# CF Ombudsman's reports on Medical Treatment of Reservists (merged)



## dapaterson (21 Nov 2012)

The Ombudsman has done a follow-up to his report on care of ill and injured Reservists.

http://www.thestar.com/news/canada/politics/article/1290828--canada-s-reservists-still-not-treated-equally-military-ombudsman-says


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## The Bread Guy (21 Nov 2012)

dapaterson said:
			
		

> The Ombudsman has done a follow-up to his report on care of ill and injured Reservists.
> 
> http://www.thestar.com/news/canada/politics/article/1290828--canada-s-reservists-still-not-treated-equally-military-ombudsman-says



These, from the 'Budman....

News Release:  _"Ombudsman Releases Follow-up Report into the Treatment of Injured Reservists"_


> I am very pleased to release today our latest special report into the medical care of Canadian Forces Reservists who become ill or injured while serving in Canada.
> 
> The report, entitled Reserved Care: A Follow Up into the Treatment of Injured Reservists, reviews the progress of 12 recommendations made by our office in 2008 to help ensure Reservists have proper access to medical care and administrative support.
> 
> ...



Ombudsman Special Report:  _"Reserved Care: A Follow Up into the Treatment of Injured Reservists"_

No Info-machine response yet from the Minister/CF at the forces.gc.ca site as of this post.


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## TCM621 (30 Nov 2012)

Just to provide a slightly different perspective on this. When I was working at a reserve unit, there was a mbr who came back from overseas with some serious mental health issues. The unit tried its best to help this member but he stopped showing up and returning calls. Eventually, they just had to admit that he didn't want help and there was nothing more than can do but be available. In the regular force, we can order a mbr to get treatment, what ever the problem. In the reserves, they have no such hold on these people. 

Another issue I had to deal with was the fact that reservists are most likely to get injured while away on training. Often their supervisors are reservists or augmentees for summer training. Combine this with people still not doing CF98s, and 663s, and you have a paperwork nightmare trying to get the reservist the proper care and/or compensation. I had one situation which had me sending emails all across LFWA looking for people to give statements and it took months to sort it out. Luckily, I was available to do this most reserve units don't have the personnel to run with this stuff for weeks on end.

The plain fact is Reservists are much harder to deal with when it comes to health care. The is no easy solution. I like to think that most people have the right intentions but it is very easy for people to fall through the cracks.


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## daftandbarmy (1 Dec 2012)

Tcm621 said:
			
		

> Just to provide a slightly different perspective on this. When I was working at a reserve unit, there was a mbr who came back from overseas with some serious mental health issues. The unit tried its best to help this member but he stopped showing up and returning calls. Eventually, they just had to admit that he didn't want help and there was nothing more than can do but be available. In the regular force, we can order a mbr to get treatment, what ever the problem. In the reserves, they have no such hold on these people.
> 
> Another issue I had to deal with was the fact that reservists are most likely to get injured while away on training. Often their supervisors are reservists or augmentees for summer training. Combine this with people still not doing CF98s, and 663s, and you have a paperwork nightmare trying to get the reservist the proper care and/or compensation. I had one situation which had me sending emails all across LFWA looking for people to give statements and it took months to sort it out. Luckily, I was available to do this most reserve units don't have the personnel to run with this stuff for weeks on end.
> 
> The plain fact is Reservists are much harder to deal with when it comes to health care. The is no easy solution. I like to think that most people have the right intentions but it is very easy for people to fall through the cracks.



There are a bunch of other occupations that employ 'temporary workers' that have figured this out. I'm sure we can too, as long as there's some proper leadership and resources.


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## Gunner98 (1 Dec 2012)

Tcm621 said:
			
		

> In the regular force, we can order a mbr to get treatment, what ever the problem.



No we can't - CF Refusal of Care policy last reviewed January 2010:


1.	A CF Member or other entitled personnel who refuses a recommended course of treatment must sign the form CF 2029 indicating refusal of care.  It will be retained in the member’s CF 2034.

2.	Where the refusal of treatment has medical employment limitations, the CF member’s Clinician must ensure that the CF Member understands these consequences, and records the discussion in the member’s CF 2034.

3.	When medical limitations are issued, or where there is a potential impact on the CF member’s deployability, the CF member’s Commanding Officer will be notified should the refusal to participate in the recommended treatment lead to the requirement for a change in medical employment limitations.

