APPEAL# '. PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the "ministry'') reconsideration decision of April 22 nd , 2014 wherein the ministry denied the appellant's request for a crisis supplement under section 57 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) for a Memory Foam Mattress because the appellant does not meet the criteria set out in section 57(1) EAPWDR; and section 57(3) EAPWDR states that a crisis supplement may not be provided for the purpose of obtaining any other health care goods or services. Further, the ministry determined a Memory Foam Mattress cannot be provided as a health supplement under Schedule C, section 3(1) EAPWDR because a Memory Foam Mattress is not described as medical equipment and devices in sections 3.6 (hospital bed) or section 3.7 (pressure relief mattress) of Schedule C EAPWDR. PART D -Relevant Legislation EAPWDR sections 57 (crisis supplement), 62 (general health supplements) and Schedule C sections 3(2), 3.6 and 3.7 EAA T003(10/06/01)
APPEAL# I PART E -Summary of Facts The evidence before the ministry at the time of reconsideration: • Quote dated February 24 th , 2014 for mattress and frame; • Letter dated February 25 th , 2014 from appellant's physician; • Quote dated February 28 th , 2014 for box spring and mattress; • Request for Reconsideration dated April 4 th , 2014 On January 7 th , 2014 the appellant attended at the ministry office and inquired about obtaining a Memory Foam Mattress. The ministry (EAW) had requested the appellant, along with an occupational therapist (OT) or physical therapist (PT) complete a Medical Equipment and Justification (MEJ) form, HR2138. The OT refused to complete section 3 of the HR2138 form. On February 12 th , 2014 the appellant had back surgery. On February 26 th , 2014 the appellant submitted a quote from a furniture store for a Memory Foam Mattress. The EAW requested the appellant obtain a 2 nd quote for a mattress as well as a letter from her physician explaining why the appellant needed a Memory Foam Mattress. On February 25 th , 2014 the ministry also received a fax from the appellant's physician advising that "the appellant has multi-level disc disease with stenosis and spondylosis, has had fusion surgery and could benefit from a supportive mattress". On February 28, 2014 the ap � ellant submitted a 2 nd quote for a mattress but this was the same quote that was submitted on February 26 , 2014. The EAW requested the appellant obtain another separate quote and on March 3''\ 2014 the appellant submitted additional quotes for a mattress. On March 11 th , 2014 the ministry determined the appellant's request did not fall within the list of approved items in Schedule C sections 3.1 to 3.8 EAPWDR; that a hospital bed and/or a pressure relief mattress (s. 3.6 and 3.7 respectively) did not apply to her request and that a crisis supplement could not be provided as a health supplement. The appellant requested that her request for a Memory Foam Mattress be considered under the crisis supplement legislation. The appellant was advised that additional information was required to assess how a new mattress fits within the crisis supplement criteria. The ministry advised no new information was provided. On March 28 th , 2014 the ministry advised the appellant that her request did not meet the criteria under section 57 EAPWDR or Schedule C, section 3 medical equipment EAPWDR legislation and her request for a supplement was denied. In section 3 of the Request for Reconsideration the appellant stated that "Due to my severe back problem I need a supportive mattress in order to get proper sleep. I have provided a letter from my physician to document the urgent need. I have supplied the ministry with multiple estimates for a suitable mattress. I am currently sleeping on an air mattress which is very painful and uncomfortable. I do not need a hospital bed just a mattress with good support. This is not a medical equipment request. A bed is a basic need and the medical report is supplied to show that my need is urgent as recovering from back surgery is a confirming factor of the urgency. I am happy to have the lowest bid." In the Notice of Appeal the appellant states, "I don't have a bed and I have had back surgery. I need a mattress due to ongoing chronic pain and numbness that prevents me from getting adequate sleep". At the hearing the appellant testified that: • she has been in receipt of disability assistance since 2006; • she and her spouse moved to this new community in December 2013 because it was a better place; • when they moved they could only bring what they could carry and they carried as much as they could; • they moved into a shelter and didn't need furniture; • she was waiting for back surgery which was done at former community on February 12 th , 2014; • she is presently sleeping on an air mattress which is difficult to get up from; • she is still suffering from back pain and numbness after the surgery; • she needs a good mattress to support her back; • she revisited the surgeon after the surgery and it is not known what is causing the back pain; • she did not try local a(lencies to aet a bed because she didn't know where to ao. EM T003(1 0/06/01)
