P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l D e v e l o p m d e c i s i o n d a t e d J a n u a r y 2 1 , 2 0 1 4 w h i c h d e n i e d t h e a p p e l l a n t ' s a . T h e a p p e l l a n t i s n o t e l i g i b l e f o r a n i n s u l i n p u m p a s m e o f t h e E A P W D R ; b . T h e a p p e l l a n t i s n o t e l i g i b l e f o r a n i n s u l i n p u m p a s a m t h e E A P W D R ; c . T h e a p p e l l a n t i s n o t e l i g i b l e f o r a n i n s u l i n p u m p a s i t i s C o f t h e E A P W D R ; a n d d . T h e a p p e l l a n t w a s n o t e l i g i b l e f o r t h e i n s u l i n p u m p a s o f t h e E A P W D R a s t h e a p p e l l a n t w a s e l i g i b l e f o r a h e 2 ( 1 ) ( a ) a n d ( f ) a n d 3 o f t h e E A P W D R . 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 il i t i e s R e g s e c t i o n s 2 -9A P P E A L # I e n t a n d S o c i a l I n n o v a t i o n ' s ( " t h e m i n i s t r y ' ' ) r e c o n s i d e r a t i o n r e q u e s t f o r f u n d i n g f o r a n i n s u l i n p u m p o n t h e b a s i s t h a t : d i c a l e q u i p m e n t a s p r o v i d e d f o r i n S c h e d u l e C , s e c t i o n 3 ( 1 ) e d i c a l s u p p l y a s p r o v i d e d f o r i n S c h e d u l e C , s e c t i o n 2 ( 1 ) o f n o t a n i t e m s e t o u t i n a n y o f t h e o t h e r s e c t i o n s o f S c h e d u l e 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 s p r o v i d e d f o r b y s e c t i o n 6 9 a l t h s u p p l e m e n t a s s e t o u t u n d e r S c h e d u l e C , s e c t i o n s u l a t i o n ( E A P W D R ) , s e c t i o n s 6 2 a n d 6 9 , S c h e d u l e C
APPEAL II I PART E -Summarv of Facts The appellant did not attend the hearing. The panel received confirmation from the Tribunal that the appellant had been notified of the date, time and location of the hearing. Accordingly, under s. 86(b) of the Employment and Assistance Regulation, the panel heard the appeal in the appellant's absence. The appellant's advocate attended the hearing in person and was in possession of the appeal materials. While there was no formal release of information signed by the appellant in favour of the advocate, the fact that the advocate had the appeal materials satisfied the panel that the appellant had provided implicit consent to the advocate to attend the hearing and represent her interests. The evidence before the ministry at the time of the reconsideration decision consisted of copies of the following: 1. The appellant's Request for Reconsideration dated January 6, 2014 attaching the following: a. Five pages of written submissions prepared by the appellant's advocate; b. A letter dated December 19, 2013 from the appellant's family physician and addressed to "To Whom It May Concern" (the "GP Letter"); c. Two pages of product information regarding the proposed insulin pump; d. A handwritten note dated January 6, 2014 prepared by the appellant setting out a portion of her monthly expenses and noting her employment status; and e. A two page statement from the appellant's bank for the period of November 30, 2013 through January 6, 2014. 2. A Medical Equipment Request and Justification form (the "Request Form") dated December 4, 2013 requesting an insulin pump for the appellant; 3. A letter dated October 30, 2013 from the appellant's medical specialist addressed to the appellant's family physician (the "Consult Report"); 4. A one-page Wikipedia excerpt dated December 5, 2013 setting out the definition of a medical condition; and 5. An undated quote from a medical equipment supply company for an insulin pump and associated monthly supplies. In the Request Form, the appellant's physician recommends that she use an insulin pump but no comments are provided as to the appellant's condition. In the Consult Report, the appellant's physician notes that he has followed the appellant from March 2006 through December 2011 and he summarizes the appellant's condition as "largely uncontrolled Type 1 or Type 2 diabetes, CKD [chronic kidney disease] Stage 1 last time checked, optimally controlled hypertension and has some mental health issues." The physician goes on to say that "Considering the last diagnosis and considering the fact that she is not very compliant to her insulin injections as well as not very compliant to medications and considering her forgetfulness that she insists that she has, I believe this patient would be best served with an insulin pump." In the written submissions attached to the Request for Reconsideration, the appellant's advocate submits the appellant has been diagnosed with Type 1 and Type 2 diabetes as well as mental health issues, that she has been designated as a Person With Disabilities under the EAPWDR, that she applied for the insulin pump and provided the Consult Report. The advocate submits further that in the GP Letter, the