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 r e c o n s i d e r a t i o n d e c i s i o n d a t e d A u g u s t 1 3 , 2 0 1 4 w h s u p p l e m e n t t o c o v e r t h e c o s t o f a n e w p o w e r w h e e f o u n d t h a t t h e f o l l o w i n g r e q u i r e m e n t s o f S e c t i o n 6 9 W i t h D i s a b i l i t i e s R e g u l a t i o n ( E A P W D R ) w e r e n o t m • t h e r e q u i r e m e n t f o r a d i r e c t a n d i m m i n e n t l i f e 6 9 ( a ) ] ; • t h e r e i s i n s u f f i c i e n t i n f o r m a t i o n p r o v i d e d t o s h 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 [ S e c • t h e r e i s i n s u f f i c i e n t i n f o r m a t i o n p r o v i d e d t o s h m e e t t h a t n e e d [ S e c t i o n 6 9 ( b ) ] ; • a s r e q u i r e d p u r s u a n t t o S e c t i o n 6 9 ( d ) ( i i ) o f t h p r o v i d e d t o s h o w t h a t t h e r e q u i r e m e n t s i n S c 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 e q u i p m e n t o r d e v i c e [ S e c t i o n 3 ( 1 ) ( b ) ( i i ) ] , a n d 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 i s t h e l e a s t d e v i c e [ S e c t i o n 3 ( 1 ) ( b ) ( i i i ) ] . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b a n d S c h e d u l e C , S e c t i o n s 3= D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) i c h d e n i e d t h e a p p e l l a n t ' s r e q u e s t f o r a l c h a i r w i t h t i l t a n d c u s t o m s e a t i n g . T h e m i n i s t r y o f t h e E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s e t : t h r e a t e n i n g h e a l t h n e e d w a s n o t m e t [ S e c t i o n o w t h a t 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 t i o n 6 9 ( a ) ] ; o w t h a t 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 e E A P W D R , t h e r e i s i n s u ff i c i e n t i n f o r m a t i o n h e d u l e C , S e c t i o n 3 h a v e b e e n m e t , n a m e l y t h a t : 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 m e d i c a l e x p e n s i v e a p p r o p r i a t e m e d i c a l e q u i p m e n t o r 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 2 a n d 6 9
PAR T E -Summ a ry of Facts Th e min ist r y did not at tend the h ear in g. Af t e r co nf irmi p r oceeded purs uant to Sect ion 86(b) of the Empl oy The ev i dence before the ministry at the ti me of the re 1) L et ter d ated N ove mber 21, 20 13 t o the ministr wrote that t he appel la nt suffers from para p l egi r equir es a ne w power w heelc h a ir plus protec back an d leg pr o tect io n . Without th e corr ect breakdown and ul cers which will bec o me l ife-t 2) Letter dated F ebr u a ry 1 7, 201 4 t o th e ministry in which the appellant's ph wrote that t he tilt mechanism of the appel lant's ext e nsiv e repairs es t imat e d at $6,000 . H e req b utto cks and el eva te h i s feet and le gs d u e t o s ocial worker had a p pli ed to medical s ervic es The lack o f ti lt is p l acing the appel lan t in a pot 3 ) S e atin g Ass essment Re p ort da ted F ebruar y at the facilit y wrot e that: • The a p pel la nt ur gently n eed s a ne w whe curren t chair has b rok e n down (powe r • Th e current wheelch ai r di d not m eet h o f app ropr ia t e sea t ing a re serious. • The a p pel la nt ha s a s mall empl oyment-t h e e quip me nt on hi s own des p ite the fact t en gageme nt in relations h ips a nd comm • The a p pel la nt re quires power m obili ty to ge • He n ee ds ti lt function t o of fset severe ed over the past 2 ye ars. This has b ee n a si d es of b o th feet an d up t he lower front • Thes e sor e s dev elop quick l y, the most re o f 2 013. The sores were marked by large treatment for months necessitating hou care. • The s e sores are life-thre atening if the appellan a bilit y t o raise his fee t sufficie ntly a b o v position in the chair. • The appellant has had severe and disablin r eposit ion himself in his whe elchair other than through the tilt mechanism. • Cushio ning has been insufficient under his buttocks and in support of his lower back. He has a wedge and a c u shion p i l ed on harder foam surfaces instead of the higher-end • This resident is relatively youn g and his mental health dete his daily activities. • The primary goal for the n ew device is f and change his position independently. device. He benefits greatly from the ability to get around the communi friends. He drives the chair for most of the day. ng that t he mi ni s try was n otified, t h e hea ring ment and Assi s t an ce R egu latio n . considera ti o n deci si on in cl uded: y in which the ap pellant's ph ysician at the fa cili ty a pl us la c k of bl adder or bowe l cont r o l . He t ive se ati ng n o t only for m ob il i ty but also f o r ski n, wh e elc h air and seating h e w ill dev el o p ski n h rea tening; ys ici an at th e fa cil ity wh eelch air is n ot worki ng and re quires ui re s the t ilt mechanism to tak e pres sure o ff hi s his par aplegia. He i s n o t a m in istry cli en t . The on N ovember 18, 201 3 b u t ha s not had a reply. en t iall y li fe-threate ning si tuati o n; 2 4 , 2 014 in wh i ch t h e o ccupationa l t h er ap i st ( OT ) elchair t hat a l lows fo r power tilt fu n c tion as his ti l t componen t). is s e atin g nee d s ; pot e nti a l consequence s of l ack rel ate d pensi o n but no ass e ts; he cann o t aff ord h at it i s essen t ial to his hea lth and unit y life. t arou nd the facility a nd communi ty. ema that h a s deve lo ped in his fee t an d toes si gnificant p roble m, e sp e cially on the u pper of his le g s. c e nt ep isode l asting fr om Ma y 201 2 to the fall cracks an d fissures and requi re d extensive r s of nursing, clinical resource nur se and OT t is not in the correct position with the e the le v e l o f his heart an d chan ge his s eated g b ack an d b utt o c k pai n. H e is unab le to e on top of the other, bu t bo th a re ol de r a nd air cushioning he needs. r io r a t e s if he cannot carry out o r t he appellant to be able to elevate his legs Daily activity goals are much as for his current ty and/or visit
• T h e a p p e l l a n t h a s n o m o v e m e n t i n h i s H e h a s l o w r a n g e o f m o t i o n a n d s t r e n • H e i s u n a b l e t o c h a n g e p o s i t i o n i n d e p b e d m o b i l i t y . A l l o f h i s t r a n s f e r s a r e v • " M e d i c a l d i a g n o s e s i n c l u d e : s p i n a l c o b a c k p a i n , .n e u r o g e n i c b o w e l , s c h i z o p • T h e a p p e l l a n t ' s w e i g h t i s n o t e d a t 1 1 6 • C u r r e n t e q u i p m e n t : t h e a p p e l l a n t h a d c u r r e n t t i l t m e c h a n i s m b r o k e d o w n 2 w $ 6 , 0 0 0 ) w h i c h c o u l d n o t b e c o m p l e t e d • O n c e t h e p o w e r t i l t m e c h a n i s m b r o k e i n b y t h e v e n d o r b e f o r e t h e c h a i r w a s • T h e a p p e l l a n t ' s f e e t a r e c u r r e n t l y i n t h • T h e s e a t a n g l e a n d t h e s e a t i n g s u r f a c s o m e t i m e s u n a b l e t o t o l e r a t e d a i l y u s e s u f f i c i e n t h e i g h t f o r h i s l e g s a n d f e e t . • A P e r m o b i l M 3 0 0 p o w e r w h e e l c h a i r i s m o d u l e , p o w e r t i l t , 2 1 x 2 0 i n c h s e a t , c b e a R O H O Q u a d t r o d u e t o h i s i n a b i l i t p r e s s u r e u l c e r s . 4 ) M e d i c a l E q u i p m e n t R e q u e s t a n d J u s t i f i c a t i o n c o n d i t i o n a s s e t o u t i n t h e l e t t e r s f r o m t h e a p p e q u i p m e n t r e q u i r e d t o m e e t t h e n e e d a s s e t o 5 ) Q u o t e d a t e d F e b r u a r y 2 0 , 2 0 1 4 f r o m a m e d i c f o r t h e t o t a l a m o u n t o f $ 2 4 , 3 6 8 . 2 1 ; 6 ) Q u o t e d a t e d F e b r u a r y 2 0 , 2 0 1 4 f r o m a m e d i c p r o p o s e d f o r a n e w p o w e r w h e e l c h a i r i n t h e t 7 ) R e q u e s t f o r R e c o n s i d e r a t i o n d a t e d J u l y 1 8 , 2 h a n d w r i t t e n P r o g r e s s N o t e s b y a p s y c h i a t r i s t D e n i a l l e t t e r d a t e d J u l y 1 7 , 2 0 1 4 f r o m a p h y s I n t h e R e q u e s t f o r R e c o n s i d e r a t i o n , t h e a d v o c a t e , w s t a t e d t h a t : • M a n u a l c h a i r w i l l n o t m e e t t h e a p p e l l a n t ' s n e e 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 . P r e v i o u s d o c u m d o c u m e n t s a t t a c h e d s u p p o rt r i s k o f d e c o m p e • T h e a p p e l l a n t r e q u i r e s a p o w e r t i l t w h e e l c h a i r t h e f a c i l i t y a n d c o m m u n i t y . • T h e a p p e l l a n t i s a c o m p l e t e q u a d r i p l e g i c s e c o h e r n i a t i o n f o l l o w i n g a f a l l f r o m a c h a i r i n A p r i l m a n u a l w h e e l c h a i r . • S t a f f i n g l e v e l s i n r e s i d e n t i a l c a r e d o n o t s u p p o m a n u a l c h a i r s t o t r a n s p o r t t h e m t o c o m m u n i t y n e c e s s a r y t o p r o m o t e i n d e p e n d e n c e a n d m a i b e i s o l a t e d a n d d e p e n d e n t o n t h e a v a i l a b i l i t y o f a c i l i t y . • T h e h o s i t a l f a c i l i t i s f u n d e d b t h e M i n i s ! o l e g s o r f e e t a n d n o s e n s a t i o n i n t h e l o w e r l i m b s . g t h i n a l l l i m b s a n d h a n d f u n c t i o n i s l i m i t e d . e n d e n t l y i n b e d a n d r e q u i r e s t w o p e r s o n a s s i s t f o r i a o v e r h e a d l i f t a n d s l i n g . r d i n j u r y , s t r o k e , a rt h r i t i s , c h r o n i c p a i n , s e v e r e h r e n i a w h i c h i s w e l l c o n t r o l l e d a n d s l e e p a p n e a . " k g . , w i t h n o o t h e r c o m m e n t p r o v i d e d . a p o w e r w h e e l c h a i r f o r s e v e r a l y e a r s . T h e e e k s a g o a n d w o u l d r e q u i r e e x t e n s i v e ( u p t o d u e t o l a c k o f f u n d i n g . d o w n , s e v e r a l f r e e h o u r s o f l a b o u r h a d t o b e p u t u s e a b l e . e l o w e r m o s t p o s i t i o n w h e n e v e r h e i s u p . e a r e i n a d e q u a t e i n a l l e v i a t i n g b a c k p a i n a n d h e i s o f t h e c h a i r . E l e v a t i n g f o o t r e s t s d o n o t a l l o w f o r b e i n g r e c o m m e n d e d w i t h r e t r a c t a b l e j o y s t i c k a l f s u p p o r t a n d w i d e f o o t r e s t s . C u s h i o n n e e d s t o y t o m o v e h i m s e l f i n t h e c h a i r a n d h i s r i s k o f d a t e d M a r c h 3 , 2 0 1 4 d e s c r i b i n g t h e m e d i c a l e l l a n t ' s p h y s i c i a n a n d s p e c i f y i n g t h e m e d i c a l u t i n t h e O T [ o c c u p a t i o n a l t h e r a p i s t ] r e p o r t ; a l s u p p l y c o m p a n y f o r t h e n e w p o w e r w h e e l c h a i r a l s u p p l y c o m p a n y f o r t h e c u s t o m s e a t i n g a s o t a l a m o u n t o f $ 2 , 7 4 0 . 0 0 ; a n d , 0 1 4 w i t h r e a s o n s a t t a c h e d a s w e l l a s 3 p a g e s o f a n d a n A p p e a l o f E q u i p m e n t F u n d i n g R e q u e s t i o t h e r a p i s t . h o i s t h e d i r e c t o r o f r e s i d e n t c a r e f o r t h e f a c i l i t y , d s a n d h i s r e q u e s t s h o u l d b e c o n s i d e r e d u n d e r e n t s s u b m i t t e d f o r p h y s i c a l n e e d s . A d d i t i o n a l n s a t i o n t o m e n t a l h e a l t h . w i t h c u s t o m s e a t i n g t o m a i n t a i n m o b i l i t y w i t h i n n d a r y t o d e c o m p r e s s i o n s u r g e r y f o r c e r v i c a l d i s c 2 0 1 0 . H e i s n o t c a p a b l e o f m a n e u v e r i n g a r t t h e p r o v i s i o n o f a s s i s t a n c e t o r e s i d e n t s i n a c t i v i t i e s / e v e n t s , a p p o i n t m e n t s , e t c . w h i c h a r e n t a i n g o o d m e n t a l h e a l t h . T h e a p p e l l a n t w o u l d f c a r e s t a ff t o m o v e h i m a b o u t h i s r o o m a n d t h e f H e a l t h a n d t h e s t a ff i n m o d e l i s o n e c a r e s t a ff
