PART C -Decision under Ap peal The appel l ant appea ls th e reco n sid eration deci s ion of the Min In novation (Ministry) d a t ed Augu st 19, 201 4, wh ich denied h ("MNS") fo r nutritional it ems on the bas is t hat sh e d i d n o Assistance for Per s ons with Disab ilities Regulation (EAPWDR) section 67(1.1) and S The Ministry dete rm in ed tha t the information pro vided did requested nutritional items as part of a caloric supplementation symptoms of h e r chronic, progressiv e deterioration of health, or that failur i mminen t d a ng er to her l i fe, as requir e d under subsection 7 EA PWDR. P ART D -Relevant Legislat io n Employm e nt a n d A ssista nce f o r P erson s with Disabili t i e s H ealt h Supplem en t s, s . 7 . EAA T003( 10/06/01) istry of Social Development an d So ci al e r request for M o nthly Nut ri t ional Supp lement t meet the crite ria se t out in the Emp loyment a nd chedule C, s e ction 7. not estab lish that the app ellant re quired the to a regular die tary in take to alleviate t he e to provide the i t ems wou ld r e sult in ( a) of Schedule C a nd subs. 6 7 (1.1)(d) of the R egu l ation ( EAP WD R) section 67 a nd Schedu l e C
P A R T E S u m m a r v o f F a c t s A t t h e r e c o n s i d e r a t i o n , t h e M i n i s t r y r e l i e d o n t h e f o l l o w i n • T h e M i n i s t r y ' s M N S d e c i s i o n s u m m a r y d a t e d J u l • T 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 M N S s i g n e d b y t h c o m p l e t 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 d a t e d A p • A l e t t e r f r o m t h e a p p e l l a n t ' s p h y s i c i a n a n d s o c i a l O n t h e f i r s t p a g e o f t h e M N S f o r m , t h e a p p e l l a n t ' s p h y s i c c o n d i t i o n ( q u e s t i o n # 1 ) i s H e p a t i t i s C , T y p e 2 d i a b e t e s , h r e s p o n s e t o q u e s t i o n # 2 , " A 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 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 ? I f s o , i n d i c a t e d t h a t t h e a p p e l l a n t i s o n m e d i c a t i o n f o r h e r d i a b H e p a t i t i s C a n d i s o n m e d i c a t i o n s f o r h e r m o o d . O n p a g e 2 o f t h e M N S f o r m , i n r e s p o n s e t o q u e s t i o n # 3 d e t e r i o r a t i o n o f h e a l t h n o t e d a b o v e , d o e s t h e a p p l i c a n t d a p p e l l a n t ' s p h y s i c i a n i n d i c a t e d t h a t t h e a p p e l l a n t d i s p l a y s u p p r e 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 p h y s i c i a n p r o v i d e d 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 ( 1 6 4 0 . 9 . " Q u e s t i o n # 5 o f t h e M N S f o r m i s f o r t h e r e q u e s t f o r v i t a m g r a n t e d t o t h e a p p e l l a n t a n d i s n o t a t i s s u e o n t h i s a p p e a r e q u i r e d , t h e a p p e l l a n t ' s p h y s i c i a n w r o t e t h a t s h e s h o u l d s h e c o m p l e t e s h e r H e p a t i t i s C t r e a t m e n t . I n r e s p o n s e t o p r e v e n t i m m i n e n t d a n g e r t o t h e a p p l i c a n t ' s l i f e " t h e a p p e c o n d i t i o n s a r e h i g h l y s u s c e p t i b l e t o i n f e c t i o n w h i c h w o u l d I n r e s p o n s e t o q u e s t i o n # 6 ( w h i c h h a s 3 q u e s t i o n s o n p a p h y s i c i a n i n d i c a t e d t h a t t h e a d d i t i o n a l n u t r i t i o n a l i t e m s r e p r o t e i n d i e t w i t h p l e n t y o f f r u i t s & v e g e t a b l e s a n d l o w i n f a t r e a t m e n t . " T h e p h y s i c i a n w r o t e t h a t t h e a p p e l l a n t ' s " h e p q u e s t i o n , " d o e s t h i s a p p l i c a n t h a v e a m e d i c a l c o n d i t i o n t h 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 d i e t a r y i n t a n u t r i t i o n a l i t e m s r e q u i r e d w i l l a l l e v i a t e o n e o r m o r e o f t h e 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 a p p e l l a n t ' s p h y