• s h e i s n o t a s k i n g f o r h e a l t h s u p p l e m e n t ; d o e s n ' t h a v e c o i l s p r i n g s t h a t w i l l h u r t h e r b a c k . I n r e s p o n s e t o q u e s t i o n s f r o m t h e p a n e l t h e a p p e l l a n t t e • s h e h a d n o e x p l a n a t i o n r e g a r d i n g w h y t h e m a t t r e t r y i n g t o g e t r e a d y f o r t h e a n t i c i p a t e d b a c k s u r g e • s h e w a n t e d a m a t t r e s s t h a t d i d n ' t h a v e c o i l s p r i n • s h e d i d n ' t k n o w a n y r e s o u r c e c e n t e r s w h e r e s h e • t h e o n l y i n c o m e t h e y h a v e i s d i s a b i l i t y a s s i s t a n c e b e d . T h e a p p e l l a n t ' s o r a l t e s t i m o n y p r o v i d e d a d d i t i o n a l d e t a i l t h e t i m e o f r e c o n s i d e r a t i o n , a n d h a s b e e n a d m i t t e d b y t h a c c o r d a n c e w i t h s e c t i o n 2 2 ( 4 ) o f t h e E m p l o y m e n t a n d A 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 w i t n e s s ( s p o u s e ) t e s t i f i e d • h e a n d t h e a p p e l l a n t m o v e d t o t h i s c o m m u n i t y i n t h r e a t e n e d a n d f e l t t h e i r l i v e s w e r e a t r i s k ; • a l l t h e i r p e r s o n a l b e l o n g i n g s e x c e p t w h a t t h e y c o • w h e n t h e y m o v e d t h e y l e f t m a n y p e r s o n a l i t e m s q • t h e y d i d n ' t r e q u e s t a s s i s t a n c e f o r t h e m o v e f r o m • w h e n t h e y a r r i v e d i n t h e i r n e w c o m m u n i t y t h e y l i v • i n J a n u a r y 2 0 1 4 t h e a p p e l l a n t m o v e d i n t o r e n t a l a b y t h e f o r m e r t e n a n t , i . e . d r e s s e r , c h a i r a n d t a b l e p u r c h a s e d f o r t h e m t o s l e e p o n ; • h i s s p o u s e w a s w a i t i n g f o r b a c k s u r g e r y a n d t h e y l e a r n e d t h e b e s t t y p e o f m a t t r e s s w h e n r e c o v e r i n • o n J a n u a r y ? 1 \ 2 0 1 4 t h e y w e n t t o t h e m i n i s t r y t o i t h e y h a d n o b e d a n d t h e a p p e l l a n t w a s o n a w a i t i s p o u s e a M E J f o r m a n d a d v i s e d h e r t o h a v e t h e f M e m o r y F o a m M a t t r e s s . T h e e s t i m a t e s h a d t o b e • t h e y d i d n o t m a k e a n y a t t e m p t s t o f i n d a b e d ( m a • a f t e r t h e a p p e l l a n t h a d h e r b a c k s u r g e r y h e t r i e d t s h e w o u l d h a v e a b e d b u t , d u e t o l i a b i l i t y i s s u e s , • h e w a s n o t a w a r e o f a n y a l t e r n a t i v e s r e g a r d i n g w m i n i s t r y . I n r e s p o n s e t o q u e s t i o n s f r o m t h e p a n e l t h e w i t n e s s t e s t i • h e t r i e d t h e l o c a l c h u r c h e s a n d t h e T h r i f t s t o r e s e • d i d n ' t w a n t a u s e d m a t t r e s s a s t h e y a r e o f t e n w o r s p o u s e ' s h e a l t h ( r e c o v e r y f r o m b a c k s u r g e r y ) ; • t h e m i n i s t r y a d d e d t h a t m a n y c o m m u n o f t h e b e d b u g i s s u e a n d t h e m i n i s t r y u a g e n c i e s ; • t h e a p p e l l a n t n e e d e d a m a t t r e s s t h a t d i d n o t h a v e • t h e O T ( w h e r e t h e b a c k s u r g e r y w a s d o n e ) a d v i s e s h e w a s n o t a w a r e o f t h e a p p e l l a n t ' s s i t u a t i o n ; t h a a p p e l l a n t r e s i d e d ; • i t w o u l d t a k e m o n t h s t o g e t t o s e e a n O T i n t h e i r c E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # n e e d a h o s p i t a l b e d , j u s t a g o o d m a t t r e s s t h a t d o e s n ' t s t i f i e d t h a t : s s w o u l d b e a n u n e x p e c t e d e x p e n s e a s t h e y w e r e j u s t r y a n d d i d n ' t h a v e a m a t t r e s s ; g s w h i c h s h e f e l t w o u l d b o t h e r h e r b a c k ; c o u l d g e t a m a t t r e s s ; a n d t h e G S T r e b a t e w h i c h i s n o t s u f f i c i e n t t o b u y a r e g a r d i n g i n f o r m a t i o n t h a t w a s b e f o r e t h e m i n i s t r y a t e p a n e l a s b e i n g o r a l t e s t i m o n y i n s u p p o r t , i n s s i s t a n c e A c t ( E A A ) . t h a t : D e c e m b e r 2 0 1 3 b e c a u s e t h e y h a d b e e n v e r b a l l y u l d c a r r y w e r e l e f t a t t h e f o r m e r r e s i d e n c e ; e c a u s e t h e y d i d n ' t h a v e a m o v i n g v a n ; t h e m i n i s t r y ; e d i n a s h e l t e r a n d d i d n ' t n