appellant's family physician indicates that the appellant had been recently hospitalized due to diabetic ketoacidosis which the advocate submits is a potentially life threatening complication in patients with diabetes mellitus. The advocate submits further in the written submissions that the appellant is eligible for medical equipment and devices under Schedule C of the EAPWDR, that she has had to stop work due to medical complications, has received an eviction notice and submitted a preauthorization to the Ministry for the insulin pump. The advocate states that the appellant does not have the resources to purchase the insulin pump which was prescribed by her family physician. In the GP Letter, the appellant's physician states that the appellant is in need of a continuous glucose monitor in the form of an insulin pump and that she is a diabetic patient that has obsessive compulsive disorder which prevents her from taking her medications, including insulin, in a timely manner. The physician goes on to comment that the appellant is "in desperate need of an insulin pump, as this would regularly check her blood sugar levels and constantly remind her of her body's insulin requirement." In response to a question, the advocate confirmed that the proposed insulin pump also monitors glucose levels. At the hearinq of the anneal, the ministrv confirmed that the annellant is eliqible for health sunn\ements under section 62
o f t h e E A P W D R b u t t h a t w h i l e t h e m i n i s t r y i s a b l e u n d e r t h e l s y s t e m , a n i n s u l i n p u m p a s r e q u e s t e d b y t h e a p p e l l a n t i s n o t w h i c h i n d i c a t e s t h a t t h e a p p e l l a n t " w o u l d b e b e s t s e r v e d w i t h p r o b l e m i s t h a t s h e f o r g e t s t o t a k e h e r i n s u l i n a n d t h a t t h e r e w a p p e l l a n t w a s a b l e t o c o n t r o l h e r d i a b e t e s b y t a k i n g h e r m e d i c I n r e s p o n s e t o a q u e s t i o n , t h e m i n i s t r y r e i t e r a t e d t h a t t h e l e g i s u n d e r S c h e d u l e C o f t h e E A P W D R a n d t h a t a n o n c o n v e n t i o n h e r i n s u l i n . T h e m i n i s t r y s t a t e d t h a t t h e r e i s n o r e f e r e n c e w h a a n o n c o n v e n t i o n a l g l u c o s e m o n i t o r a n d a n i n s u l i n p u m p a r e t t h e n o n c o n v e n t i o n a l g l u c o s e m o n i t o r i n c l u d e d a n i n s u l i n p u m E A P W D R .A P P E A L # I e g i s l a t i o n t o f u n d a n o n c o n v e n t i o n a l g l u c o s e m o n i t o r i n g a n e l i g i b l e i t e m . T h e m i n i s t r y r e f e r r e d t o t h e C o n s u l t L e t t e r a n i n s u l i n p u m p " a n d t h e m i n i s t r y s t a t e d t h a t t h e a p p e l l a n t ' s a s n o f o l l o w u p f r o m t h e m e d i c a l s p e c i a l i s t a s t o w h e t h e r t h e a t i o n i n t h e m o r n i n g . l a t i o n i s c l e a r t h a t a n i n s u l i n p u m p i s n o t a n e l i g i b l e i t e m a l g l u c o s e m o n i t o r i s s u f f i c i e n t t o a l e r t t h e a p p e l l a n t t o t a k e t s o e v e r i n t h e l e g i s l a t i o n t o a n i n s u l i n p u m p a n d s t a t e d t h a t w o d i f f e r e n t t h i n g s . T h e m i n i s t r y f u rt h e r s t a t e d t h a t e v e n i f p , i t w o u l d s t i l l n o t s a t i s f y s e c t i o n 3 . 1 2 o f S c h e d u l e C o f t h e
, � P E M # ---------� 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 t h e r e a s o n a b l e n e s s o f t h e m i n i s t r y ' s d e c i s i o n t o d e n y t h e a p p e l l a n t ' s r e q u e s t f o r a n i n s u l i n p u m p o n t h e b a s i s t h a t : a . T h e a p p e l l a n t i s n o t e l i g i b l e f o r a n i n s u l i n p u m p a s m e d i c a l e q u i p m e n t a s p r o v i d e d f o r i n S c h e d u l e C , s e c t i o n 3 ( 1 ) o f t h e E A P W D R ; b . T h e a p p e l l a n t i s n o t e l i g i b l e f o r a n i n s u l i n p u m p a s a m e d i c a l s u p p l y a s p r o v i d e d f o r i n S c h e d u l e C , s e c t i o n 2 ( 1 ) o f t h e E A P W D R ; c . T h e a p p e l l a n t i s n o t e l i g i b l e f o r a n i n s u l i n p u m p a s i t i s n o t a n i t e m s e t o u t i n a n y o f t h e o t h e r s e c t i o n s o f S c h e d u l e C o f t h e E A P W D R ; a n d d . T h e a p p e l l a n t w a s n o t e l i g i b l e f o r t h e i n s u l i n p u m p a 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 s p r o v i d e d f o r b y s e c t i o n 6 9 o f t h e E A P W D R a s t h e a p p e l l a n t w a s e l i g i b l e f o r a h e a l t h s u p p l e m e n t a s s e t o u t u n d e r S c h e d u l e C , s e c t i o n s 2 ( 1 ) ( a ) a n d ( f ) a n d 3 o f t h e E A P W D R . T h e a p p l i c a b l e l e g i s l a t i o n i s f o u n d i n t h e E A P W D R a s f o l l o w s : G e n e r a l h e a l t h s u p p l e m e n t s 6 2 ( 1 ) S u b j e c t t o s u b s e c t i o n s ( 1 . 