t o 6 o r 7 r e s i d e n t s a n d ( o v e r n i g h t ) , o n e c a r e • T h e a p p e l l a n t h a s a l o n g s t a n d i n g m e n t a l h e a n d r e p o r t s n u m e r o u s o c c a s i o n s o f s u i c i d e i P T S D . I n t h e A p p e a l o f E q u i p m e n t F u n d i n g R e q u e s t D e n i a f r o m t h e h e a l t h a u t h o r i t y a d d e d : • T h e a p p e l l a n t p r e s e n t s w i t h c h r o n i c s e v e r e l u d e p e n d e n t l e g e d e m a w i t h l y m p h e d e m a w h i c p r o n e t o e d e m a . C o m p r e s s i o n s t o c k i n g s h a v m a n a g e t h e s w e l l i n g a n d s k i n b r e a k d o w n i s s • H e r e m a i n s a t v e r y h i g h r i s k o f l i f e t h r e a t e n i n a v o i d l o n g p e r i o d s o f h a v i n g h i s l o w e r l e g s i n i n d e p e n d e n t l y a n d r e g u l a r l y e l e v a t e h i s l o w e m e a n s t h a t h i s p o w e r c h a i r r e q u i r e s p o w e r t i l • " O n e m i g h t a r g u e t h a t h e l i v e s i n a c a r e f a c i l i t h a t s t a f f a r e s c a r c e l y a v a i l a b l e t o m a n u a l l y c • I t i s u n s o u n d t o c o n s i d e r a m a n u a l c h a i r t o m d o b e t t e r t o s t a y i n h i s b e d a n d u s e t h e p o w e s o u n d s . • P o s t u r a l p o s i t i o n i n g i n s i t t i n g a f f e c t s s a f e s w a w h i c h a r e s i g n i f i c a n t h e a l t h r i s k f a c t o r s f o r t h e • T h e a p p e l l a n t p r e s e n t s w i t h s e v e r e c h r o n i c b p o w e r s e a t f u n c t i o n s , t h e a p p e l l a n t w i l l b e a b m e d i c a t i o n . • T h e a p p e l l a n t l a c k s m o t o r c o n t r o l a t b o t h a r m w h e e l c h a i r e v e n i n d o o r s . • T o c o n t i n u e t o p r o v i d e h i m w i t h p o w e r m o b i l i t g o a l f o r i n d i v i d u a l s w i t h d i s a b i l i t i e s i n c l u d e s " a n d i n c l u s i o n i n t h e c o m m u n i t y . " • T h e p o w e r e l e v a t i n g l e g r e s t s w i l l a l l o w t h e a p c o r n e r s a n d a r e a s . I n t h e h a n d w r i t t e n P r o g r e s s N o t e s , t h e a p p e l l a n t ' s p • T h e a p p e l l a n t ' s m e d i c a l h i s t o r y i n c l u d e s p a r a s t r e s s d i s o r d e r ] b o t h c u r r e n t l y s t a b l e o n m e d • T h e r e i s r e c e n t c o n c e r n r e g a r d i n g t h e a p p e l l a i d e a t i o n ] . • F i n a n c i a l i s s u e s c a u s e s t r e s s d u e t o i n a b i l i t y r e m a i n a c t i v e a n d s t r u c t u r e d . • T h e a p p e l l a n t ' s p s y c h i a t r i c c o n d i t i o n i s w e l l m e p i s o d i c S I ; h e c l e a r l y n e e d s t o s t a y s t r u c t u r e w h e e l c h a i r t o m a i n t a i n p s y c h o s o c i a l r e h a b i l i t a A t t h e h e a r i n g , t h e a d v o c a t e p r o v i d e d t h e f o l l o w i n g a 1 ) O n e p a g e o f a 4 p a g e H o m e a n d C o m m u n i t y s e t s o u t a l i s t o f " c h a r a e a b l e i t e m s , " i n c l u d i n a s t a f f t o 2 5 r e s i d e n t s . a l t h h i s t o r y . H e h a s a t t e m p t e d s u i c i d e i n t h e p a s t d e a t i o n . H e h a s d i a g n o s e s o f s c h i z o p h r e n i a a n d l l e t t e r d a t e d J u l y 1 7 , 2 0 1 4 , t h e p h y s i o t h e r a p i s t n g a n d c i r c u l a t i o n i s s u e s . H e h a s b i l a t e r a l h m e a n s t h a t w h e n h i s l e g s a r e d o w n h e i s q u i t e e b e e n h e l p f u l b u t a r e n o t n e a r l y e n o u g h t o u e s . g D V T [ d e e p v e i n t h r o m b o s e s ] . I t i s i m p o r t a n t t o a d e p e n d e n t p o s i t i o n a n d h e n e e d s t h e a b i l i t y t o r l e g s a t o r a b o v e t h e l e v e l o f h i s h e a r t . T h i s t / r e c l i n e / l e g e l e v a t i o n t o a d e q u a t e l y a c h i e v e t h i s . t y w i t h 2 4 h o u r c a r e , b u t i t i s c o m m o n k n o w l e d g e h a n g e h i s p o s i t i o n . " e e t t h e a p p e l l a n t ' s p o s i t i o n i n g n e e d s . H e w o u l d r f u n c t i o n s a v a i l a b l e t h e r e , a s l u d i c r o u s a s t h a t l l o w i n g , d i g e s t i v e a n d r e s p i r a t o r y f u n c t i o n s , a p p e l l a n t . a c k p a i n a n d i t i s e x p e c t e d t h a t w i t h t h e r e q u i r e d l e t o m a n a g e t h e p a i n w i t h l e s s h i g h r i s k p a i n s s o i s n o t a b l e t o f u n c t i o n a l l y w h e e l a m a n u a l y i s a p a r a m o u n t g o a l a n d t h e m i n i s t r y s t a t e s a t o g a i n a n d m a i n t a i n m e a n i n g f u l i n d e p e n d e n c e p e l l a n t t o q u i c k l y a d j u s t t o a l l o w f o r c l e a r i n g t i g h t s y c h i a t r i s t w r o t e i n p a r t : n o i d s c h i z o p h r e n i a a n d P T S D [ p o s t t r a u m a t i c i c a t i o n . n t ' s l o w m o o d a n d o c c a s i o n a l S I [ s u i c i d a l t o a f f o r d a p o w e r w h e e l c h a i r t h a t i s v i t a l t o a n a g e d b u t t h e r e i s c o n c e r n o f d e p r e s s i o n w i t h d a n d a c t i v e a n d n e e d s a c c e s s t o p o w e r t i o n a n d t o s t a y p o s i t i v e l y e n g a g e d . d d i t i o n a l d o c u m e n t s : C a r e P o l i c y M a n u a l , c h a p t e r 6 , s e c t i o n F , w h i c h " p u r c h a s e o r r e n t a l o f e a u i p m e n t t h a t i s f o r t h e
e x c l u s i v e u s e o f t h e c l i e n t , s u c h a s a w a l k e r , m a i n t e n a n c e a s r e q u i r e d ; " 2 ) N o t e d a t e d A u g u s t 2 6 , 2 0 1 4 ' T o w h o m i t m a w i t h t h e m e d i c a l s u p p l y c o m p a n y w r o t e : • T h e a p p e l l a n t ' s Q u a n t u m 6 0 0 w h e e l c h a r e a p p r o x i m a t e l y $ 6 , 0 0 0 . • T h e t i l t a n d s e a t f r a m e i s w o r n o u t , u n s y s t e m i s n o n f u n c t i o n i n g . T h i s i s d e t o v e r a l l h e a l t h . • T h e b a s e i s a l s o n e a r i n g t h e e n d o f i t s b a s e n e e d s s u b s t a n t i a l r e p a i r s t o t h e c h a i r n e a r s 5 y e a r s o f u s e . • T h e a p p e l l a n t i s v e r y c l o s e t o t h e w e i g r a t e o f w e a r . • I n t h e i r o p i n i o n , t h i s p o w e r c h a i r i s n o t 3 ) Q u o t e d a t e d S e p t e m b e r 8 , 2 0 1 4 f r o m a m e d i r e l a t i n g t o t h e a p p e l l a n t ' s Q 6 0 0 p o w e r w h e e l • C a s t e r s ( $ 1 3 8 . 3 2 ) , • M o t o r a s s e m b l y ( $ 1 , 3 6 7 . 0 2 ) , • A r m r e s t p a d d i n g ( $ 3 9 . 9 5 ) , • J o y s t i c k c o n t r o l l e r ( $ 7 4 8 . 2 2 ) • T i l t c o m p l e t e w i t h c e n t r e m o u n t w i t h f l i • L a b o u r ( $ 3 6 0 ) • F o r a t o t a l c o s t o f $ 6 , 3 1 1 . 7 1 . • T h e Q u o t e i n c l u d e s a c o m m e n t t h a t " i i r e p l a c e m e n t p a r t s o u t w e i g h ( s i c ) t h e v • " C h a i r s u p p l i e d J a n u a r y 1 0 , 2 0 1 1 ; " 4 ) S u m m a r y o f m o b i l i t y i s s u e s d a t e d S e p t e m b e p r o v i d e d t h e S e a t i n g A s s e s s m e n t R e p o r t , w r • R e g a r d i n g t h e " a p p r o p r i a t e n e s s o f c u r s m a l l f o r h i m a n d n o t a d j u s t a b l e f o r w i • T h e t i l t f u n c t i o n i s n o t w o r k i n g , t h e c h a h i g h e r e n d m o d e l t h a t w o u l d o u t l i v e i t s • R e c o m m e n d r e p l a c e m e n t o f t h i s c h a i r • R e g a r d i n g " p r e s s u r e r e d u c t i o n " , t h e O t h r e a t e n i n g r e a l i t y f o r t h e a p p e l l a n t . • T h e a p p e l l a n t a l t e r s h i s p o s i t i o n f r e q u e c a n c h a n g e h i s p o s i t i o n o f t e n e n o u g h • A m a n u a l t i l t f u n c t i o n w i l l w o r s e n r a t h e d e v e l o p i n g i n t h e f u t u r e . W h i l e s t a f f m u n a b l e t o d o s o a s f r e q u e n t l y a s h e r e q • R e g a r d i n g " m e n t a l h e a l t h " , t h e a p p e l l a a n d i t i s a g e a p p r o p r i a t e f o r h i m t o h a v i s a l s o e x p e c t e d t h a t h e h a v e a s m u c h w h i c h i n c l u d e s t h e i n d e p e n d e n t a b i l i t y p o s i t i o n i n h i s c h a i r w i t h t h e t i l t m e c h a n • T h e a n n e l l a n t h a s d o n e w e l l a t t h e h o s w h e e l c h a i r , c r u t c h e s , c a n e s o r o t h e r d e v i c e s , a n d y c o n c e r n ' i n w h i c h a r e h a b e q u i p m e n t s p e c i a l i s t a i r i s c u r r e n t l y i n n e e d o f s u b s t a n t i a l r e p a i r s t h a t s a f e a n d n e e d s r e p l a c i n g . C u r r e n t l y t h e t i l t r i m e n t a l t o t h e a p p e l l a n t ' s s k i n i n t e g r i t y a n d l i f e e x p e c t a n c y . I n t h e i r e x p e r i e n c e , t h e Q 6 0 0 m o t o r s , g e a r s b o x e s a n d s u s p e n s i o n w h e n t h e h t l i m i t o f t h i s m o d e l o f c h a i r , w h i c h i n c r e a s e s t h e w o r t h r e p a i r i n g a n d s h o u l d b e r e p l a c e d ; c a l s u p p l y c o m p a n y s e t t i n g o u t a l i s t o f p a r t s c h a i r a n d t h e c o s t s , i n c l u d i n g : p u p f o o t ( $ 3 , 6 5 8 . 2 0 ) a n d i s t h e t e c h n i c i a n ' s o p i n i o n t h a t t h e c o s t o f t h e s e a l u e o f t h e c l i e n t ' s e x i s t i n g c h a i r . r 1 6 , 2 0 1 4 i n w h i c h t h e O T f r o m t h e f a c i l i t y , w h o o t e : r e n t c h a i r " t h a t t h e a p p e l l a n t ' s c u r r e n t c h a i r i s t o o d t h . i r n e e d s s i g n i f i c a n t r e p a i r s a n d t h e c h a i r i s n o t a e x p e c t e d l i f e s p a n . . T w r o t e t h a t p r e s s u r e u l c e r s a r e a s i g n i f i c a n t , l i f e  n t l y a n d h e r e q u i r e s p o w e r t i l t f u n c t i o n s o t h a t h e t o p r e v e n t a n d a l l e v i a t e p r e s s u r e d i f f i c u l t i e s . r t h a n h e l p t h e a p p e l l a n t t o p r e v e n t u l c e r s f r o m e m b e r s c a n c h a n g e h i s t i l t p o s i t i o n i n g , t h e y a r e u i r e s . n t i s o n e o f t h e y o u n g e r r e s i d e n t s a t t h e h o s p i t a l e p e o p l e t o v i s i t a n d a c t i v i t i e s d u r i n g t h e d a y . I t c o n t r o l o v e r h i s c i r c u m s t a n c e s a s p o s s i b l e , t o g o o u t s i d e a n d t h e a b i l i t y t o c h a n g e h i s i s m . p i t a l m e n t a l l y a n d e m o t i o n a l l v . H i s m e n t a l h e a l t h
has stabilized and he has developed a life for himself outside the hospital. He goes out daily for a minimum of 8 hours per day. He drives for short periods within the hospital but mostly goes outdoors. He meets friends and family members. • When his power chair stopped functioning, the appellant quickly began to show signs of depression. If he is limited to his room or unit on a continual basis, he risks becoming deeply depressed and possibly suicidal. His food/fluid intake will then tend to decrease. This could exacerbate his severe skin integrity problems and lead to a spiraling of pain and depressive symptoms. • If the appellant had a manual tilt wheelchair, staff members would be unable to assist him around the facility because the chair/resident combination would be too heavy for them to push consistently without risking injury. In addition, staff would be unable to spend as much individual time with the appellant as needed. • No other individuals are available for assisting with pushing/mobility. Volunteers are not permitted to take residents outside facility grounds. The appellant is financially unable to purchase companion services and friends are not consistently available to assisUpush him. Even if available, these people could not consistently push him more than around his unit due to the weight of the chair/resident, especially considering the hills surrounding the hospital. • A service such as HandyDart could take the appellant to a designated location, but it remains that the appellant requires a person to push and tilt his chair once he has arrived at his destination. • The appellant requires a power wheelchair with power tilt function for the maintenance of his mental health and physical health. 5 ) Report on the appellant's risk and history of skin breakdown dated September 15, 2014 in which a clinical resource nurse from the facility wrote: • The appellant was admitted to the hospital on March 8, 2011. • The appellant is at extreme risk for skin breakdown related to quadriplegia and resultant immobility. • Related issues include a history of severe lymphedema (swelling and leaking of fluid to both feet and legs to above knees) that is currently being managed with daily compression using two pairs of prescribed and measured compression stockings during the day and a pair of TED compression stockings during the night. • Since admission to hospital, the appellant has had extensive treatment to manage his lymphedema and related skin breakdown. He has been seen multiple times at the Foot and Leg Ulcer Clinic between June 2012 and June 2013. • History of lymphedema management includes the first appointment on May 2, 2012 with the diagnosis of bilateral chronic lymphedema and goal to get into compression stockings ASAP. • From May 2013 to present, 2 or 3 compression stockings are used to manage edema plus a pair of TED stockings at night. These stockings apply continuous graduated compression (days) and even compression (nights) and require training and time to apply correctly. • The appellant has also had skin breakdown on his coccyx area on and off since admission. • Prior to the loss of his electric tilt mechanism in June 2013, the appellant had two episodes in 2011 where his coccyx area became reddened and required regular treatment, increased positioning and monitoring.
