of something. In a letter dated January 22, 2014, her physician describes several medical devices that locate the positions in the bodv where abnormalities are present, such as tomoaraphv
m a c h i n e s , m a g n e t i c r e s o n a n c e i m a g i n g d e v i c e s , X l o c a t e d a b n o r m a l i t i e s a n d p r o v i d e e l e c t r o t h e r a p y t r a s e x a m p l e s o f p o s i t i o n i n g e q u i p m e n t , i t i s n o t a p p " p o s i t i o n i n g d e v i c e s " t o d e v i c e s r e l a t e d o n l y t o o c c u h a d 3 h o t p l a t e s i s s u e d t o h e r a s " p o s i t i o n i n g d e v i c s h o w s t h e w i d e r a n g e o f i t e m s t h a t c a n b e i n c l u d e d T h e a p p e l l a n t a r g u e d t h a t t h e c o u r t h e l d i n H u d s o n s i g n i f i c a n t w e i g h t o n t h e a p p e l l a n t ' s e v i d e n c e u n l e s a p p e l l a n t a r g u e d t h a t t h e m e d i c a l e v i d e n c e e s t a b l i s a c c e s s o r y i s u s e d a s a p o s i t i o n i n g d e v i c e . T h e a p p i n t h e m a n u f a c t u r e r ' s i n f o r m a t i o n , a s a b a l l o n w h i c h e l d i n p l a c e b y a s t r a p , a n d a t t a c h e d t o t h e l n t e r X t h i g h o r b a c k , c a n b e t r e a t e d w i t h a f o r m o f e l e c t r o t a p p e l l a n t a r g u e d t h a t t h e l n t e r X t e c h n o l o g y b o t h l o c t h r o u g h t h e u s e o f t h e D o m e a c c e s s o r y , h o l d s h e r h t o d e l i v e r t h i s t r e a t m e n t . T h e a p p e l l a n t a r g u e d t h a t t h e m i n i s t r y c a n n o t p r o v i d a u t h o r i t y . T h e p o l i c y m a n u a l r e s p e c t i n g t h e l e g i s l a t i d e v i c e s a s a p p r o v e d b e n e f i t s . I n t h i s c a s e , t h e l e g i s p e c i f i c a l l y s u b s e c t i o n ( 1 ) ( d ) w h i c h i d e n t i f i e s t h e m e p r o v i d e d . T h e m i n i s t r y c o n f i r m e d i n a l e t t e r t o h e r d c o n s i d e r e d a n e l i g i b l e i t e m p r i o r t o A p r i l 1 , 2 0 1 0 a n d d e v i c e s . " P a n e l ' s R e a s o n s · L e g i s l a t i o n D e f i n i n g " P o s i t i o n i n g D e v i c e " W h e n c o n s i d e r i n g t h e a p p l i c a t i o n o f s e c t i o n 3 ( 1 ) ( d ) m e a n i n g o f t h e t e r m " p o s i t i o n i n g d e v i c e . " T h e a p p e c o n s t r u c t i o n t h a t " t h e w o r d s o f a n A c t a r e t o b e r e a d a n d o r d i n a r y s e n s e h a r m o n i o u s l y w i t h t h e s c h e m e o o f P a r l i a m e n t . " T h e a p p e l l a n t a r g u e d t h a t t h e w o r d s s e p a r a t e l y a n d a r e t h e r e b y r e n d e r e d a m b i g u o u s a s a p p e l l a n t p o i n t e d t o a d i c t i o n a r y d e f i n i t i o n o f " p o s i t i o p o s i t i o n " a s w e l l a s " t o d e t e r m i n e t h e p o s i t i o n o f , l o c d e v i c e " c a n b e d e f i n e d a s a d e v i c e t h a t l o c a t e s p o s a n d t h e s i t e s o n t h e b o d y t h a t n e e d t o b e t r e a t e d , w m a n u f a c t u r e r ' s i n f o r m a t i o n f o r t h e l n t e r X t e c h n o l o g y i s a b l e t o s c a n a n d i d e n t i f y o p t i m a l t r e a t m e n t p o i n t s a p p e l l a n t a r g u e d t h a t s i n c e t h e d e f i n i t i o n t h a t s h e p u p a n e l , a s s e t o u t b y t h e S u p r e m e C o u r t o f C a n a d a i W h i l e t h e S u p r e m e C o u r t o f C a n a d a h e l d i n A b r a h a l e g i s l a t i v e l a n g u a g e s h o u l d b e r e s o l v e d i n f a v o u r o f p a r t i c u l a r l