e e d m a n y t h i n g s ; c c o m m o d a t i o n ; t h e r e w a s s o m e f u r n i t u r e l e f t b e h i n d , b u t t h e r e w a s n o b e d a n d s o a n a i r m a t t r e s s w a s n e e d e d a b e d / m a t t r e s s s o h e d i d s o m e r e s e a r c h a n d g f r o m b a c k s u r g e r y w a s M e m o r y F o a m ; n q u i r e a b o u t o b t a i n i n g a M e m o r y F o a m M a t t r e s s a s n g l i s t f o r b a c k s u r g e r y . T h e E A W g a v e t h e a p p e l l a n t ' s o r m c o m p l e t e d a n d t o g e t t w o e s t i m a t e s f o r t h e u n d e r a c e r t a i n a m o u n t t o b e c o n s i d e r e d . t t r e s s ) u p o n a r r i v i n g i n t h e c o m m u n i t y ; o s e e i f t h e a p p e l l a n t c o u l d r e t u r n t o t h e s h e l t e r w h e r e t h e s h e l t e r w o u l d n o t l e t h e r s t a y t h e r e ; h e r e t o o b t a i n a b e d i n t h e c o m m u n i t y s o w e n t t o f i e d t h a t : v e r a l t i m e s w i t h o u t s u c c e s s . n o u t ( s a g g i n g ) a n d t h a t w o u l d b e d e t r i m e n t a l t o h i s i t y a g e n c i e s d o n o t p r o v i d e u s e d m a t t r e s s e s b e c a u s e s u a l l y d o e s n ' t r e c o m m e n d c l i e n t s g o t o c o m m u n i t y c o i l s p r i n g s ; d s h e c o u l d n o t c o m p l e t e a n d s i g n t h e M E J b e c a u s e t t h e f o r m h a d t o b e s i g n e d b y a n O T w h e r e t h e o m m u n i t y ;
T h e o r a l t e s t i m o n y o f t h e w i t n e s s p r o v i d e d a d d i t i o n a l d e a t t h e t i m e o f r e c o n s i d e r a t i o n , a n d , w i t h t h e e x c e p t i o n o f c o m m u n i t y , t h e w i t n e s s ' t e s t i m o n y h a s b e e n a d m i t t e d b y i n f o r m a t i o n a n d r e c o r d i n a c c o r d a n c e w i t h s e c t i o n 2 2 ( 4 ) T h e p a n e l c o n s i d e r s t h e a p p e l l a n t ' s r e a s o n f o r m o v i n g t 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 r e c o n s i d e r a t i o n a n d t h e a c c o r d a n c e w i t h s e c t i o n 2 2 ( 4 ) o f t h e E A A . T h e a p p e l l a n t ' s a d v o c a t e s u b m i t t e d a t w o p a g e d o c u m e e v i d e n c e . T h e m i n i s t r y p r o v i d e d n o o b j e c t i o n o n t h e a d m a d d i t i o n a l d e t a i l a n d t h e a p p e l l a n t ' s p o s i t i o n o n t h e a p p e s u p p o r t o f t h e i n f o r m a t i o n a n d r e c o r d s t h a t w e r e b e f o r e a d m i s s i b l e i n a c c o r d a n c e w i t h s e c t i o n 2 2 ( 4 ) o f t h e E A A . 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 . T h e m a w a r e t h a t t h e a p p e l l a n t a n d h e r s p o u s e f e l t t h e i r l i f e w a t h e i r p e r s o n a l i t e m s b e h i n d a t t h e f o r m e r r e s i d e n c e . T h e p a n e l m a k e s t h e f o l l o w i n g f i n d i n g o f f a c t : 1 . T h e a p p e l l a n t i s 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 2 . 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 a c r i s i s s u p p l e m e n t ; 3 . 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 m e d i c a l e q u i p m e n t o r 4 . T h e a p p e l l a n t m o v e d t o t h i s c o m m u n i t y i n D e c e m 5 . T h e a p p e l l a n t w a s o n a w a i t i n g l i s t f o r b a c k s u r g e 6 . O n J a n u a r y ? ' h , 2 0 1 4 t h e a p p e l l a n t a p p l i e d f o r a c 7 . O n F e b r u a r y 1 2 t h , 2 0 1 4 t h e a p p e l l a n t u n d e r w e n t E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # _J � _ � _ _ _ _ _ _ _ _ _ _ _ _ I t a i l r e g a r d i n g i n f o r m a t i o n t h a t w a s b e f o r e t h e m i n i s t r y t h e r e a s o n t h a t t h e a p p e l l a n t ' s m o v e d t o t h i s t h e p a n e l a s b e i n g o r a l t e s t i m o n y i n s u p p o r t o f t h e o f t h e E A A . o t h e c o m m u n i t y a s n e w i n f o r m a t i o n t h a t w a s n o t r e f o r e i s n o t a d m i s s i b l e a s n e w e v i d e n c e i n n t w h i c h s u b s t a n t i a l l y r e i t e r a t e d t h e a b o v e n o t e d o r a l i s s i b i l i t y o f t h i s d o c u m e n t . A s t h e d o c u m e n t p r o v i d e d a l , t h e p a n e l a c c e p t s t h e d o c u m e n t a s b e i n g i n t h e m i n i s t r y a t t h e t i m e o f r e c o n s i d e r a t i o n a n d i s i n i s t r y s t a t e d t h a t u n t i l t o d a y t h e m i n i s t r y w a s n o t s i n d a n g e r a n d t h e y h a d t o m o v e l e a v i n g m a n y o f e ; d e v i c e s , a s p r o v i d e d i n s e c t i o n 3 o f S c h e d u l e C ; b e r 2 0 1 3 l e a v i n g p e r s o n a l b e l o n g i n g b e h i n d ; r y ; r i s i s s u p p l e m e n t t o o b t a i n a M e m o r y F o a m M a t t r e s s ; b a c k s u r g e r y .