1 ) a n d ( 1 . 2 ) , t h e m i n i s t e r m a y p r o v i d e a n y h e a l t h s u p p l e m e n t s e t o u t i n s e c t i o n 2 [ g e n e r a l h e a l t h s u p p l e m e n t s ] o r 3 [ m e d i c a l e q u i p m e n t a n d d e v i c e s ] o f S c h e d u l e C t o o r f o r a f a m i l y u n i t i f t h e h e a l t h s u p p l e m e n t i s p r o v i d e d t o o r f o r a p e r s o n i n t h e f a m i l y u n i t w h o i s ( a ) a r e c i p i e n t o f d i s a b i l i t y a s s i s t a n c e , . . . H e a l t h s u p p l e m e n t f o r p e r s o n s f a c i n g d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g h e a l t h n e e d 6 9 T h e m i n i s t e r m a y p r o v i d e t o a f a m i l y u n i t a n y h e a l t h s u p p l e m e n t s e t o u t i n s e c t i o n s 2 ( 1 ) ( a ) a n d ( f ) [ g e n e r a l h e a l t h s u p p l e m e n t s ] a n d 3 [ m e d i c a l e q u i p m e n t a n d d e v i c e s ] o f S c h e d u l e C , i f t h e h e a l t h s u p p l e m e n t i s p r o v i d e d t o o r f o r a p e r s o n i n t h e f a m i l y u n i t w h o i s o t h e r w i s e n o t e l i g i b l e f o r t h e h e a l t h s u p p l e m e n t u n d e r t h i s r e g u l a t i o n , a n d i f t h e m i n i s t e r i s s a t i s f i e d t h a t ( a ) t h e p e r s o n f a c e s a d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g n e e d a n d t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e p e r s o n ' s f a m i l y u n i t w i t h w h i c h t o m e e t t h a t n e e d , ( b } t h e h e a l t h s u p p l e m e n t i s n e c e s s a r y t o m e e t t h a t n e e d , ( c ) t h e p e r s o n ' s f a m i l y u n i t i s r e c e i v i n g p r e m i u m a s s i s t a n c e u n d e r t h e M e d i c a r e P r o t e c t i o n A c t , a n d ( d ) t h e r e q u i r e m e n t s s p e c i f i e d i n t h e f o l l o w i n g p r o v i s i o n s o f S c h e d u l e C , a s a p p l i c a b l e , a r e m e t : ( i ) p a r a g r a p h ( a ) o r ( f ) o f s e c t i o n ( 2 ) ( 1 ) ; ( i i ) s e c t i o n s 3 t o 3 . 1 2 , o t h e r t h a n p a r a g r a p h ( a ) o f s e c t i o n 3 ( 1 ) . T h e a p p l i c a b l e p r o v i s i o n t h a t a d d r e s s e s 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 s f o u n d i n S c h e d u l e C o f t h e E A P W D R a s f o l l o w s : G e n e r a l h e a l t h s u p p l e m e n t s 2 ( 1 ) T h e f o l l o w i n g a r e t h e h e a l t h s u p p l e m e n t s t h a t m a y b e p a i d f o r b y t h e m i n i s t e r i f p r o v i d e d t o a f a m i l y u n i t t h a t i s e l i g i b l e u n d e r s e c t i o n 6 2 [ g e n e r a l h e a l t h s u p p l e m e n t s ] o f t h i s r e g u l a t i o n : ( a ) m e d i c a l o r s u r g i c a l s u p p l i e s t h a t a r e , a t t h e m i n i s t e r ' s d i s c r e t i o n , e i t h e r d i s p o s a b l e o r r e u s a b l e , i f t h e m i n i s t e r i s s a t i s f i e d t h a t a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : ( i ) t h e s u p p l i e s a r e r e q u i r e d f o r o n e o f t h e f o l l o w i n g p u r p o s e s : ( A ) w o u n d c a r e ; ( B ) o n g o i n g b o w e l c a r e r e q u i r e d d u e t o l o s s o f m u s c l e f u n c t i o n ; ( C ) c a t h e t e r i z a t i o n ; ( D ) i n c o n t i n e n c e ; ( E ) s k i n p a r a s i t e c a r e ; ( F ) l i m b c i r c u l a t i o n c a r e ; ( i i ) t h e s u p p l i e s a r e ( A ) p r e s c r i b e d b y 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 r a c t i t i o n e r , ( B ) t h e l e a s t e x p e n s i v e s u p p l i e s a p p r o p r i a t e f o r t h e p u r p o s e , a n d ( C ) n e c e s s a r y t o a v o i d a n i m m i n e n t a n d s u b s t a n t i a l d a n g e r t o h e a l t h ; / i i i ) t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e f a m i l v u n i t t o p a y t h e c o s t o f o r
o b t a i n t h e s u p p l i e s ; ( a . 1 ) t h e f o l l o w i n g m e d i c a l o r s u r g i c a l s u p p l i e s t h a t a r e , a t t h e m i n i s t e r i s s a t i s f i e d t h a t a l l t h e r e q u i r e m e n t s d e s c r i b e d i n p a r a ( i ) l a n c e t s ; ( i i ) n e e d l e s a n d s y r i n g e s ; ( i i i ) v e n t i l a t o r s u p p l i e s r e q u i r e d f o r t h e e s s e n t i a l o p e r a t i o n o r ( i v ) t r a c h e o s t o m y s u p p l i e s ; ( a . 2 ) c o n s u m a b l e m e d i c a l s u p p l i e s , i f t h e m i n i s t e r i s s a t i s f i e d ( i ) t h e s u p p l i e s a r e r e q u i r e d t o t h i c k e n f o o d ; ( i i ) a l l t h e r e q u i r e m e n t s d e s c r i b e d i n p a r a g r a p h ( a ) ( i i ) a n d ( i i i ( b ) R e p e a l e d . [ B . C . R e g . 2 3 6 / 2 0 0 3 , S c h . 2 , s . 