y h e l p f u l t o c o n s i d e r p o s s i b l e m e a n i n g s o f i s p a r t o f a l e g i s l a t i v e p h r a s e . T h e p a n e l f i n d s t h a t t " p o s i t i o n i n a d e v i c e " w i t h t h e w o r d s t o a e t h e r t o i o i n t l v I A P P E A L # R a y e q u i p m e n t , a n d l n t e r X d e v i c e s t h a t b o t h e a t m e n t . G i v e n t h a t t h e p h y s i c i a n d e s c r i b e s t h e s e r o p r i a t e f o r t h e m i n i s t r y t o l i m i t t h e d e f i n i t i o n o f p a t i o n a l t h e r a p y . 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 e s " t h r o u g h a T r i b u n a l d e c i s i o n i n 2 0 0 3 , w h i c h w i t h i n t h i s d e f i n i t i o n . t h a t i t i s p a t e n t l y u n r e a s o n a b l e n o t t o p u t s t h e r e i s a l e g i t i m a t e r e a s o n n o t t o d o s o . T h e h e s t h a t , i n h e r p a r t i c u l a r c a s e , t h e D o m e e l l a n t d e s c r i b e d t h e D o m e a c c e s s o r y , a s s e t o u t h t h e h a n d i s s u p p o r t e d s o t h e m u s c l e s c a n r e s t , d e v i c e s o t h a t l a r g e r a r e a s o f s k i n t i s s u e , l i k e t h e h e r a p y b y m o v i n g t h e b a l l o v e r t h e b o d y . T h e a t e s a r e a s o f t h e b o d y t h a t r e q u i r e t r e a t m e n t a n d , a n d i n a n e r g o n o m i c a l l y c o r r e c t p o s i t i o n i n o r d e r e a b e n e f i t / s u p p l e m e n t w i t h o u t l e g i s l a t i v e o n i n p l a c e o n M a r c h 3 1 , 2 0 1 0 l i s t s e l e c t r o t h e r a p y s l a t i v e a u t h o r i t y i s s e c t i o n 3 o f S c h e d u l e C , d i c a l e q u i p m e n t a n d d e v i c e s w h i c h m a y b e a t e d M a r c h 4 , 2 0 1 1 t h a t T E N S m a c h i n e s w e r e t h a t t h e y w e r e b e i n g i s s u e d a s " p o s i t i o n i n g t o t h e c i r c u m s t a n c e s o f t h i s c a s e , a t i s s u e i s t h e l l a n t r e f e r r e d t o t h e m o d e m p r i n c i p l e o f s t a t u t o r y i n t h e i r e n t i r e c o n t e x t a n d i n t h e i r g r a m m a t i c a l f t h e A c t , t h e o b j e c t o f t h e A c t , a n d t h e i n t e n t i o n " p o s i t i o n i n g " a n d " d e v i c e " s h o u l d b e c o n s i d e r e d c a p a b l e o f t w o o r m o r e p l a u s i b l e m e a n i n g s . T h e n i n g " a s m e a n i n g b o t h " t o p u t i n p l a c e o r a t e . " T h e a p p e l l a n t a r g u e d t h a t " p o s i t i o n i n g i t i o n s i n t h e b o d y w h e r e a b n o r m a l i t i e s a r e p r e s e n t h i c h i s c o n s i s t e n t w i t h l a n g u a g e u s e d i n t h e t o g e t h e r w i t h t h e D o m e a c c e s s o r y , s t a t i n g t h a t i t a n d t r e a t o n l y t h o s e a r e a s t h a t a r e i n j u r e d . T h e t s f o r t h i s p l a u s i b l e , i t m u s t b e f a v o u r e d b y t h e n A b r a h a m s . m s t h a t a n y d o u b t a r i s i n g f r o m d i f f i c u l t i e s i n t h e c l a i m a n t , t h e c o u r t a l s o o p i n e d t h a t i t i s n o t o n e o f t h e w o r d s s t a n d i n g a l o n e , w h e n t h e w o r d h e m i n i s t r y r e a s o n a b l y c o n s i d e r e d t h e p h r a s e r e f e r t o a d e v i c e s i m i l a r i n t v p e t o t h e o t h e r
