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 a p p e l l a n t a p p e a l s 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 o f t h I n n o v a t i o n ( M i n i s t r y ) d a t e d A u g u s t 2 8 , 2 0 1 4 , w h i c h d e n i e ( " M N S " ) f o r v i t a m i n / m i n e r a l s u p p l e m e n t s a n d n u t r i t i o n a l o u t i n t h e E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h S c h e d u l e C , s e c t i o n 7 ( a ) . T h e M i n i s t r y s p e c i f i c a l l y f o u n d • T h e a p p e l l a n t ' s n u r s e p r a c t i t i o n e r d i d n o t c o n f i r m d e t e r i o r a t i o n o f h e a l t h , t h e a p p e l l a n t i s d i s p l a y i n 6 7 ( 1 . 1 ) ( b ) ; • T h e n u r s e p r a c t i t i o n e r d i d n o t c o n f i r m t h a t t h e a p o f a c a l o r i c s u p p l e m e n t a t i o n t o a r e g u l a r d i e t a r y 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 a n d t o p r e v e n s u b s e c t i o n 7 ( a ) o f S c h e d u l e C a n d s u b s . 6 7 ( 1 . 1 • T h e n u r s e p r a c t i t i o n e r d i d n o t c o n f i r m t h a t t h e a p s u p p l e m e n t s 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 h e 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 fo r P e r s o n s w i t h D i s a b i l i t i e s H e a l t h S u p p l e m e n t s , s . 7 . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )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 e n t a n d S o c i a l d h e r r e q u e s t f o r a M o n t h l y N u t r i t i o n a l S u p p l e m e n t i t e m s o n t h e b a s i s t h a t s h e d i d n o t m e e t t h e c r i t e r i a s e t D i s a b i l i t i e s R e g u l a t i o n ( E A P W D R ) s e c t i o n 6 7 ( 1 . 1 ) a n d t h e f o l l o w i n g : t h a t a s a r e s u l t o f h e r c h r o n i c , p r o g r e s s i v e g t w o o r m o r e o f t h e s y m p t o m s s e t o u t i n s u b s . p e l l a n t r e q u i r e d 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 a s p a r t i n t a k e t o a l l e v i a t e t h e s y m p t o m s o f h e r c h r o n i c , t a n i m m i n e n t d a n g e r t o h e r l i f e , a s r e q u i r e d u n d e r ) ( d ) o f t h e E A P W D R ; a n d p e l l a n t r e q u i r e d t h e r e q u e s t e d v i t a m i n s a n d m i n e r a l l i f e a s r e q u i r e d b y s u b s . 6 7 ( 1 . 1 ) ( d ) o f t h e E A P W D R . R e g u l a t i o n ( E A P W D R ) s e c t i o n 6 7 a n d S c h e d u l e C
PART E -Summa ry of F acts The appellant did not attend the hea r ing . The pane l confir location of the hearing and the hearing procee ded in the a Employment and Assistance Regulati o n. At the reconsi d erat i o n, the Minis try had its MNS decision su application for M NS signed by the appell ant on June 3, 2014, with the Part C portion comp practi tioner on J une 3, 2014 , (the " MNS f orm") d escribed in her re quest f or reconsideration dat ed Augu st 20, 2014. On the first page o f the M NS a p pl i cat ion form, t h e nurse practitioner indicat medical conditions (question # 1 ) are schi z o phrenia with the comment "seve and "HPTN" (hypertension) with the com ment " r equires l the re sponse to qu estion #2 , " As a direct result of the severe m t r eat ed for a ch roni c, progressive deteriorat i on of h ealth? MN S form, in respon se to q ues tion # 3, "As a direct r e sul n o t e d ab ove, doe s th e appl icant d i splay t wo or m o re of the not checke d any o f the l i sted sympt o ms. In resp ons e to a p pell a n t's he i g ht and w eig h t (154 c m and 18 0 l bs). In re sp on se to the b ull e t s und e r qu estion 5 regarding vit practiti oner w ro te that t he s pecific vitami n o r mineral s u p speci f ic food s" a nd she wr ote, " follows stric t di et" for the b allev iate th e s pec i fic s y mptoms