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

[dapaterson]

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

 

[The Bread Guy]

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.

While we were disappointed to learn that only four of 12 recommendations have been fully actioned in the past four years, a further six recommendations have been partially implemented. Two have not been addressed at all.

Of particular note, no change has been made to the Accidental Dismemberment Insurance Plan, which maintains an unfair disparity as some Reservists are still not entitled to the same compensation as their counterparts for exactly the same dismemberment. I have called for a ministerial intervention in order to correct this grave unfairness.

On a positive note, the Canadian Forces has made a significant improvement with the implementation of recommended measures to ensure that all Reservist members of the Canadian Forces now have electronic medical files accessible anywhere within the Canadian Forces medical system.

However, Reservists are still not subject to periodic health assessments and routine immunizations. Although there is a limited trial underway, inconsistent medical screening standards applied to the Reserve Force poses two problems – a risk to the medical well-being of reservists, and the potential inability to deploy medically-fit Reservists on domestic operations (floods, ice storms, etc.) because they lack the appropriate medical screening.

While the Department of National Defence released an interim guidance in 2009 which clarified the entitlement to medical care for Reservists, our office has found that the guidance is not widely known by Reservists, the Reservist Chain of Command or the Canadian Forces medical system. The policy needs to be formalized and disseminated throughout the entire Canadian Forces.

The 12 recommendations were the culmination of an extensive special report to the Minister of National Defence released in April 2008. The report drew upon the inputs of some 389 people – most of whom were Reservists.

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.

 

[TCM621]

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.

 

[daftandbarmy]

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.

 

[Gunner98]

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)

 

[TCM621]

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.

 

[dapaterson]

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.

 

[daftandbarmy]

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

 

[The Bread Guy]

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.

We have also focused some of our systemic investigations on Reserve matters, reviewing two significant issues:

    Operational stress injuries and the Reserve Force; and   
    Compensation for ill and injured Reservists.
   
In the coming months we will be publishing a series of educational products focusing on members of the Primary Reserve, as well as the findings and recommendations of the above-mentioned systemic investigations. I invite you to monitor our website and Twitter account for:

    An information sheet on the Primary Reserve Force (summer 2015);   
    A study by the Office in partnership with the Director Health Services Reserves on the feasibility of providing periodic health assessments to all members of the Primary Reserve (summer 2015);   
    Educational products on ill and injured Reservists’ entitlements to compensation (summer 2015);   
    Educational products on Reservists’ entitlements to health care (summer 2015);   
    Investigation findings and recommendations on the compensatory system for ill and injured Reservists (fall 2015); and   
    Investigation findings and recommendations on the tracking, support and care of Reservists with potential operational stress injuries (winter 2015).
   
I encourage Reservists and their family members to contact my Office if they have any questions or concerns about the processes affecting their care or compensation, or about any other issue relating to the Department of National Defence or the Canadian Armed Forces. We are ready to help.

Gary Walbourne
Ombudsman

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

 

[The Bread Guy]

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.

In our 2008 report, Reserved Care: An Investigation into the Treatment of Injured Reservists and its 2012 follow-up, we recommended that Periodic Health Assessment standards be applied equally to Regular and Primary Reserve Force personnel.

The role of Canada’s Primary Reserve Force has evolved dramatically over the last several years. As such, it has become necessary to ensure that, like the Regular Force, they are fit and ready to serve at any given moment; but there are policies, directives, and, consequently, practices that have not caught up with this change. One of those is the Periodic Health Assessment.

Without Reservists receiving regular medical assessments, the Canadian Armed Forces cannot guarantee that Reservists are fit to train, to participate in exercises, to be employed, or to be ready for deployment and domestic emergencies.

There are over 30 Canadian Forces Health Services Centres located throughout Canada. Several have identified possible resource constraints should they be required to take on the additional assessments which could amount to over 6,000 additional medical assessments per year.

The report includes comprehensive data that the Canadian Forces Health Services Group can use to determine the total investment required (money, time and personnel) to provide Periodic Health Assessments to all Primary Reservists ....

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

 

[RedcapCrusader]

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.

 

[Armymedic]

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.

 

[dapaterson]

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.

 

[Oldgateboatdriver]

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.

 

[daftandbarmy]

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?

 

[dapaterson]

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.

 

[ModlrMike]

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

 

[Blackadder1916]

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".

 

[Fishbone Jones]

Empires & Stovepipes :

 

[medicineman]

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