APPEAL# I items of medical equipment and devices listed in section 3 of Schedule C. 'Wheelchairs/ canes" [Section 3(1)(a)], "orthotics/ bracing" [Section 3(1)(b)], "hearing aids" [Section 3(1)(c)] and "breathing devices" [Section 3(1)(e)] all have a common feature of functioning to provide external support or aid to address a deficiency in a person's ability to independently [ambulate], [hear]. or [breathe]. All of the medical equipment and devices listed in the section are basic items for personal use and are of a different type than those listed by the physician in the January 22, 2014 letter, which are sophisticated diagnostic and treatment equipment primarily intended for use in a clinical or hospital setting. There is no need to dissect the words when, together, there is plain and common sense meaning, consistent with the context of the other listed items in section 3. Statutory "interpretation," or relying on extra-textual considerations, is only required when a text is found to be ambiguous, or capable of two or more plausible meanings, in order to decide which of two or more plausible alternatives is better. In the context of the section setting out various types of medical equipment and devices, the panel finds that the ministry provided a plausible, orr easonable, definition of "positioning device" as " . .. a device which provides external support to address a deficiency in a person's ability to independently position." The appellant argued that this definition is too restrictive and it is an error in law for the ministry to add criteria to the legislation since section 3 of Schedule C does not say that the device is limited to external support or restrict the circumstances under which the device can be used. The panel finds that the ministry's definition appropriately includes the common features of the items listed in section 3, all of which are equipment or devices designed to address a deficiency in a person's ability to independently perform a particular physical function and accomplishes this through providing a basic, external support or aid. While the appellant proposes a possible definition of "positioning device" to include devices that locate and treat the positions in the body where abnormalities are present, the panel finds that this definition is not plausible, or reasonable, in the context of section 3. The appellant argued that she was granted 3 hot plates as "positioning devices;" however, the panel finds this was as a result of a Tribunal decision which applied section 2 of the Disability Benefits Program Regulation relating to "durable medical equipment and appliances that are medically necessary to provide for basic mobility, positioning, breathing or other functions essential to the sustenance of life." Considering the larger context of Schedule C of the EAPWDR relating to health supplements, section 2 of the legislation already provides the option for using various services employing pain relief therapies under 'general health supplements.' Services for acupuncture, naturopathy, and physiotherapy, for example, include forms of treatment, using different types of techniques and equipment that are applied specifically to the site of the body that need to be treated. If the legislative eligibility criteria for section 2 of Schedule C of the EAPWDR are met, a person with disabilities is entitled to receive treatments to alleviate pain and, thereby, attain greater independence. In the context of the health supplements section of Schedule C, the panel has considered the plain meaning of the term in Section 3 in which "positioning device" means a device that is used to position a person or a body part and support it in place for a period of time. This view is consistent with the definition proffered by the ministry -a device which provides external support to address a deficiency in a person's ability to independently position.