identi fied. The nurse practitione this item or i tems wi ll pre v e nt immin ent dange r to t he applica In r e spons e to question 6 of the MNS form, whic h has 1 b addition a l nutrition a l i tems ind i ca ted by the n ur s e pr a ctit ioner foo ds ." In res p o nse to the se cond bu llet question, "do es the ina bili t y to abso r b sufficien t c a lo ries t o satisfy daily req p leas e d escribe ", the nurse p rac t ition er wrote, "no." In respon i t e ms requi r ed w ill al levia te on e or m ore of th e symptoms spec supp lementat ion t o t he regul ar die t," th e n urse p ra ctitioner wrote, "wi l ow s alt di et''. In response to the question, "Describe how the nutritional danger to the applicant's life", the nurs e practitioner wrote, "healthy heart diet." In her written submission on recons i de rat ion, the appellant wrote that her health care provider "says that I have all kinds of mental problems but I don't." The appellant listed the medications she takes for high blood pressure and heart burn, as well as another medicati o n "b w rote, "I a m trying to lose weight because I am overweight" and that she is on medication because she is "criminal insane." The appellant indicates "vitamins/minerals: mult mi n era l s with lutein and lyc opene." In he r noti ce of appeal dated Sept need to pay for some cancer meds, and I need to lose weight, there are some foods that I can't eat or used some [soups] cause of my health problems." The Ministry indicated that the appellant is a person with disabilities in receipt of disability assistance. EAAT003(10/06/01) m ed that she had be en n oti fied of th e date, time and p pel lant's a bsence , pu r s uant to s. 86(b) of the m mary dated July 31, 2014, the appellant's l eted by a nu rse below, as well as the appellant's written submissio ns ed that the a ppellant's severe re, r equi res daily nu m er ous meds" ow fa t, low salt diet." The nurse practitioner left b l a nk e d ic al condition(s ) . .. i s the applicant being I f s o, p l eas e pr o vi de details ... " On page 2 of the t of the chron ic, p rogre ssi ve d eterior at ion o f heal t h f o llo wing symptoms? " t he nu r s e practi tion er has qu est i on #4 , the nurse practiti on er pro vided t he a min or min e ral supp l em entatio n, the n u rs e ple mentation req ui re d is, "addi ti o nal mon ey for u ll et askin g fo r a descripti on of how this ite m will r di d no t ans w er the thi rd bullet -des cribe h o w nt's life. u ll et on page 2 a nd 3 bu lle ts on pa g e 3, t he are, " requir es addi tional mon ey for sp ec ific t his ap plica nt ha v e a me d i cal co ndition t ha t results in uirements thr ou gh a r e gular d i etary int ak e ? If y e s, se to th e ques tion , "De sc r ibe how th e n u t r i tional i fied i n question 3 a nd p rovid e c aloric ll a ssist i n f ol lowing M editerranean diet, items requ ested will prevent imminent ecause I have tried to kill myself." The appellant i extra dye free as essential vitam ins a nd ember 8, 2014, th e appell a nt wrote "I
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 i s a p p e a l i s w h e t h e r t h e M i n i s t r y ' s d e c i s i f o l l o w i n g b a s e s i s r e a s o n a b l y s u p p o r t e d b y t h e e v i d e n c e r e s u l t o f h e r 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 d i s p l a y s t w o o r m o r e o f t h e s y m p t o m s s e t o u t i n s u b s . 6 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 a d d i t i o n a l n u t r r e g u l a r d i e t a r y i n t a k e , a s s e t o u t i n s . 7 ( a ) o f S c h e d u l e C b y s u b s . 6 7 ( 1 . 