• F o l l o w i n g t h e l o s s o f h i s e l e c t r i c t i l t , t h a n d r e q u i r e d m o r e t i m e i n b e d t o r e l i e r e l a t e d p a i n . • T h e a p p e l l a n t m a n a g e s h i s o w n t i l t p o i m p r o v e h i s c i r c u l a t i o n a n d c o m f o r t w h • T h e a p p e l l a n t ' s s e l f p o s i t i o n i n g m o r e c w o u l d d o w i t h o u t t h i n k i n g a b o u t i t . • T h e s t a f f a t t h e h o s p i t a l c o u l d n e v e r p h e d o e s i t h i m s e l f w i t h p o w e r t i l t . • H e h a s t h e a b i l i t y t o f o l l o w a p l a n o f c a t h e e q u i p m e n t a l l o w s . T h e a d v o c a t e e x p l a i n e d t h a t s h e h a d r e f e r r e d t o t h e h e r r e a s o n s f o r t h e a p p e a l f i l e d w i t h t h e N o t i c e o f A T h e p a n e l r e v i e w e d t h e d o c u m e n t s a n d a d m i t t e d t h r e g a r d i n g t h e a p p e l l a n t ' s h e a l t h c o n d i t i o n s , h i s r e s u t h o s e n e e d s , a n d b e i n g i n s u p p o r t o f i n f o r m a t i o n t h a p u r s u a n t t o 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 T h e p a n e l d i d n o t a d m i t t h e o p i n i o n s p r o v i d e d b y t h e m o r e e c o n o m i c a l t o r e p a i r o r r e p l a c e t h e a p p e l l a n t ' s 2 0 1 4 a n d i n t h e Q u o t e d a t e d S e p t e m b e r 8 , 2 0 1 4 , a s r e c o r d s t h a t w e r e b e f o r e t h e m i n i s t r y o n r e c o n s i d e r a 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 s s i s t a n c e A c I n t h e N o t i c e o f A p p e a l , t h e a d v o c a t e w r o t e t h a t • T h e s o c i a l w o r k e r s u b m i t t e d a n a p p l i c a t i o n f o " M e d i c a l S e r v i c e s O n l y " u n d e r L i f e T h r e a t e n i n H e a l t h . • T h e M i n i s t r y o f H e a l t h d o e s n o t f u n d r e s i d e n t M i n i s t r y o f H e a l t h H o m e a n d C o m m u n i t y P o l i c • T h e h o s p i t a l r e c e i v e s i t s o p e r a t i n g g r a n t f r o m H e a l t h , a n d t h i s d o e s n o t i n c l u d e f u n d i n g f o r p • T h e a p p e l l a n t d o e s n o t h a v e r e s o u r c e s t o p u r m o d i f i c a t i o n s . H i s m o n t h l y i n c o m e i s $ 1 , 4 9 4 r a t e f o r a c c o m m o d a t i o n i n r e s i d e n t i a l c a r e i s $ p e r s o n a l e x p e n d i t u r e s , s u c h a s t r a n s p o rt a t i o n m a i n t e n a n c e , e t c . • T h e a p p e l l a n t o p e r a t e s a p o w e r c h a i r , i s i n d e p f r i e n d s . H e h a s s t a t e d " b e i n g a b l e t o g e t o u t o w a n t t o g e t o u t o f b e d . " H e h a s a l s o s t a t e d t h t h e p o i n t o f l i v i n g ? " • T h e a p p e l l a n t h a s a l o n g h i s t o r y o f s c h i z o p h r e h i g h r i s k t o d e c o m p e n s a t e i f h e l o s e s h i s a b i l i t • T h e a p p e l l a n t d o e s n o t h a v e t h e r e s o u r c e s t o f o r m o b i l i t y o u t s i d e t h e f a c i l i t y / a c t i v i t i e s a n d i n w e i a h i n a 2 4 0 l b s . i n t h e c o m m u n i t v .e a p p e l l a n t h a s h a d m o r e f r e q u e n t b r e a k d o w n v e p r e s s u r e o n t h e a r e a s a f f e c t e d a n d t o m a n a g e s i t i o n i n g a n d i t g i v e s h i m t h e a b i l i t y t o e a s i l y e n h e n e e d s t o , w i t h o u t a s k i n g f o r a s s i s t a n c e . l o s e l y a p p r o x i m a t e s w h a t a n a b l e b o d i e d p e r s o n o s s i b l y r e p o s i t i o n t h e a p p e l l a n t t o t h e e x t e n t t h a t r e a n d w i l l m a n a g e h i s o w n p o s i t i o n i n g n e e d s i f p a g e f r o m t h e C o m m u n i t y C a r e P o l i c y M a n u a l i n p p e a l , b u t i t w a s i n a d v e r t e n t l y o m i t t e d a t t h e t i m e . e m , f o r t h e m o s t p a r t , a s p r o v i d i n g f u r t h e r d e t a i l l t i n g n e e d s a n d t h e r e s o u r c e s a v a i l a b l e t o m e e t t w a s b e f o r e t h e m i n i s t r y o n r e c o n s i d e r a t i o n , s s i s t a n c e A c t . m e d i c a l s u p p l y c o m p a n y a s t o w h e t h e r i t i s w h e e l c h a i r , f o u n d i n t h e N o t e d a t e d A u g u s t 2 6 , t h i s i s n o t i n s u p p o r t o f i n f o r m a t i o n o r t h e t i o n a n d , t h e r e f o r e , d i d n o t m e e t t h e t e s t i n t . r f u n d i n g o n N o v e m b e r 1 8 , 2 0 1 3 t o t h e m i n i s t r y g N e e d s R e q u e s t a n d n o t t o t h e M i n i s t r y o f ' s m e d i c a l e q u i p m e n t . R e f e r e n c e a c o p y o f t h e y S e c t i o n s C a n d F ( " c h a r g e a b l e i t e m s " ) . t h e H e a l t h A u t h o r i t y , f u n d e d b y t h e M i n i s t r y o f e r s o n a l m o b i l i t y e q u i p m e n t . c h a s e a p o w e r w h e e l c h a i r w i t h s p e c i f i c f r o m C P P a n d L T D [ l o n g t e r m d i s a b i l i t y ] a n d h i s 1 , 1 0 5 p e r m o n t h , w h i c h d o e s n o t i n c l u d e a n y , t e l e p h o n e , c a b l e , d e n t a l c a r e , w h e e l c h a i r e n d e n t i n t h e c o m m u n i t y , a n d m e e t s u p w i t h f t h e f a c i l i t y i s t h e o n l y t h i n g t h a t m a k e s m e a t i f h e d i d n o t h a v e h i s i n d e p e n d e n c e " w h a t i s n i a , d e p r e s s i o n a n d s u i c i d e a t t e m p t s a n d i s a t y t o b e m o b i l e . p u r c h a s e p r i v a t e p a y ' P a i d C o m p a n i o n ' s e r v i c e s d i v i d u a l s w o u l d n o t b e a b l e t o p u s h a r e s i d e n t
• T h e a p p e l l a n t ' s Q u a n t u m 6 0 0 w h e e l c h a i r i s c T h e t i l t a n d s e a t f r a m e a r e w o r n o u t a n d n e e w h i c h w a s p r e v i o u s l y q u o t e d a t $ 6 , 0 0 0 . T h e e x p e c t a n c y . • I n t h e m e d i c a l s u p p l i e r ' s e x p e r i e n c e , t h e Q 6 0 g e a r b o x e s a n d s u s p e n s i o n w h e n t h e c h a i r n e p r e v i o u s e s t i m a t e . • T h e a p p e l l a n t i s a l s o v e r y c l o s e t o t h e w e i g h r a t e o f w e a r . A t t h e h e a r i n g , t h e a d v o c a t e s t a t e d t h a t : • T h e a p p e l l a n t w a s a d m i t t e d t o t h e h o s p i t a l i n p r o b l e m s . • H e h a s m o v e m e n t w i t h h i s r i g h t h a n d b u t o n l m o t o r s k i l l s . W h e n t h e t i l t f u n c t i o n w a s o p e r a • H e c a n n o t c h a n g e p o s i t i o n a t a l l o n h i s o w n , m i n u t e s . • T h e h o s p i t a l i s f u n d e d b y t h e M i n i s t r y o f H e a r e s i d e n t s . T h e s t a f f m e m b e r c a n n o t b e r e p o T h e r e i s n o o n e i n t h e f a c i l i t y t o m o v e h i m a r o • T h e a p p e l l a n t l i k e s t o s t a y u p l a t e b u t h a s b e r e l i e v e t h e p r e s s u r e . T h e r e a r e l e s s s t a f f o n h i s c h a i r s o h e g o e s t o b e d b e f o r e s h i f t c h a n g • I f h e i s i m m o b i l i z e d , i t w i l l m a k e h i s m e n t a l h e f a m i l y a n d f r i e n d s . H e i s o u t o f t h e f a c i l i t y f o r • T h e a p p e l l a n t ' s m o n t h l y i n c o m e f r o m C P P i s t h e f a c i l i t y , a n d n o t $ 1 , 1 0 5 a s s t a t e d i n t h e N o • 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 s s i s t a n c e b e p a y a b l e f r o m t h e m i n i s t r y . • T h e t i l t f u n c t i o n o n t h e a p p e l l a n t ' s e x i s t i n g w h • A s k e d h o w s k i n b r e a k d o w n i s l i f e t h r e a t e n i n g b r e a k d o w n a n d t h e n a n u l c e r d e v e l o p s a n d i t c o u r s e o f a n t i b i o t i c s a n d , i f t h e a n t i b i o t i c s w e r s y s t e m i c . I f t h e u l c e r b e c o m e s d e e p , i n f e c t i o s e p t i c e m i a b e f o r e b e i n g d i s c o v e r e d . W i t h s e p a n d t h e s u r v i v a l r a t e f o r c a s e s o f s e p t i c e m i a i • T h e a p p e l l a n t c u r r e n t l y h a s s k i n b r e a k d o w n s • T h e i n c i d e n t d e s c r i b e d b y t h e c l i n i c a l r e s o u r c e 2 0 1 3 , w a s r e s o l v e d b u t i t c o u l d h a v e p o s s i b l y t h a t e p i s o d e , t h e a p p e l l a n t h a d p r e s s u r e u l c e r • A s k e d a b o u t t h e D V T t h r e a t , t h e a d v o c a t e s t a p o o l i n g o f b l o o d , e s p e c i a l l y w h e n t h e l e g s a r e m o v i n g t h e r i s k o f c l o t t i n g b e c o m e s r e a l . B l o o a s r e d n e s s a n d s o r e n e s s i n t h e l e g b u t , w i t h t n o t n o t i c e t h e s e s y m p t o m s . B l o o d c l o t s t h a t t • S h e c a n n o t s a y t h a t i n a m o n t h ' s t i m e t h e a p p n e w p o w e r w h e e l c h a i r i s a o r e v e n t a t i v e m e a s u r r e n t l y i n n e e d o f r e p a i r s , e s t i m a t e d a t $ 4 , 0 0 0 . d r e p l a c i n g a n d t h e t i l t s y s t e m i s n o n f u n c t i o n i n g , b a s e i s a l s o n e a r i n g t h e e n d o f i t s l i f e 0 b a s e n e e d s s u b s t a n t i a l r e p a i r s t o t h e m o t o r , a r s 5 y e a r s o f u s e , w h i c h i s n o t i n c l u d e d i n t h e t l i m i t o f t h i s m o d e l o f c h a i r , w h i c h i n c r e a s e s t h e M a r c h o f 2 0 1 1 a n d h e h a s m a n y m e d i c a l y w i t h g r o s s m o t o r s k i l l s ; h e d o e s n o t h a v e f i n e t i n g i n h i s c h a i r , h e c o u l d o p e r a t e i t b y h i m s e l f . a s a n a b l e b o d i e d p e r s o n d o e s e v e r y 5 t o 1 0 l t h a n d o n e s t a f f m e m b e r m u s t c a r e f o r 6 s i t i o n i n g t h e a p p e l l a n t a s o f t e n a s h e r e q u i r e s . u n d t h e f a c i l i t y . e n g o i n g t o b e d e a r l i e r t o h a v e m o r e t i m e t o a t n i g h t a n d t h e y w o u l d n o t h a v e t i m e t o a d j u s t e . a l t h i s s u e w o r s e . H e l i k e s t o g e t o u t a n d v i s i t h i s a p p r o x i m a t e l y 8 h o u r s p e r d a y . $ 1 , 4 9 4 a n d h e i s c u r r e n t l y p a y i n g $ 1 , 2 1 3 . 6 6 t o t i c e o f A p p e a l . c a u s e h i s p e n s i o n i n c o m e e x c e e d s t h e r a t e e e l c h a i r h a s n o t b e e n o p e r a t i n g f o r a b o u t a y e a r . , t h e a d v o c a t e r e s p o n d e d t h a t i t s t a rt s w i t h s k i n s t a r t s t o " g o d e e p . " I n f e c t i o n i s t r e a t e d w i t h a e n o t e f f e c t i v e , t h e i n f e c t i o n c o u l d b e c o m e n c o u l d e n t e r t h e b l o o d s t r e a m a n d l e a d t o t i c e m i a , t h e p a t i e n t w o u l d r e q u i r e i n t e n s i v e c a r e s " v e r y l o w . " o n h i s b u t t o c k s a n d h i s c o c c y x a r e a . n u r s e , w h i c h o c c u r r e d f r o m M a y 2 0 1 2 t o M a y r e s u l t e d i n t h e a p p e l l a n t l o s i n g h i s l e g . D u r i n g s o n b o t h s i d e s . t e d t h a t w h e n t h e r e I s a l a c k o f m o b i l i t y , t h e r e i s d o w n . E v e n w h e n a p e r s o n i s i n b e d a n d n o t d c l o t s w o u l d p r e s e n t i n a n a b l e b o d i e d p e r s o n h e a p p e l l a n t ' s p a r a p l e g i a , t h e a p p e l l a n t w o u l d r a v e l t o t h e h e a r t o r t h e b r a i n a r e o f t e n f a t a l . e l l a n t w i l l b e p a l l i a t i v e b u t t h e r e q u e s t fo r t h e u r e s o t h i s w i l l n o t h a o o e n .
• W ith a ll c i rcul a t i on pro bl em s and s kin prob lems • We a lso kno w h o w th e ap pella nt has rea cted thoug hts. He w as living i n a ssistive livin g at on • A sked a bout the se rvi c es that ar e included wit c a re , medications , fo od, laund ry, dr ess i ngs, recre p r ovided. Th e "charg eable item s", as se t out responsib le to p a y fo r . • Th e fac ilit y has e quip m ent for the residents to are no po wer wheel chairs . • Th e manual wheelc h airs h av e t ilt functi ons. The ma wo uld not have s p eciali z e d seati ng, an d would ap pellant can not re-positi on to the same e x tent Th e e quipm ent a t th e f acil i ty is o lder. • Th e t re at me nt s provi ded t o the a ppell ant, as detailed in t nu r s e , we re p r ovid e d by th e f acilit y, with the exception of the Since May 20 13, com pression stoc king s have bee • The r e has never b een a request m ade to the whe elchair. T h e only req u est was t h a t ma d e appeal. • When the min istry wa s con t acted ab out th e timing o was r equest ed by the mi nis try r egarding the cost of • The s umm ary o f th e ps ychiat rist's Pr ogress No accu ra tely captures t h e import ant f ea tures of the a t r e at men t. At t h e h earing, t h e OT from the f acility sta te d t hat: • She has wor ked closely w ith th e a p pe l lant f o r some time pe r fo rme d t o the a p pell ant 's exi s ti ng wheelc hair. to th e foot rest. A b o ut 5 months a g o, th e re wa c ur rent ly ope ra ting but it does n ot h ave th e tilt f • A ske d how the repairs to the m otor of the a ppella r esp onded t hat a bout a yea r a g o the me d ical su ope rating again. T he appellant has h a d use of the power wh • The medical supply company has said that the base expectancy. Th e type of the appel lant's existi not last past its life expectancy. • The seating on the appellant's current wheelchair is very tight and this is causi breakdown. • Currently, the appe llant's feet are down all the time. transfer his weight all the lime. • While the appellant's wheelchair was being repaire f u n cti o n provided by the facility for about 2 wee his p osition for him. There were not able to d o • The attendant pushed the appellant in the manual wheelchair around room most of the time. • His pressure ulcers caused more pain and there was a lowering of his mood, which can result in chanq es to his eatinq and sleepinq pattern s , t hey c a n es cal ate at any t im e. to d e pre ssion in the p a st . H e has ha d suicidal e t im e for his men tal hea lth i ssues. h the f acility, the a d voca t e stat e d that 2 4 -hour at i ona l activ ities , and mu s i c therapy are in t he Policy, are t he t hing s t hat the re sid ents ar e s har e, in cl ud ing manual whee lchairs, but there nual whe elchair s ar e n ot cu s tomi zed, not allow for o pera t in g from the righ t si de. Th e a s he could with the t ilt in a power whe elchair . h e R ep ort by the clinic al r esourc e Ci r ca id Com p re ssio n S y st em . n us e d t o man age the appellan t 's ed e ma. M i nistry o f Heal th for fu n d ing of the n ew power to the m inist r y, whic h is the subject of t his f a response to the reques t , in for mat i o n a ma n ua l whee lchair wit h a tilt fun ct i on. tes as s e t o ut i n the reconsi deration decisi o n p pella n t' s psychiat ric con dit i o n an d an d has see n man y repair s About 2 year s ago , th ere we re repairs ma d e s an iss ue with the m oto r. T h e wheelchair is unc tion. n t 's whe elcha i r w ere fu n d ed, t h e OT pply company put in "f ree" time t o get th e chair e elch air since then. of the chair is nearing the end of its life n g wheelchair is "not the highest end" and w i l l n g ski n With the lilt function, the appellant can d, he used a manual wheelchair with a tilt ks. A n attendant with the facility had to change 115 th of what the appellant can do for himself. his unit and he was in his .