s h e r w e i g h t a n d h e r r e s i s t a n c e t o i n f e c t i o n . " I n r e s p o n s e t o i t e m s r e q u e s t e d w i l l p r e v e n t i m m i n e n t d a n g e r t o t h e a p p l i n f e c t i o n s � l o w e r i m m i n e n t d a n g e r . " I n t h e l e t t e r o f J u l y 3 1 , 2 0 1 4 , t h e a p p e l l a n t ' s p h y s i c i a n a n M N S f o r m , a n d w r o t e t h a t t h e a p p e l l a n t i s p r e p a r i n g f o r t r m e d i c a t i o n s h e l p m a n a g e h e r c o n d i t i o n s , " s h e i s a l s o r e q h e r h e a l t h a n d t o p r e v e n t f u r t h e r d e t e r i o r a t i o n o f h e r m e d w o r k e r w r o t e t h a t w h i l e t h e a p p e l l a n t r e c e i v e s t h e h i g h p r f u r t h e r f i n a n c i a l a s s i s t a n c e t o m a n a g e r h e r h e a l t h n e e d s . s h e a l s o r e q u i r e s a l o w s o d i u m d i e t a n d a d i a b e t i c d i e t . T h y p e r t e n s i o n a n d t h e d i a b e t i c d i e t m a y p r e v e n t f u r t h e r e x t h r e a t e n i n g c o n s e q u e n c e s . " E A A T 0 0 3 ( 1 0 / 0 6 / 0 1 )g : y 1 0 , 2 0 1 4 ; e a p p e l l a n t o n A p r i l 1 5 , 2 0 1 4 , w i t h t h e p o r t i o n r i l 2 9 , 2 0 1 4 ( " M N S f o r m " ) , d e s c r i b e d b e l o w ; a n d w o r k e r d a t e d J u l y 3 1 , 2 0 1 4 . i a n i n d i c a t e d 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 y p e r l i p i d e m i a , m o r b i d o b e s i t y a n d d e p r e s s i o n . I n m e d i c a l c o n d i t i o n ( s ) . . . i s t h e a p p l i c a n t b e i n g t r e a t e d p l e a s e p r o v i d e d e t a i l s . . . " , t h e a p p e l l a n t ' s p h y s i c i a n e t e s a n d h y p e r t e n s i o n , i s a w a i t i n g t r e a t m e n t f o r h e r ( " 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 i s p l a y t w o o r m o r e o f t h e f o l l o w i n g s y m p t o m s ? " ) , t h e e d t h e s y m p t o m s o f m o d e r a t e t o s e v e r e i m m u n e ( h e r l i v e r ) . I n r e s p o n s e t o q u e s t i o n # 4 , t h e a p p e l l a n t ' s 4 c m a n d 1 1 0 k g ) , w r i t i n g " B M I [ b o d y m a s s i n d e x ] i n o r m i n e r a l s u p p l e m e n t a t i o n , w h i c h t h e M i n i s t r y l . I n s p e c i f y i n g t h e v i t a m i n o r m i n e r a l s u p p l e m e n t s t a k e 1 m u l t i v i t a m i n d a i l y i n d e f i n i t e l y o r a t l e a s t u n t i l t h e q u e s t i o n " D e s c r i b e h o w t h i s i t e m o r i t e m s w i l l l l a n t ' s p h y s i c i a n w r o t e , " c l i e n t s w i t h t h e a b o v e b e l i f e t h r e a t e n i n g . " g e s 2 a n d 3 o f t h e M N S f o r m ) , t h e a p p e l l a n t ' s q u i r e d a n d e x p e c t e d d u r a t i o n o f n e e d a r e " h i g h t i n d e f i n i t e l y , o r a t l e a s t u n t i l c o m p l e t i o n o f h e p c a t i t i s c a u s e s t h i s p r o b l e m " i n r e s p o n s e t o t h e a t r e s u l t s i n t h e i n a b i l i t y t o a b s o r b s u f f i c i e n t c a l o r i e s k e ? " I n r e s p o n s e t o t h e q u e s t i o n , " D e s c r i b e h o w t h e s y m p t o m s s p e c i f i e d i n q u e s t i o n 3 a n d p r o v i d e c a l o r i c i c i a n w r o t e , " t h e s e n u t r i t i o n a l i t e m s s h o u l d i m p r o v e t h e t h i r d q u e s t i o n , " 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 c a n t ' s l i f e , " t h e a p p e l l a n t ' s p h y s i c i a n w r o t e , ' f o w e r d s o c i a l w o r k e r l i s t e d t h e s a m e c o n d i t i o n s a s o n t h e e a t m e n t f o r h e r H e p a t i t i s C a n d t h a t w h i l e h e r u i r e d t o a d h e r e t o a f a i r l y s t r i c t d i e t r e g i m e t o m a n a g e i c a l c o n d i t i o n s . " T h e a p p e l l a n t ' s p h y s i c i a n a n d s o c i a l o t e i n d i e t a n d t h e v i t a m i n s u p p l e m e n t s , " s h e r e q u i r e s I n o r d e r t o p r e v e n t f u r t h e r d e t e r i o r a t i o n o f h e r h e a l t h h e l o w s o d i u m d i e t i s r e c o m m e n d e d f o r p e o p l e w i t h a c e r b a t i o n o f h e r T y p e I I D i a b e t e s w i t h l i f e
