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 ry o f S o c i a l D 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 F e b r u a r y 2 7 , 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 n 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 m r e g u l a r d i e t a ry 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 7I A P P E A L j / 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 a l i t e m s . T h e m i n i s t ry 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 : s a s p a rt 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 i s 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 m m a r y o f F a c t s T h e a p p e l l a n t d i d n o t a t t e n d t h e h e a r i n g . A f t e r c o n f p r o c e e d e d u n d e r S e c t i o n 8 6 ( b ) o f t h e E m p l o y m e n t 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 O c t o b e r 2 8 , 2 0 1 3 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 p r o g r e s s i v e w o u n d r e q u i r i n g d a i l y c a r • 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 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 f o r a c h r m e d i c a l p r a c t i t i o n e r w r o t e : " y e s , T 3 p a s u r g i c a l p r o c e d u r e s a n d a m p u t a t i o n s . • 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 l 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 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 a n d w r o t e " m u l t i p l e o p e n n o n h e a l i n g • 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 " n o t a p p l i c a b l e , " L E [ l o w e r e x t r e m i t y ] a • 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 f y t h e p r a c t i t i o n e r w r o t e : " h i g h p r o t e i n d i e t , E l i f e l o n g " • 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 ry 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 : " f i n a n c i a l b s u p p l e m e n t a t i o n " ; • 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 t o i m p r o v e h e a l i n g . " • A d d i t i o n a l c o m m e n t s b y t h e m e d i c a l p s u m m a r i e s , w o u n d c a r e d o n e A T L E A 2 ) H o m e a n d C o m m u n i t y C a r e D i s c h a r g e S u m m t h e a p p e l l a n t w a s d i s c h a r g e d f r o m h o m e c a r e t o h o s p i t a l ; 3 ) H o s p i t a l D i s c h a r g e S u m m a ry d a t e d M a y 1 2 , 2 • T h e a p p e l l a n t w a s a d m i t t e d f r o m e m e r a s s o c i a t e d w i t h p a r a p l e g i a a n d a p r o l a • T h e a p p e l l a n t w a s t r e a t e d w i t h I V a n t i b 4 ) L e t t e r f r o m 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 t h a t : • T h e a p p e l l a n t i s a T 3 p a r a p l e g i c w i t h m d e c u b i t u s u l c e r s t h a t r e q u i r e d m u l t i p l e m o n t h s a t a t i m e .I A P P E A L # i r m i n g t h a t t h e a p p e l l a n t w a s n o t i f i e d , t h e h e a r i n g a n d A s s i s t a n c e R e g u l a t i o n . 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 : s 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 a c h r o n i c w o u n d , d e s c r i b e d a s " a e " ; s a d i r e c t r e s u l t o f t h e s e v e r e m e d i c a l c o n d i t i o n , 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 , t h e r a p l e g i a , c h r o n i c o p e n d e c u b i t u s u l c e r s , m u l t i p l e " 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 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 , 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 , i o n a n d 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 d e c u b i t u s u l c e r s " ; n o t r e c o r d e d a n d 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 m p u t a t i o n " ; 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 n s u r e , B o o s t P l u s t . i . d . [ t h r e e t i m e s a d a y ] 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 l e f t t h i s s e c t i o n b l a n k ; 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 u r d e n t o a f f o r d h i g h p r o t e i n d i e t a n d n e c e s s a r y 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 : " i n c r e a s e d n u t r i t i o n a n d h i g h p r o t e i n d i e t r a c t i t i o n e r a r e : " s e e e n c l o s e d d i s c h a r g e S T 2 t i m e s p e r w e e k b y n u r s e s " ; a r y d a t e d N o v e m b e r 2 5 , 2 0 1 1 s t a t i n g i n p a r t t h a t n u r s i n g f o r w o u n d c a r e s i n c e h e w a s r e a d m i t t e d 0 1 3 w h i c h s t a t e s i n p a r t t h a t : g e n c y w i t h a d i a g n o s i s o f u r o s e p s i s , q u e r y s t r e p p s e t o t h e c o l o s t o m y . i o t i c s f o r a p p r o x i m a t e l y 3 w e e k s ; r d a t e d F e b r u a ry 7 , 2 0 1 4 , w h i c h s t a t e s i n p a r t u l t i p l e f r a c t u r e s a n d c h r o n i c n o n h e a l i n g h o s p i t a l i z a t i o n s , s o m e t i m e s f o r a s l o n g a s