• W h e n t h e a p p e l l a n t ' s m o b i l i t y i s l o s t , t h e i n c i d " d o w n w a r d s p i r a l " w a i t i n g t o h a p p e n . • W i t h t h e l o s s o f t h e t i l t f u n c t i o n , t h e a p p e l l a n t h i s s i d e t o r e l i e v e t h e p r e s s u r e a r e a s , e s p e c i f u n c t i o n t h a t t h e a p p e l l a n t c a n o p e r a t e w i t h h r e p o s i t i o n h i s b o d y a b o u t 4 t i m e s . • S i n c e t h e t i l t f u n c t i o n c e a s e d , t h e a p p e l l a n t ' s • T h e s t a f f m e m b e r s a r e u n a b l e t o a s s i s t t h e a t h e i r i n j u r y . T h e r e i s n o o n e e l s e t o h e l p h i m a n d t h e a p p e l l a n t h a s n o r e s o u r c e s t o p a y f o h a s f r i e n d s , t h e y w o u l d n o t b e a v a i l a b l e o n a t h e f a c i l i t y t h a t m a k e i t d i ff i c u l t t o p u s h a m a n n e e d s a w a y t o g e t t o h i s o r h e r a c t i v i t i e s . • A s k e d a b o u t h o w . " i m m i n e n t " t h e a p p e l l a n t ' s h a r e d i ff e r e n t g r a d a t i o n s . H e i s n o t c u r r e n t l y p p r o b l e m d e v e l o p i n g . • A s k e d a b o u t w h e t h e r n e w s e a t i n g c o u l d b e a O T r e p l i e d t h a t i t c o u l d b e a d d e d . • A s k e d h o w t h e O T k n o w s t h a t t h e p o w e r w h e O T r e s p o n d e d t h a t t h e y f i n d t h a t t h e r e i s n o t v a r i o u s l o c a l s u p p l i e r 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 s t a t e d : • H e r e a l l y l i k e s h i s w h e e l c h a i r . H e g o e s o u t t o l o o k s f o rw a r d t o g o i n g w h e r e h e w a n t s t o g o . • H e w o u l d b e d e v a s t a t e d a n d d e p r e s s e d i f h e w h e e l c h a i r w o u l d b e l i k e h i m l o s i n g h i s l e g s . • H e h a s h a d s o m e p r o b l e m s w i t h t h e g e a r s r e T h e m e d i c a l s u p p l y c o m p a n y t o l d h i m i t w a s • H e c a n n o t a f f o r d t o p a y f o r a n y r e p a i r s t o t h e • H e t h i n k s h e h a s h a d h i s c u r r e n t w h e e l c h a i r f a t a r e h a b i l i t a t i o n c e n t r e , p o s s i b l y t h r o u g h t h e i n i t i a t i v e ] p r o g r a m , s i n c e h e t h o u g h t h e w o u l d w h e e l c h a i r f r o m t h e s a m e m e d i c a l s u p p l y c o m • S i n c e h e c a n n o l o n g e r t i l t i n h i s c h a i r t o t a k e p a i n k i l l e r s . S o m e t i m e s h e w i l l p u s h h i m s e l f u p r e s s u r e o f f . • H e w a s t r a u m a t i z e d b y w i t n e s s i n g h i s b r o t h e r • S i n c e h e h a s b e e n a t t h e h o s p i t a l , h i s l i f e h a s w h e e l c h a i r . M o s t d a y s h e g o e s o u t f o r s e v e r a a n d t h e n g o e s b a c k o u t i n t o t h e s u r r o u n d i n g c • H e l o v e s h i s e l e c t r i c w h e e l c h a i r a n d h e w o u l d 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 .e n c e o f d e p r e s s i o n s t a r t s t o i n c r e a s e . I t i s l i k e a h a s h a d t o s p e n d m o r e t i m e i n b e d a n d l y i n g o n a l l y o n h i s b u t t o c k s . T h e h o s p i t a l b e d h a s a t i l t i s l e f t h a n d . D u r i n g t h e n i g h t , t h e f a c i l i t y s t a f f w i l l s k i n i n t e g r i t y i s g e t t i n g w o r s e . p p e l l a n t t o g e t a r o u n d t h e f a c i l i t y w i t h o u t r i s k o f b e c a u s e v o l u n t e e r s c a n n o t g o o f f t h e g r o u n d s r a c o m p a n i o n s e r v i c e . A l t h o u g h t h e a p p e l l a n t c o n s i s t e n t b a s i s a n d t h e r e a r e m a n y h i l l s a r o u n d u a l c h a i r . E v e n w i t h H a n d y D a r t , t h e p e r s o n s t i l l e a l t h i s s u e s a r e , t h e O T r e s p o n d e d t h a t t h e r e a l l i a t i v e b u t t h e r e i s a s t r o n g p o s s i b i l i t y o f a d d e d t o t h e a p p e l l a n t ' s e x i s t i n g w h e e l c h a i r , t h e e l c h a i r i s t h e " l e a s t e x p e n s i v e " a l t e r n a t i v e , t h e m u c h d i f f e r e n c e i n t h e q u o t e s p r o v i d e d b y t h e v i s i t w i t h h i s f r i e n d s i n h i s w h e e l c h a i r a n d h e d i d n o t h a v e h i s w h e e l c h a i r . T a k i n g a w a y h i s c e n t l y . T h e c h a i r w i l l j u m p f o rw a r d a n d t h e n s t o p . a w i r i n g i s s u e . w h e e l c h a i r . o r a b o u t 5 y e a r s . H e g o t t h e c h a i r w h e n h e w a s E A T I [ e q u i p m e n t a n d a s s i s t i v e t e c h n o l o g y b e g o i n g b a c k t o w o r k . H e g o t h i s e x i s t i n g p a n y w h o p r o v i d e d t h e q u o t e f o r a n e w c h a i r . t h e p r e s s u r e o f f , h e i s i n a l o t o f p a i n a n d i s o n p o u t o f t h e c h a i r j u s t t o t a k e s o m e o f t h e ' s d e a t h b y h i s o w n h a n d . b e e n s t a b l e . I t i s " w o n d e r f u l " t o h a v e h i s e l e c t r i c l h o u r s , c o m e s b a c k t o t h e f a c i l i t y f o r a w h i l e , o m m u n i t y . b e l o s t w i t h o u t i t . H e n e e d s i t r e a l l y b a d l y .
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e o n t h e a p p e a l i s w h e t h e r t h e m i n i s t r y ' s d e s u p p l e m e n t t o c o v e r t h e c o s t o f a n e w p o w e r w h e e l d i d n o t m e e t t h e r e q u i r e m e n t s o f S e c t i o n 6 9 o f t h e E S e c t i o n 3 o f S c h e d u l e C o f t h e E A P W D R , w a s r e a s 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 P u r s u a n t t o S e c t i o n 6 2 o f t h e E m p l o y m e n t a n d A s s i ( E A P W D R ) , i n o r d e r t o r e c e i v e g e n e r a l h e a l t h s u p p l o u t i n S c h e d u l e C , t h e a p p l i c a n t m u s t b e a r e c i p i e n t p e r s o n i n r e c e i p t o f d i s a b i l i t y a s s i s t a n c e i n a v a r i e t y S e c t i o n 6 9 s e t s o u t t h a t i f t h e f a m i l y u n i t i s n o t o t h e r E A P W D R , t h e r e q u e s t c a n b e c o n s i d e r e d u n d e r S e c r e q u i r e m e n t o f S e c t i o n 6 2 h a s n o t b e e n m e t i n t h a t t a s s i s t a n c e a n d h e i s n o t a d e p e n d e n t o f a p e r s o n i n A t i s s u e i s w h e t h e r 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 e w m e e t s t h e r e q u i r e m e n t s u n d e r S e c t i o n 6 9 o f t h e E A P 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 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 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 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 rw i s e n o t e l i g i b l e f o r t h 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 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 ( 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 ( 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 S e c t i o n 3 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 s o u t a d e q u i p m e n t a n d d e v i c e s , a s f o l l o w 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 3 ( 1 ) S u b j e c t t o s u b s e c t i o n s ( 2 ) t o ( 5 ) o f t h i s s e c t i o n , t h e m e d i c o f t h i s S c h e d u l e 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 ) t h e s u p p l e m e n t s a r e 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 r e g u l a t i o n , a n d ( b ) 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 f a m i l y u n i t h a s r e c e i v e d t h e p r e a u t h o r i z a t i o n o f t h ( 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 y u n i t t o ( i i i ) 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 i s t h e l e a s t e x p e n s c i s i o n , w h i c h d e n i e d t h e a p p e l l a n t ' s r e q u e s t f o r a c h a i r w i t h t i l t a n d c u s t o m s e a t i n g a s t h e r e q u e s t A P W D R a n d t h e a d d i t i o n a l r e q u i r e m e n t s o f 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 o r a r e a s o n a b l e s t a n c e s o f t h e a p p e l l a n t . 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 i l i t i e s R e g u l a t i o n e m e n t s o r 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 a s s e t o f d i s a b i l i t y a s s i s t a n c e , o r b e a d e p e n d e n t o f a o f s c e n a r i o s . w i s e 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 e t i o n 6 9 . I n t h i s c a s e , i t i s n o t d i s p u t e d t h a t t h e h e a p p e l l a n t i s n o t a r e c i p i e n t o f d i s a b i l i t y r e c e i p t o f d i s a b i l i t y a s s i s t a n c e . p o w e r w h e e l c h a i r w i t h t i l t a n d c u s t o m s e a t i n g W D R , w h i c h p r o v i d e s a s f o l l o w 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 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 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 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 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 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 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 : t i o n 3 ( 1 ) . d i t i o n a l c r i t e r i a t h a t m u s t b e m e t f o r m e d i c a l a l e q u i p m e n t a n d d e v i c e s d e s c r i b e d i n s e c t i o n s 3 . 1 t o 3 . 1 1 r o v i d e d b y t h e m i n i s t e r i f 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 e m i n i s t e r f o r 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 r e q u e s t e d ; p a y t h e c o s t o f o r o b t a 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 ; i v e a p p r o p r i a t 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 .