Prior to the hearing, the appellant provided a letter from her social worker dated September 15, 2014. In this letter, the appellant's social worker refers to the reconsideration decision and writes that it is "important to highlight that while [the appellant] may not meet the underweight status that [the] Ministry would like to see in order to approve this supplement, her family doctor has confirmed that her medical condition (Hepatitis) leads to the inability to absorb sufficient calories. If [the appellant] does not increase her caloric intake it may lead to her being underweight, at increased risk of infections, and increased need of medical care. If she is able to maintain an increased caloric intake at this point in her illness, then she will be able to maintain a healthy lifestyle and lower her imminent danger in prevention of infections." The Ministry did not object to the admission of the social worker's September 15, 2014 letter at the hearing. This panel admits the September 15, 2014 letter from the appellant's social worker as written testimony in support of the information and records that were before the minister when the decision being appealed was made under subs. 22(4)(b} of the Employment and Assistance Act. The September 15, 2014 letter restates information referenced in the Ministry's reconsideration decision. The appellant receives disability assistance and she also receives monthly vitamin/mineral supplement and a dietary supplement for a high protein diet. At the hearing, the appellant said that she really needs the MNS for additional nutritional items because she needs the extra money every month to purchase better quality food, such as spinach, to improve her diet, help her to continue to lose weight and get healthy. She said that food is more expensive than it used to be and the food available to her through the food bank is not healthy as it is often processed and has too much sugar and salt. The appellant told the panel that in the past year (12-13 months), she had lost approximately 70 pounds and she is continuing to lose weight through her diet and walking. She said that she "is not dying" but thinks that it is common sense that she should receive extra money every month so she can afford to purchase better quality food and follow a diabetic and low sodium diet. She said that her doctor has indicated she needs a better diet because she has both diabetes and hepatitis C, and refers to the information in the letters from her doctor and social worker of July 31, 2014 and from the social worker of September 15, 2014. EAAT 003(1 0/06/01)
PART F -Reasons for Panel Decision The issue on this appeal is whether the Ministry's decision to deny the appellant's request for the MNS on the basis that the information did not establish that that the appellant requires the requested additional nutritional items as part of a caloric supplementation to a regular dietary intake, as set out in s. 7(a) of Schedule C, and to prevent imminent danger to life, as required by subs. 67(1.1)(d), was reasonable. Legislation EAPWDR 67. Nutritional Supplement (1) The minister may provide a nutritional supplement in accordance with section 7 [monthly nutritional supplement] of Schedule C to or for a person with disabilities in a family unit who receives disability assistance under (a) section 2 [monthly support allowance], 4 [monthly shelter allowance], 6 [people receiving room and board] or 9 [people in emergency shelters and transition houses] of Schedule A, or (b) section 8 [people receiving special care] of Schedule A, if the special care facility is an alcohol or drug treatment center, if the minister is satisfied that (c) based on the information contained in the form