Ministry of Social Development and Poverty Reduction

Appeal Number 2024-0295 Part C – Decision Under Appeal The Appellant appealed the Reconsideration Decision of the Ministry of Social Development and Poverty Reduction (the “Ministry”) dated June 20, 2024, denying a health supplement for transportation to Edmonton from May 20 to May 27, 2024 for the Appellant’s child (the “child”) to attend appointments with a pediatrician, physical therapist, dietitian, and occupational therapist.

Part D – Relevant Legislation This decision cites: Employment and Assistance for Persons with Disabilities Act: Section 5 Employment and Assistance for Persons with Disabilities Regulation (the “Regulation”): Sections 61.01, 60.1, 62, and 69 Schedule C: Section 1 -Definition of “specialist”, and section 2(1)(f) Hospital Insurance Act Section 1 – Definition of “hospital” Hospital Insurance Act Regulations Section 1 – Definitions of “general hospital” and “rehabilitation hospital” Hospital Act Section 1 – Definition of “hospital” Interpretation Act Section 29 – Definition of “medical practitioner” and “nurse practitioner”.” Text of the above legislation is attached at the end of the decision.

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Part E – Summary of Facts

Appeal Number 2024-0295

Hearing Proceeding The hearing was by telephone. Background and Relevant Information The following is a summary of the key dates and information for this Appeal as stated in the Reconsideration Decision or hearing testimony:

The Appellant formerly lived in Alberta. The Appellant is a sole recipient of disability assistance in BC with four dependent children. 2019: Child began care at BC Children’s Hospital. 2022-September: Moved to Alberta with approved Ministry funding and extension of MSP coverage before lapse. The Appellant’s stated purpose was to relocate for a time for “coordinated medical care [of the child that the Appellant] had not been able to find …. in BC”.

2022-October: Child’s care “transferred to Alberta”. 2023-December: Appellant returned to BC (after over a year away) after being notified by the Ministry that return to BC was required to maintain status and benefits. No move back funding was provided by the Ministry.

2024-January: Approved for Non-Local Medical Transportation Assistance to go to Edmonton in February.

2024-Early in year: Denied Non-Local Medical Transportation Assistance to go to Edmonton in March or April.

2024-May-06: The Appellant submitted a Request for Non-Local Medical Transportation Assistance to go to Edmonton in May 2024 . It indicated, among other things, the following:

• The Appellant sought a medical transportation supplement for medical appointments on May 22 through 24. The appointments were with: o An Edmonton pediatrician (the “AB Pediatrician”). o 2024-May-23 with ”Edmonton Rehabilitation”. o 2024-May-24 with “Rehabilitation Glenrose”. • The Specialist / Hospital / Speciality Clinics the Appellant will be attending are Glenrose / Stollery / Garneau Pediatrics. • The Appellant’s “Referring Medical/Nurse Practitioner” was the AB Pediatrician. • No medical escort was required.

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Appeal Number 2024-0295 • The Appellant will be departing for th e appointments from the Appellant’s BC location on May 20, 2024, and returning on May 27, 2024. • The Appellant was not able to contribute to the cost of the medical transportation, but had considered the option of asking family, friends and volunteer agencies for assistance. • The Appellant required overnight accommodation for the travel but had not yet booked accommodation arrangements. • The Appellant required arrangements for wheelchair accessibility. • The Appellant would be travelling by personal vehicle.

2024-May-14: The Appellant submitted the following documents: • An Assessment from a BC Physician (the “BC Physician”). It indicated the following: o The BC Physician is a family physician who assessed the Appellant’s child with the Appellant present. o The child:

… has a complex medical history, including brain injury secondary to near-SIDS, Cerebral Palsy, cortical vision impairment, hip dysplasia (awaiting surgery), G-Tube, and global developmental delay (non-verbal).