CF 2029 (Canadian Forces Declaration of Release from Responsibility)


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## TCM621 (10 Dec 2012)

Simian, thanks for the info. That is news to me. However, we can still order a mbr to the MIR, right? I guess we can order a horse to water but can't make him drink.

daftandbarmy, I am not saying it can't be done it is just a hell of a lot harder to do with reservists than with regular force members. There are a lot more obstacles when dealing with a reservist. As I said before, is that when a reservist doesn't show up for parade there is very little you can do. This is especially problematic for OSIs where withdrawl from your peers is one of the symptoms. In the regular force, the mbr is almost forced to be among the people who can help him. In the reserves it has to be handled on a much more informal manner. This is one area where the death of mess culture really hurts the CF. If the boys (and girls) in the mess can keep the person in touch and part of the family you have a much better chance of getting the mbr help.


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## dapaterson (10 Dec 2012)

To his credit, the MND has done considerable work on fixing the problems with the Accidental Dismemberment plan.

http://www.forces.gc.ca/site/news-nouvelles/news-nouvelles-eng.asp?id=4544



> Reserve Force Personnel in both full-time and part-time service are essential to Canadian Armed Forces operational effectiveness at home and abroad. Under the amended Accidental Dismemberment Insurance Plan, all Reserve Force Personnel, including members of the Cadet Organizations Administrative and Training Service, Canadian Rangers and Officer Cadets in the Reserve Entry Training Plan, are now entitled to the same compensation as their Regular Force counterparts for accidental dismemberment, loss of use of a limb, or the loss of sight, speech or hearing, which is attributable to military service.


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## daftandbarmy (10 Dec 2012)

Tcm621 said:
			
		

> Simian, thanks for the info. That is news to me. However, we can still order a mbr to the MIR, right? I guess we can order a horse to water but can't make him drink.
> 
> daftandbarmy, I am not saying it can't be done it is just a hell of a lot harder to do with reservists than with regular force members. There are a lot more obstacles when dealing with a reservist. As I said before, is that when a reservist doesn't show up for parade there is very little you can do. This is especially problematic for OSIs where withdrawl from your peers is one of the symptoms. In the regular force, the mbr is almost forced to be among the people who can help him. In the reserves it has to be handled on a much more informal manner. This is one area where the death of mess culture really hurts the CF. If the boys (and girls) in the mess can keep the person in touch and part of the family you have a much better chance of getting the mbr help.



Yeah, I know, but if we can train thousands and spend billions to travel to Central Asia and kill lots of bad guys, destoy things, kiss babies, run national elections, and build schools, we should be able to figure out something like this with relative ease, especially if there are building loads of expereinced/smart staff officers just waiting for an inspired leader to galvanize them in to action.

And especially if others out there are already doing it in some way, shape or form.

Whew, I just tired myself out there a little...better sign TWO paysheets


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## The Bread Guy (28 Jul 2015)

From the CF Ombudsman's web page:


> My Office acts as a direct source of information, referral and education for the Defence community. We are also responsible for reviewing and investigating complaints from constituents who believe they have been treated improperly or unfairly by the Department of National Defence or the Canadian Armed Forces.
> 
> Reservists, both serving and retired, as well as their immediate families, form an important part of our constituency. Recently, we have focused our engagement activities to reach out to Reservists in order to inform them of the Office and the role that we play, make our services more readily available to them, and gather a better understanding of the issues and challenges facing Reservists and their families. We will continue to do this over the coming years.
> 
> ...


Statement also attached in case link doesn't work for you.


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## The Bread Guy (23 Oct 2015)

This from the CF Ombudsman's Office:


> Today our office released the results of its first joint study with the Department of National Defence and Canadian Forces. Produced in partnership with the Canadian Forces Health Services Group, The Feasibility of Providing Periodic Health Assessments to All Primary Reservists examines and reports on the resources involved in providing regular medicals to members of the Primary Reserve at the same standard as the Regular Force.
> 
> A Periodic Health Assessment is a structured health review given at fixed intervals to ensure Forces personnel are medically fit for military duties. Regular Force members are assessed regularly; Reserve members usually are not.
> 
> ...


Link to _"The Feasibility of Providing Periodic Health Assessments to All Primary Reservists"_  here (html) or here (52 page 2630 kB PDF)


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## RedcapCrusader (23 Oct 2015)

We should. The problem is, in places like Calgary our Medical Section does not have a regularly posted MO. The doctor is in Calgary once a month for medicals on an appointment basis, so unless they start reopening Base Medical Centres and having full time or even part time MOs I don't see how it can be achieved.