required under subsection (1.1 ), the requirements set out in subsection (1.1) (a) to (d) are met in respect of the person with disabilities, (d) the person is not receiving a supplement under section 2(3) [general health supplement] of Schedule C, (e) the person is not receiving a supplement under subsection (3) or section 66 [diet supplements], (f) the person complies with any requirement of the minister under subsection (2), and (g) the person's family unit does not have any resources available to pay the cost of or to obtain the items for which the supplement may be provided. (1.1) In order for a person with disabilities to receive a nutritional supplement under this section, the minister must receive a request, in the form specified by the minister, completed by a medical practitioner or nurse practitioner, in which the practitioner has confirmed all of the following: (a) the person with disabilities to whom the request relates is being treated by the practitioner for a chronic, progressive deterioration of health on account of a severe medical condition; (b) as a direct result of the chronic, progressive deterioration of health, the person displays two or more of the following symptoms: (i) malnutrition; (ii) underweight status; (iii) significant weight loss; (iv) significant muscle mass loss; (v) significant neurological degeneration; (vi) significant deterioration of a vital organ; (vii)moderate to severe immune suppression; (c) for the purpose of alleviating a symptom referred to in paragraph (b), the person requires one or more of the items set out in section 7 of Schedule C and specified in the request; (d) failure to obtain the items referred to in paragraph (c) will result in imminent danger to the person's life. EAAT 003( 10/06/01)
S c h e d u l e C H e a l t h S u p p l e m e n t s 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 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 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 $ 1 6 5 e a c h m o n t h ; ( b ) R e p e a l e d ( 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 S u b m i s s i o n s A t t h e h e a r i n g , t h e a p p e l l a n t e x p r e s s e d h e r f r u s t r a t i o n w n o t e d 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 c o n t a i n e d m i s t a k l a s t n a m e ) . S h e a r g u e d t h a t s h e s h o u l d b e e n t i t l e d t o s t h a t s h e c a n p u r c h a s e b e t t e r q u a l i t y f o o d t o h e l p h e r l o s e d o c t o r a n d s o c i a l w o r k e r h a v e i n d i c a t e d t h a t s h e n e e d s p r e v e n t h e r c o n d i t i o n s f r o m g e t t i n g w o r s e . T h e a p p e l l a n s u p p l e m e n t ( s u c h a s E n s u r e o r B o o s t ) , b u t a r g u e d t h a t s a d d i t i o n a l n u t r i t i o n a l i t e m s o f f r e s h f r u i t a n d v e g e t a b l e s t s o c i a l w o r k e r h a v e t o l d h e r s h e n e e d s t o b e o n a d i a b e t i s e n s e t h a t t h e M i n i s t r y s h o u l d p r o v i d e h e r f u n d s s o s h e T h e M i n i s t r y s t o o d b y 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 f o r n u t r i t i o n a l i t e m s u n d e r E A P W D R s e c t i o n 6 7 ( 1 . 1 ) a n d $ 1 6 5 p e r m o n t h f o r t h e r e q u e s t e d n u t r i t i o n a l i t e m s . T h e f o r a s p e c i f i c d i a b e t i c d i e t o r l o w s o d i u m d i e t . T h e M i n i s t t h a t a m e d i c a l o r n u r s e p r a c t i t i o n e r c o n f i r m t h a t t h e r e q u 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 r y i n t a k e . T h e M i n i s t r y i n f o r m a t i o n f r o m h e r p h y s i c i a n o r a n u r s e p r a c t i t i o n e r t h a 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 h e r r e g u l a r d i e t . T h e M i n i s t c o n f i r m e d b y t h e a p p e l l a n t , t h a t s h e i s n o t u n d e r w e i g h t . i n d i c a t e d t h a t t h e a p p e l l a n t r e q u i r e s f i n a n c i a l a s s i s t a n c e t h a t t h i s d o e s n o t c o n f i r m t h a t s h e r e q u i r e s n u t r i t i o n a l s u p M i n i s t r y a l s o s a y s t h a t s e c t i o n 6 7 ( 1 . 