1 ) ( d ) ; a n d t h a t t [ l e n u r s e p r a c t i t i o n e r d i d n v i t a m i n s a n d m i n e r a l s u p p l e m e n t s t o p r e v e n t i m m i n e n t d L e g i s l a t i o n E A P W D R 6 7 . N u t r i t i o n a l S u p p l e m e n t ( 1 ) T h e m i n i s t e r m a y p r o v i d e a n u t r i t i o n a l s u p p l e m e n t s u p p l e m e n t ] o f S c h e d u l e C t o o r f o r a p e r s o n w i t h a s s i s t a n c e u n d e r ( a ) s e c t i o n 2 [ m o n t h l y s u p p o r t a l l o w a n c e ] , 4 [ m o n b o a r d ] o r 9 [ p e o p l e i n e m e r g e n c y s h e l t e r s a n d t r a ( b ) s e c t i o n 8 [ p e o p l e r e c e i v i n g s p e c i a l c a r e ] o f S c d r u g t r e a t m e n t c e n t e r , 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 ( c ) b a s e d o n t h e i n f o r m a t i o n c o n t a i n e d i n t h e f o r m s e t o u t i n s u b s e c t i o n ( 1 . 1 ) ( a ) t o ( d ) a r e m e t i n r e ( d ) t h e p e r s o n i s n o t r e c e i v i n g a s u p p l e m e n t u n d e S c h e d u l e C , ( e ) t h e p e r s o n i s n o t r e c e i v i n g a s u p p l e m e n t u n d e ( f ) t h e p e r s o n c o m p l i e s w i t h a n y r e q u i r e m e n t o f t h ( g ) t h e p e r s o n ' s f a m i l y u n i t d o e s n o t h a v e a n y r e s i t e m s f o r w h i c h t h e s u p p l e m e n t m a y b e p r o v i d e d . ( 1 . 1 ) I n o r d e r f o r a p e r s o n w i t h d i s a b i l i t i e s t o r e c e i v e a m u s t r e c e i v e a r e q u e s t , i n t h e f o r m s p e c i f i e d b y t h n u r s e p r a c t i t i o n e r , i n w h i c h t h e p r a c t i t i o n e r h a s c ( a ) t h e p e r s o n w i t h d i s a b i l i t i e s t o w h o m t h e r e q u e c h r o n i c , p r o g r e s s i v e d e t e r i o r a t i o n o f h e a l t h o n ( b ) a s a d i r e c t r e s u l t o f t h e c h r o n i c , p r o g r e s s i v e d o f t h e f o l l o w i n g s y m p t o m s : ( i ) m a l n u t r i t i o n ; ( i i ) u n d e r w e i g h t s t a t u s ; ( i i i ) s i g n i f i c a n t w e i g h t l o s s ; ( i v ) s i g n i f i c a n t m u s c l e m a s s l o s s ; ( v ) s i g n i f i c a n t n e u r o l o g i c a l d e g e n e r a t i o n ; ( v i ) s i g n i f i c a n t d e t e r i o r a t i o n o f a v i t a l o r g a n ; ( v i i ) m o d e r a t e t o s e v e r e i m m u n e s u p p r e s s i o n ; ( c ) f o r t h e p u r p o s e o f a l l e v i a t i n g a s y m p t o m r e f e r m o r e o f t h e i t e m s s e t o u t i n s e c t i o n 7 o f S c h e d ( d ) f a i l u r e t o o b t a i n t h e i t e m s r e f e r r e d t o i n p a r a g r l i f e . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )r 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 t h e M N S o n t h e : t h a t t h e n u r s e p r a c t i t i o n e r d i d n o t c o n f i r m t h a t a s a o n a c c o u n t o f a s e v e r e m e d i c a l c o n d i t i o n t h e a p p e l l a n t 7 ( 1 . 1 ) ( b ) ; t h a t t h e n u r s e p r a c t i t i o n e r d i d n o t c o n f i r m i t i o n a l i t e m s a s 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 n t o a , a n d t o p r e v e n t i m m i n e n t d a n g e r t o l i f e , a s r e q u i r e d o t c o n f i r m 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 a n g e r t o l i f e , a s r e q u i r e d b y s u b s . 6 7 ( 1 . 1 ) ( d ) . i n a c c o r d a n c e w i t h s e c t i o n 7 [ m o n t h l y n u t r i t i o n a l d i s a b i l i t i e s i n a f a m i l y u n i t w h o r e c e i v e s d i s a b i l i t y t h l y s h e l t e r a l l o w a n c e ] , 6 [ p e o p l e r e c e i v i n g r o o m a n d n s i t i o n h o u s e s ] o f S c h e d u l e A , o r h e d u l e A , i f t h e s p e c i a l c a r e f a c i l i t y i s a n a l c o h o l o r r e q u i r e d u n d e r s u b s e c t i o n ( 1 . 