A p p l y i n g " P o s i t i o n i n g D e v i c e " T h e p a n e l f i n d s t h a t t h e D o m e a c c e s s o r y d o e s n o t w h i c h , a s s t a t e d a b o v e , t h e p a n e l f i n d s c o n s i s t e n t w d e v i c e , " a s a d e v i c e w h i c h p r o v i d e s e x t e r n a l s u p p o i n d e p e n d e n t l y p o s i t i o n . T h e a p p e l l a n t p r o v i d e d n u m e q u i p m e n t , i n c l u d i n g t h e D o m e a c c e s s o ry , a s " p o s i c o n s i s t e n t w i t h t h e m a n u f a c t u r e r ' s i n f o r m a t i o n b e f o a b i l i t y o f t h e l n t e r X e q u i p m e n t t o l o c a t e o r p o s i t i o n o a p p e l l a n t ' s p h y s i c i a n s ' d e f i n i n g o f t h e l n t e r X e q u i p m i n t e r p r e t t h e l e g i s l a t i v e l a n g u a g e i s n o t d e t e r m i n a t i v r e p e a t e d l y r e f e r s t o t h e l n t e r X e q u i p m e n t a s e l e c t r o F u r t h e r , t h e p a n e l f i n d s t h a t a l t h o u g h t h e D o m e a c c e r g o n o m i c a l l y c o r r e c t p o s i t i o n , t h e p r i m a r y u s e o f t h t o d e l i v e r t h e p a i n t r e a t m e n t p r o v i d e d b y t h i s t e c h n o T h e a p p e l l a n t a r g u e d t h a t T E N S m a c h i n e s , a s a t y p t h e m i n i s t r y , t h a t t h i s m u s t h a v e b e e n d o n e w i t h l e g p u r s u a n t t o s e c t i o n 3 o f S c h e d u l e C , a n d t h i s p o s i t i o M a r c h 4 , 2 0 1 1 l e t t e r t o h e r . T h e m i n i s t r y d e s c r i b e d w h i c h a t t a c h e s t o t h e b o d y w i t h e l e c t r o d e p a d s t o s e a s a r t i f i c i a l m e s s a g e s w h i c h c a u s e s t h e b r a i n t o p r o f i n d s t h a t e l e c t r o t h e r a p y e q u i p m e n t , a s a p a i n m a n a w h i c h p r o v i d e s e x t e r n a l s u p p o r t t o a d d r e s s a d e f i c i e a n d , t h e r e f o r e , d o e s n o t f a l l w i t h i n t h e p l a i n m e a n i n g f r o m o n e m i n i s t ry w o r k e r s t a t i n g t h a t T E N S m a c h i n e f o l l o w e d b y a l e t t e r t o t h e a p p e l l a n t d a t e d M a r c h 1 1 t h e d e f i n i t i o n o f a p o s i t i o n a l d e v i c e . " T h e m i n i s t r y s t a t e d t h a t e l e c t r o t h e r a p y e q u i p m e n t a p p a n e l f i n d s m e a n s t h e r e w a s n o l e g i s l a t i v e " p a r e n t " I f a T E N S m a c h i n e w a s p r o v i d e d b y t h e m i n i s t ry a s b e e n d o n e i n e r r o r , a n d t h i s p a s t p r a c t i c e w o u l d n o t m i n i s t ry a c k n o w l e d g e d t h a t e l e c t r o t h e r a p y e q u i p m e n t h e m i n i s t ry a l s o c o n s i d e r e d t h e a p p e l l a n t ' s r e q u e s t b e l o w . F o r t h e a b o v e r e a s o n s , t h e p a n e l i s o f t h e o p i n i o n t h s e c t i o n 3 o f S c h e d u l e C o f t h e E A P W D R i s n o t a m b s e n s e m e a n i n g t h a t c o r r e s p o n d s w i t h a r e a s o n a b l e f i n d s t h a t t h e m i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t t h " p o s i t i o n i n g d e v i c e " d e f i n i t i o n a n d i s , t h e r e f o r e , n o t a t h e E A P W D R . M i n i s t r y ' s P o s i t i o n P o l i c y R e g a r d i n g t h e p o l i c y r e s p e c t i n g s e c t i o n 3 o f S c h e d u M a r c h 3 1 , 2 0 1 0 , t h e m i n i s t r y a r g u e d t h a t t h e r e a r e a c a t e g o r y o f ' p o s i t i o n i n g d e v i c e s ' s u c h a s b e d s , s p e c e q u i p m e n t u s e d f o r e l e c t r o t h e r a p y i s n o t i n c l u d e d i n A P P E A L # I f a l l w i t h i n t h e p l a i n m e a n i n g o f " p o s i t i o n i n g d e v i c e " i t h t h e m i n i s t r y ' s d e f i n i t i o n f o r " p o s i t i o n i n g r t t o a d d r e s s a d e f i c i e n c y i n a p e r s o n ' s a b i l i t y t o e r o u s p h y s i c i