• T h e a p p e l l a n t i s u n d e r g o i n g d a i l y w o u • T h e a p p e l l a n t h a s s i g n i f i c a n t m u s c l e m r e s u l t o f h i s p r o g r e s s i v e a n d c h r o n i c d • T h e a p p e l l a n t r e q u i r e s a l i f e l o n g h i g h m a s s , p r e v e n t d e t e r i o r a t i o n o f h i s c h r o d a n g e r t o h i s l i f e ; a n d , 5 ) 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 F e b r u a ry I n h i s 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 r f a m i l y d o c t o r . H e h a s i n s u f f i c i e n t f u n d s v i t a l t o h i s r p a r t i a l l y d u e t o p a r a p l e g i a . T h e a p p e l l a n t w r o t e t h a d i r e c t r e s u l t o f 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 l o s s , a n d 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 , I n t h e 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 i s 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 h e r e q u i r e s a d d i s u 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 ry i n t a k e a n d t o p w r o t e t h a t w i t h o u t s u p p l e m e n t , h i s c o n d i t i o n w i l l c o n T h e m i n i s t r y 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 w P e r s o n W i t h D i s a b i l i t i e s ( P W D ) i n r e c e i p t o f d i s a b i l i t m i n e r a l s a t t h e r a t e o f $ 4 0 p e r m o n t h . A t t h e h e a r i n 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 a s s i s t a n c 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 r a t i o n o f h e a l t h w i t h s y m n e i t h e r t h e s y m p t o m o f m a l n u t r i t i o n n o r s i g n i f i c a n t m d e m o n s t r a t e a w a s t i n g c o n d i t i o n . T h e m i n i s t r y s t a t e t h e a p p e l l a n t ' s c u r r e n t h e i g h t a n d w e i g h t w h i c h w o u a n d w h e r e i t f a l l s o n t h e r a n g e i n r e l a t i o n t o n o r m a l , s i g n i f i c a n t l o s s o v e r a s p e c i f i c p e r i o d o f t i m e . T h e s d a n g e r t o t h e 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 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 m i n i s t r y a c k n o w l e d g e 2 0 1 4 l e t t e r t h a t t h e h i g h p r o t e i n d i e t i s n e c e s s a ry t o a n d d i d n o t h a v e c o m m e n t f u r t h e r t o t h e m i n i s t r y ' s a I A P P E A L # n d c a r e . a s s l o s s a n d s h o w s e v i d e n c e o f m a l n u t r i t i o n a s a e b i l i t a t i n g h e a l t h c o n d i t i o n . p r o t e i n d i e t t o e n a b l e h i m t o d e v e l o p m u s c l e n i c d e c u b i t u s u l c e r s a n d t o p r e v e n t i m m i n e n t 1 3 , 2 0 1 4 . o t e t h a t h e r e q u e s t s a r e v i e w o f t h e l e t t e r f r o m h i s e c o v e r y a n d h e a l i n g f r o m a c h r o n i c w o u n d t h e i s e x p e r i e n c i n g t h e f o l l o w i n g s y m p t o m s a s a f h e a l t h : m a l n u t r i t i o n , s i g n i f i c a n t m u s c l e m a s s a s d e t a i l e d i n t h e d o c t o r ' s n o t e . 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 t i o n a l n u t r i t i o n a l i t e m s a s p a r t o f c a l o r i c r e v e n t i m m i n e n t d a n g e r t o h i s l i f e . T h e a p p e l l a n t t i n u e t o d e t e r i o r a t e . h i c h i n c l u d e d e v i d e n c e t h a t t h e a p p e l l a n t i s a y a s s i s t a n c e a s w e l l a s t h e M N S f o r v i t a m i n s a n d 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 r M N S 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 u s i n g a p t o m s o f w a s t i n g . T h e m i n i s t r y s t a t e d t h a t u s c l e m a s s l o s s i s s u f f i c i e n t , o n i t s o w n , t o d t h a t t h e r e i s n o s u p p o r t i n g e v i d e n c e s u c h a s l d a l l o w c a l c u l a t i o n o f h i s B M I [ b o d y m a s s i n d e x ] o r t h e c h a n g e i n h i s m u s c l e m a s s t o s h o w a u p p l e m e n t 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 e c i f i e d i t e m s t o s u p p l e m e n t c a l o r i e s b e y o n d d t h a t t h e p h y s i c i a n s t a t e d i n h e r F e b r u a r y 7 , 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 a p p e l l a n t ' s l i f e n a l y s i s i 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 .