The services that [the child] needs to maintain a stable medical condition are not available to [the child’s] family in British Columbia and as a result she needs to travel to Edmonton regularly to receive care from [the child’s] regular medical team. This care is delivered at the Garneau Medical Clinic, the Stollery Children's Hospital, and the Glenrose Rehabilitation Centre in Edmonton. These teams of medical professionals are very familiar with [the child’s] complex medical needs and have been providing ongoing care for the last 2 years.

• A screenshot of an email reminder of a May 24, 2024 (1pm) appointment for the child’s Wheelchair Seating Assessment and measurement at an Edmonton clinic. • A screenshot of an email confirming an appointment with the AB Pediatrician. • A screenshot from the Alberta Health Services MyHealth Records application showing appointments as follows: o 2024-May-23 (10am): Multidisciplinary appointment at Glenrose Rehabilitation Hospital o 2024-May-23 (1pm): Multidisciplinary appointment at Stollery Children’s Hospital Pediatric Home Nutrition Support Program. o 2024-May-24 (1pm): Community Visit appointment at Glenrose Rehabilitation Hospital Seating Service.

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Appeal Number 2024-0295 o 2024-May-29: Virtual Initial appoin tment with Glenrose Rehabilitation Hospital I CAN Centre for Assistive Technology. o 2024-June-21 (2:30pm): Assessment at Glenrose Rehabilitation Hospital I CAN Centre for Assistive Technology.

• A Service Inquiry at Little Buddies Pediatric Therapy advising that there is currently an approximate wait of 5-6 months for their British Columbia clinic, depending on the Appellant’s availability.

2024-May-16: The Appellant submitted two Consultation Summaries from a ‘telehealth’ provider as follows:

• 2024-April-27: A Consultation Summary from the BC Physician with a “To Whom It May Concern” memorandum containing the same details as shown on the assessment previously submitted on May 14, 2024 (the “BC Physicians’ Memo”). • 2024-May-06: A Consultation Summary from a BC Nurse Practitioner. The notes state that this was a first appointment with the child, and there was no access to the child’s medical treatment plan or specialists’ chart. The record states:

client requests "Needing a medical note for the government to cover my daughters travel expenses to access her medical team in Alberta" notes specific requirements for letter that daughter cannot access care in BC and requires BC MSP coverage of services in Alberta.

.… [The Appellant] reports … comprehensive care team in Alberta unmatched by BC.

…reports conflict with senior medical director of BC Children’s Hospital; disagreement surrounding not following careplan and suggestions of Alberta care team.

… [the Appellant] found Toronto doctor [for second opinion from] …BC Children’s Hospital team [who] did not want to work with this doctor or change treatment plan.

- [The Appellant] does not feel BC Children’s medical services was taking proper care of client. ….

Plan: - Request currently outside my scope as I am limited in my access to health documents. …

2024-May-17:

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Appeal Number 2024-0295 • The Appellant submitted a printout of car rental information from the Appellant’s region. • The Ministry recorded calling the office of the BC Physician to discuss the Appellant’s request and was told that the child only had one appointment. • The Ministry determined that the Appellant was ineligible for the requested health supplement for transportation to Edmonton.

2024-May-23, 2024: The Appellant submitted a Request for Reconsideration and requested an extension to allow more time to gather supporting information.

2024-June-20: The Reconsideration Decision of the Ministry that decided that the Appellant was ineligible for the Local Medical Transportation Assistance for transportation to Edmonton on May 20 with return on May 27, 2024.

2024-August-07: The Appellant filed an appeal with this Tribunal. No “Reasons for Appeal” were stated.

Appellant Submissions At the hearing the Appellant reviewed the child’s health and described that it was “compromised through BC Children’s Hospital or neglectful pediatric care and failed follow-up, being misdiagnosed and over sedated to the point of having a cardiac arrest. After seeking a second opinion in Toronto the recommendations were not supported at the BC Children’s Hospital “and they did not want to be held accountable.”

The child has received appropriate care in Alberta “and her health has done a 360.” The child just had a major surgery there and the Appellant was calling in from Edmonton.