1 ) ( d ) r e q u i r e s t h a t a m p r o v i d e t h e r e q u e s t e d n u t r i t i o n a l i t e m s w i l l r e s u l t i n i m m i n t h a t t h e w o r d " i m m i n e n t " " c o n n o t e s a d e g r e e o f i m m e d i a c h a s n o t p r o v i d e d i n f o r m a t i o n t h a t t h e r e q u e s t e d n u t r i t i o n a i m m i n e n t d a n g e r t o t h e a p p e l l a n t ' s l i f e a s t h e i n f o r m a t i o n f r o m f u t u r e i n f e c t i o n s . P a n e l D e c i s i o n T h e M i n i s t r y 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 ' s p h y s i c i a n c o 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 n t o f a s e v e r e T y p e 2 D i a b e t e s , h y p e r l i p i d e m i a , m o r b i d o b e s i t y a n d d e p s h e d i s p l a y s t w o o r m o r e o f t h e l i s t e d s y m p t o m s ( m o d e r a 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 h e r l i v e r ) , m e e t i n g t h e c r i t e E A P W D R . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )r o v i d e d 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 f o l l o 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 a l o r i c 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 r y i n t a k e , u p t o . i t h t h e M i n i s t r y ' s d e n i a l o f h e r r e q u e s t e d M N S . S h e e s ( s u c h a s t h e i n c o r r e c t s p e l l i n g o f h e r p h y s i c i a n ' s o m e e x t r a m o n e y s h e e s t i m a t e d $ 3 0 p e r m o n t h s o w e i g h t a n d i m p r o v e h e r h e a l t h . S h e s a i d t h a t h e r t o f o l l o w a s t r i c t d i e t t o m a n a g e h e r h e a l t h a n d t o t c o u l d n o t i d e n t i f y a s p e c i f i c t y p e o f n u t r i t i o n a l h e r e q u i r e s t h e 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 t h e o i m p r o v e h e r d i e t . S h e s a i d t h a t h e r d o c t o r a n d h e r c a n d l o w s o d i u m d i e t a n d t o h e r , i t m a k e s c o m m o n c a n a f f o r d t o p u r c h a s e b e t t e r q u a l i t y f o o d . i n i s t r y s a i d t h a t 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 M N S s e c t i o n 7 o f S c h e d u l e C , w h i c h p r o v i d e s f o r u p t o M i n i s t r y p o i n t e d o u t t h a t t h e a p p e l l a n t h a s n o t a p p l i e d r y s a y s t h a t s e c t i o n 6 7 ( 1 . 1 ) ( c ) a n d s e c t i o n 7 ( a ) r e q u i r e e s t e d a d d i t i o n a l n u t r i t i o n a l i t e m s b e p a r t o f a c a l o r i c a r g u e s t h a t t h e a p p e l l a n t h a s n o t p r o v i d e d t c o n f i r m s t h a t s h e r e q u i r e s n u t r i t i o n a l i t e m s a s p a r t o f r y p o i n t s t o t h e i n f o r m a t i o n i n t h e M N S f o r m , T h e M i n i s t r y s a y s t h a t t h e a p p e l l a n t ' s p h y s i c i a n h a s t o i m p r o v e h e r d i e t f o r a s p e c i f i c t y p e o f d i e t b u t p l e m e n t s a s p a r t o f c a l o r i c s u p p l e m e n t a t i o n . T h e e d i c a l o r n u r s e p r a c t i t i o n e r c o n f i r m t h a t f a i l u r e t o e n t d a n g e r t o t h e a p p e l l a n t ' s l i f e . T h e M i n i s t r y s a y s y . " T h e M i n i s t r y a r g u e s t h a t t h e a p p e l l a n t ' s p h y s i c i a n l i t e m s ( d i a b e t i c a n d / o r l o w s o d i u m d i e t s ) w i l l p r e v e n t 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 m a y o r m a y n o t s u f f e r n f i r m e d t h a t s h e i s b e i n g t r e a t e d b y f o r a c h r o n i c , m e d i c a l c o n d i t i o n ( m o d e r a t e l y s e v e r e H e p a t i t i s C , r e s s i o n ) , a n d t h a t a s a d i r e c t r e s u l t o f h e r c o n d i t i o n s , 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 a n d s i g n i f i c a n t r i a s e t o u t i n s u b s . 6 7 ( 1 . 1 ) ( a ) a n d ( b ) o f t h e