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 o 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 o 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 r i 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 i 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 b 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 n ( 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 u ( 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 ( ct ) 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 ( c 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 / 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 , T 3 p a r a p l e g i a , c h r o n i c o p e n d e c u b i t u s u a m p u t a t i o n s a n d a c h r o n i c w o u l d r e a u i r i n a d a i l y c a r e I A P P E A L # 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 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 n s W i t h D i s a b ili 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 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 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 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 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 ; ) 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 i t i 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 , l c e r s , m u l t i p l e s u r g i c a l p r o c e d u r e s a n d , " p u r s u a n t t o S e c t i o n 6 7 1 1 . 1 \ l a \ o f t h e
EAPWDR. Sectio n 6 7 (1. 1 )(b) o f the EA PWD R re quires dire c t r esult of the ch ronic, pro gressi ve deterio r a t i on sy mptoms listed. T h e m in i s try acknowledg ed t hat there i pra ctiti oner to e s ta blish that the appel lant disp la ys two or m muscle mas s loss a nd ma l n u tr ition . Sec tion 67(1. t)(c) an d Sec tion 7 of S ch edu le C of t he Th e ministry ' s pos it i on is t hat it i s not sat is fied t hat the as p a rt of a c aloric su ppl em ent atio n to a regu lar die p rogressive deterioratio n of hea lth. The m inistry stated that additiona l nut ritional item r equired is high p ro tein d i et and this will allevi at e the spe ci f i c sym pt o ms, t h e me dic al rat h er than a m edical c o n dition that requ ires n utritional T he m in is tr y s t a ted t hat the ap pel lant also re fe rred to Rec ons ide ration, w h ich fu nd s a re vital to rec o very and hea s ta te d th at the medical p ractitio n er als o di d not confir r es u l ts in th e inabilit y to ab s orb s u f fici e nt c al o ries to di e tar y intak e. Th e ministry s t ated that t he medical prac the appe llant is displaying un derweight s tatus o r significa wrot e that th e appellant's heig ht and we i ght i s "not a calculate his BMI [body ma ss i n dex ] a nd determi n e if dieta ry intake. The ministry stated that t he m ed i cal pr hig h pr otei n di et which r e p resent s a specific nu trit ional app e llant' s regu lar dieta ry intake and does not d emo regul ar dietary i ntake. Th e app el la n t' s po s i tion is that s ufficie n t informa tion both the ori g in al Applic at ion and the add it ional le tter, nutritio nal i tems as par t of a caloric sup plementati on sy mpto ms of a ch ronic, p rogressive deter io ra ti on of hea appella nt emphasized the letter from h is family doc tor a hi s recovery an d hea ling f rom a chronic wound partially due to paraplegia. The appellant argued that he is experiencing the following symptoms, as detailed in his doctor's notes, as a direct result of a chronic progressive deterioration of health: malnutrition, significant muscle mass loss, and moderate to seve re immune suppr e s sion. Panel decision S ecti on 7 of Schedul e C and Section 67(1. 1) (c) of the EAPWDR stipulate that the medical practitioner must confi rm that, for t h e purpose of alleviating a symptom referred to in sub-section (b), appellant re qui re s t h e additiona l nutritional items that a regular dietary intake as specified in the request. In response to a request to specify the additional nutritional items requi red, the medical pra ctitioner wrote Ensur e, B oost Plus t. i . d . [three times a day] lifelong." items will alleviate o n e or more of the sympt oms and provide caloric diet, the medical practitioner wrote: "financial burden to afford high protein diet and necessary supp lementation." In her Febru ary 7, 2014 l etter , th e requires a life-Iona hiah protein diet. The panel considered the ordinarv meanina of I APPEA L# _ -_-_ _____J th at a medical prac titioner con f irm that as a of hea lt h , the pers on displays t wo or mo re of the s s uff i cient i n forma tion f rom th e m edical ore o f the sym ptoms, namely signi fica nt EAPWDR-Caloric S upplementa tion appell ant re quires add i tiona l nutr ition al i tems t a ry intake to a l levi ate t h e sympt oms of a chroni c , the me dic al pr a c titioner specifi ed that the Ens u re / Boo st Pl u s and, in de scribi n g how prac titioner r ef err e d to fi n a ncia l circ ums tan ces item s as part of a c aloric s up pleme n tation. his insuffic ient f u nd s in hi s Requ e st for ling fr om a c hroni c wou n d. The