(2) For medical e quipmen t or d evic es r eferre d t o in sect io ns 3 and su bsecti o n (1) of t h is section, the family unit mu st p requ e sted b y the minister: (a) a p r esc r i ption of a medic al practi tioner or nurse practit (b) an asse ssment by an o ccupational ther apist or ph ysical equ i p ment or device. ... Sectio n 69(a) and (b) of the EAPWDR-Dir e c t and Imminent Life Threa Mini stry 's position The ministr y's position is that there is no evide n c e of n e w p ow e r whee lc hair w ith tilt and custom seating. "life-th re a te ning h e alth need" refers to a n imme d iate need for med verifi ed by a medical or nurse pract itioner, withou t the spec The minis try a rgued that the in iti al ap plication proc ess ha s managed wi th his e xisti n g po w e r w heelc hair for bre akdo wn or le g ul cers. The minist r y p o int e d out th 2013 and n o rec u rr e n c es o f s ki n break dow n o r ul c ers are rep hos pi tal in July 20 14. The mi n i s t r y p o in te d out that t period s where t he appell ant's le gs are in a d e p e n dent other pr ev entative m e asu res av ailab le, including intermi ch ai r where power fun c t ions all o w for e l e vation of hi The ministry argued t hat the fa cility's l a ck of staff i n g f actor in creating situations that mi gh t l ea d to a l if e -threa ar gued that t he Progre s s Note s from th e p sych i a t rist a nd active and that h e n eed s access to a p ower w hee an d to s tay p osit ively e nga ged but whee lc hairs and cus purpo s e s of basi c m o b ili t y an d not to a dd r e s s a m e nt outdoor a ctivities . N o resources available The ministry acknowledge d that the appellant does not personally have adequat to p urchase a new p o w er w heelchair w ith tilt and custom ministry argued, however, that the ministry is the payer of last resort and requires evidence that all other available resources have been explored first. The mi in a hospital facility funded by the Ministry of Health and the residents' needs for medical equipment must be met through the facili ty. The ministry pointed out that the social wor Ministry of Health for funding on November 18, 2013 and no reply was received by February 2014 and this resource is still a possibility. Appellant's position The appellant's position is that there is sufficient evid need for a new power wheelchair with tilt and custom seating. The advocate argued that the appellant requires the tilt function with custom seating because of his skin breakdown and the need to adjust his position every few minutes. The inability to adjust the position of his legs independently places the appellant in imminent risk of life threatening skin breakdown issues and ulcers. breakdowns and ul cers are eas ily in f ected and, because of the de .1 to 3 . 8, in addition to the r equ ire ments in t hose se ctions rovide t o the min i s t e r o ne or b oth of the followi ng, as ioner f o r the m edical equip ment or dev i ce ; therapist confirming th e me d ica l need for the medical ten ing Need a direct and imminent life -threat ening n e ed for a The ministr y argued th at the m i ni stry de finition of ical equipme nt in situations where, ific supplement the person's life is at risk. b egan on Fe bruary 17, 2014 and t he appe l lant several mont hs w ithout an acut e epi sode o f ski n at the last r e ported epi sode end e d in the fall of or ted i n the late s t in f orm a t ion from t h e he O T not es the impo rtance of a voiding long p o sition an d th e mi n i stry a rgu e d th a t ther e are t t e nt rests in his hos pit al bed o r reclining s legs to reliev e swelli n g an d potent ial for DVT. to re pos i tio n t he a ppellant i s not an ac ceptable te ni ng n eed by a pati e nt. The minist ry reco m mend t hat t he appellant s tay structured l chair t o maintain psy chos ocial re hab i litatio n t o m sea ti ng are pro vide d b y th e ministr y for a l healt h n e ed to s ocialize and engag e in e f inancial re sources seat ing a t a total cost of $27,108.21. The n istry argued t h at the appel lant is a patient ker applied to the e nce o f a direc t and i mminen t life-threatening The skin pth of the w oun d, c a n aui cklv l ea d
t o s e p t i c e m i a ; t h e s u r v i v a l r a t e f o r c a s e s o f s e p t i c e m t h e l o s s o f t h e t i l t f u n c t i o n o n t h e a p p e l l a n t ' s e x i s t i n g s k i n i n t e g r i t y i s g e t t i n g w o r s e . T h e a d v o c a t e a r g u e d w i t h c u s t o m s e a t i n g t o t a k e p r e s s u r e o f f h i s b u t t o c k p a r a p l e g i a . T h e l a c k o f t h e t i l t i s p l a c i n g t h e a p p e l l a i n a b i l i t y t o e l e v a t e l e g s r e s u l t s i n t h e c o l l e c t i o n o f b l c l o t s . T h e s e c l o t s w o u l d n o r m a l l y p r e s e n t a s r e d n e e x i s t i n g e d e m a i n t h e l e g a n d h i s p a r a p l e g i a , t h e a p c l o t s r e a c h i n g t h e h e a r t o r b r a i n a r e o f t e n f a t a l . T h e a d v o c a t e a r g u 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 t h e c u r r e n t l y s p e n d s a b o u t 8 h o u r s a d a y o u t s i d e o f t h e h a v i n g c o f f e e . T h e a p p e l l a n t h a s s t a t e d " B e i n g a b l e m a k e s m e w a n t t o g e t o u t o f b e d " a n d , i f h e d i d n ' t h G i v e n t h e a p p e l l a n t ' s b a c k g r o u n d , i t i s r e a s o n a b l e t o i n t e r a c t i o n o u t s i d e o f t h e c a r e f a c i l i t y w i l l c r e a t e a l i f T h e a d v o c a t e a r g u e d t h a t a n e w p o w e r w h e e l c h a i r w t h e a p p e l l a n t ' s l i f e t h r e a t e n i n g n e e d . W h i l e a s h a r e f a c i l i t y , i t i s i n a d e q u a t e f o r t h e a p p e l l a n t ' s n e e d s . A s p e c i f i c u s e r i f t h e y a r e g o i n g t o u s e i t e x t e n s i v e l y . t h e a p p e l l a n t ' s w h e e l c h a i r w a s i n o p e r a b l e . D u r i n g t n o t i c e a b l y . T h e a d v o c a t e a r g u e d t h a t a m a n u a l t i l t f a p p e l l a n t p r e v e n t u l c e r s f r o m d e v e l o p i n g i n t h e f u t u r a p p r o x i m a t e l y t h e s a m e f r e q u e n c y a s a n o n d i s a b l e f r e q u e n t l y a s i s r e q u i r e d . T r a n s f e r r i n g t h e a p p e l l a n t o v e r h e a d s l i n g . O n c e i n b e d , t h e a p p e l l a n t c a n c o n t r e q u i r e s a t w o p e r s o n a s s i s t a p p r o x i m a t e l y e v e r y t w h i g h e r r i s k t o t h e p a t i e n t . R e q u i r i n g a n o t h e r w i s e i n d j u s t t o u s e t h e a u t o m a t e d d e v i c e s t h e b e d p r o v i d e s r f a c i l i t y s t a f f a n d v o l u n t e e r s a r e n o t a l l o w e d t o t a k e , o o n s t a f f t o p e r f o r m t h e t i l t a n d r e p o s i t i o n i n g f u n c t i o n s w o u l d n o t m e e t t h e r e q u i r e m e n t t o m a i n t a i n t h e p s y c r e q u i r e d t o p r e v e n t h i s d e p r e s s i o n a n d s u i c i d a l i d e a t N o r e s o u r c e s a v a i l a b l e 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 r e a r e n o o t h e r r e s 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 . T h h a v e s u f f i c i e n t r e s o u r c e s t o p a y t h e c o s t o f t h e n e w w h i c h i s a t o t a l o f $ 2 7 , 1 0 8 . 2 1 . T h e a d v o c a t e a r g u e d d o e s n o t p r o v i d e m e d i c a l d e v i c e s . P e r t h e M i n i s t r y o 6 F , " p u r c h a s e o r r e n t a l o f e q u i p m e n t t h a t i s f o r t h e e w h e e l c h a i r , c r u t c h e s , c a n e s o r o t h e r d e v i s e s , a n d m " C h a r g e a b l e I t e m s M a y I n c l u d e " , i n d i c a t i n g t h a t t h e c a d v i s e d t h a t t h e r e i s n o s e p a r a t e r e q u e s t t o t h e M i n i s a p p e l l a n t m a d e t h e N o v e m b e r 2 0 1 3 r e q u e s t t o t h e m 9 , 2 0 1 4 i s t h e d e n i a l .i a i s " v e r y l o w . " T h e a d v o c a t e a r g u e d t h a t s i n c e p o w e r w h e e l c h a i r i n J u n e 2 0 1 3 , t h e a p p e l l a n t ' s t h a t t h e a p p e l l a n t a l s o r e q u i r e s t h e t i l t f u n c t i o n s a n d t o e l e v a t e h i s f e e t a n d l e g s d u e t o h i s n t i n a p o t e n t i a l l y l i f e t h r e a t e n i n g s i t u a t i o n . T h e o o d i n t h e l e g s a n d t h e d e v e l o p m e n t o f b l o o d s s a n d s o r e n e s s i n t h e l e g . H o w e v e r , d u e t o t h e p e l l a n t w o u l d n o t n o t i c e t h e s e s y m p t o m s . B l o o d p o w e r w h e e l c h a i r f o r m o b i l i t y s i n c e t h e a p p e l l a n t c a r e f a c i l i t y , v i s i t i n g w i t h f r i e n d s a n d f a m i l y o r j u s t t o g e t o u t o f t h e f a c i l i t y i s t h e o n l y t h i n g t h a t a v e h i s i n d e p e n d e n c e " w h a t i s t h e p o i n t o f l i v i n g ? " a s s u m e t h a t i s o l a t i n g t h e a p p e l l a n t f r o m s o c i a l e t h r e a t e n i n g r i s k o f s u i c i d e . i t h t i l t a n d c u s t o m s e a t i n g i s n e c e s s a r y t o m e e t d w h e e l c h a i r w i t h m a n u a l t i l t i s a v a i l a b l e i n t h e w h e e l c h a i r n e e d s t o b e c u s t o m i z e d t o t h e I n a d d i t i o n , t h e u n i t w a s u s e d f o r t w o w e e k s w h i l e h i s t i m e t h e a p p e l l a n t ' s m o o d d e t e r i o r a t e d u n c t i o n w i l l w o r s e n , r a t h e r t h a n h e l p , t h e e . T h e a p p e l l a n t n e e d s t o c h a n g e p o s i t i o n s a t d p e r s o n w o u l d ; s t a f f i s u n a b l e t o d o s o a s b e t w e e n h i s c h a i r a n d h i s b e d r e q u i r e s u s e o f a n r o l t h e t i l t m e c h a n i s m . H o w e v e r , r e p o s i t i o n i n g o h o u r s . T h e s t r a i n o n p e r s o n n e l w i l l r e s u l t i n a e p e n d e n t p e r s o n t o s p e n d l o n g p e r i o d s i n b e d e d u c e s t h e a p p e l l a n t ' s q u a l i t y o f l i f e . C a r e r a c c o m p a n y , a c l i e n t o f f s i t e . T h e r e f o r e , r e l y i n g w o u l d r e s t r i c t t h e a p p e l l a n t t o t h e f a c i l i t y a n d h o l o g i c a l r e h a b i l i t a t i o n a n d p o s i t i v e e n g a g e m e n t i o n s . o u r c 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 m e e t h i s e a d v o c a t e a r g u e d t h a t t h e a p p e l l a n t d o e s n o t p o w e r w h e e l c h a i r w i t h t i l t a n d c u s t o m s e a t i n g , t h a t t h e m i n i s t r y i s m i s t a k e n ; t h e c a r e f a c i l i t y f H e a l t h ' s H o m e a n d C o m m u n i t y P o l i c y , S e c t i o n x c l u s i v e u s e o f t h e c l i e n t , s u c h a s a w a l k e r , a i n t e n a n c e a s r e q u i r e d " f a l l s u n d e r t h e c a t e g o r y l i e n t i s r e s p o n s i b l e f o r t h e c o s t . T h e a d v o c a t e t r y o f H e a l t h . T h e a d v o c a t e c l a r i f i e d t h a t t h e i n i s t ry a n d t h e l e t t e r f r o m t h e m i n i s t r y d a t e d J u l y
P a n e l ' s d e c i s i o n S e c t i o n 6 9 s e t s o u t t h a t i f t h e f a m i l y u n i t i s n o t o t h e E A P W D R , t h e r e q u e s t f o r a h e a l t h s u p p l e m e n t c a n a p p e l l a n t h a s n o t d i s p u t e d t h a t h e h a s n o t m e t t h e r n o t a r e c i p i e n t o f d i s a b i l i t y a s s i s t a n c e a n d h e i s n o t a s s i s t a n c e a n d , t h e r e f o r e , i s n o t o t h e r w i s e e l i g i b l e f E A P W D R . S e c t i o n 6 9 o f t h e E A P W D R r e q u i r e s t h a 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 , t h w i t h w h i c h t o m e e t t h a t n e e d , a n d t h a t t h e r e q u e s t e d n e e d . D i r e c t a n d i m m i n e n t li f e t h r e a t e n i n g n e e 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 p r o p o s e d a r e a s o n l h r e a t e n i n g h e a l t h n e e d " a s a n i m m e d i a t e n e e d f o r m 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 , w i t h o u t t h e s p e c i f i c T h e 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 m u s t b e b o t h ' i m m i d e f i n i t i o n s o f d i r e c t i s " w i t h o u t i n t e r v e n i n g f a c t o r s " a n a n y m o m e n t " a n d " i m p e n d i n g . " T h e a d v o c a t e a r g u e c o n d i t i o n s i s s k i n b r e a k d o w n a n d u l c e r s w h i c h w i l l b c o n s t a n t r e p o s i t i o n i n g . W h e n a s k e d a t t h e h e a r i n g t h r e a t e n i n g , t h e a d v o c a t e r e s p o n d e d t h a t i i s t a r t s w i a n d i t s t a r t s t o " g o d e e p . " I f t h e u l c e r b e c o m e s d e e p t o s e p t i c e m i a b e f o r e b e i n g d i s c o v e r e d . T h e r e i s a p c o u r s e o f a n t i b i o t i c s a n d , i f t h e a n t i b i o t i c s w e r e n o t e p o s s i b l y l e a d t o s e p t i c e m i a . W i t h s e p t i c e m i a , t h e p a s u r v i v a l r a t e f o r c a s e s o f s e p t i c e m i a i s " v e r y l o w . " T h a s s k i n b r e a k d o w n s o n h i s b u t t o c k s a n d h i s c o c c y x W h i l e t h e a p p e l l a n t p h y s i c i a n a t t h e f a c i l i t y w r o t e i n N w h e e l c h a i r a n d s e a t i n g h e w i l l d e v e l o p s k i n b r e a k d o t h r e a t e n i n g " , a n d a g a i n o n F e b r u a r y 1 7 , 2 0 1 4 w r o t e p o t e n t i a l l y l i f e t h r e a t e n i n g s i t u a t i o n , " t h e m i n i s t r y r e a t h e t i m e o f 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 a n d t h e r e w a a p p e l l a n t ' s p h y s i c i a n t o i n d i c a t e a n a c u t e e p i s o d e o f e v i d e n c e p r o v i d e d f r o m 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 o v e r t h i s p e r i o d t h a t r e q u i r e d a c o u r s e o f a n t i b i o t i c s , s e p t i c e m i a . T h e c l i n i c a l r e s o u r c e n u r s e w r o t e , i n t h e a p p e l l a n t h a s b e e n w i t h o u t h i s e l e c t r i c t i l t m e c h a n i s m y e a r , a n d t h e r e w a s n o e v i d e n c e o f t h e a p p e l l a n t b e i b r e a k d o w n o r t h e b e g i n n i n g o f t h e c h a i n o f e v e n t s w t h i s p e r i o d . A ft e r r e v i e w i n g t h e p h y s i c i a n ' s l e t t e r s , t h o f t h e a p p e l l a n t ' s c o n d i t i o n s i n c e t h e i n i t i a l a p p l i c a t i o c o n c l u d e d t h a t t h e a p p e l l a n