U n d e r s u b s . 6 7 ( 1 ) ( c ) o f t h e E A P W D R , i n o r d e r t o q u a l i f p r a c t i t i o n e r m u s t c o n f i r m t h a t t h e a p p e l l a n t m e e t s a ll o f ( d ) . S u b s e c t i o n 6 7 ( 1 . 1 ) ( c ) r e f e r s t o s . 7 o f S c h e d u l e C a p p e l l a n t ' s s y m p t o m s , t h e m e d i c a l o r n u r s e p r a c t i t i o n e r o u t i n s e c t i o n 7 o f S c h e d u l e C ) . U n d e r s . 7 ( a ) o f S c h e d u b e p r o v i d e d i f t h e y " a r e p a r t o f a c a l o r i c s u p p l e m e n t a t i o 6 7 ( 1 . 1 ) ( d ) o f t h e E A P W D R , f a i l u r e t o p r o v i d e t h e a d d i t i o t h e a p p e l l a n t ' s l i f e . 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 t e r m i n a t i o n t h a t t h e a p p e l l a n t r e q u i r e s t h e r e q u e s t e d M N S t o p r o v i d e c a l o r i c b a s e d o n t h e e v i d e n c e . I n t h e M N S , t h e a p p e l l a n t ' s p h y r e q u i r e d a r e " h i g h p r o t e i n d i e t w i t h p l e n t y o f f r u i t s a n d v e a p p e l l a n t r e c e i v e s a m o n t h l y s u p p l e m e n t f o r a h i g h p r o t t h e r e q u e s t e d M N S w i l l a l l e v i a t e t h e a p p e l l a n t ' s l i s t e d s y r e g u l a r d i e t a s , " t h e s e n u t r i t i o n a l i t e m s s h o u l d i m p r o v e h 3 1 , 2 0 1 4 l e t t e r , i n a d d i t i o n t o t h e h i g h p r o t e i n d i e t a n d d a p h y s i c i a n ( a n d s o c i a l w o r k e r ) i d e n t i f i e d t h e r e q u e s t e d n u d i e t ' ' f o r t h e r e a s o n s t h a t t h e a p p e l l a n t " r e q u i r e s f u r t h e r f p r e v e n t f u r t h e r d e t e r i o r a t i o n o f h e r h e a l t h " a n d t h e d i e t " D i a b e t e s w i t h l i f e t h r e a t e n i n g c o n s e q u e n c e s . " I n t h e S e t h a t i f t h e a p p e l l a n t d o e s n o t i n c r e a s e h e r c a l o r i c i n t a k e r i s k o f i n f e c t i o n s , a n d i n c r e a s e d n e e d o f m e d i c a l c a r e . " i n d i c a t e d t h a t t h e a p p e l l a n t ' s H e p a t i t i s C r e d u c e s h e r a b e v i d e n c e r e l a t i n g t o t h e p o s s i b l e e x t e n t o f t h i s r e d u c t i o n , i n f e c t i o n a s a r e s u l t o f t h e r e d u c e d c a l o r i c i n t a k e . T h e p t h e J u l y 3 1 a n d S e p t e m b e r 1 5 , 2 0 1 4 l e t t e r s ) t h e a p p e l l a n o f a d i a b e t i c a n d / o r a l o w s o d i u m d i e t w i l l p r o v i d e c a l o r i c i s t h i s e v i d e n c e w h i c h i s r e q u i r e d b y s u b s . 6 7 ( 1 . 1 ) ( c ) a n d 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 t e r m i n a t i o n t h a t t h e r e c e i v e t h e r e q u e s t e d M N S 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 I n t h e M N S f o r m a n d t h e J u l y 3 1 , 2 0 1 4 l e t t e r , t h e a p p e l l a r e q u e s t e d d i a b e t i c a n d / o r l o w s o d i u m d i e t s , s h e w i l l h a v e a p p l i c a t i o n ) a n d t h e d i a b e t i c d i e t " m a y p r e v e n t f u r t h e r e x c o n s e q u e n c e s " ( J u l y 3 1 l e t t e r ) . I n t h e S e p t e m b e r 1 5 , 2 0 d o e s n o t r e c e i v e t h e r e q u e s t e d d i e t s , i t " m a y l e a d t o h e r a n d i n " i n c r e a s e d n e e d o f m e d i c a l c a r e . " T h e s o c i a l w o r m a i n t a i n a n i n c r e a s e d c a l o r i c i n t a k e a t t h i s p o i n t i n h e r i l l l i f e s t y l e a n d l o w e r h e r i m m i n e n t d a n g e r i n p r e v e n t i o n o f i i n f o r m a t i o n d o e s n o t c o n f i r m t h a t f a i l u r e t o p r o v i d e t h e r e i m m i n e n t d a n g e r t o h e r h e a l t h t h e i n f o r m a t i o n i n d i c a t e s o c c u r r e n c e t h a t i s u n s p e c i f i e d a n d m a y n o t , i n f a c t , o c c u r d e t e r m i n a t i o n t h a t t h i s e v i d e n c e d o e s n o t c o n f i r m t h e r e q T h e r e f o r e , t h e p a n e l c o n f i r m s t h e M i n i s t r y ' s d e c i s i o n t o d E A A T 0 0 3 ( 1 0 / 0 6 / 0 1 )y f o r t h e M N S , t h e a p p e l l a n t ' s m e d i c a l o r n u r s e t h e r e q u i r e m e n t s s e t o u t i n s u b s . 