a n s ' l e t t e r s d e s c r i b i n g t h e l n t e r X t i o n i n g d e v i c e s " w h i c h , t h e a p p e l l a n t a r g u e d , a r e r e t h e m i n i s t ry a t r e c o n s i d e r a t i o n r e s p e c t i n g t h e p t i m a l t r e a t m e n t p o i n t s . T h e p a n e l f i n d s t h a t t h e e n t a s a " p o s i t i o n i n g d e v i c e " o r p u r p o r t i n g t o e o f t h e i s s u e . T h e m a n u f a c t u r e r ' s i n f o r m a t i o n t h e r a p y t r e a t m e n t o r t h e r a p y f o r p a i n r e l i e f . e s s o ry s e r v e s t o h o l d t h e a p p e l l a n t ' s h a n d i n a n e a c c e s s o r y i s t o a t t a c h t o t h e l n t e r X d e v i c e a n d l o g y . e o f e l e c t r o t h e r a p y e q u i p m e n t , w e r e p r o v i d e d b y i s l a t i v e a u t h o r i t y a s " p o s i t i o n i n g d e v i c e s , " n h a s b e e n c o n f i r m e d b y t h e m i n i s t r y i n t h e a b a s i c T E N S u n i t a s a b a t t e ry p o w e r e d d e v i c e n d i m p u l s e s t h r o u g h n e r v e e n d i n g s t o t h e b r a i n d u c e e n d o r p h i n s t o m a n a g e p a i n . T h e p a n e l g e m e n t t h e r a p y , c a n n o t b e s a i d t o b e a d e v i c e n c y i n a p e r s o n ' s a b i l i t y t o i n d e p e n d e n t l y p o s i t i o n o f " p o s i t i o n i n g d e v i c e . " T h e M a r c h 4 , 2 0 1 1 l e t t e r s w e r e b e i n g i s s u e d a s " p o s i t i o n i n g d e v i c e s " w a s , 2 0 1 1 s t a t i n g t h a t T E N S d e v i c e s " d o n o t f i t i n t o p e a r s t o b e a " l e g i s l a t i v e o r p h a n , " w h i c h t h e o r a u t h o r i t y f o r i s s u i n g t h i s e q u i p m e n t i n t h e p a s t . a " p o s i t i o n i n g d e v i c e " i n t h e p a s t , t h i s m a y h a v e b e d e t e r m i n a t i v e o f t h e a p p e l l a n t ' s r e q u e s t . T h e t h a s b e e n p r o v i d e d p r i o r t o A p r i l 1 , 2 0 1 0 a n d u n d e r t h e m i n i s t r y ' s p o l i c y t h a t a p p l i e s , a s s e t o u t a t " p o s i t i o n i n g d e v i c e s " a s u s e d i n t h e c o n t e x t o f i g u o u s a n d i s c a p a b l e o f a p l a i n a n d c o m m o n d e f i n i t i o n p u t f o r t h b y t h e m i n i s t r y . T h e p a n e l e D o m e a c c e s s o r y d o e s n o t f a l l w i t h i n t h e n e l i g i b l e i t e m u n d e r s e c t i o n 3 o f S c h e d u l e C o f l e C [ 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 ] i n e f f e c t o n n u m b e r o f i t e m s w h i c h m a y f a l l w i t h i n t h e i a l i z e d m a t t r e s s e s , a n d l u m b a r s u p p o rt s b u t t h a t t h i s l i s t . R a t h e r , a s e p a r a t e c a t e a o r v e x i s t s i n
t h e policy for "electrotherapy" sp e ci f i cally as medical e TENS ( plus gels, electrodes o r ac cessories) were provided w func t iona l ity (b a s ic TENS), quantit y (sin gle unit), a nd R eg arding function ali t y , the ministry a r gu e d that a ba attaches to the body with electrode pads to se nd impulses through ne ar tificial mess ages which causes the brai n to pr o duce endorphins is a l ow-vo lt b at tery p ow e red TENS device whic h wo devic e has a biofeedbac k co mp o nent and, togeth er basic TENS unit nor a mic rocurrent device. The min manufa cturer of th e ln terX de vi ce and the Dom e a c b y pain and rehab ilitation specialis ts. Th e ministry argued that the functionality of outside the policy parameters for t he provi sion of a The ministry ar g u e d f urther that the Do me does no t qu ant i t y (s in gle uni t ) and co st (maximu m of $250). Dome is a n ac cess ory to the lnt erX device and ca n no u sed in con junct i o n with the lnterX devic e; therefo r e, c o nj un ction with t he app ellan t ' s e l igibi lity for the lnt erX fr om t he a ppella nt's physician in h e r le tt e r dated July delive red t