1 ) , t h e r e q u i r e m e n t s s p e c t o f t h e p e r s o n w i t h d i s a b i l i t i e s , r s e c t i o n 2 ( 3 ) [ g e n e r a l h e a l t h s u p p l e m e n t ] o f r s u b s e c t i o n ( 3 ) o r s e c t i o n 6 6 [ d i e t s u p p l e m e n t s ] , e m i n i s t e r u n d e r s u b s e c t i o n ( 2 ) , a n d o u r c e s a v a i l a b l e t o p a y t h e c o s t o f o r t o o b t a i n t h e n u t r i t i o n a l s u p p l e m e n t u n d e r t h i s s e c t i o n , t h e m i n i s t e r e m i n i s t e r , c o m p l e t e d b y a m e d i c a l p r a c t i t i o n e r o r o n f i r m e d a l l o f t h e f o l l o w i n g : s t r e l a t e s i s b e i n g t r e a t e d b y t h e p r a c t i t i o n e r f o r a a c c o u n t o f a s e v e r e m e d i c a l c o n d i t i o n ; e t e r i o r a t i o n o f h e a l t h , t h e p e r s o n d i s p l a y s t w o o r m o r e r e d t o i n p a r a g r a p h ( b ) , t h e p e r s o n r e q u i r e s o n e o r u l e C a n d s p e c i f i e d i n t h e r e q u e s t ; a p h ( c ) w i l l r e s u l t i n i m m i n e n t d a n g e r t o t h e p e r s o n ' s
S c hedule C -Healt h Supplem en ts M on thly nutritional supp l em ent 7 The amou n t of a n ut ritional su pp lement that may be pro th is regulation is the sum of the amoun t s for th o se of the f un d e r section 67 (1 )(c ): ( a) for ad dit ion a l nutri tion a l it ems tha t are par t o f a calori $165 e a ch mont h; ( b) Repeale d ( c) For vitamins a nd mineral s, up t o $ 40 each m o n th Base d on her su bm i ssion s on reco n s id era tion and in her Min istry 's decisi on to d en y her re quest for MN S -sh e argues be cau se sh e i s ove rwei ght , she n ee d s t o pay for cancer medicat b ecau se of her hea lt h prob lems and she needs e sse n t ial In i ts rec onsider ati on d eci sion , th e Mi nistry f ound that t he fo rm that the ap pel la nt is bein g trea ted for a ch r on ic, progressi med ic al cond it ion -th e a pp e llant ' s s e ver e schizop hr enia altho u gh the appellan t has written i n her no tice o f app eal medical or nu rs e pr acti tioner has n o t confirme d that th e a a ppe llant's MN S f orm, n o ting th a t the n urse p rac t itioner di the l i sted sy mptom s as a r esul t of her chr onic, pr og r essiv 67(1. 1 )(b) of the EAP W DR. T he Min istry also n o ted that sh e requ i r es MN S to supp le me n t ca loric inta k e (a s required by T he Min istry a rgu e d that the in f ormat i o n wa s for diet re c within t h e app ellant' s regula r diet. The Mi nist r y als o a r gued that t practi tion er in th e M NS form did not specif y t he t ypes of v re q ue s ted vitamins /mine r a ls wil l pre v ent imm inent danger 67(1.1)( d ) of the EAPWDR. Pa n el's decisio n Under subs. 67(1 )(c) of the EAPWDR, in order to qualify for the MNS, the appellant's medical or nurse practitioner must confirm that the appellant meets all of the requirements set out in subs. 67(1. 1 )(a) through (d). Under s. 7(a) of Schedule C of the EA PWD R, a d ditio of a caloric supplementation to a regular dietary intake ." practitioner confirmed that she is being treated for severe schizophrenia and HPTN (a chronic, progressive deterior a t ion of health on account of a severe medical condition), thereby meeting the criterion set out in sub 67(1.1 )(a). The panel finds that the Ministr y' s determination th at t he displays 2 or more of the listed symptoms as a direct result of her chronic, progressive deteriorat reasonab l e based on the evidence. The panel notes that on the MNS form, the appell did not indicate that the appellant displayed any of the listed symptoms -none of the boxes are checked and there is no commentary. Accordingly, the panel finds that the Ministry reasonably determined based on the information provided that the appellant's nurse practitioner had not confirmed that as a result of her schizophrenia and HPTN, she displays two or more of the symptoms listed in subs. 67(1.1 EAAT003(10/06/01) vid