PART F Reasons for Pan el Dec i s ion Th e i ssu e und er app eal is the reas onab l en e s s of t h e min w here i n the mini st ry deni e d the ap pel l ant' s reque st fo r a Memo ry F oam M a ttress because the ap pe l l an t does not a nd sec tio n 57(3) EA PWDR states t h at a crisis sup plemen an y o ther health c ar e goods or service s . Furthe r, the m in istry det er min ed a M emor y Foam M at tre S chedu l e C, secti o n 3(1) EAP WD R b ec aus e a Memory Foa and d evices i n s e ction 3.6 (hos p it al bed) or sec t ion 3. 7 (pr Th e le g islation conside red: EAPWDR Cr isis s upplement S ect i on 57 (1) The minister may pro v ide a cris i s suppl eme nt t o or for a ha r d s hip assista nc e if (a ) th e fa m i ly un it or a pe r son in the fam ily un it re q uires t obtain an item un e xpectedly neede d and i s un able to meet t a re no re so urce s avai lable to the fa mily u ni t , and ( b) th e m i nister considers that f ailure to meet th e expense or ( i ) i mminent danger t o t he ph ysic al hea lth of any person in th ( i i) remova l o f a chil d un de r the C hild , Fa m i l y a n (2 ) A crisis suppl ement may be prov i ded only for t he calendar mo s uppl em e n t i s made. ( 3) A crisis supple m e n t m ay not be provided for th e p u rpose (a) a su ppl emen t describe d in Schedule C , o r (b) any othe r healt h c are good s o r service s. General h ealt h supplem ents Section 6 2 (1 ) Subject to s u bs ect ions (1.1) and (1.2) , th e mini s ter may pro { g e neral healt h supp lements ] o r 3 [med ic a l equip me nt a nd healt h su p pl e ment is prov i de d to o r f o r a person in the family (a) a recipient of disabil ity assistance, Sc h e dul e C -Hea lth Supp lement s 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 t o 3.12 of this S c h e dule are th e health supplements that may b 197/2012) (a) the supp lem e nts a re p r ovide d to a family unit tha t supplements] of this regulation, and (b) all of the following requireme nts 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 appropr 2 For medical e ui m en! or devices referred to in sections 3.1 to 3.8 or section 3.1 EMT 003(10/06/01) I APPE A L# ist r y's recon sideration d e cisi on of A pril 22 n d , 201 4 crisis supplement un der secti o n 5 7 E A PWDR fo r a m eet the crite ria set o ut in sec tio n 57(1 ) EAPWD R; t may not be pro v ided for the purpose o f obt aining s s ca n not b e pro vided as a he alt h s up ple ment un der m Ma ttress is n o t des cri bed as medic a l equipme nt ess ure r el ief mat tre s ses) of Sc hedule C EAP WDR. f amily u nit that is e li gib le for d i s a bili t y as sis t ance o r he su p pl ement t o me et an unexpected e x pense or he e x pense or obtain the item bec aus e th e re o b t ai n th e item will resul t in e fa mily un i t , o r d Com munity Servi c e Act. nth in which the appli cation or r eq uest for th e of obtaining vide any health supp l e ment se t out in section 2 d evices] of Sched ule C to or for a fa mily un it if the u nit w h o is e p rov id ed by the mini ster i f (B.C. Reg. is elig ible under sect i on 6 2 {g eneral health i at e medical equipment or device. 2, in a ddi tion to th e
'. APPEAi ii 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: (B.C. Reg. 197/2012) (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. (B.C. Reg. 197/2012) (3) Subject to subsection (6), the minister may provide as a health supplement a replacement of medical equipment or 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. (B.C. Reg. 197/2012) (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.C. Reg. 197/2012) (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 dam aged through misuse. Medical equipment and devices -hospital bed Section 3.6 (1) Subject to subsection (3) of this section, the following items are health supplements for the purposes of section 3 of this Schedule if the minister is satisfied that the item is medically essential to facilitate transfers of a person to and from bed or to adjust or maintain a person's positioning in bed: (a) a hospital bed; (b) an upgraded component of a hospital bed; (c) an accessory attached to a hospital bed; (d) a positioning item on a hospital bed. (B.C. Reg. 197/2012) (2) The period of time referred to in section 3 (3) (b) of this Schedule with respect to replacement of an item described in subsection (1) of this section is 5 years from the date on which the minister provided the item being replaced. (3) The following items are not health supplements for the purposes of section 3 of this Schedule: (a) an automatic turning bed; (b) a containment type bed. Medical equipment and devices -pressure relief mattresses EAA T003(10/06/01)