2 ( b ) . ] ( c ) s u b j e c t t o s u b s e c t i o n ( 2 ) , a s e r v i c e p r o v i d e d b y a p e r s o n d d e l i v e r e d i n n o t m o r e t h a n 1 2 v i s i t s p e r c a l e n d a r y e a r , ( i ) f o r w h i c h 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 r a c t i t i o n e r h a s c ( i i ) i f t h e v i s i t s a v a i l a b l e u n d e r t h e M e d i c a l a n d H e a l t h C a r e S h a v e b e e n p r o v i d e d a n d f o r w h i c h p a y m e n t i s n o t a v a i l a b l e u n ( i i i ) f o r w h i c h t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e f a m i l y u n I t e m S e r v i c e P r o v i d e d b y R e g i s 1 a c u p u n c t u r e a c u p u n c t u r i s t C o l l e g P r o f e s 2 c h i r o p r a c t i c c h i r o p r a c t o r C o l l e g H e a l t h 3 m a s s a g e t h e r a p y m a s s a g e C o l l e g t h e r a p i s t t h e H e 4 n a t u r o p a t h y n a t u r o p a t h C o l l e g u n d e r 5 n o n s u r g i c a l p o d i a t r i s t C o l l e g p o d i a t r y t h e H e 6 p h y s i c a l t h e r a p y p h y s i c a l t h e r a p i s t C o l l e g t h e H e ( d ) a n d ( e ) R e p e a l e d . ( B . C . R e g . 7 5 / 2 0 0 8 , s . ( a ) . ] ( f ) t h e l e a s t e x p e n s i v e a p p r o p r i a t e m o d e o f t r a n s p o r t a t i o n t o o ( i ) a n o f f i c e , i n t h e l o c a l a r e a , 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 ( i i ) t h e o f f i c e o f t h e n e a r e s t a v a i l a b l e s p e c i a l i s t i n a f i e l d o f m e s p e c i a l i s t i n t h a t f i e l d b y a l o c a l 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 ( i i i ) t h e n e a r e s t s u i t a b l e g e n e r a l h o s p i t a l o r r e h a b i l i t a t i o n h o s p H o s p i t a l I n s u r a n c e A c t R e g u l a t i o n s , o r ( i v ) t h e n e a r e s t s u i t a b l e h o s p i t a l a s d e f i n e d i n p a r a g r a p h ( e ) o I n s u r a n c e A c t , p r o v i d e d t h a t ( v ) t h e t r a n s p o rt a t i o n i s t o e n a b l e t h e p e r s o n t o r e c e i v e a b e n e s e r v i c e u n d e r t h e H o s p i t a l I n s u r a n c e A c t , a n d ( v i ) t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e p e r s o n ' s f a m i l y u n i ( g ) R e p e a l e d . [ B . C . R e g . 7 5 / 2 0 0 8 , s . ( a ) . ] ( 1 . 1 ) F o r t h e p u r p o s e s o f s u b s e c t i o n ( 1 ) ( a ) , m e d i c a l a n d s u r g v i t a m i n s , m i n e r a l s o r p r e s c r i p t i o n m e d i c a t i o n s . ( 2 ) N o m o r e t h a n 1 2 v i s i t s p e r c a l e n d a r y e a r a r e p a y a b l e b y t h p h y s i c a l t h e r a p y s e r v i c e s , c h i r o p r a c t i c s e r v i c e s , m a s s a g e t h e r s e r v i c e s a n d a c u p u n c t u r e s e r v i c e s . ( 2 . 1 ) I f e l i g i b l e u n d e r s u b s e c t i o n ( 1 ) ( c ) a n d s u b j e c t t o s u b s e c t s e c t i o n 6 2 o f t h i s r e g u l a t i o n f o r p h y s i c a l t h e r a p y s e r v i c e s , c h i r o p o d i a t r y s e r v i c e s , n a t u r o p a t h y s e r v i c e s a n d a c u p u n c t u r e s e r v i c 3 I f t h e m i n i s t e r r o v i d e d a b e n e f i t t o o r f o r a e r s o n u n d e r s I A P P E A L # -� --------m i n i s t e r ' s d i s c r e t i o n , e i t h e r d i s p o s a b l e o r r e u s a b l e , i f t h e g r a p h ( a ) ( i i ) a n d ( i i i ) a r e m e t i n r e l a t i o n t o t h e s u p p l i e s : s t e r i l i z a t i o n o f a v e n t i l a t o r ; t h a t a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : ) a r e m e t i n r e l a t i o n t o t h e s u p p l i e s ; e s c r i b e d o p p o s i t e t h a t s e r v i c e i n t h e f o l l o w i n g t a b l e , o n f i r m e d a n a c u t e n e e d , e r v i c e s R e g u l a t i o n , B . C . R e g . 4 2 6 / 9 7 , f o r t h a t c a l e n d a r y e a r d e r t h e M e d i c a r e P r o t e c t i o n A c t , a n d i t t o c o v e r t h e c o s t : t e r e d w i t h e o f T r a d i t i o n a l C h i n e s e M e d i c i n e u n d e r t h e H e a l t h s i o n s A c t e o f C h i r o p r a c t o r s o f B r i t i s h C o l u m b i a u n d e r t h e P r o f e s s i o n s A c t e o f M a s s a g e T h e r a p i s t s o f B r i t i s h C o l u m b i a u n d e r a l t h P r o f e s s i o n s A c t e o f N a t u r o p a t h i c P h y s i c i a n s o f B r i t i s h C o l u m b i a t h e H e a l t h P r o f e s s i o n s A c t e o f P e d i a t r i c S u r g e o n s o f B r i t i s h C o l u m b i a u n d e r a l t h P r o f e s s i o n s A c t e o f P h y s i c a l T h e r a p i s t s o f B r i t i s h C o l u m b i a u n d e r a l t h P r o f e s s i o n s A c t r f r o m e p r a c t i t i o n e r , d i c i n e o r s u r g e r y i f t h e p e r s o n h a s b e e n r e f e r r e d t o a r a c t i t i o n e r , i t a l , a s t h o s e f a c i l i t i e s a r e d e f i n e d i n s e c t i o n 1 . 