ed under secti o n 67 [nutritional suppl eme n t ] of ollow ing i tem s spec ifie d as r e quir e d in the request c suppleme nta ti o n to a regular dietary inta ke, up to . n otice of appeal, the appe l lant disagre es with the th at s h e need s and wants to l ose w eight io n, there a r e so me food s s he c a n't eat vitam ins and m i nera ls. appe l lant's nurs e practitio ner confirmed in t he MNS ve deterioratio n o f health o n acco u nt of a s e ver e an d HPTN . The M inist r y note d at the hearin g that th a t s he n e eds mon e y fo r cance r med i catio n, a ppella n t has c an c er. The Min istry p ointe d to t he d n ot indicat e o n it t h a t the ap pe llant disp l a ys a n y o f e d eterio ra t ion of health , as r equire d by s ubs. the a ppella n t's nurse pr act it ion e r did not i ndicat e that sec tio n 7 (a) of Schedule C of t he E APW D R). omm endatio ns involving a pp ropriate f ood choic e s h e i nformatio n pr o v id ed by the nu rse itam i ns/m i ner al s t h e app ell an t requ i r es, or h ow t h e to the appe llant's l if e, a s r eq uired u nder sub s. nal n u tritional items m a y be provided if they "are part The Ministry d eter mi ned that the appellant's nur se s. a ppellant's nurse p ract itioner did not confirm that she ion of health is ant's nurse practitioner ) (b).
Additional Nutritional Items The panel finds that the Ministry's determination that the appellant's nurse practitioner has not indicated that the appellant requires the requested MNS to provide caloric intake to supplement her regular diet is reasonable based on the evidence. In the MNS form, the appellant's nurse practitioner wrote in response to the request to describe how the requested MNS will alleviate the appellant's listed symptoms and provide caloric supplementation to her regular diet, "will assist in following Mediterranean diet, low salt diet." The panel notes that the appellant's nurse practitioner made no reference to how the requested MNS will provide caloric supplementation to her regular diet, as required by subs. 67(1.1)(c) and section ?(a) of Schedule C (the nurse practitioner had indicated "requires additional money to pay for specific foods"). The panel further finds that the Ministry's determination that the appellant's nurse practitioner has not confirmed that failure to receive the requested MNS will result in imminent danger to her health is reasonable based on the evidence. In response to the question, "Describe how the nutritional items requested will prevent imminent danger to the applicant's life", the nurse practitioner wrote, "healthy heart diet." The panel finds that the Ministry reasonably determined that this evidence does not confirm the requirement of subs. 67(1.1)(d) that failure to provide the requested MNS will result in imminent danger to the appellant's life. Vitamin/Mineral Supplements The panel finds that the Ministry's determination that the appellant's nurse practitioner has not indicated that failure to provide the requested vitamin or mineral supplementation will result in imminent danger to her health is reasonable based on the evidence. On the MNS form, the nurse practitioner's response to the question to specify the vitamin or mineral supplements requested is "additional money to pay for specific foods." The nurse practitioner did not respond to the question, "Describe how this item or items [vitamin or mineral supplements] will prevent imminent danger to the applicant's life" -the section is left blank. The panel finds that the Ministry reasonably determined that this evidence does not confirm the requirement of subs. 67(1.1)(d). Accordingly, the panel confirms the Ministry's reconsideration decision to deny the appellant's request for MNS. EAAT 003( 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.