The Appellant described the following: • Talking to senior people in government who describe the Appellant as setting precedent and providing encouragement. • Receiving Ministry funding to move to Alberta with an extension granted for health coverage beyond the normal cut-off. • Being in Alberta for just over a year and then receiving a notice that assistance would be cut-off unless moved back to BC by December 31 st . • Moving back to BC “just before Christmas” with nothing but a few clothes because no assistance was given. • Not having a doctor in BC. • Losing the Appellant’s vehicle. • Received Non-Local Medical Transportation Assistance to return to Edmonton for care in February.

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Appeal Number 2024-0295 • Applying for Non-Local Medical Transpo rtation Assistance for a trip in March or April but that was denied, and this one for May was also denied. Both are being appealed. • Having received legal advice supporting being subjected to wrongdoing. • That the denial is a “total breach of human rights, and it has to stop.”

The Appellant responded to questions and further described the following: • The child received care at BC Children’s Hospital and from a community pediatrician from about 3 weeks of age in 2019 though to October 2022 when care was transferred to Alberta. • The Appellant has a pending court case and “lawyer for that” related to the BC Children's Hospital. • It has been “very challenging” to find a pediatrician. “Nobody wants to take [the child] on as a patient” because: o “there’s the legalities”; o “all the doctors talk”; o “their patient load is so high”; and o “working with children like [the child] leads to burned out”. • There is about a 6-12 months or more waitlist, including for physiotherapist, occupational therapists, speech therapy.

• BC doesn’t have a specialized complex care facility to support children like the child. • The child is “thriving now” but the Appellant doesn’t know what to do to fill the “void” because the appropriate care “is simply not existent” in BC.

Ministry Submissions The Ministry reviewed the reasons as expressed in the Reconsideration Decision as showing that required criteria were not met.

The first set of criteria involves visits to nearby BC medical professionals. Neither of the 2 options was met because the transportation was not for a visit to:

1) An office in the local area of a “medical practitioner” or “nurse practitioner”. That is because those are terms defined in the Interpretation Act as referring to people registered with their profession’s BC health regulators. Alberta doctors and nurses do not satisfy that definition. 2) The office of the nearest available specialist in field of medicine or surgery. “Specialist” is a defined term in the Regulation as a medical practitioner, meaning a registrant of the College of Physicians and Surgeons that is recognized by that College as a specialist. The Alberta doctors and nurses do not satisfy that definition.

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Appeal Number 2024-0295 The second set of criteria required that the tra vel be to the nearest suitable hospital or rehabilitation hospital. The Ministry found that there was not enough evidence provided to explain what specific services are needed but cannot be provided in BC. So the Ministry found that it couldn't confirm that travel to Alberta was the nearest suitable option.

The last issue was that the Ministry lacked information to be satisfied that the application was for the “least expensive appropriate mode of transportation”. The Appellant did not explain the extra 2 nights of accommodation for a 12-hour journey where one night would be expected.

Separate from those decisions the file does show that in January a Medical Transportation Supplement was approved for travel to Alberta. No details or criteria are shown, but it was a special approval suggesting it would be denied unless a special exception was approved under other authority.

Admissibility of New Evidence Under section 22(4) of the Employment and Assistance Act, the Panel may admit evidence that is reasonably required for a full and fair disclosure of all matters related to the decision under appeal.

During the course of the hearing, the Appellant submitted a “To Whom It May Concern” memorandum dated August 21, 2024 signed on behalf of the AB Pediatrician. The Panel admitted this into evidence.

The Panel also admitted oral testimony as evidence from the Appellant and the Ministry. Any of that evidence relevant to the decision is cited in the decision below.

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Appeal Number 2024-0295 Part F – Reasons for Panel Decision Purpose and Standard of Review The purpose of the Panel is not to redo the Reconsideration Decision under appeal or decide whether it agrees with the Ministry’s decision. It is to decide whether the Ministry did, or did not, reasonably come to the decision it made considering two factors. These are whether the applicable laws were reasonably applied and whether the evidence was also reasonably applied in the circumstances. The standard includes whether any evidence, that might alter the outcome, was overlooked, unreasonably given improper weight, or mischaracterized. The decision itself must be internally coherent, and be justified, intelligible and transparent as required for the circumstances. However, the Panel has the unique power to admit and consider any new or updated evidence as if the Ministry knew it at the time. That means this decision assesses the reasonableness of the Reconsideration Decision based on what is known now.