1 o f t h e f t h e d e f i n i t i o n o f " h o s p i t a l " i n s e c t i o n 1 o f t h e H o s p i t a l f i t u n d e r t h e M e d i c a r e P r o t e c t i o n A c t o r a g e n e r a l h o s p i t a l t t o c o v e r t h e c o s t . i c a l s u p p l i e s d o n o t i n c l u d e n u t r i t i o n a l s u p p l e m e n t s , f o o d , e m i n i s t e r u n d e r t h i s s e c t i o n f o r a n y c o m b i n a t i o n o f a p y s e r v i c e s , n o n s u r g i c a l p o d i a t r y s e r v i c e s , n a t u r o p a t h y i o n ( 2 ) , t h e a m o u n t o f a g e n e r a l h e a l t h s u p p l e m e n t u n d e r p r a c t i c s e r v i c e s , m a s s a g e t h e r a p y s e r v i c e s , n o n s u r g i c a l e s i s $ 2 3 f o r e a c h v i s i t . e c t i o n 2 3 o f S c h e d u l e C o f t h e D i s a b i l i t B e n e f i t s
I APPEAL# Program Regulation, B.C. Reg. 79/97, the Income Assistance Regulation, B.C. Reg. 75/97 or the Youth Works Regulation, B.C. Reg. 77/97, as applicable, for the month during which the regulation was repealed, the minister may continue to provide that benefit to or for that person as a supplement under this regulation on the same terms and conditions as previously until the earlier of the following dates: (a) the date the conditions on which the minister paid the benefit are no longer met; (b) the date the person ceases to receive disability assistance. 2.1 Optical supplements. 2.2 Eye examination supplements Medical equipment and devices 3 (1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.12 of this Schedule are the health supplements that may be provided by the minister if (a) the supplements are provided to a family unit that is eligible under section 62 [general health supplements] of this regulation, and (b) all of the following requirements are met: (i) the family unit has received the pre-authorization of the minister for the medical equipment or device requested; (ii) there are no resources available to the family unit to pay the cost of or obtain the medical equipment or device; (iii) the medical equipment or device is the least expensive appropriate medical equipment or device. (2) For medical equipment or devices referred to in sections 3.1 to 3.8 or section 3.12, in addition to the requirements in those sections and subsection (1) of this section, the family unit must provide to the minister one or both of the following, as requested by the minister: (a) a prescription of a medical practitioner or nurse practitioner for the medical equipment or device; (b) an assessment by an occupational therapist or physical therapist confirming the medical need for the medical equipment or device. (2.1) For medical equipment or devices referred to in section 3.9 (1) (b) to (g), in addition to the requirements in that section and subsection (1) of this section, the family unit must provide to the minister one or both of the following, as requested by the minister: (a) a prescription of a medical practitioner or nurse practitioner for the medical equipment or device; (b) an assessment by a respiratory therapist, occupational therapist or physical therapist confirming the medical need for the medical equipment or device. (3) Subject to subsection (6), the minister may provide as a health supplement a replacement of medical equipment or a medical device, previously provided by the minister under this section, that is damaged, worn out or not functioning if (a) it is more economical to replace than to repair the medical equipment or device previously provided by the minister, and (b) the period of time, if any, set out in sections 3.1 to 3.12 of this Schedule, as applicable, for the purposes of this paragraph, has passed. (4) Subject to subsection (6), the minister may provide as a health supplement repairs of medical equipment or a medical device that was previously provided by the minister if it is more economical to repair the medical equipment or device than to replace it. (5) Subject to subsection (6), the minister may provide as a health supplement repairs of medical equipment or a medical device that was not previously provided by the minister if (a) at the time of the repairs the requirements in this section and sections 3.1 to 3.12 of this Schedule, as applicable, are met in respect of the medical equipment or device being repaired, and (b} it is more economical to repair the medical equipment or device than to replace it. (6) The minister may not provide a replacement of medical equipment or a medical device under subsection (3) or repairs of medical equipment or a medical device under subsection (4) or (5) if the minister considers that the medical equipment or device was damaged through misuse. 3.1 Medical equipment and devices -canes, crutches and walkers 3.2 Medical equipment and devices -wheelchairs 3.3 Medical equipment and devices -wheelchair seating systems