S e c t i o n 3 . 7 ( 1 ) A p r e s s u r e r e l i e f m a t t r e s s i s a h e a l t h s u p p l e m e n t f o r 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 r e s s u r e r e l i e f m a t t r e s s i s m m a i n t a i n s k i n i n t e g r i t y . ( 2 ) 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 d e s c r i b e d i n s u b s e c t i o n ( 1 ) o f t h i s s e c t i o n i s 5 y e a r s f r o m b e i n g r e p l a c e d . T h e i s s u e a t a p p e a l i s t h a t t h e m i n i s t r y i n i t i a l l y c o n s i d e r e a s h e a l t h g o o d s u n d e r S c h e d u l e C , s e c t i o n 3 a n d t h e a p a h e a l t h s u p p l e m e n t a n d t h e r e q u e s t s h o u l d o n l y b e c o n 1 . C r i s i s S u p p l e m e n t T h e m i n i s t r y ' s p o s i t i o n i s t h a t t h e a p p e l l a n t d o e s n o t m e e E A P W D R t o b e e l i g i b l e f o r a c r i s i s s u p p l e m e n t ; t h a t o n J o f f i c e a n d i n q u i r e d a b o u t o b t a i n i n g a M e m o r y F o a m M a t m a t t r e s s w o u l d b e n e e d e d t o a s s i s t h e r w i t h h e r r e c o v e r o n t h e c o s t o f a M e m o r y F o a m M a t t r e s s , c o m p l e t e t h e M T h e m i n i s t r y a r g u e d t h a t t h e O T r e f u s e d t o c o m p l e t e o n e E A P W D R l e g i s l a t i o n w h e n c o n s i d e r i n g a h e a l t h s u p p l e m w a s a d v i s e d f u r t h e r i n f o r m a t i o n w a s r e q u i r e d t o e n a b l e t t h e l e g i s l a t e d c r i t e r i a f o r a c r i s i s s u p p l e m e n t , n o a d d i t i o n T h e m i n i s t r y a r g u e d i t w a s n o t p r e v i o u s l y i n f o r m e d t h a t t c o m m u n i t y b e c a u s e t h e y h a d b e e n t h r e a t e n e d a n d t h a t , p o s s e s s i o n s b e h i n d . T h e m i n i s t r y a r g u e d t h a t t h e M e m o a p p e l l a n t ' s r e c o v e r y f r o m b a c k s u r g e r y , a n d t h a t t h e m i n T h e m i n i s t r y s t a t e d t h a t h a d t h e E A W b e e n f u l l y i n f o r m e d l e a v i n g t h e i r f o r m e r c o m m u n i t y , t h e r e q u e s t m a y h a v e b e T h e m i n i s t r y a l s o a r g u e d t h e a p p e l l a n t r e c e i v e s m o n t h l y r e b a t e t o a s s i s t w i t h t h e i r n e e d s . 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 h e d i d n o t h a v e a b e d o r s p r i n g s b u t w o u l d p r o v i d e g o o d b a c k s u p p o r t , t o a s s i s t h a p p e l l a n t a r g u e d t h e a i r m a t t r e s s t h a t t h e y w e r e s l e e p i n g w a s n o t s l e e p i n g p r o p e r l y ; a n d , t h a t s h e f o u n d i t v e r y d i f f a p p e l l a n t a r g u e d n e i t h e r s h e n o r h e r s p o u s e w e r e a w a r e m a t t r e s s t h a t w o u l d m e e t t h e i r n e e d s . T h e a p p e l l a n t a r g u h a v e t h e f i n a n c i a l r e s o u r c e s t o p u r c h a s e t h e m a t t r e s s . T a m a t t r e s s t h a t i t d i d n ' t h a v e t o b e a M e m o r y F o a m M a t t r c o i l s p r i n g s w o u l d b o t h e r h e r b a c k . I n r e f e r e n c e t o s e c t i o n 5 7 ( 1 ) ( a ) E A P W D R • T h e e v i d e n c e i s t h a t t h e a p p e l l a n t w a s g o i n g o n a w a i t i n g n e e d a s u p p o r t i v e m a t t r e s s . T h e a p p e l l a n t ' s s p o u s e t e s t i F o a m M a t t r e s s w o u l d p r o v i d e t h e b e s t b a c k s u p p o r t a n d T h e p a n e l f i n d s t h a t 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 a t t r e s m a t t r e s s w a s n e e d e d t o a s s i s t h e r i n h e r r e c o v e r y f r o m b t h a t t h e e x e n s e w o u l d n o t b e u n e x e c t e d o r t h a t t h e i t e m E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I 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 e d i c a l l y e s s e n t i a l t o p r e v e n t s k i n b r e a k d o w n a n d 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 i t e 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 i t e m 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 e m o r y F o a m M a t t r e s s p e l l a n t ' s p o s i t i o n i s t h e M e m o r y F o a m M a t t r e s s i s n o t s i d e r e d f o r a c r i s i s s u p p l e m e n t . t t h e l e g i s l a t e d r e q u i r e m e n t s s t a t e d i n s e c t i o n 5 7 ( 1 ) a n u a r y ? ' h , 2 0 1 4 t h e a p p e l l a n t a t t e n d e d t h e m i n i s t r y t r e s s b e c a u s e s h e w a s a w a i t i n g b a c k s u r g e r y a n d t h e y . T h e E A W r e q u e s t e d t h e a p p e l l a n t o b t a i n e s t i m a t e s E J f o r m a n d r e t u r n t h e s e d o c u m e n t s t o t h e m i n i s t r y . s e c t i o n o f t h e M E J f o r m w h i c h i s r e q u i r e d b y e n t . T h e m i n i s t r y a r g u e d t h a t a l t h o u g h t h e a p p e l l a n t h e m i n i s t r y t o a s s e s s h o w a n e