t d o e s n o t c u r r e n t l y f a c e b r e a k d o w n s i n c e t h e e v i d e n c e s h o w s t h a t , w h i l e p o s o c c u r a t a n y m o m e n t . " T h e a d v o c a t e a r g u e d t h a t o n e o f t h e a p p e l l a n t ' s s e r i o i n c l u d i n e d e m a a n d t h e r i s k o f D V T d u e t o a r a l e r w i s e 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 e b e c o n s i d e r e d u n d e r S e c t i o n 6 9 . I n t h i s c a s e , t h e e q u i r e m e n t o f S e c t i o n 6 2 i n t h a t t h e a p p e l l a n t i s a d e p e n d e n t o f a p e r s o n i n r e c e i p t o f d i s a b i l i t y o r t h e r e q u e s t e d h e a l t h s u p p l e m e n t u n d e r t h e t t h e m i n i s t r y m u s t b e s a t i s f i e d t h a t t h e p e r s o n a t 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 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 a b l e d e f i n i t i o n o f a d i r e c t a n d i m m i n e n t " l i f e  e d i c a l e q u i p m e n t i n s i t u a t i o n s w h e r e , v e r i f i e d b y e q u i p m e n t r e q u e s t e d t h e p e r s o n ' s l i f e i s a t r i s k . n e n t , ' a n d ' d i r e c t , ' a n d t h e o r d i n a r y d i c t i o n a r y d t h e d e f i n i t i o n o f i m m i n e n t i s " l i k e l y t o o c c u r a t d t h a t o n e o f t h e a p p e l l a n t ' s s e r i o u s m e d i c a l e c o m e l i f e t h r e a t e n i n g a n d f o r w h i c h h e r e q u i r e s t o d e s c r i b e h o w s k i n b r e a k d o w n i s l i f e  t h s k i n b r e a k d o w n a n d t h e n a n u l c e r d e v e l o p s , i n f e c t i o n c o u l d e n t e r t h e b l o o d s t r e a m a n d l e a d o s s i b i l i t y o f i n f e c t i o n , w h i c h w o u l d r e q u i r e a f f e c t i v e , t h e i n f e c t i o n c o u l d b e c o m e s y s t e m i c a n d t i e n t w o u l d r e q u i r e i n t e n s i v e c a r e a n d t h e h e a d v o c a t e s t a t e d t h a t t h e a p p e l l a n t c u r r e n t l y a r e a . o v e m b e r 2 1 , 2 0 1 3 t h a t " w i t h o u t t h e c o r r e c t w n a n d u l c e r s w h i c h w i l l b e c o m e l i f e  t h a t " t h e l a c k o f t i l l i s p l a c i n g t h e a p p e l l a n t i n a s o n a b l y p o i n t e d o u t t h a t 6 m o n t h s h a d p a s s e d a t s n o u p d a t e d i n f o r m a t i o n p r o v i d e d f r o m t h e s k i n b r e a k d o w n o r l e g u l c e r s . T h e r e w a s n o e r t h a t t h e a p p e l l a n t h a d d e v e l o p e d a n i n f e c t i o n o r t h a t t h e r e w a s a n y c u r r e n t r i s k o f i m p e n d i n g r e p o r t d a t e d S e p t e m b e r 1 5 , 2 0 1 4 , t h a t t h e o n h i s c h a i r s i n c e J u n e 2 0 1 3 , o r w e l l o v e r a n g i n a s t a t e o f m e d i c a l e m e r g e n c y d u e t o s k i n h i c h c o u l d l e a d t o s e p t i c e m i a a t a n y t i m e o v e r e a d v o c a t e s ' s t a t e m e n t s , a n d t h e m a n a g e m e n t 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 ry r e a s o n a b l y a n " 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 d u e t o s k i n s i b l e , a l i f e t h r e a t e n i n g n e e d i s n o t " l i k e l y t o u s m e d i c a l c o n d i t i o n s i s c i r c u l a t o r y p r o b l e m s , i a , f o r w h i c h h e r e u i r e s t h e a b i l i t t o e l e v a t e h i s
f e e t a n d l e g s a b o v e t h e l e v e l o f h i s h e a r t . A l t h o u g h 1 7 , 2 0 1 4 l e t t e r 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 t i l t m e l e v a t e h i s f e e t a n d l e g s d u e t o h i s p a r a p l e g i a , " t h e 1 7 , 2 0 1 4 a p h y s i o t h e r a p i s t p r o v i d e d a n A p p e a l o f E s h e w r o t e t h a t t h e a p p e l l a n t " h a s b i l a t e r a l d e p e n d e n w h e n h i s l e g s a r e d o w n h e i s q u i t e p r o n e t o e d e m a . a r e n o t n e a r l y e n o u g h t o m a n a g e t h e s w e l l i n g a n d s r i s k o f l i f e t h r e a t e n i n g D V T ' s . " T h e p h y s i o t h e r a p i s t c p e r i o d s o f h a v i n g h i s l o w e r l e g s i n a d e p e n d e n t p o s a n d r e g u l a r l y e l e v a t e h i s l o w e r l e g s a t o r a b o v e t h e D V T t h r e a t , t h e a d v o c a t e s t a t e d t h a t w h e n t h e r e i s a e s p e c i a l l y w h e n t h e l e g s a r e d o w n . T h e r i s k o f b l o o a b l e b o d i e d p e r s o n a s r e d n e s s a n d s o r e n e s s i n t h e a p p e l l a n t w o u l d n o t n o t i c e t h e s e s y m p t o m s . T h e a d h e a r t o r t h e b r a i n a r e o f t e n f a t a l . I n t h e r e p o r t d a t e d S e p t e m b e r 1 5 , 2 0 1 4 , t h e c l i n i c a l h i s t o r y o f s e v e r e l y m p h e d e m a t h a t i s c u r r e n t l y b e i n g c o m p r e s s i o n s t o c k i n g s . A t t h e h e a r i n g , t h e O T s t a t e s u f f i c i e n t o n t h e i r o w n a n d , w i t h t h e l o s s o f t h e t i l t f u i n b e d a n d l y i n g o n h i s s i d e t o r e l i e v e t h e p r e s s u r e a a p p e l l a n t c a n o p e r a t e w i t h h i s l e f t h a n d a n d , d u r i n g t i m e s . T h e p a n e l f i n d s t h a t t h e e v i d e n c e d e m o n s t r a c u r r e n t l y b e i n g m a n a g e d w i t h c o m p r e s s i o n s t o c k i n g t h e p o w e r f e a t u r e s o f h i s h o s p i t a l b e d c o m b i n e d w i t h e a r i n g a b o u t h o w " i m m i n e n t " t h e a p p e l l a n t ' s h e a l t h d i f f e r e n t g r a d a t i o n s a n d w h i l e h e i s n o t c u r r e n t l y p a l d e v e l o p i n g . T h e a p p e l l a n t h a s b e e n w i t h o u t h i s e l e c o r w e l l o v e r a y e a r , a n d t h e r e w a s n o e v i d e n c e o f t h D V T o r b e i n g i n a s t a t e o f m e d i c a l e m e r g e n c y d u e t o p e r i o 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 ry r e a s o n a b l y f a c e a n " 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 d u e t o c i r c u l i f e t h r e a t e n i n g n e e d d u e t o D V T i s a p o s s i b i l i t y i t h a m o m e n t " . T h e a d v o c a t e a r g u e d t h a t o n e o f t h e a p p e l l a n t ' s s e r i c o n d i t i o n f o r w h i c h h e i s b e i n g t r e a t e d b y a p s y c h i a t r a p p e l l a n t ' s p s y c h i a t r i s t w r o t e i n p a r t t h a t t h e a p p e l l a s c h i z o p h r e n i a a n d P T S D . T h e p s y c h i a t r i s t p r o v i d e d c o n d i t i o n i s w e l l m a n a g e d b u t t h e r e i s c o n c e r n o f d e s t a y s t r u c t u r e d a n d a c t i v e a n d n e e d s a c c e s s t o p o w e r e h a b i l i t a t i o n a n d t o s t a y p o s i t i v e l y e n g a g e d . W h i l e t s t a y s t r u c t u r e d a n d a c t i v e , h e d i d n o t s p e c i f y t h a t t h e f a c i l i t y f o r 8 h o u r s e a c h d a y , o r s o m e l e s s e r t i m e , o r s o c i a l a c t i v i t i e s w i t h i n t h e f a c i l i t y a n d a c h i e v e t h e s a m t o t h e a p p e l l a n t ' s w h e e l c h a i r , t h e O T r e s p o n d e d t h a t p u t i n f r e e t i m e t o g e t t h e c h a i r o p e r a t i n g a g a i n a n d t w h e e l c h a i r f o r m o b i l i t v s i n c e t h e n . I n h e r r e p o r t d a t 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 i n h i s F e b r u a r y e c h a n i s m t o t a k e p r e s s u r e o f f h i s b u t t o c k s a n d p h y s i c i a n d i d n o t r e f e r t o a r i s k o f D V T . O n J u l y q u i p m e n t F u n d i n g R e q u e s t D e n i a l l e t t e r i n w h i c h t l e g e d e m a w i t h l y m p h e d e m a w h i c h m e a n s t h a t C o m p r e s s i o n s t o c k i n g s h a v e b e e n h e l p f u l b u t k i n b r e a k d o w n i s s u e s . H e r e m a i n s a t v e r y h i g h o n c l u d e d t h a t " w h a t i s i m p o r t a n t i s a v o i d i n g l o n g i t i o n a n d h e n e e d s t h e a b i l i t y t o i n d e p e n d e n t l y l e v e l o f h i s h e a rt . " A s k e d a t t h e h e a r i n g a b o u t t h e l a c k o f m o b i l i t y , t h e r e i s p o o l i n g o f b l o o d , d c l o t s b e c o m e s r e a l a n d w o u l d p r e s e n t i n a n l e g b u t , w i t h t h e a p p e l l a n t ' s p a r a p l e g i a , t h e v o c a t e s t a t e d t h a t b l o o d c l o t s t h a t t r a v e l t o t h e r e s o u r c e n u r s e w r o t e t h a t t h e a p p e l l a n t h a s a m a n a g e d w i t h d a i l y c o m p r e s s i o n u s i n g d t h a t t h e c o m p r e s s i o n s t o c k i n g s a r e n o t n c t i o n , t h e a p p e l l a n t h a s h a d t o s p e n d m o r e t i m e r e a s ; t h e h o s p i t a l b e d h a s a t i l t f u n c t i o n t h a t t h e t h e n i g h t , t h e f a c i l i t y s t a f f r e p o s i t i o n h i m a b o u t 4 t e s t h a t t h e a p p e l l a n t ' s c i r c u l a t o r y p r o b l e m s a r e s a l o n g w i t h e l e v a t i o n o f h i s f e e t a n d l e g s u s i n g h r e p o s i t i o n i n g b y f a c i l i t y s t a f f . A s k e d a t t h e i s s u e s a r e , t h e O T r e s p o n d e d t h a t t h e r e a r e l i a t i v e , t h e r e i s a ' s t r o n g p o s s i b i l i t y ' o f a p r o b l e m t r i c t i l t m e c h a n i s m o n h i s c h a i r s i n c e J u n e 2 0 1 3 , e a p p e l l a n t h a v i n g e x p e r i e n c e d a b l o o d c l o t o r c i r c u l a t o r y p r o b l e m s a t a n y t i m e o v e r t h i s c o n c l u d e d t h a t t h e a p p e l l a n t d o e s n o t c u r r e n t l y l a t o r y p r o b l e m s , i n c l u d i n g e d e m a , a n d w h i l e a s n o t b e e n s h o w n t o b e " l i k e l y t o o c c u r a t a n y o u s m e d i c a l c o n d i t i o n s i s h i s p s y c h i a t r i c i s t . I n t h e h a n d w r i t t e n P r o g r e s s N o t e s , t h e n t ' s m e d i c a l h i s t o r y i n c l u d e s p a r a n o i d h i s o p i n i o n t h a t t h e a p p e l l a n t ' s p s y c h i a t r i c p r e s s i o n w i t h e p i s o d i c S I ; h e c l e a r l y n e e d s t o r w h e e l c h a i r t o m a i n t a i n p s y c h o s o c i a l h e p s y c h i a t r i s t s t a t e d t h a t t h e a p p e l l a n t n e e d s t o a p p e l l a n t n e e d s t o h a v e t h e a b i l i t y t o l e a v e t h e w h e t h e r h e m i g h t e n g a g e i n r e c r e a t i o n a l a n d e g o a l . A s k e d a t t h e h e a r i n g a b o u t t h e r e p a i r s a b o u t a y e a r a g o t h e m e d i c a l s u p p l y c o m p a n y h e a p p e l l a n t h a s h a d u s e o f t h e p o w e r d S e o t e m b e r 1 6 , 2 0 1 4 , t h e O T w r o t e t h a t t h e
a p p e l l a n t h a s d o n e w e l l a t t h e h o s p i t a l m e n t a l l y a n d h e h a s d e v e l o p e d a l i f e f o r h i m s e l f o u t s i d e t h e h o s p p e r d a y a n d m e e t s f r i e n d s a n d f a m i l y m e m b e r s . T h p o w e r w h e e l c h a i r p r o v i d i n g h i m w i t h m o b i l i t y a n d t h a p p e l l a n t d o e s n o t c u r r e n t l y f a c e e i t h e r a " d i r e c t " o r p s y c h i a t r i c c o n d i t i o n . N e w p o w e r w h e e l c h a i r w i t h t i l t a n d c u s t o m s e a t i n g 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 t h a t t h e r e q u e s t e d n e w p o w e r w h e e l c h a i r w i t h t i l t a n 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 . T h e p a n e l f i n d s o t h e r p r e v e n t a t i v e m e a s u r e s a r e a v a i l a b l e a n d , i n d e e v i d e n c e d e m o n s t r a t e s t h a t a l l o f t h e a p p e l l a n t ' s i d e s i n c e t h e t i l t f u n c t i o n o n h i s e x i s t i n g p o w e r w h e e l c h a h e d o e s n o t c u r r e n t l y f a c e a d i r e c t a n d i m m i n e n t l i f e T h e c l i n i c a l r e s o u r c e n u r s e w r o t e i n t h e r e p o r t d a t e d m u l t i p l e t i m e s a t t h e F o o t a n d L e g U l c e r C l i n i c b e t w e s t a t e d a t t h e h e a r i n g t h a t d u r i n g t h i s i n c i d e n t t h e a p p l e g s a n d , a l t h o u g h t h e y w e r e s u c c e s s f u l l y t r e a t e d a t r e s u l t e d i n t h e a p p e l l a n t l o s i n g h i s l e g . T h e p a n e l f i n p o w e r w h e e l c h a i r a n d t i l t m e c h a n i s m w e r e f u n c t i o n i n w h e n t h e a p p e l l a n t ' s c o n d i t i o n d e t e r i o r a t e d a n d t h e f u n c t i o n w e r e , t h e r e f o r e , i n e ff e c t i v e i n p r e v e n t i n g t h e o u t , t h e r e a r e o t h e r p r e v e n t a t i v e m e a s u r e s a v a i l a b l e p r e v e n t i n g a n e x a c e r b a t i o n o f m e d i c a l c o n d i t i o n s , i n u s e o f a n t i b i o t i c s t o f i g h t i n f e c t i o n , a n d i n t e r m i t t e n t r e f u n c t i o n s a l l o w f o r e l e v a t i o n o f h i s l e g s t o r e l i e v e s w e E q u i p m e n t F u n d i n g R e q u e s t D e n i a l l e t t e r d a t e d J u l y a r g u e t h a t h e l i v e s i n a c a r e f a c i l i t y w i t h 2 4 h o u r c a r e s c a r c e l y a v a i l a b l e t o m a n u a l l y c h a n g e h i s p o s i t i o n . " d e t e r m i n e d t h a t i t i s u n t e n a b l e f o r t h e 2 4 h o u r c a r e f s u f f i c i e n t s t a f f i n g w h i c h c o u l d c a u s e t h e a p p e l l a n t t o N o r e s o u r c e s a v a i l a b l e T h e m a j o r i t y v i e w o f t h e p a n e l i s t h a t t h e m i n i s t r y w a i n s u f f i c i e n t e v i d e n c e t o s h o w t h a t t h a t t h e r e a r e n o r e m e e t t h a t n e e d . T h e m i n i s t r y d e c i s i o n g i v e s t w o r e a s f u n d i n g h a d b e e n m a d e t o t h e M i n i s t r y o f H e a l t h a n d p r o v i d e a s o u r c e o f f u n d s ; a n d , t h a t t h e f a c i l i t y i n w h i p r o v i d i n g a n y n e e d e d m o b i l i t y d e v i c e . T h e r e h a d n e H e a l t h . A s s h o w n b y t h e e v i d e n c e p r o v i d e d , t h e o n l y a p p e a l i s b a s e d , t h e d e n i a l o f w h i c h w a s t h e r e a s o n f A c c o r d i n g t o t h e H o m e a n d C o m m u n i t y C a r e P o l i c y M p e r s o n a l m o b i l i t y d e v i c e s a r e t h e r e s p o n s i b i l i t y o f t h e o n e p a g e o f t h e 4 p a g e p o l i c y w a s p r o v i d e d s o t h e p a H o w e v e r , t h e a d v o c a t e ( a n d c a r e f a c i l i t y d i r e c t o r ) a s s i t e m s t h a t t h e c a r e f a c i l i t y w i l l n o t o r o v i d e a n d w h i