Discussion of Issues In the Reconsideration Decision, the Ministry found that transportation to appointments with the Alberta pediatrician, physical therapist, dietitian, and occupational therapist did not meet the requirements set out in the Regulation, Schedule C section 2(1)(f) because the travel was:

• Not “to a local office of a medical or nurse practitioner”; • Not “to the office of the nearest available specialist”, as that term is defined; and • Not “to the nearest suitable hospital or rehabilitation hospital”.

While the Ministry recognized the BC Physician stated that the child needed medical services not available in BC, the Ministry was not satisfied that this was the case. This is because the BC Physician had only had one appointment with the child and did not “explain what services specifically are needed that cannot be provided in British Columbia.“ Also, the AB Pediatrician appointment was not in a hospital or rehabilitation hospital.

Lastly, the Ministry stated that the information provided showed 2 additional nights of accommodation during the travel period and that it was “unable to establish that the costs for which [the Appellant was] requesting a health supplement … to attend [the child’s] appointments in Edmonton represent the least expensive appropriate mode of transportation for [the Appellant’s] travel.”

The Reconsideration Decision and the appeal only focus on the criteria that the Ministry says was not meta under the Regulation, Schedule C section 2(1)(f). The Panel addresses only compliance with those criteria and not entitlement generally, or the authorization or

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Appeal Number 2024-0295 special exemption that may have been granted for other travel in other circumstances. The Panel also does not explore other options that might apply and that might include the power of the Ministry to make exceptions where applications would be denied otherwise.

This discussion will focus, on the reasons given by the Ministry for the denial in the Reconsideration Decision, as set out above.

Local Area Office of a Medical or Nurse Practitioner (BC) One of the available listed criteria for a Medical Transportation Supplement is under the Regulation, Schedule C section 2(1)(f)(i). This is for transportation to or from:

(i) an office, in the local area, of a medical practitioner or nurse practitioner … One key element here is that “medical practitioner” and “nurse practitioner” are defined terms and mean only certain individuals. Section 29 of the Interpretation Act applies to provide the definitions. These are as expressed by the Ministry in its Reconsideration Decision, and the medical practitioner or nurse practitioner involved must be registrants of their respective health profession regulators in BC as set out in the Interpretation Act. These are the College of Physicians and Surgeons of British Columbia and the British Columbia College of Nurses and Midwives (or their successors).

There is no evidence that the AB Pediatrician or any of the others to be seen in Alberta were registrants of an applicable health profession regulator in BC.

Although not expressly stated in the Reconsideration Decision, the offices in Edmonton are also not local to the Appellant’s location, so that criteria is also not met.

With respect to the foregoing, whereby the medical or nurse practitioner are not registrants in a respective health profession regulator in BC and that the medical office is not located in BC either; the Panel finds that the Ministry reasonably applied the applicable laws to the evidence in the circumstance.

Office of the Nearest Available Specialist A second of the list of criteria for Medical Transportation Supplement is under the Regulation, Schedule C section 2(1)(f)(ii). This is for transportation to or from:

(ii) the office of the nearest available specialist in a field of medicine or surgery if the person has been referred to a specialist in that field by a local medical practitioner or nurse practitioner …

Similar to the issue above, a key element here is that “specialist” is a defined term and means only certain individuals. This term is defined in the section 1 of Schedule C of the Regulation meaning “a medical practitioner recognized as a specialist …”. The first part of that is the defined term “medical practitioner”. As discussed above, there is no evidence

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Appeal Number 2024-0295 that the AB Pediatrician to be seen in Alberta is a registrant of the College of Physicians and Surgeons of British Columbia. It then also follows that there is no evidence that the AB Pediatrician is recognized by that College as one of its registrants with a specialty.