w m a t t r e s s f i t s w i t h i n a l i n f o r m a t i o n w a s p r o v i d e d b y t h e a p p e l l a n t . h e a p p e l l a n t ( a n d h e r s p o u s e ) h a d l e f t t h e i r f o r m e r a s a r e s u l t , h a d t o l e a v e m a n y o f t h e i r p e r s o n a l r y F o a m M a t t r e s s w a s n e e d e d t o a s s i s t w i t h t h e i s t r y c o n s i d e r e d t h e r e q u e s t a s a h e a l t h s u p p l e m e n t . o f t h e a p p e l l a n t ' s r e a s o n s a n d c i r c u m s t a n c e s f o r e n c o n s i d e r e d d i f f e r e n t l y . i n c o m e o f s u p p o r t a n d s h e l t e r a l l o w a n c e a n d a G S T m a t t r e s s b u t w o u l d n e e d o n e t h a t d i d n o t h a v e c o i l e r i n h e r r e c o v e r y a f t e r t h e b a c k s u r g e r y . T h e o n w a s n o t p r o v i d i n g p r o p e r b a c k s u p p o r t ; t h a t s h e i c u l t t o g e t u p a f t e r s h e h a d b e e n l y i n g d o w n . T h e o f a n y l o c a l a g e n c i e s w h e r e t h e y c o u l d g e t a e d t h a t h e r s p o u s e d o e s n o t w o r k a n d t h e y d o n o t h e a p p e l l a n t a r g u e d ( a t t h e h e a r i n g ) t h e y o n l y w a n t e d e s s b u t t h e m a t t r e s s c o u l d n ' t h a v e c o i l s p r i n g s a s t h e l i s t t o h a v e b a c k s u r g e r y a n d t h e a p p e l l a n t w o u l d f i e d t h a t f r o m h i s r e s e a r c h h e f o u n d t h a t a M e m o r y a s s i s t i n t h e a p p e l l a n t r e c o v e r y f r o m s u r g e r y . s ( m e m o r y f o a m ) w a s s p e c i f i c i n n a t u r e ; t h a t t h e a c k s u r g e r y w h i c h s u p p o r t s t h e m i n i s t r y ' s p o s i t i o n w a s u n e x e c t e d l n e e d e d a s t h e fl o p e l l a n t k n e w
s h e w o u l d b e h a v i n g b a c k s u r g e r y . T h e p a n e l f i n d s t h a t t h e a p p e l l a n t r e c e i v e s m o n t h l y d i s a 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 e a p p e l l a n t d o e s h a v e m a y n e e d . P a n e l D e c i s i o n T h e p a n e l f i n d s t h a t , b a s e d o n t h e i n f o r m a t i o n a t r e c o n s a p p e l l a n t ' s r e q u e s t f o r a c r i s i s s u p p l e m e n t t o o b t a i n a M i n s e c t i o n 5 7 ( 1 ) ( a ) E A P W D R . I n r e f e r e n c e t o s e c t i o n 5 7 ( 1 ) ( b ) E A P W D R w h i c h r e q u i e x p e n s e o r o b t a i n t h e i t e m 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 o r r e m o v a l o f a c h i l d u n d e r t h e C h i l d , F a m il y a n d C o m m T h e m i n i s t r y ' s p o s i t i o n i s t h a t t h e a p p e l l a n t ' s r e q u e s t f o r t h a t t h e a p p e l l a n t d i d n o t p r o v i d e a n y f u r t h e r i n f o r m a t i o n r e q u e s t t o c o n s i d e r o b t a i n i n g t h e m a t t r e s s a s a c r i s i s s u T h e a p p e l l a n t ' s p o s i t i o n i s t h a t t h e s u r g e o n , w h o p e r f o r m " s h e m a y b e n e f i t f r o m a s u p p o r t i v e m a t t r e s s " . T h e a p p e l s u p p o r t s h e r p o s i t i o n t h a t f a i l u r e b y t h e m i n i s t r y t o m e e t i m m i n e n t d a n g e r t o h e r p h y s i c a l h e a l t h . P a n e l D e c i s i o n A l t h o u g h t h e s u r g e o n s l e t t e r s t a t e s " t h e a p p e l l a n t m a y b i s n o t s u f f i c i e n t t o e s t a b l i s h t h a t i f t h e m i n i s t r y d i d n o t p r o t h a t t h i s w o u l d r e s u l t i n i m m i n e n t d a n g e r t o h e r p h y s i c a l T h e p a n e l a l s o f i n d s t h e a p p e l l a n t d o e s n o t h a v e c h i l d r e n r e g a r d i n g t h e r e m o v a l o f c h i l d r e n d o e s n o t a p p l y . P a n e l D e c i s i o n T h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s d e c i s i o n t o d e t e r m i n e u n e x p e c t e d l y n e e d e d w o u l d n o t r e s u l t i n t h e i m m i n e n t d a u n i t o r t h e r e m o v a l o f a c h i l d u n d e r C h i l d , F a m i l y a n d C o E A P W D R w a s r e a s o n a b l e . C o n c l u s i o n : S e c t i o n 5 7 ( 1 ) E A P W D R s t a t e s t h a t f o r t h e m i n i s t r y t o p r o f a m i l y u n i t m u s t m e e t a l l c r i t e r i a s e t o u t i n 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 r e a s o n a b l y d e t e r m i n e d s u p p l e m e n t f o r a M e m o r y F o a m M a t t r e s s b e c a u s e s h e d E A P W D R a n d t h e r e f o r e , 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 J a n u a r y ? ' h , 2 0 1 4 w a s r e a s o n a b l e . I n r e f e r e n c e t o s e c t i o n 5 7 ( 3 ) E A P W D R a c r i s i s s u p p l e o b t a i n i n g a s u p p l e m e n t d e s c r i b e d i n S c h e d u l e C , o r a n y T h e m i n i s t r y p o s i t i o n ' s i s t