hroug h the electrode on t he l nter X de vice the D o m e, t o t he lnte rX devi ce , and that t h e appellant units. With r e spect to c ost , the ministry point ed ou t in h e r lett er date d November 9 , 2010 is t hat the co st Do me is $25 0 US O, fo r a total co st of $ 4 , 245 US O, Appel lant' s Pos i tion-Po l icy T h e min istry c anno t prov ide a benefit/s up plement witho co nfir m ed by the ministr y in the let te r t o h er d a te d Oc the le gislat ion in plac e on Mar ch 31, 20 1 0 list s el e ctr app ellan t argu ed t hat e lec t rot hera py equipme nt has been 2002. When the legislation is amended, the ministry reviews i legislat i on and this was done in 2003, again in 2005 and also in 2008 and electrotherapy equipmen continued to be provide d and, there f ore, must h ave br eas t pumps are listed as being e ligible for coverage in the ministry's policy guidel categorized a s " positionin g d evices" an d thi s shows wide l what is incl uded within the definition of "positioning" devic The appellant's position is that the parameters set in the ministry's policy for electrotherapy equipment do not a p ply but, i n th e al tern at iv e, if found to be applicable, the parameters hav met w i th r espect to the D ome acc ess or y. Th e appellant argue lnterX devices and accessories qualify as basic TENS machines as they were licensed by the FDA as su ch. T he appellant argued that although the ministry argued that she does not 5002 device and, therefore, the Dome accessory is useless, she still has a judicial review application pending as well as a human rights complaint ongoing and she may still be issued the lnterX 5002 device. The appellant argued that even without the lnterX 5002, she will be able to secure the lnterX 1000 device for which the Dome accessory is compatible. confirmed that while the lnterX 5002 device and all the accessories are ideal for her comolete A PPEAL# I q ui pm e n t and devices under which on ly basic i thin the set out parameters r e specti ng cost (maximum of $2 5 0). sic TENS unit is a battery powered d evice whi ch r v e endings to the b rain as to ma nage t he p ain. M icroc u r rent r k s in the same manner as TENS. The ln terX with the Dome accessory , is therefore n either a istry argued that the evide nce from the cessory i s that t he equipment is in tended for use the Dome falls basic TENS as electrotherapy eq ui pm ent. meet the ot h er pa ra m et er s with res pec t t o Reg ar ding qua ntity , the ministry ar gue d that the t p r ovid e e l e ct rothe rapy al o ne , but must be th e appe llan t 's req u est m u st b e considered i n dev i c e. The mi nis try argu ed that t he e viden ce 7, 2 0 1 0 is t h at the high a mplitu d e p ul ses are b y att ac hi n g one of the acces sori es , in cluding 's ne eds ca n no t be me t thr o ugh only one o f the t hat the eviden ce from the appe llant' s phys ician f or t he l nter X d evice is $3,995 USO and the which exc ee d s the maximu m of $250. ut l egis l ative aut hority, a n d t h is ha s been t ober 28, 2013. The po lic y ma nual res p e ctin g otherap y d ev i ces a s app ro ve d benefit s. The provided as a bene fit b y t h e ministry s ince t s policy to ensure t ha t it fits with the t h ad a legislative b a sis. The a p pe ll a n t argued th a t ine and are atitude in ho w the ministry is to consid er es. e been d that, with respect to functionality, the have th e l nter X The appellant argued that her doctor has !