A P P E A L # I 3 . 4 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 s c o o t e r s 3 . 5 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 t o i l e t i n g , t r a n s f e r s a n d p o s i t i o n i n g a i d s 3 . 6 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 h o s p i t a l b e d 3 . 7 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 p r e s s u r e r e l i e f m a t t r e s s e s 3 . 8 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 f l o o r o r c e i l i n g l i f t d e v i c e s 3 . 9 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 b r e a t h i n g d e v i c e s 3 . 1 0 M e d i c a l e q u i p m e n t a n d d e v i c e s o r t h o s e s 3 . 1 1 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 h e a r i n g i n s t r u m e n t s 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 n o n c o n v e n t i o n a l g l u c o s e m e t e r s 3 . 1 2 ( 1 ) I n t h i s s e c t i o n , " n o n c o n v e n t i o n a l g l u c o s e m e t e r " i n c l u d e s ( a ) a c o n t i n u o u s g l u c o s e m o n i t o r i n g m e t e r , a n d ( b ) a t a l k i n g g l u c o s e m e t e r . ( 2 ) A n o n c o n v e n t i o n a l g l u c o s e m e t e r i s a h e a l t h s u p p l e m e n t f o r t h e p u r p o s e s o f s e c t i o n 3 o f t h i s S c h e d u l e i f t h e m i n i s t e r i s s a t i s f i e d t h a t ( a ) t h e g l u c o s e m e t e r i s m e d i c a l l y e s s e n t i a l t o t e s t b l o o d g l u c o s e l e v e l s , a n d ( b ) t h e p e r s o n f o r w h o m t h e n o n c o n v e n t i o n a l g l u c o s e m e t e r h a s b e e n p r e s c r i b e d i s u n a b l e t o u s e a c o n v e n t i o n a l g l u c o s e m e t e r . ( 3 ) T h e p e r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( b ) o f t h i s S c h e d u l e w i t h r e s p e c t t o r e p l a c e m e n t o f a n o n c o n v e n t i o n a l g l u c o s e m e t e r i s 5 y e a r s f r o m t h e d a t e o n w h i c h t h e m i n i s t e r p r o v i d e d t h e g l u c o s e m e t e r b e i n g r e p l a c e d . 4 D e n t a l s u p p l e m e n t s P o s i t i o n s o f P a r t i e s I n h e r N o t i c e o f A p p e a l d a t e d J a n u a r y 3 0 , 2 0 1 4 , t h e a p p e l l a n t s u b m i t s t h a t 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 w a s a n u n r e a s o n a b l e i n t e r p r e t a t i o n o f t h e l a w t o t h e f a c t s . T h e a p p e l l a n t t a k e s t h e f o l l o w i n g p o s i t i o n : 1 . T h e a p p e l l a n t i s e l i g i b l e f o r f u n d i n g f o r a n i n s u l i n p u m p a s m e d i c a l e q u i p m e n t u n d e r s e c t i o n 6 2 a n d S c h e d u l e C o f t h e E A P W D R ; 2 . T h e r e q u e s t e d i n s u l i n p u m p i s a l s o a c o n t i n u o u s g l u c o s e m o n i t o r a n d a s s u c h i s a 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 . 1 2 o f S c h e d u l e C o f t h e E A P W D R ; a n d 3 . T h a t a m b i g u i t i e s w i t h i n t h e c o n t e x t o f s o c i a l w e l f a r e b e n e f i t s 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 t h e c l a i m a n t c i t i n g t h e S u p r e m e C o u r t o f C a n a d a d e c i s i o n o f A b r a h a m s v . C a n a d a ( 1 9 8 3 ) 1 4 2 D L R ( 3 d ) 1 . T h e m i n i s t r y ' s p o s i t i o n a s s e t o u t 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 i s t h a t : 1 . T h e a p p e l l a n t i s n o t e l i g i b l e f o r f u n d i n g f o r a n i n s u l i n p u m p a s m e d i c a l e q u i p m e n t a s t h e a p p e l l a n t h a s n o t s a t i s f i e d s e c t i o n 3 ( 1 ) o f S c h e d u l e C o f t h e E A P W D R ; 2 . T h e a p p e l l a n t i s n o t e l i g i b l e f o r f u n d i n g f o r a n i n s u l i n p u m p a s a m e d i c a l s u p p l y a s t h e a p p e l l a n t h a s n o t s a t i s f i e d s e c t i o n 2 ( 1 ) o f S c h e d u l e C o f t h e E A P W D R ; 3 . T h e a p p e l l a n t i s n o t e l i g i b l e f o r f u n d i n g f o r a n i n s u l i n p u m p a s i t d o e s n o t m e e t t h e c r i t e r i a a s t h e r a p y o r a h e a l t h s u p p l e m e n t a s p r o v i d e d b y s e c t i o n s 2 t h r o u g h 9 o f S c h e d u l e C o f t h e E A P W D R ; 4 . T h e a p p e l l a n t i s n o t e l i g i b l e f o r f u n d i n g f o r a n i n s u l i n p u m p a s a h e a l t h s u p p l e m e n t f o r a p e r s o n f a c i n g a d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g h e a l t h n e e d a s t h e a p p e l l a n t h a s n o t s a t i s f i e d s e c t i o n 6 9 o f t h e E A P W D R ; a n d 5 . T h e S u p r e m e C o u r t o f C a n a d a ' s d e c i s i o n i n A b r a h a m s h a s n o b e a r i n g o n t h e l e g i s l a t i o n t h a t g u i d e s t h e a p p e a l o f t h i s m a t t e r .