h a t t h e a p p e l l a n t ' s r e q u e s t w a s r e c o v e r v f r o m b a c k s u r a e r v a n d o r o v i d e d a l e t t e r f r o m h e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # b i l i t y a s s i s t a n c e a n d G S T r e b a t e a n d t h e r e f o r e t h e r e s o u r c e s a v a i l a b l e t o o b t a i n v a r i o u s i t e m s t h a t t h e y i d e r a t i o n , 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 e m o r y F o a m M a t t r e s s d i d n o t m e e t t h e c r i t e r i a s e t o u t r e s t h a t t h e m i n i s t e r c o n s i d e r s t h a t f a i l u r e t o m e e t t h e r t o t h e p h y s i c a l h e a l t h o f a n y p e r s o n i n t h e f a m i l y u n i t , u n i t y S e rv i c e A c t . a M e m o r y F o a m M a t t r e s s i s a h e a l t h s u p p l e m e n t a n d t o a s s i s t t h e m i n i s t r y i n a s s e s s i n g t h e a p p e l l a n t ' s p p l e m e n t . e d t h e b a c k s u r g e r y , p r o v i d e d a l e t t e r s t a t i n g t h a t l a n t s t a t e s t h a t t h i s s a t i s f i e s t h e l e g i s l a t i o n a n d t h e e x p e n s e i n p r o v i d i n g t h e m a t t r e s s w i l l r e s u l t i n e n e f i t f r o m a s u p p o r t i v e m a t t r e s s " t h e p a n e l f i n d s t h i s v i d e a s u p p o r t i v e m a t t r e s s ( M e m o r y F o a m M a t t r e s s ) h e a l t h . l i v i n g i n t h e h o m e a n d t h e r e f o r e t h e l e g i s l a t i o n t h a t f a i l u r e t o m e e t t h e e x p e n s e o r o b t a i n t h e i t e m n g e r t o t h e p h y s i c a l h e a l t h o f a n y p e r s o n i n t h e f a m i l y m m u n i t y S e rv i c e A c t a s s t a t e d i n s e c t i o n 5 7 ( 1 ) ( b ) v i d e a c r i s i s s u p p l e m e n t t o o r f o r a f a m i l y u n i t t h a t t h e 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 t o r e c e i v e a c r i s i s i d n o t a l l m e e t t h e c r i t e r i a s e t o u t i n s e c t i o n 5 7 ( 1 ) h e a p p e l l a n t ' s a p p l i c a t i o n f o r a c r i s i s s u p p l e m e n t o n m e n t m a y n o t b e p r o v i d e d f o r t h e p u r p o s e o f o t h e r h e a l t h c a r e g o o d s o r s e r v i c e s . f o r a M e m o r y F o a m M a t t r e s s t o a s s i s t w i t h h e r r d o c t o r s t a t i n a t h a t s h e w o u l d b e n e f i t f r o m a
APPFAI # : supportive mattress . The ministry deemed the appellant's request for a Memory Foam Mattress to be health care goods, a health supplement, and denied the appellant's request for a crisis supplement in accordance with section 57(3) EAPWDR. The ministry then applied the legislation in Schedule C, section 3 to her request. The appellant argued that a mattress is not health care goods but is a basic need and because the appellant was going to undergo back surgery she needed a mattress that provided proper support and it was the ministry's responsibility to provide this basic need. Panel Decision The panel finds that the appellant's request for a mattress was a specific request for a specific type of mattress, Memory Foam Mattress; and, that the appellant's request for a crisis supplement was not for an ordinary type of mattress but for one that, didn't have coil springs and would provide proper support to assist her in her recovery from back surgery. The panel finds that the ministry reasonably determined that the appellant's request for a Memory Foam Mattress was for health care goods and the ministry's decision to apply the provisions of section 57(3) EAPWDR was reasonable. 2. In reference to providing health care goods or services -General health supplements At appeal, the appellant stated emphatically that her request for reconsideration was for the panel to only consider her request for reconsideration as a crisis supplement and not a health care goods supplement. In the reconsideration, the ministry made a determination on the appellant's request as a health care supplement under Schedule C, section 3 EAPWDR and the panel is bound to make a finding on the reasonableness of ministry's decision. Section 62 states that subject to subsections (1.1) and (1.2), the minister may provide any health supplement set out in section 2 [general health supplements] or 3 [medical equipment and devices] of Schedule C to or for a family unit if the health supplement is provided to or for a person in the family unit who is a recipient of disability assistance. Schedule C -Health Supplements Medical equipment and devices Section 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. Section 3(2) states that if 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 section 3, 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 e ui ment or device. EMT003(10/06/01)