c h a e m o t i o n a l l y ; h i s m e n t a l h e a l t h h a s s t a b i l i z e d a n d i t a l . H e g o e s o u t d a i l y f o r a m i n i m u m o f 8 h o u r s 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 h a s u s e o f a e m i n i s t r y r e a s o n a b l y c o n c l u d e d t h a t t h e a n " 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 d u e t o h i s e c e s s a ry t o m e e t t h a t n e e d c o n c l u d i n g t h e r e i s i n s u f f i c i e n t e v i d e n c e t o s h o w d c u s t o m s e a t i n g i s n e c e s s a r y t o m e e t a d i r e c t 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 d , h a v e b e e n t a k e n . T h e p a n e l f i n d s t h a t t h e n t i f i e d m e d i c a l c o n d i t i o n s h a v e b e e n m a n a g e d i r s t o p p e d f u n c t i o n i n g o v e r a y e a r a g o a n d t h a t t h r e a t e n i n g n e e d , a s d e t a i l e d a b o v e . S e p t e m b e r 1 5 , 2 0 1 4 t h a t t h e a p p e l l a n t w a s s e e n e n J u n e 2 0 1 2 a n d J u n e 2 0 1 3 a n d t h e a d v o c a t e e l l a n t h a d p r e s s u r e u l c e r s o n b o t h s i d e s o f h i s t h e t i m e , h i s c o n d i t i o n c o u l d h a v e p o s s i b l y d s t h a t t h e t i l t f u n c t i o n o n t h e a p p e l l a n t ' s e x i s t i n g g d u r i n g t h i s p e r i o d o f J u n e 2 0 1 2 t o J u n e 2 0 1 3 f e a t u r e s o f a p o w e r w h e e l c h a i r w i t h t h e t i l t d e v e l o p m e n t o f u l c e r s . A s t h e m i n i s t r y p o i n t e d w h i c h h a v e b e e n e f f e c t i v e i n t r e a t i n g a n d c l u d i n g t h e u s e o f c o m p r e s s i o n s t o c k i n g s , t h e s t s i n t h e a p p e l l a n t ' s h o s p i t a l b e d w h e r e p o w e r l l i n g a n d p o t e n t i a l f o r D V T . I n t h e A p p e a l o f 1 7 , 2 0 1 4 , t h e p h y s i o t h e r a p i s t w r o t e : " O n e m i g h t , b u t i t i s c o m m o n k n o w l e d g e t h a t s t a f f a r e ( s i c ) 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 a c i l i t y t o a r g u e t h a t i t i s t h e f a c i l i t y ' s l a c k o f f a c e a l i f e t h r e a t e n i n g s i t u a t i o n . s n o t r e a s o n a b l e i n c o n c l u d i n g t h a t t h e r e i s s o u r c 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 w i t h w h i c h t o o n s f o r t h e i r c o n c l u s i o n : t h a t a n a p p l i c a t i o n f o r , b e c a u s e i t h a d n o t b e e n d e n i e d , c o u l d s t i l l c h t h e a p p e l l a n t l i v e s w a s r e s p o n s i b l e f o r v e r b e e n a n a p p l i c a t i o n m a d e t o t h e M i n i s t r y o f a p p l i c a t i o n m a d e w a s t h e o n e u p o n w h i c h t h i s o r 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 u n d e r a p p e a l . a n u a l , c h a p t e r 6 , s e c t i o n F , " c h a r g e a b l e i t e m s " , i n d i v i d u a l , n o t t h e f a c i l i t y . U n f o r t u n a t e l y , o n l y n e l c o u l d n o t r e v i e w t h e c o n t e n t i n c o n t e x t . u r e d t h e p a n e l t h a t t h i s s e c t i o n d e f i n e s t h e r e t h e r e s p o n s i b i l i t y o f t h e i n d i v i d u a l . G i v e n
t h a t t h e m i n i s t r y ' s c o n c l u s i o n w a s b a s e d o n t w o e r r a c k n o w l e d g e m e n t t h a t t h e a p p e l l a n t d i d n o t h a v e t h t h a t t h e m i n i s t r y w a s n o t r e a s o n a b l e i n d e t e r m i n i n g d e t e r m i n a t i o n w a s n o t s u p p o r t e d b y t h e e v i d e n c e . D i s s e n t i n g v i e w T h e d i s s e n t i n g v i e w i 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 c t h a t 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 a p p e l l a n t h r e a t e n i n g n e e d . T h e m i n i s t r y a c k n o w l e d g e d t h a t 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 a n e w p o w e r w h e e l $ 2 7 , 1 0 8 . 2 1 . T h e d i s s e n t i n g v i e w f i n d s t h a t t h e m i n i s t h e S e c t i o n t o i n c l u d e a s u p p l y o f m o n e y a s w e l l a s a v a i l a b l e t o m e e t a n e e d , a n d t h a t t h e r e m u s t b e s u o t h e r a v a i l a b l e r e s o u r c e s h a v e b e e n e x p l o r e d . W h i m a d e t o t h e M i n i s t r y o f H e a l t h f o r f u n d i n g o n N o v e m b e c a u s e i t h a d n o t y e t b e e n d e n i e d , t h e a d v o c a t e c l r e q u e s t m a d e t o t h e M i n i s t r y o f H e a l t h f o r f u n d i n g . r e a s o n a b l y c o n c l u d e d t h a t t h e a p p e l l a n t i s n o t a m i n a h o s p i t a l f a c i l i t y a n d r e l i a n t o n t h e M i n i s t r y o f H e a l t A t t h e h e a r i n g , t h e a d v o c a t e p o i n t e d t o o n e p a g e o f M a n u a l , c h a p t e r 6 , s e c t i o n F , w h i c h s e t s o u t a l i s t o f o f e q u i p m e n t t h a t i s f o r t h e e x c l u s i v e u s e o f t h e c l i e n o r o t h e r d e v i c e s , a n d m a i n t e n a n c e a s r e q u i r e d " a n d r e s p o n s i b i l i t y o f t h e r e s i d e n t s . T h e a d v o c a t e s t a t e d s h a r e , i n c l u d i n g m a n u a l w h e e l c h a i r s w i t h t i l t f u n c t i o n c u s t o m i z e d , w o u l d n o t h a v e s p e c i a l i z e d s e a t i n g , a n d t i l t f u n c t i o n b y t h e a p p e l l a n t . T h e a d v o c a t e s t a t e d t h e x t e n t a s h e c o u l d w i t h t h e t i l t f u n c t i o n i n a p o w e r w h I n t h e A p p e a l o f E q u i p m e n t F u n d i n g R e q u e s t D e n i a l w r o t e t h a t i t i s u n s o u n d t o c o n s i d e r a m a n u a l c h a i r t o w o u l d d o b e t t e r t o s t a y i n h i s b e d a n d u s e t h e p o w e r s o u n d s . " A t t h e h e a r i n g , t h e O T s t a t e d t h a t , w i t h t h e a p p e l l a n t h a s h a d t o s p e n d m o r e t i m e i n h i s h o s p i t a l a r e a s , t h a t t h e h o s p i t a l b e d h a s a t i l t f u n c t i o n t h a t t h e d u r i n g t h e n i g h t , t h e f a c i l i t y s t a f f r e p o s i t i o n h i m a b o u v i e w i s t h a t t h e e v i d e n c e d e m o n s t r a t e s t h a t t h e a p p e m a n a g e d w i t h c o m p r e s s i o n s t o c k i n g s a n d e l e v a t i o n h i s h o s p i t a l b e d c o m b i n e d w i t h r e p o s i t i o n i n g b y f a c i l i T h e m i n i s t r y p o i n t e d 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 f a c i l i t y f o r m o r e i n f o r m a t i o n a b o u t t h e a p p e l l a n t ' s c u r n e c e s s a r y r e p a i r s , t h e i n f o r m a t i o n w a s n o t f o r t h c o m i d i s s e n t i n g v i e w f i n d s t h a t t h e r e i s n o e v i d e n c e o f t h e r e s o u r c e o f f u n d i n g f o r r e p a i r s t o b e m a d e t o t h e p o w I n t h e Q u o t e d a t e d S e p t e m b e r 8 , 2 0 1 4 f r o m t h e m e d i n c l u d e s a t i l t c o m l e t e w i t h c e n t r e m o u n t w i t h f l i u o n e o u s a s s u m p t i o n s , a n d t h e m i n i s t r y ' s e r e s o u r c e s r e q u i r e d h i m s e l f , t h e m a j o r i t y f i n d s t h a t t h e c r i t e r i a w a s n o t s a t i s f i e d a n d t h a t t h e o n c l u d e d t h e r e i s i n s u f f i c i e n t e v i d e n c e t o s h o w t w i t h w h i c h t o m e e t a d i r e c t a n d i m m i n e n t l i f e  t h e a p p e l l a n t d o e s n o t p e r s o n a l l y h a v e a d e q u a t e c h a i r w i t h t i l t a n d c u s t o m s e a t i n g a t a t o t a l c o s t o f t r y r e a s o n a b l y i n t e r p r e t e d " r e s o u r c e s a v a i l a b l e " i n a c c e s s t o o t h e r e q u i p m e n t o r s e r v i c e s t h a t a r e ff i c i e n t e v i d e n c e p r o v i d e d b y t h e a p p e l l a n t t h a t a l l l e t h e m i n i s t r y s t a t e d t h a t a n a p p l i c a t i o n w a s b e r 1 8 , 2 0 1 3 a n d t h i s r e s o u r c e i s s t i l l a p o s s i b i l i t y a r i f i e d a t t h e h e a r i n g t h a t t h e r e h a s n e v e r b e e n a T h e d i s s e n t i n g v i e w f i n d s t h a t t h e m i n i s t r y i s t r y c l i e n t b u t i s , r a t h e r , a r e s i d e n t a n d p a t i e n t i n h t o m e e t h i s n e e d s f o r b a s i c m e d i c a l e q u i p m e n t . a 4 p a g e H o m e a n d C o m m u n i t y C a r e P o l i c y " c h a r g e a b l e i t e m s , " i n c l u d i n g " p u r c h a s e o r r e n t a l t , s u c h a s a w a l k e r , w h e e l c h a i r , c r u t c h e s , c a n e s e x p l a i n e d t h a t t h e s e i t e m s a r e t h e f i n a n c i a l t h a t t h e f a c i l i t y h a s e q u i p m e n t f o r t h e r e s i d e n t s t o s , b u t t h e m a n u a l w h e e l c h a i r s a r e n o t w o u l d n o t a l l o w f o r i n d e p e n d e n t o p e r a t i n g o f t h e a t t h e a p p e l l a n t c a n n o t r e p o s i t i o n t o t h e s a m e e e l c h a i r . l e t t e r d a t e d J u l y 1 7 , 2 0 1 4 , t h e p h y s i o t h e r a p i s t m e e t t h e a p p e l l a n t ' s p o s i t i o n i n g n e e d s a n d " h e f u n c t i o n s a v a i l a b l e t h e r e , a s l u d i c r o u s a s t h a t l o s s o f t h e t i l t f u n c t i o n o v e r t h e p a s t y e a r , t h e b e d a n d l y i n g o n h i s s i d e t o r e l i e v e t h e p r e s s u r e a p p e l l a n t c a n o p e r a t e w i t h h i s l e ft h a n d a n d , t 4 t i m e s . A s p r e v i o u s l y d e t a i l e d , t h e d i s s e n t i n g l l a n t ' s c i r c u l a t o r y p r o b l e m s a r e c u r r e n t l y b e i n g o f h i s f e e t a n d l e g s u s i n g t h e p o w e r f e a t u r e s o f t y s t a f f . i o n t h a t a l t h o u g h a r e q u e s t w a s m a d e t o t h e r e n t w h e e l c h a i r , i n c l u d i n g a q u o t e o f t h e n g f r o m t h e a p p e l l a n t o r h i s a d v o c a t e s . T h e a p p e l l a n t o r h i s a d v o c a t e h a v i n g e x p l o r e d t h e e r w h e e l c h a i r a n d , s p e c i f i c a l l y , t h e t i l t f u n c t i o n . i c a l s u p p l y c o m p a n y , t h e l i s t o f p a r t s r e q u i r e d f o o t a t a c o s t o f $ 3 , 6 5 8 . 2 0 . A t t h e h e a r i n o . t h e
a p p e l l a n t s t a t e d t h a t h e c a n n o t a f f o r d t o p a y f o r a n y c l a r i f i e d a t t h e h e a r i n g t h a t t h e a p p e l l a n t ' s m o n t h l y p a y i n g $ 1 , 2 1 3 . 6 6 t o t h e f a c i l i t y , w h i c h o n l y l e a v e s a e x p e n d i t u r e s . A s k e d h o w t h e r e p a i r s t o t h e m o t o r o f u n d e d , t h e O T r e s p o n d e d t h a t a b o u t a y e a r a g o t h e t h e c h a i r o p e r a t i n g a g a i n . T h e r e i s n o e v i d e n c e o f a h i s a d v o c a t e s t o t h e m e d i c a l s u p p l y c o m p a n y t o d o n m e c h a n i s m o n t h e a p p e l l a n t ' s w h e e l c h a i r o p e r a t i n g T h e d i s s e n t i n g v i e w n o t e s t h a t s u b s e c t i o n s 3 ( 4 ) a n m i n i s t r y t o p r o v i d e a s u p p l e m e n t t o c o v e r t h e c o s t o p r e v i o u s l y p r o v i d e d b y t h e m i n i s t r y o r n o t , a s l o n g a T h e r e i s a l s o n o e v i d e n c e o f a r e q u e s t h a v i n g b e e n m i n i s t r y o r a n y o t h e r c o m m u n i t y r e s o u r c e t o a c c e s s f u n c t i o n o r t h e a p p e l l a n t ' s p o w e r w h e e l c h a i r . I n f a c o n l y r e q u e s t m a d e o n b e h a l f o f t h e a p p e l l a n t w a s t h w h e e l c h a i r w i t h t i l t a n d c u s t o m s e a t i n g , w h i c h i s t h e 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 c o n c l u d e d t h e r e i s i n s u ff r e s o u r c 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 w i t h w h i c h t o m S e c t i o n 3 ( 1 ) ( b ) ( i i ) o f S c h e d u l e C o f t h e E A P W D R M i n i s t r y ' s p o s i t i o n 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 p o w e r w h e e l c h a i r w i t h t i l t a n d c u s t o m s e a t i n g d o e s o f S c h e d u l e C o f t h e E A P W D R . T h e m i n i s t ry s t a t e d n o t b e e n m e t a s t h e r e i s i n s u f f i c i e n t i n f o r m a t i o n t o s t o p a y t h e c o s t o r o b t a i n t h e m e d i c a l e q u i p m e n t o r d t h a t s e t o u t u n d e r a r e v i e w o f t h e c r i t e r i a i n S e c t i o n 6 A p p e l l a n t ' s p o s i t i o n 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 r e q u i r e m e n t s i n S s u f f i c i e n t i n f o r m a t i o n t o s h o w t h a t t h e r e a r e n o r e s o u 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 . T h e a p p e l l a n t ' s a r r e v i e w o f t h e c r i t e r i a i n S e c t i o n 6 9 ( a ) o f t h e E A P W D P a n e l ' s d e c i s i o n 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 s t a t e s t h i n s e c t i o n s 3 . 1 t o 3 . 1 2 o f t h e S c h e d u l e a r e t h e h e a l t h r e q u i r e m e n t s a r e m e t , i n c l u d i n g s u f f i c i e n t e v i d e n c e t 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 t o o b t a i n t h e m T h e m a j o r i t y v i e w o f t h e p a n e l i s t h a t t h e m i n i s t r y w a i n s u f f i c i e n t e v i d e n c e t o s h o w t h a t t h a t t h e r e a r e n o r e m e e t t h a t n e e d , a s s e t o u t u n d e r a r e v i e w o f t h e c r i t e D i s s e n t i n g v i e w T h e d i s s e n t i n g v i e w i s 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 p r o v i d e d b v t h e a n n e l l a n t t o s h o w t h a t t h e r e a r e n o r r e p a i r s t o h i s w h e e l c h a i r a n d t h e a d v o c a t e i n c o m e f r o m C P P i s $ 1 , 4 9 4 a n d h e i s c u r r e n t l y p p r o x i m a t e l y $ 2 8 0 p e r m o n t h t o c o v e r p e r s o n a l f t h e a p p e l l a n t ' s w h e e l c h a i r w e r e p r e v i o u s l y m e d i c a l s u p p l y c o m p a n y p u t i n " f r e e " t i m e t o g e t r e q u e s t h a v i n g b e e n m a d e b y t h e a p p e l l a n t o r a t e s o m e a d d i t i o n a l f r e e t i m e t o g e t t h e t i l t . d ( 5 ) o f S c h e d u l e C o f t h e E A P W D R a l l o w s t h e f r e p a i r s o f m e d i c a l e q u i p m e n t , w h e t h e r i t w a s s t h e r e q u i r e m e n t s i n t h o s e s u b s e c t i o n s a r e m e t . m a d e b y t h e a p p e l l a n t o r h i s a d v o c a t e s t o t h e f u n d i n g f o r t h e n e c e s s a r y r e p a i r s t o t h e t i l t t , t h e a d v o c a t e c o n f i r m e d a t t h e h e a r i n g t h a t t h e a t m a d e t o t h e m i n i s t r y f o r a n e w p o w e r s u b j e c t o f t h i s a p p e a l . T h e d i s s e n t i n g v i e w i s i c i e n t e v i d e n c e t o s h o w t h a t t h e r e a r e n o e e t h i s n e e d . N o r e s o u r c e s a v a i l a b l e t f o r a s u p p l e m e n t t o c o v e r t h e c o s t o f a n e w n o t m e e t a l l o f t h e a p p l i c a b l e c r i t e r i a o f S e c t i o n 3 t h a t t h e r e q u i r e m e n t s i n S e c t i o n 3 ( 1 ) ( b ) ( i i ) h a v e h o w t h a t t h e r e a r e n o r e s o u r c e s t o t h e f a m i l y u n i t e v i c e . T h e m i n i s t r y ' s a r g u m e n t i s t h e s a m e a s 9 ( a ) o f t h e E A P W D R , a s s e t o u t a b o v e . e c t i o n 3 ( 1 ) ( b ) ( i i ) h a v e b e e n m e t a s t h e r e i s r c e s 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 r o b t a i n g u m e n t i s t h e s a m e a s t h a t s e t o u t u n d e r a R , a s s e t o u t a b o v e . a t 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 d e s c r i b e d s u p p l e m e n t s t h a t m a y b e p r o v i d e d i f a l l o f t h e o e s t a b l i s h t h a t 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 e d i c a l e q u i p m e n t o r d e v i c e [ S e c t i o n 3 ( 1 ) ( b ) ( i i ) ] . s u n r e a s o n a b l e i n c o n c l u d i n g t h a t t h e r e i s s o u r c 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 w i t h w h i c h t o r i a i n S e c t i o n 6 9 ( a ) o f t h e E A P W D R , a b o v e . c o n c l u d i n g t h a t t h e r e i s i n s u f f i c i e n t e v i d e n c e e s o u r c e s 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 r