Also as above, although not expressly stated in the Reconsideration Decision, the offices in Edmonton are not local to the Appellant’s BC location, so that criteria is also not met.

With respect to the foregoing, where neither the referring medical or nurse practitioner nor the “specialist” in question are registrants in a respective health profession regulator in BC; the Panel finds that the Ministry reasonably applied the applicable laws to the evidence in the circumstance.

Nearest Suitable Hospital to Receive Benefits (under MPA) or Hospital Services (under HIA) A third and fourth of the listed criteria addressed in the reasons of the Reconsideration are provided under the Regulation, Schedule C section 2(1)(f)(iii) and (iv). Here, the options are for transportation to or from:

(iii) the nearest suitable general hospital or rehabilitation hospital, as those facilities are defined in section 1.1 of the Hospital Insurance Act Regulations, or

(iv) the nearest suitable hospital as defined in paragraph (e) of the definition of "hospital" in section 1 of the Hospital Insurance Act,

The key elements are: • The “nearest suitable” hospital. • The definition of the different types of ‘hospitals’.

-Nearest Suitable Addressing the “nearest suitable” element in the above, the Ministry recognized the BC Physicians’ Memo on the matter but was not satisfied that any medical services needed by the child were not available in BC. As such, the Panel finds that the Ministry did not accept that the “nearest suitable” facility was in Edmonton and not in BC.

The stated reason from the Ministry for its decision was that the BC Physician had only one appointment with the child and did not “explain what services specifically are needed that cannot be provided in British Columbia.“ The Panel finds no need to address that the appointment was a single one, but does address the BC Physicians’ Memo. With respect to that memo the Panel finds that the statement was unsupported and the Ministry’s assessment to be reasonable. The Panel notes the lack of explanation of needed services also fails to indicate any enquiry or other basis upon which the BC Physician determined that BC lacked such services. The May 6, 2024 Consultation Summary from the BC Nurse Practitioner also made no representations on the matter.

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Appeal Number 2024-0295 The Panel accepts the Appellant’s testimony th at there are long wait lists for certain treatment but that is indicative of services being available but, perhaps, delayed. The Panel has no information, and none was provided in evidence or testimony to transform being waitlisted to there being no “suitable” facility in BC, or nearer than Edmonton.

Although not expressly addressed in the Reconsideration Decision, the Ministry did not apply “nearest suitable” as being based upon the assessment of the Appellant (i.e. that the BC Children’s Hospital was not suitable). In testimony the Appellant only referenced the BC Children’s Hospital and expressed that it was not suitable. The Appellant testified to being unable to find a physician there, in the circumstances of the waitlists, workload and others including prior conflict, perceived malpractice, pending litigation, rejection of treatment plans, and use of unprescribed alternatives.

The Panel finds that it was reasonable for the Ministry to interpret “nearest suitable” as an objective standard and not decided on a subjective assessment of an applicant of what hospital was suitable. The Panel finds that there is a lack evidence to demonstrate that the BC Children’s Hospital is unavailable as distinct from unwilling to adopt a treatment plan developed elsewhere or that may engage other practical risks.

Considering all the above the Panel finds that the Ministry was reasonable to find that it lacked information to be satisfied that there was no “suitable” facility in BC, or nearer than Edmonton.

-Hospital Addressing the definition of the different types of ‘hospitals’ the Ministry commented on one component. It noted that the AB Pediatrician’s office was a private clinic. As such it found that the child’s appointment at that place was not at a hospital or rehabilitation hospital, as is necessary to satisfy sections 2(1)(f)(iii) and (iv) of Schedule C of the Regulation.

It says that based upon that “the [M]inistry is not satisfied that [the child’s] appointments are to take place at the nearest suitable hospital / rehabilitation hospital.” However, the Ministry does not state whether the other facilities in Alberta satisfied those provisions. It fails to address whether the definition of “hospital” and “rehabilitation hospital” under BC legislation applies to facilities in Alberta (with “hospital” in their names).