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## Armymedic (23 Oct 2015)

LunchMeat said:
			
		

> so unless they start reopening Base Medical Centres and having full time or even part time MOs I don't see how it can be achieved.



Military Physician Assistants.


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## dapaterson (23 Oct 2015)

I fail to see the problem.   Worst case is an additional 6000 PHAs per year, each taking 2 hours, for a total of 12000 hours.  One FTE (civilian) is just over 2000 hours per year; the incremental demand would be the equivalent of six people (nationally).  That is not an impossible obstacle, particualrly since the majority of Reservists are close to existing clinics.

If we assume that we'd need 12 new doctors paid $150K per year to deliver these PHAs, and that each PHA costs $500 in tests and materials, we get $1.8M for doctors and $3M in O&M, for a total of $4.8M/year.

This is a problem of will, not of resources.


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## Oldgateboatdriver (23 Oct 2015)

I don't see how that would be a problem: We used to do it in the 70's and 80's. We had regular medicals (I think it was every third or fourth year, unless in a specific trade that required more frequent, like divers who were evaluated every year.) at fixed intervals and upon request by the CO in between (usually upon return to service after we had some illness or accident that was treated by a civilian doctor).

In many cases, these medicals were carried out by either reserve MO or by local doctors hired on contract to do so. I don't remember anybody complaining about the system not working, or cheats.


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## daftandbarmy (23 Oct 2015)

dapaterson said:
			
		

> I fail to see the problem.   Worst case is an additional 6000 PHAs per year, each taking 2 hours, for a total of 12000 hours.  One FTE (civilian) is just over 2000 hours per year; the incremental demand would be the equivalent of six people (nationally).  That is not an impossible obstacle, particualrly since the majority of Reservists are close to existing clinics.
> 
> If we assume that we'd need 12 new doctors paid $150K per year to deliver these PHAs, and that each PHA costs $500 in tests and materials, we get $1.8M for doctors and $3M in O&M, for a total of $4.8M/year.
> 
> This is a problem of will, not of resources.



Or just give me a form for my regular doctor to fill out, and pay me a 1/2 day to go see him for him to run me through the medical.

Or are 'Army Doctors' more speshul than civilian doctors?


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## dapaterson (23 Oct 2015)

daftandbarmy said:
			
		

> Or just give me a form for my regular doctor to fill out, and pay me a 1/2 day to go see him for him to run me through the medical.
> 
> Or are 'Army Doctors' more speshul than civilian doctors?



You also have to pay the civilian doctor; and, according to the study, 38% of Reservists don't have a family doctor.


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## ModlrMike (23 Oct 2015)

It's taking 4 months to get a in Wpg right now. If we go down this road, I'll be booking my next medical the same day I have my current one.  ;D


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## Blackadder1916 (23 Oct 2015)

daftandbarmy said:
			
		

> Or just give me a form for my regular doctor to fill out, and pay me a 1/2 day to go see him for him to run me through the medical.
> 
> Or are 'Army Doctors' more speshul than civilian doctors?



Of course "Army Doctors are more speshul"!  But having knowledge of some of them in the past that may mean "speshul" as in riding the "special short bus to school".  But joking aside,  there are pros and cons to army doctors vs an individual's civilian GP.  The "military" primary providers will have knowledge of the medical category system (and having that properly applied is the primary desired end result);  a reservist's family doc will (hopefully) know the patient and have ready access to his medical history/records (that makes completing the PHA much easier).  But there is more to a PHA than examination by a physician who fills out a form.  Most family practices are not usually equipped to do audiograms, visual acuity, EKGs, X-rays and the various other medical related chores that may be done at the time of a member's PHA.  As well, an individual's GP (if he is lucky enough to have one) may be inclined to err on the side of the patient (who in the end is his primary concern) whereas as military physician (or PA, or a hired civilian practitioner) is more likely to err on the side of the CF's requirement (which in the end, though he must have legitimate concern for the patient, is his primary loyalty).  How often have potential recruits come on these means bemoaning the quality of reports by provided their family doctor or the fact that the RMO did not agree with their doc saying "Little Johnny should have no problem being a soldier even though he must take medication every day".