obtain the medical equipment or device. The dissenting view notes the distinction in wording between Section 69(a) of the EAPWDR and Section 3(1 )(b)(ii) of Schedule C of the EAPWDR regarding resources available to meet a need in contrast to the resources available to pay the cost of or obtain the medical equipment specifically requested by the appellant. The ministry acknowledged, and it is not disputed, that the appellant does not personally have adequate financial resources to purchase a new power wheelchair with tilt and custom seating at a total cost of $27,108.21. In the Quote dated September 8, 2014, the medical supply company reported that the appellant's chair was "supplied January 10, 2011," and the information from the clinical resource nurse at the facility is that the tilt mechanism stopped functioning in June 2013, or a little over 2 years later. There was no information provided by the appellant or his advocates to show that there is no applicable warranty from the medical supply company or the manufacturer to cover the cost of repairs to the tilt mechanism. There was also no information provided by the appellant or his advocates to show that he had explored other resources in the community as alternate ways to obtain a new power wheelchair with tilt and custom seating or possibly a used power wheelchair with a functioning tilt mechanism. At the hearing, the appellant stated that he got his existing power wheelchair when he was at a rehabilitation centre, possibly through the EATI program. There was no information provided by the appellant or his advocates to show that he had explored funding for a replacement power wheelchair through this or any other community program. Section 3(1)(b)(iii) of Schedule C of/he EAPWDR-Least Expensive appropriate medical equipment or device Ministry's position The ministry's position is that the appellant's request for a supplement to cover the cost of a new power wheelchair with tilt and custom seating does not meet all of the applicable criteria of Section 3 of Schedule C of the EAPWDR. The ministry argued that the requirements in Section 3(1 )(b) of Schedule C have not been met as the a new power wheelchair with tilt and custom seating is not shown to be the least expensive appropriate medical equipment or device. The ministry points out in the decision that the appellant's current power wheelchair that is "a few years old" was assessed to require $6,000 in repairs to the tilt function and the vendor made adequate repairs to make the chair useable. The ministry requested more information about the appellant's current wheelchair, including a quote of the necessary repairs, and the information was not forthcoming. The ministry argued that it is possible that repairs to the existing power wheelchair and possibly a new cushion would suffice and be the least expensive appropriate medical equipment or device. Appellant's position The appellant's position is that the requirements of the section have been met by the information provided by the OT and the physiotherapist and the requested new power wheelchair with tilt and custom seating is the least expensive appropriate medical equipment or device. The advocate argued that the power wheelchair with tilt and custom seating is the only appropriate medical equipment since it is the only option that meets all of the appellant's needs. The advocate pointed out that the appellant is unable to effectively utilize a manual wheelchair for mobility because the appellant lacks motor control at both arms so is not able to functionally wheel a manual wheelchair even indoors. The advocate argued that staffing levels in residential care do not support the provision of assistance to residents in manual chairs to transport them to community activities/events, appointments, etc. which are necessary to promote independence and maintain good mental health. In the Summary of mobility issues dated September 16, 2014, the OT wrote that no other individuals are available for assisting with oushina/mobilitv since volunteers are not permitted to take residents
o u t s i d e f a c i l i t y g r o u n d s , t h e a p p e l l a n t i s f i n a n c i a l l y u f r i e n d s a r e n o t c o n s i s t e n t l y a v a i l a b l e t o a s s i s t / p u s h c o n s i s t e n t l y p u s h t h e a p p e l l a n t m o r e t h a n a r o u n d h e s p e c i a l l y c o n s i d e r i n g t h e h i l l s s u r r o u n d i n g t h e h o s H a n d y D a rt c o u l d t a k e t h e a p p e l l a n t t o a d e s i g n a t e d r e q u i r e a p e r s o n t o p u s h a n d t i l t a m a n u a l w h e e l c h a S e a t i n g A s s e s s m e n t R e p o r t d a t e d F e b r u a r y 2 4 , 2 0 1 n o t m e e t t h e a p p e l l a n t ' s s e a t i n g n e e d s a n d s h e c l a r S e p t e m b e r 1 6 , 2 0 1 4 t h a t t h e a p p e l l a n t ' s c u r r e n t c h a w i d t h , t h e c h a i r n e e d s s i g n i f i c a n t r e p a i r s , a n d t h e c h i t s e x p e c t e d l i f e s p a n . P a n e l d e c i s i o n T h e r e q u i r e m e n t i n S e c t i o n 3 ( 1 ) ( b ) o f S c h e d u l e C o f w h e e l c h a i r w i t h t i l l a n d c u s t o m s e a t i n g i s t h e l e a s t e d e v i c e a n d t h e p a n e l f i n d s t h a t a n a s s e s s m e n t o f a l l a p p e l l a n t ' s m e d i c a l c o n d i t i o n a n d t h e a s s o c i a t e d c o p a n e l f i n d s t h a t , a s p a r t o f t h i s a n a l y s i s , t h e O T c o n s t i l l a n d c u s t o m s e a t i n g i n r e l a t i o n t o s o m e t y p e s o f e r e l a t i v e c o s t s o f t h e o t h e r o p t i o n s . F o r e x a m p l e , t h e w i t h " c o m p a n i o n s e r v i c e s " t o p u s h t h e a p p e l l a n t i n t h m e c h a n i s m w a s d i s m i s s e d b y t h e O T b e c a u s e t h e a c o m p a n i o n s e r v i c e s , " b u t n o i n f o r m a t i o n o f t h e c o s t a d v o c a t e w r o t e i n t h e N o t i c e o f A p p e a l t h a t p a i d c o m r e s i d e n t w e i g h i n g 2 4 0 l b s . , t h e r e i s n o i n f o r m a t i o n p p a t i e n t s d o n o t e x i s t , o r t h e c o s t o f t h i s s e r v i c e i n c o a t t h e h e a r i n g a b o u t w h e t h e r n e w s e a t i n g c o u l d b e a O T a g r e e d t h a t i t c o u l d b e a d d e d , b u t t h e c o s t o f a d i n c l u d i n g a d d e d o r i m p r o v e d c u s h i o n i n g , w a s a l s o n W h i l e t h e c o s t o f r e p a i r s t o t h e a p p e l l a n t ' s w h e e l c h a s u p p l y c o m p a n y , t h e O T d i s m i s s e d t h i s o p t i o n s i n c e r e p a i r s a n d t h e c h a i r i s n o t a h i g h e r e n d m o d e l t h a t w h e a r i n g , t h e O T s t a t e d t h a t t h e m e d i c a l s u p p l y c o m p t h e e n d o f i t s l i f e e x p e c t a n c y ; h o w e v e r , i n t h e N o t e d s p e c i a l i s t w i t h t h e m e d i c a l s u p p l y c o m p a n y w r o t e t h a w h e e l c h a i r n e e d s s u b s t a n t i a l r e p a i r s t o t h e m o t o r s , g 5 y e a r s o f u s e . I n t h e Q u o t e d a t e d S e p t e m b e r 8 , 2 0 1 t h e a p p e l l a n t ' s c h a i r w a s " s u p p l i e d J a n u a r y 1 0 , 2 0 1 1 o l d . W i t h t h e M e d i c a l E q u i p m e n t R e q u e s t a n d J u s t i f i c a t i o F e b r u a r y 2 0 , 2 0 1 4 w e r e p r o v i d e d f r o m t h e m e d i c a l s t h e a m o u n t o f $ 2 4 , 3 6 8 . 2 1 a n d t h e c u s t o m s e a t i n g i n $ 2 7 , 1 0 8 . 2 1 . A s k e d a t t h e h e a r i n g h o w t h e O T k n o w s " l e a s t e x p e n s i v e " a l t e r n a t i v e , t h e O T r e s p o n d e d t h a t q u o t e s p r o v i d e d b y t h e v a r i o u s l o c a l s u p p l i e r s . H o w e p o w e r w h e e l c h a i r w i t h t i l t a n d c u s t o m s e a t i n a o r o r o v n a b l e t o p u r c h a s e c o m p a n i o n s e r v i c e s , a n d h i m . E v e n i f a v a i l a b l e , t h e s e p e o p l e c o u l d n o t i s u n i t d u e t o t h e w e i g h t o f t h e c h a i r / r e s i d e n t , p i t a l . T h e O T a l s o w r o t e t h a t a s e r v i c e s u c h a s l o c a t i o n , b u t i t r e m a i n s t h a t t h e a p p e l l a n t w o u l d i r o n c e h e h a s a r r i v e d a t h i s d e s t i n a t i o n . I n t h e 4 , t h e O T w r o t e t h a t t h e c u r r e n t w h e e l c h a i r d i d i f i e d i n t h e S u m m a r y o f m o b i l i t y i s s u e s d a t e d i r i s t o o s m a l l f o r h i m a n d n o t a d j u s t a b l e f o r a i r i s n o t a h i g h e r e n d m o d e l t h a t w o u l d o u t l i v e t h e E A P W D R i s t h a t t h e r e q u e s t e d n e w p o w e r x p e n s i v e a p p r o p r i a t e m e d i c a l e q u i p m e n t o r t h e t y p e s o f e q u i p m e n t a p p r o p r i a t e t o t h e s t i s r e l e v a n t a n d n e c e s s a r y t o t h i s a n a l y s i s . T h e i d e r e d t h e n e e d f o r a n e w p o w e r w h e e l c h a i r w i t h q u i p m e n t a v a i l a b l e , b u t d i d n o t c o n s i d e r t h e o p t i o n o f t h e m a n u a l w h e e l c h a i r w i t h t i l t a l o n g e m a n u a l c h a i r a n d t o a s s i s t w i t h u s e o f t h e t i l t p p e l l a n t " i s f i n a n c i a l l y u n a b l e t o p u r c h a s e o f t h i s c o m b i n a t i o n i s d i s c u s s e d . W h i l e t h e p a n i o n s e r v i c e s w o u l d n o t b e a b l e t o p u s h a r o v i d e d t o s h o w t h a t s e r v i c e s t o a s s i s t h e a v i e r m b i n a t i o n w i t h H a n d y D a r t t r a n s p o rt a t i o n . A s k e d d d e d t o t h e a p p e l l a n t ' s e x i s t i n g w h e e l c h a i r , t h e a p t a t i o n s t o t h e a p p e l l a n t ' s e x i s t i n g w h e e l c h a i r , o t d i s c u s s e d i n t h e O T ' s r e p o rt s . i r w a s i t e m i z e d i n t h e Q u o t e f r o m t h e m e d i c a l s h e s t a t e d t h a t t h e c h a i r n e e d s s i g n i f i c a n t o u l d o u t l i v e i t s e x p e c t e d l i f e s p a n . A t t h e a n y h a s s a i d t h a t t h e b a s e o f t h e c h a i r i s n e a r i n g a t e d A u g u s t 2 6 , 2 0 1 4 , a r e h a b e q u i p m e n t t i n t h e i r e x p e r i e n c e , t h e b a s e o f a Q u a n t u m 6 0 0 e a r b o x e s a n d s u s p e n s i o n w h e n t h e c h a i r n e a r s 4 , t h e m e d i c a l s u p p l y c o m p a n y c o n f i r m e d t h a t " w h i c h w o u l d m a k e i t a p p r o x i m a t e l y 3 ½ y e a r s n d a t e d M a r c h 3 , 2 0 1 4 , t w o Q u o t e s d a t e d u p p l y c o m p a n y f o r t h e n e w p o w e r w h e e l c h a i r i n t h e a m o u n t o f $ 2 , 7 4 0 . 0 0 , f o r a t o t a l c o s t o f t h a t t h e r e c o m m e n d e d p o w e r w h e e l c h a i r i s t h e t h e y f i n d t h a t t h e r e i s n o t m u c h d i f f e r e n c e i n t h e v e r , t h e O T d i d n o t e x p l o r e t h e o p t i o n o f a u s e d i d e e s t i m a t e d c o s t i n g f o r t h i s a l t e r n a t i v e . T h e
I APPEAL# 2014-00565 . panel finds that the OT has not provided information in her assessment about the cost of the other possible appropriate equipment options, namely: a used power wheelchair with tilt and custom seating, adaptations to the seating and repairs of the existing power wheelchair and tilt mechanism, or the manual wheelchair together with specialized companion services and HandyDart and intermittent use of the elevation features in the appellant's hospital bed. Therefore, the panel finds that the ministry's conclusion that the new power wheelchair with tilt and custom seating is not shown to be the least expensive appropriate medical equipment or device, pursuant to Section3 (1)(b) of Schedule C of the EAPWDR, was reasonable. Conclusion Section 69 of the EAPWDR stipulates that all of the requirements of the section, as well as the applicable sections of Section 3 of Schedule C, must be met in order f o r the person to be eligible f o r a requested health supplement. While there are differing views of the panel on whether the ministry was reasonable in concluding that the requirements of Section 69(a) of the EAPWDR and Section 3(1)(b)(ii) of Schedule C of the EAPWDR were not met, the panel was unanimous in finding that the ministry was reasonable in determining that the requirements of Section 69 (b) of the EAPWDR and Section 3(1)(b)(iii) of Schedule C of the EAPWDR were not met. Therefore, the panel finds that the ministry's reconsideration decision, which denied the appellant's request for a new power wheelchair with tilt and custom seating as all of the legislative requirements were not met, was a reasonable application of the applicable enactment in the appellant's circumstances and confirms the decision. Page 22 of 23
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