APPEAL# I treatment, that she will still be able to derive some benefit from use of the lnterX 1000 device and the Dorne accessory. The appellant argued that her doctor has also confirmed that the cost of the Dorne accessory is $250 and does not exceed the maximum set out in the policy. Panel's Reasons-Policy The panel concurs that the provision of positioning devices is not limited to standing bed frames, which is acknowledged in the reconsideration decision; however, the panel finds that the analysis within the decision demonstrates that the ministry considered the appellant's request under both the legislation, section 3 of Schedule C, and the ministry policy. While the appellant asserts that the legislative authority for electrotherapy devices must be section 3(1 )(d) -positioning devices -of Schedule C of the EAPWDR, the panel finds that given that the provision of electrotherapy devices precedes this legislation, the policy respecting the provision of electrotherapy devices may have originated from the much broader language of the predecessor Disability Benefits Program Regulation, namely the provision of "durable medical equipment and appliances" that are medically necessary to provide for "other functions essential to the sustenance of life." The panel notes that the physician's request for the CellStirn electrotherapy device repeatedly references this legislative language, although the July 4, 2002 ministry decision finding the appellant eligible did not specify the section of legislation relied upon. The ministry stated in its reconsideration decision that electrotherapy equipment appears to be a "legislative orphan" and proceeded to consider the appellant's request, which is the subject of this appeal, under the parameters set out in the ministry policy at the time of the appellant's request on March 31, 2010. It appears to the panel that ministry policy respecting electrotherapy in effect at the time of the appellant's request for the Dorne accessory expands upon the health supplements provided under section 3 of Schedule C, as electrotherapy is not reasonably viewed as a "positioning device" or any of the other devices set out in that section. The panel finds that the ministry has considered this policy, which allows for the provision of a basic TENS machine (plus gels, electrodes or accessories) within certain parameters, and has reasonably concluded, based on the manufacturer's description of the Dorne accessory, that it exceeds the parameters set out in policy. The ministry argued that the Dorne is an accessory to the lnterX 5002 device and cannot provide electrotherapy alone, but must be used in conjunction with the lnterX 5002 device; therefore, the appellant's request must be considered in conjunction with her eligibility for the lnterX device. The appellant's physician wrote in her July 7, 201 O letter that the high amplitude pulses are delivered through the electrode on the lnterX 5002 by attaching one of the accessories. Although the appellant argued that she may still receive the lnterX 5002 device as a result of a pending judicial review application and a human rights claim, the panel finds that the ministry reasonably concluded that the accessory cannot deliver electrotherapy on its own. By a decision of the Tribunal dated September 18, 2013, the ministry's decision denying the appellant's request for the lnterX 5002 device was confirmed, and the panel finds that the Dorne, as an accessory to the lnterX 5002 device, has no function without the device. The appellant stated that her disability trust does not currently have sufficient funds to purchase the lnterX 5002 device. With respect to cost, the ministry pointed out that the evidence from the appellant's physician in her letter dated November 9, 201 0 is that the cost for the lnterX device is $3,995 USO and the Dorne is $250 USO, for a total cost of $4,245 USO, which exceeds the maximum amount of $250 as set out in the oolicv. Although the cost of the accesso,y alone was $250 in US dollars in 2010, the oanel finds