ministry m that the appel lant has a medi cal con diti on that s atisf y d aily require me nts th ro ug h a regu lar ti ti oner did not pr ovi d e detai l t o confi rm that nt we ight los s, since th e medical p ractiti on er ppli cab le", a nd th e m inis t ry w a s unab l e to h e req uires cal ori c supp leme n t at ion to a regu lar act iti oner rep orted tha t the a pp ella nt requ ires a r e gime which is recom mended for the n stra te a need f o r calori c suppl ementation to a has been pro v i ded by the medical p rac tit ioner, in to establish that he requ ires add i tional to a regular dietar y i n ta ke to all ev iate th e l th. In hi s Reques t for Reco n siderati on , the n d wrote that he has insufficient funds v i tal_ to the re par t of a caloric sup plementation to a in the original ap plication "high protein d i et, When asked to describe how the nutritional supplementation to the regular medical practitioner reiterated tha t the ap pellant
I APPEAL# "supplementation" to be something added and finds that the ministry reasonably determined that the medical practitioner recommendation is for a higher proportion of protein within the appellant's regular diet rather than an addition of calories to his regular dietary intake. In the original MNS application, in response to the question whether the appellant has a medical condition that results in the inability to absorb sufficient calories to satisfy daily requirements through a regular dietary intake, the medical practitioner left this section of the application blank. The ministry pointed to the absence of a response to this question as well as no record of the height and weight for the appellant as areas where the ministry found a lack of sufficient information to support a finding of a wasting condition and, consequently, a need for .caloric supplementation. While the appellant is displaying the symptoms of malnutrition and significant muscle mass loss, the ministry argued that neither symptom is sufficient, without further detail, to establish a wasting condition. The ministry stated that there is no supporting evidence such as the appellant's current height and weight which would allow calculation of his BMI and where it falls on the range in relation to normal. Rather than provide the appellant's height and weight in the application, the medical practitioner wrote "not applicable, "LE [lower extremity] amputation" and, although it is not clear from the medical practitioner's notes, it may be that the amputation of a body part compromises the accuracy of a BMI calculation. The medical practitioner wrote in her February 7, 2014 letter that the appellant has significant muscle mass loss and shows evidence of malnutrition as a result of his health condition, and she also reported that it is a high protein diet, rather than a supplement of calories, that is necessary to alleviate these symptoms. The panel considers that while evidence of malnutrition, or a lack of proper nutrition, would appear to be a symptom of wasting, it can also be caused by not having enough to eat due to the scarcity of food or by not eating enough of the right things as a result of choices made regarding the composition of one's regular dietary intake, as well as by being unable to use, or process, the food that one eats as a result of a medical condition. By requiring evidence of a need for caloric "supplementation" to a regular dietary intake, or calories in addition to the regular diet, the MNS for additional nutritional items is geared specifically for those experiencing one of the listed symptoms as a result of a regular diet being insufficient, rather than for those who do not have enough to eat or who are not eating enough of the right things. The panel finds that the ministry reasonably concluded that there is not sufficient information from the medical practitioner to confirm that specified additional nutritional items are required by the appellant as part of a caloric supplementation to a regular dietary intake to alleviate a related symptom, as set out in Section 67(1.1 )(c) of the EAPWDR. Section 67(1. 1) (d) of the EAPWDR-Imminent Danger to Life The ministry's position is that it is not satisfied that the appellant requires additional nutritional items to prevent an imminent danger to the appellant's life. The ministry pointed out that in describing how the nutritional items required will prevent imminent danger to life, the medical practitioner indicated in the MNS application that "increased nutrition and high protein diet to improve healing" and this does not constitute confirmation that the appellant requires caloric supplementation to prevent imminent danger to his life. The ministry stated that the medical practitioner wrote in the letter dated February 7, 2014, that the nutritional items will enable the appellant " ... to develop muscle mass, prevent deterioration of his chronic decubitus ulcers and to prevent imminent danger to [his] life" and the ministry argued that this does not constitute confirmation that failure to provide nutritional items will result in 'imminent' danger to life.