E l i g i b i l i t y f o r i n s u l i n p u m p a s m e d i c a l e q u i p m e n t u n d e r S S e c t i o n s 3 . 1 t o 3 . 1 2 o f S c h e d u l e C o f t h e E A P W D R s e t o u t t h m a y b e p r o v i d e d b y t h e m i n i s t r y w h e r e a p e r s o n s a t i s f i e s t h e 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 m a y b e p r o v i d e d b y t h e m i n i s r e s o u r c e s a v a i l a b l e t o t h e f a m i l y u n i t t o p a y t h e c o s t o f o r o b t a I n t h e p r e s e n t c a s e , t h e a p p e l l a n t t h r o u g h h e r p h y s i c i a n h a s r a d v o c a t e a r g u e s t h a t t h e p r o p o s e d d e v i c e s e r v e s a d u a l p u r p a s a n i n s u l i n p u m p a n d a s s u c h i t s a t i s f i e s t h e d e f i n i t i o n o f " n o u n d e r S c h e d u l e C s e c t i o n 3 . 1 2 o f t h e E A P W D R . T h e m i n i s t r y n o t a n e l i g i b l e i t e m u n d e r S c h e d u l e C s e c t i o n 3 . 1 2 o f t h e E A P i n c l u d e a n i n s u l i n p u m p . T h e p a n e l n o t e s t h a t a n i n s u l i n p u m p i s n o t i n c l u d e d i n s e c t i o n s e c t i o n 3 . 1 2 , w h i c h d e s c r i b e a n o n c o n v e n t i o n a l g l u c o s e m e t e t o i t a s i n c l u d i n g a n i n s u l i n p u m p . T h e p a n e l f u r t h e r n o t e s t h a s p e c i f i c a l l y r e q u e s t e d a n i n s u l i n p u m p a n d t h a t t h e m e d i c a l s p a p p e l l a n t w o u l d b e b e s t s e r v e d b y a n i n s u l i n p u m p . F u r t h e r , t a p p e l l a n t i s i n n e e d o f " a c o n t i n u o u s g l u c o s e m o n i t o r i n t h e f o T h e p a n e l f u r t h e r n o t e s t h a t w h i l e t h e a p p e l l a n t h a s p r o v i d e d e t h e r e i s n o e v i d e n c e a s t o w h e t h e r t h e r e a r e a n y o t h e r r e s o u r c r e q u e s t e d i n s u l i n p u m p i n c l u d i n g , a s t h e m i n i s t r y a r g u e s , t h e m G i v e n t h e a f o r e m e n t i o n e d e v i d e n c e , t h e p a n e l f i n d s t h a t t h e m a p p e l l a n t ' s r e q u e s t f o r f u n d i n g f o r a n i n s u l i n p u m p o n t h e b a s i s e c t i o n s 3 . 1 t o 3 . 1 2 o f S c h e d u l e C o f t h e E A P W D R a n d o n t h 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 h e r t o p a y t h e c o s t o f o r t o o b t a i n S c h e d u l e C o f t h e E A P W D R . E l i g i b i l i t y f o r i n s u l i n p u m p a s a m e d i c a l s u p p l y u n d e r S c h S e c t i o n 2 ( 1 ) ( a ) o f S c h e d u l e C o f t h e E A P W D R l i s t s t h e h e a l t h 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 l i g i b l e u n d e r s e c t i o n 6 2 . T h e s m e d i c a l o r s u r g i c a l s u p p l i e s a n d c o n s u m a b l e m e d i c a l s u p p l i e s O n r e v i e w o f t h e l e g i s l a t i o n , t h e p a n e l f i n d s t h a t t h e m i n i s t r y w f o r f u n d i n g f o r a n i n s u l i n p u m p o n t h e b a s i s t h a t i t i s n o t i n c l u d S c h e d u l e C o f t h e E A P W D R . E l i g i b i l i t y f o r i n s u l i n p u m p u n d e r a n y o t h e r s e c t i o n o f S c h S e c t i o n s 2 ( 1 ) ( c ) , 2 ( 2 ) a n d 2 ( 2 . 1 ) o f S c h e d u l e C o f t h e E A P W D c h i r o p r a c t i c , m a s s a g e t h e r a p y , n a t u r o p a t h y , n o n s u r g i c a l p o d i p a n e l f i n d s t h a t t h e m i n i s t r y w a s r e a s o n a b l e i n i t s d e c i s i o n t o d o n t h e b a s i s t h a t i t i s n o t i n c l u d e d i n t h e s e s e c t i o n s o f S c h e d u l S e c t i o n s 2 . 1 , 2 . 2 , 4 , 4 . 1 , 5 , 6 , 7 , 8 a n d 9 o f S c h e d u l e C o f t h e E s u p p l e m e n t s , e y e e x a m i n a t i o n s u p p l e m e n t s , d e n t a l s u p p l e m e n s u p p l e m e n t s , d i e t s u p p l e m e n t s , 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 h e p a n e l f i n d s t h a t t h e m i n i s t r y w a s r e a s o n a b l e i n i t s d e c i s i o n p u m p o n t h e b a s i s t h a t i t i s n o t i n c l u d e d i n t h e s e s e c t i o n s o f S c E l i g i b i l i t y f o r i n s u l i n p u m p a s 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 e c t i o n 6 9 o f t h e E A P W D R p r o v i d e s t h a t t h e m i n i s t e r m a y p r o s e c t i o n s 2 ( 1 ) ( a ) a n d ( f ) a n d 3 o f S c h e d u l e C i f t h e h e a l t h s u p p l i s o t h e r w i s e n o t e l i a i b l e f o r t h e h e a l t h s u n n l e m e n t u n d e r t h e r e I A P P E A L # c h e d u l e C o f t h e E A P W D R e v a r i o u s e x a m p l e s o f 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 t h a t r e q u i r e m e n t s o f s e c t i o n 6 2 o f t h e E A P W D R . T h e l i s t e d t e r i f c e r t a i n c o n d i t i o n s a r e m e t i n c l u d i n g t h a t t h e r e a r e n o i n t h e m e d i c a l e q u i p m e n t o r d e v i c e . e q u e s t e d f u n d i n g f o r a n i n s u l i n p u m p . T h e a p p e l l a n t ' s o s e i n s o f a r i s i t m o n i t o r s g l u c o s e l e v e l s w h i l e a l s o s e r v i n g n c o n v e n t i o n a l g l u c o s e m e t e r ' ' w h i c h i s a n e l i g i b l e i t e m a r g u e s t h a t t h e i n s u l i n p u m p r e q u e s t e d b y t h e a p p e l l a n t i s W D R a n d t h a t a n o n c o n v e n t i o n a l g l u c o s e m e t e r d o e s n o t s 3 . 