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## Fishbone Jones (23 Oct 2015)

Empires & Stovepipes :


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## medicineman (23 Oct 2015)

I seem to remember having to spend a weekend at work in Victoria one year doing just this - mainly as a form of a DAG for the sand box, but no different really.  We also did it on a limited trial basis here in the Peg - big issue was getting people to do the soldiers' medicals, not getting the folks in.  One year I managed to knock out a pile of my own unit folks and last year they ran it, well nobody bothered checking in with me and ran them on one of my weekends on and instead of having our unit MO and myself, pad for my Unit MO and 2 Calian ones a bazillion dollars to come in and work.  The Wing/Shilo don't want to set up the VPN tunnel for the CFHIS to get into our little MIR at the Armouries so we can do this on parade nights - I can do a Part 2 on a healthy 20 something year old in about a half hour and a not so simple one in about 45 minutes.  Part 1 can be done at the same spot, with the exception of the labs, which can be done at the Wing or the lab of choice of the soldier.  

The issue is time and personnel...and of course money.  I hate to say it, but it's cheaper to give me some Class A days than the money to pay a Calian employee for overtime.  It is something that needs to be done - I've seen a large number of folks on FTX's that have no business being there, but nobody will put them on a category and release them, thinking "well it's only the Reserves".  I actually remember doing a post deployment medical on someone that went to Afghanistan, with a serious condition, that convinced their civvy specialist it would be OK because they'd be in some HQ somewhere - and that person was in fact on a category that was essentially unfit field operations and deployments further than 20 minutes from definitive care.  They were essentially fit office work in a large urban centre in Canada only...this is precisely why a civilian MD without prior military exposure/experience has ZERO BUSINESS doing these medicals.

 :2c: (my half day's Class A after taxes).

MM


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## OldSolduer (23 Oct 2015)

MM is correct.


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## The Bread Guy (13 Apr 2016)

This out yesterday:


> Today I released the second in a series of three reports which focus exclusively on Canada’s Reserve Force.
> 
> The first report, _The Feasibility of Providing Periodic Health Assessments to All Primary Reservists_, looked at Periodic Health Assessments and found that 30% of Canada’s military Reserve Force – roughly 6,000 members – are missing valid medical assessments.
> 
> ...


Here's a link to the report, and here's a link to the Minister's response.

Threads dealing with previous 'Budman reports on reservists here and here.


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## ModlrMike (13 Apr 2016)

I'm dealing with the case of a sailor injured on the job. The weakest link... Class A. Getting admin done in the Class A model is a nightmare.


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## Staff Weenie (13 Apr 2016)

Good morning all - we are getting a slideshow on administration of RFC posted onto the DCSM Intranet website shortly at: http://cmp-cpm.mil.ca/en/support/casualty/casualty-support.page 

As per the new Treasury Board guidelines on internet content, we cannot post a slide deck on that page, but we will post a series of FAQs, or revised content to help.

In the meantime, people can always email me at paul.barnshaw@forces.gc.ca for a copy of the slide deck.

If you have questions on RFC, call your nearest IPSC for assistance. The weblink to find the nearest IPSC and its contact info is: http://www.forces.gc.ca/en/caf-community-support-services-casualty-support/contact-info.page

Or, call our national numbers at:

- Canada-wide Toll Free at: 1-800-883-6094 (Not staffed 24/7, any messages will be answered on the next working day)
- In Ottawa at: 613-995-1457


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## The Bread Guy (14 Jun 2016)

_"Part-Time Soldiers with Full-Time Injuries:  A Systemic Review of Canada's Primary Reserve Force and Operational Stress Injuries"_


> Since 2002, this Office has been tracking and reporting on the issues of operational stress injuries and the adequacy of the health care provided to members of the Canadian Armed Forces.
> 
> Because different rules apply, we have also focussed our attention on the same issues as they relate to Canada’s Reserve Force. Today, we are releasing the last of a series of three reports.
> 
> ...


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## The Bread Guy (13 Mar 2017)

An update from the CF Ombudsman:


> *Update on the Ombudsman’s Report on The Feasibility of Providing Periodic Health Assessments to All Primary Reservists*
> 
> In October 2015, I released a study in partnership with the Canadian Forces Health Services Group – The Feasibility of Providing Periodic Health Assessments to All Primary Reservists – with the purpose of examining whether Periodic Health Assessments could be provided to members of the Primary Reserve with the same standard of periodicity as the Regular Force.
> 
> ...


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## medicineman (13 Mar 2017)

Sounds like I won't be around to roll out the PHA trial - that was going to land squarely on my lap...but my release date is before it happens.  I'm still not holding my breath of course.

MM


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