I A PPE A L# The ministry's position is that the EAW provided the appellant with a MEJ form to be completed by an OT, however the OT refused to complete the form and the form was not returned to EAW. The ministry did receive a letter from the appellant's surgeon which stated that "she has had fusion surgery and may benefit from a supportive mattress". The appellant's position is that the request for a mattress is not for health care goods and this legislation does not apply to their request. Panel decision The evidence indicates that the ministry determined that the appellant's request for a memory foam mattress was for health care goods and that the appellant did not include an assessment from an OT or a PT confirming the medical need for a Memory Foam Mattress. The panel finds that the ministry's decision that the appellant did not comply with the legislative requirements for an OT or PT assessment in Schedule C section 3(2) EAPWDR was reasonable. In reference to Section 3.6 -Medical equipment and devices • Hospital Bed Section 3.6 states subject to subsection (3) of this section, the following items are health supplements for the purposes of section 3 of this Schedule ii the minister is satisfied that the item is medically essential to facilitate transfers of a person to and from bed or to adjust or maintain a person's positioning in bed: ( a) a hospital bed; (b) an upgraded component of a hospital bed; (c) an accessory attached to a hospital bed; (d) a positioning item on a hospital bed. The ministry's position is that there is no information included in the appellant's Request for Reconsideration to confirm that her requirement for a Memory Foam Mattress is medically essential to facilitate her transferring to and from bed or to adjust or maintain her positioning in bed. The appellant advanced no argument regarding this provision stating she did not need a hospital bed and that her request was not for a hospital bed. Panel decision The evidence before the panel indicates that the appellant's request was for a Memory Foam Mattress and not a hospital bed. The appellant acknowledged that she did not need a hospital bed. The panel finds the appellant's request for a Memory Foam Mattress does not address the legislative requirement respecting transferring or positioning needs set out for a hospital bed and therefore the ministry's decision to deny the appellant's request for a supplement was reasonable. In reference to Section 3.7-Medical equipment and devices -Pressure Relief Mattresses Section 3.7 (1) A pressure relief mattress is a health supplement for the purposes of section 3 of this Schedule if the minister is satisfied that the pressure relief mattress is medically essential to prevent skin breakdown and maintain skin integrity. (2) The period of time referred to in section 3 (3) (b) of this Schedule with respect to replacement of an item described in subsection 1 of this section is 5 ears from the date on which the minister rovided the item EAAT003(10/06/01)
I APPEAL# being replaced. The ministry's position is that there is no information included in the appellant's Request for Reconsideration to confirm that her requirement for a Memory Foam Mattress is medically essential to prevent skin breakdown and maintain skin integrity. The appellant advanced no argument regarding this provision of the legislation. The appellant testified does not have any problems or concerns with her skin. The appellant told the panel she did not need a pressure relief mattress and that her request for assistance was not for a pressure relief mattress. Panel decision The evidence before the panel indicates that the appellant's request was for a Memory Foam Mattress and not a pressure relief mattress. The appellant acknowledged that she does not have problems with her skin breaking down or with maintaining her skin's integrity, that she does not need a pressure relief mattress. The panel finds the ministry's conclusion that the appellant's request for a Memory Foam Mattress does not meet the legislative requirements set out for a pressure relief mattress and therefore the ministry's decision to deny the appellant's request for a supplement to obtain a Memory Foam Mattress was reasonable. CONCLUSION The panel finds that the ministry's decision to deny the appellant's request for a crisis supplement to obtain a Memory Foam Mattress because she did not meet all the legislated criteria set out in section 57(1) EAPWDR; or the criteria set out in sections 3(2), 3.6 and 3.7 of Schedule C EAPWDR is reasonably supported by the evidence. Therefore, the panel finds the ministry's decision to deny the appellant's application of January ? 1h , 2014 for a Memory Foam Mattress was reasonable and confirms the decision pursuant to section 24(1)(a) and section 24(2)(a) of the EAA. EAAT003(10/06/01)
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.