1 t h r o u g h 3 . 1 2 o f S c h e d u l e C o f t h e E A P W D R a n d t h a t r a s e l i g i b l e m e d i c a l e q u i p m e n t , d o e s n o t m a k e r e f e r e n c e t t h e R e q u e s t F o r m p r e p a r e d b y t h e a p p e l l a n t ' s p h y s i c i a n e c i a l i s t r e c o m m e n d s i n t h e C o n s u l t R e p o r t t h a t t h e h e a p p e l l a n t ' s p h y s i c i a n n o t e s i n t h e G P L e t t e r t h a t t h e r m o f a n i n s u l i n p u m p . " v i d e n c e o f h e r m o n t h l y e x p e n s e s a n d a b a n k s t a t e m e n t , e s a v a i l a b l e t o t h e a p p e l l a n t t o p a y t h e c o s t o f o r o b t a i n t h e i n i s t r y o f h e a l t h d i s a b i l i t y a s s o c i a t i o n . i n i s t r y w a s r e a s o n a b l e i n i t s d e c i s i o n t o d e n y t h e s t h a t i t i s n o t i n c l u d e d a s m e d i c a l e q u i p m e n t o r d e v i c e s i n b a s i s t h a t t h e a p p e l l a n t h a s n o t d e m o n s t r a t e d t h a t t h e r e t h e i n s u l i n p u m p a s r e q u i r e d b y s e c t i o n 3 ( 1 ) ( b ) o f e d u l e C o f t h e E A P W D R 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 e r i f e h e a l t h s u p p l e m e n t s i n c l u d e d i s p o s a b l e o r r e u s a b l e . a s r e a s o n a b l e i n i t s d e c i s i o n t o d e n y t h e a p p e l l a n t ' s r e q u e s t e d a s a m e d i c a l s u p p l y a s p r o v i d e d b y s e c t i o n 2 ( 1 ) ( a ) o f e d u l e C o f t h e E A P W D R R p r o v i d e t h a t t h e m i n i s t r y m a y p r o v i d e a c u p u n c t u r e , a t r y a n d p h y s i o t h e r a p y t r e a t m e n t s t o a f a m i l y u n i t . T h e e n y t h e a p p e l l a n t ' s r e q u e s t f o r f u n d i n g f o r a n i n s u l i n p u m p e C o f t h e E A P W D R . A P W D R p r o v i d e t h a t t h e m i n i s t r y m a y p r o v i d e o p t i c a l t s , c r o w n a n d b r i d g e w o r k s u p p l e m e n t s , e m e r g e n c y d e n t a l t s , n a t a l s u p p l e m e n t s a n d i n f a n t f o r m u l a t o a f a m i l y u n i t . t o d e n y t h e a p p e l l a n t ' s r e q u e s t f o r f u n d i n g f o r a n i n s u l i n h e d u l e C o f t h e E A P W D R . u n d e r s e c t i o n 6 9 o f t h e E A P W D R v i d e t o a f a m i l y u n i t a n y h e a l t h s u p p l e m e n t s e t o u t i n 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 r s o n i n t h e f a m i l y u n i t w h o a u l a t i o n a n d i f t h e m i n i s t e r i s s a t i s f i e d t h a t t h e p e r s o n f a c e s
a d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g n e e d a n d t h e r e a r e n o r m e e t t h a t n e e d . I n t h i s c a s e h o w e v e r , t h e a p p e l l a n t h a s r e q u e s t e d a n i n s u l i n p p u m p d o e s n o t c o n s t i t u t e a " H e a l t h S u p p l e m e n t " a s c o n t e m p l a n y o f t h e m e d i c a l e q u i p m e n t o r d e v i c e s i n s e c t i o n s 3 . 1 t h r o u o r ( f ) . A s t h e a p p e l l a n t ' s r e q u e s t f o r a n i n s u l i n p u m p d o e s n o t m e e t a b l e t o p r o v i d e t h a t t o t h e a p p e l l a n t u n d e r s e c t i o n 6 9 o f t h e E a n d i m m i n e n t l i f e t h r e a t e n i n g n e e d a n d a s s u c h , t h e p a n e l c o t h e a p p e l l a n t w a s n o t e l i g i b l e f o r i n s u l i n p u m p o n t h e b a s i s t h a p r o v i d e d f o r b y s e c t i o n 6 9 o f t h e E A P W D R . C o n c l u s i o n H a v i n g r e v i e w e d a n d c o n s i d e r e d a l l o f t h e e v i d e n c e a n d r e l e v r e c o n s i d e r a t i o n d e c i s i o n w h i c h d e t e r m i n e d t h a t t h e a p p e l l a n t 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 e n a c t m e n t i n t h e c i r c u m s t a n c e s o A P P E A L I I I e s o u r c e s a v a i l a b l e t o t h e p e r s o n ' s f a m i l y u n i t w i t h w h i c h t o u m p a n d , a s s e t o u t a b o v e , t h e p a n e l f i n d s t h a t a n i n s u _ l i n a t e d b y S c h e d u l e C o f t h e E A P W D R a s i t d o e s n o t f i t w i t h i n g h 3 . 1 2 a n d i s n o t a s u p p l e m e n t a s s e t o u t i n s e c t i o n 2 ( 1 ) ( a ) t h e d e f i n i t i o n o f a " H e a l t h S u p p l e m e n t " , t h e m i n i s t r y i s n o t A P W D R r e g a r d l e s s o f w h e t h e r t h e r e i s e v i d e n c e o f a d i r e c t n c l u d e s t h a t t h e m i n i s t r y w a s r e a s o n a b l e i n d e t e r m i n i n g t h a t t s h e w a s f a c i n g a d i r e c t a n d 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 s a n t l e g i s l a t i o n , t h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s w a s n o t e l i g i b l e f o r a n i n s u l i n p u m p w a s a r e a s o n a b l e f t h e a p p e l l a n t , a n d t h e r e f o r e c o n f i r m s t h e d e c i s i o n .
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.