The appellant's position is that the informatio n from the medical letter confir med tha t fai lu re to obtain the additi on al nutritional items will result in imminen his li fe. The appella n t wrote in his Notice of Appeal tha co ntinue to deteriorate. Pan e l decision Sec t io n 67( 1 . 1 )(d) requir es that the med i c al practitioner confirm that failure to obtai items that are part of a caloric suppl emen tation to a da nger to th e person's life. In th e o r iginal Application, the medical question how the nutritional items will pre vent i mminent " ...i ncreased nutrition and high protein diet to improve healing." wrote that the appe llant re q uires a life-long h i gh pr o pre vent deterior ation of his chronic decub i tus ulcers also wrote tha t the appellant has chronic non-healing decubitus ulcers that hospitalizations, som etimes for as long as months at a tim undergone a t l e ast one lower e x t r e mity am p ut a t i on a the ev ide n c e of t h e medi cal practitioner de m onstr ates h e aling and to en a b le t h e a ppell a nt to d eve lop m uscle hospital stays and preve nt ing im mine nt dange r t o th t h e le gisla tio n is that fai lure to obtain nu t r it ional i t ems that regular dieta r y i n t ake wil l r esult.in i mm i ne nt dange r to th minis t ry re asona bl y d etermined that ther e is not suff for calor ic supplementatio n, as s et o u t ab ove . Th e panel that the medi cal practi t i one r has not confirmed that fail nu tritio nal items t hat a re pa r t of a ca lor i c sup plem en imminent dang e r t o the ap pellant's l ife , as r e qu ired by Se Conclus io n The panel f i nds that the minist ry's re cons ide ratio n deci Monthl y Nutri t i on al Sup plement fo r ad di t i onal n u trition Secti on 67 (1. 1) o f the E APWDR were not m et, was r panel confirms the minis t r y's de cision. I APPEA L# practitioner in the a pplication and her t danger to t without supplement his condition wil l n the nutritional regul ar dietary int ake will result in imm i nent practit ioner re spond e d to t he d a n g er to the appellant ' s lif e , b y stating In her le tter, t he medical pract i t i one r t ein d ie t t o enable hi m to develop muscle mass, and to preven t imminent danger to his life." S h e have required multip le e and th at th e appella n t has already s a resu lt of h is c ond i t i on . T he p anel finds tha t a n ee d for a h i g h protein diet to i mpr o ve mass, r e du c ing t h e n umber of lo n g-term e a ppell ant's life. Ho w ev er , the r equi rement o f a re part of a calo r ic supple m e ntation to a e p e r s on 's lif e. The pa n el finds t h a t the i cient e vide nc e prov i d ed of the appel la n t's n ee d find s that t he ministry re asonabl y c o n cl ud ed ur e to obt ain the requeste d ad ditional t atio n to a r e gu l ar diet ar y i n t ake will resu lt in ction 67( 1.1)( d) of the EA PWD R . sion, wh ich d enie d the ap pellant's req uest fo r a al it em s bec au se a ll of t h e req u i r e men t s of e asona b ly supp or t ed by th e evi dence and the
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.