APPEAL# I that the Dome, as an accessory to the lnterX 5002 device, exceeds the maximium cost allowed for the TENS machine itself, which is $250 in Canadian funds, and the Dome accessory has no function without the device. Disability Benefits Program Regulation (DBPR), Schedule C, section 2 [as it read on July 4, 20021 Ministry's Position The ministry acknowledged that the appellant was provided with a CellStim device which is a microcurrent machine on July 4, 2002 at a cost of $631.30, but argued that it has not been established that it was provided as a "positioning device." Rather, the ministry pointed to the legislation in effect on July 4, 2002 which allowed for the provision of "durable medical equipment and appliances" for positioning and other set out purposes including "other functions essential to the sustenance of life." The ministry also noted that the decision to provide the CellStim device does not speak to the legislation that was applied or specify whether the microcurrent unit was necessary to provide basic mobility, positioning, breathing or other functions essential to the sustenance of life. The ministry's position is that its past decision to provide the CellStim microcurrent device does not set a precedent obliging the ministry to continue to provide the appellant with electrotherapy equipment indefinitely or to provide electrotherapy equipment that exceeds the parameters set out in the policy in effect on March 31, 2010. Appellant's Position The appellant argues that the microcurrent device (CellStim) provided to her in July 2002 was provided as a "positioning device." Panel's Reasons The July 4, 2002 ministry decision granting approval of the CellStim microcurrent device did not specify under which legislative criteria it was provided. The Disability Benefits Program Act was repealed by the EAPWDA, which came into effect September 30, 2002, and the new Regulation provided for 'medical equipment and devices' in Schedule C by setting out the eligible items in detail. The panel finds that the July 4, 2002 decision is of no value or assistance to interpreting section 3 of Schedule C as it read on March 31, 2010, the date of the appellant's request, given the substantial amendments that have been made to the legislation since 2002. Further, while administrative decisions may be persuasive, they are generally not binding on subsequent decision-makers. The panel finds that the ministry reasonably concluded that its decision to find the appellant eligible for the CellStim device in 2002 does not establish a precedent for the provision of the lnterX equipment, including the Dome, and that each request must be determined pursuant to the legislation in effect at the time of the request. EAPWDR, section 69 Life-threatening Health Need Ministry's Position The ministry's position is that the appellant is not eligible for the Dome for use in conjunction with the lnterX device, under section 69 because: (1) information has not been provided to establish that the appellant faces a life-threatening health need for the requested equipment, and (2) the Dome accessory requested exceeds the parameters for the provision of electrotherapy equipment in terms of function, cost and intended user.
APPEAL# I Appellant's Position The appellant did not advance a position that she is eligible for the Dome accessory under section 69 of the EAPWDR. Panel's Reasons The panel finds that the ministry reasonably concluded that there is insufficient evidence to indicate that the Dome accessory in particular was required to meet a life-threatening health need at the time of the appellant's original request in March of 2010, at the time of reconsideration, or at present. The panel finds that the ministry appears to have considered the request under s. 69 as a request for an electrotherapy device under policy given its conclusion that the parameters for the provision of TENS machines were exceeded. Conclusion Based on the foregoing reasons, the panel finds that the ministry's decision to deny the Dome accessory was a reasonable application of the legislation in the circumstances of the appellant and confirms the decision.
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