6 7 ( 1 . 1 ) ( a ) t h r o u g h o f t h e E A P W D R ( f o r t h e p u r p o s e s o f a l l e v i a t i n g t h e m u s t c o n f i r m s h e r e q u i r e s o n e o r m o r e o f t h e i t e m s s e t l e C o f t h e E A P W D 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 m a y 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 n d e r s u b s e c t i o n n a l n u t r i t i o n a l i t e m s w i l l r e s u l t i n i m m i n e n t d a n g e r t o a p p e l l a n t ' s p h y s i c i a n h a s n o t i n d i c a t e d t h a t t h e s u p p l e m e n t a t i o n t o h e r r e g u l a r d i e t i s r e a s o n a b l e s i c i a n i n d i c a t e d t h a t t h e a d d i t i o n a l n u t r i t i o n a l i t e m s g e t a b l e s a n d l o w i n f a t . " T h e p a n e l n o t e s t h a t t h e e i n d i e t . I n t h e M N S f o r m , t h e p h y s i c i a n i n d i c a t e d t h a t m p t o m s a n d p r o v i d e c a l o r i c s u p p l e m e n t a t i o n t o t h e e r w e i g h t a n d h e r r e s i s t a n c e t o i n f e c t i o n . " I n t h e J u l y i l y m u l t i v i t a m i n a p p r o v e d b y t h e M i n i s t r y , t h e t r i t i o n a l i t e m s a s " l o w s o d i u m d i e t a s w e l l a s a d i a b e t i c i n a n c i a l a s s i s t a n c e t o m a n a g e h e r h e a l t h n e e d s , " " t o m a y p r e v e n t f u r t h e r e x a c e r b a t i o n o f h e r T y p e I I p t e m b e r 1 5 , 2 0 1 4 l e t t e r , t h e s o c i a l w o r k e r i n d i c a t e s " i t m a y l e a d t o h e r b e i n g u n d e r w e i g h t , a t i n c r e a s e d T h e p a n e l n o t e s t h a t t h e a p p e l l a n t ' s p h y s i c i a n h a s i l i t y t o a b s o r b s u f f i c i e n t c a l o r i e s ; h o w e v e r , t h e r e i s n o t h e l i k e l i h o o d o f i t , o r t h e p r o b a b i l i t y o f a p o t e n t i a l a n e l n o t e s t h a t i n a l l o f t h e i n f o r m a t i o n ( t h e M N S f o r m , t ' s p h y s i c i a n d i d n o t i n d i c a t e h o w t h e r e q u e s t e d M N S s u p p l e m e n t a t i o n t o t h e a p p e l l a n t ' s r e g u l a r d i e t , a n d i t s e c t i o n 7 ( a ) o f S c h e d u l e C . a p p e l l a n t ' s p h y s i c i a n h a s n o t c o n f i r m e d t h a t f a i l u r e t o r t o h e r h e a l t h i s r e a s o n a b l e b a s e d o n t h e e v i d e n c e . n t ' s d o c t o r d e s c r i b e s t h a t i f t h e a p p e l l a n t r e c e i v e s t h e " f e w e r i n f e c t i o n s âž” l o w e r i m m i n e n t d a n g e r ' ' ( M N S a c e r b a t i o n o f h e r T y p e I I d i a b e t e s w i t h l i f e t h r e a t e n i n g 1 4 l e t t e r , t h e s o c i a l w o r k e r w r i t e s t h a t i i t h e a p p e l l a n t b e i n g u n d e r w e i g h t , " " a t i n c r e a s e d r i s k o f i n f e c t i o n s " k e r a l s o w r i t e s t h a t " i f [ t h e a p p e l l a n t ] i s a b l e t o n e s s , t h e n s h e w i l l b e a b l e t o m a i n t a i n a h e a l t h y n f e c t i o n s . " H o w e v e r , t h e p a n e l n o t e s t h a t t h i s q u e s t e d d i e t s ( d i a b e t i c a n d l o w s o d i u m ) w i l l r e s u l t i n t h a t t h e d i e t s w i l l h e l p t h e a p p e l l a n t p r e v e n t a f u t u r e . A c c o r d i n g l y , 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 u i r e m e n t o f s u b s . 6 7 ( 1 . 1 ) ( d ) i s r e a s o n a b l 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 M N S .
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.