Question Period Note: MEDICAL ASSISTANCE IN DYING – INVESTIGATIVE REPORT STATUS

• The confidence and trust that Veterans and their families have with Veterans Affairs Canada is, and remains of paramount importance.
• Since the initial reporting of Medical Assistance in Dying being inappropriately raised (in July 2022), Canadians, Veterans and their families alike have understandably expressed their deep dismay and concern regarding this matter.
• Following a thorough review, VAC has concluded that there were four (4) isolated incidents related to one
(1) employee and it is not indicative of a wider pattern of behavior or a systemic issue.
• Additional training, processes and oversight have been put in place at Veterans Affairs.
• The Department continues to encourage any impacted Veterans to come forward to report any incidence where MAiD may have been inappropriately brought up by a Veterans Affairs Canada employee.
• MAiD is not a service that is offered by VAC, and VAC does not and will not initiate any discussion surrounding MAiD with any Veteran or member of their family.

• If a Veteran has chosen to pursue MAiD with their primary care provider and calls to inform VAC, employees can help the Veteran and their family understand the VAC benefits to which they would be entitled, as well as to discuss any other supports or services that might be relevant in the Veteran’s circumstances.

• This support can include resource coordination and navigation such as connecting a Veteran and their family to community resources, mental health practitioners, grief counsellors, pastoral outreach or other local resources. This support does not include VAC employees providing advice or suggestions on MAiD-related considerations.

• Veterans Affairs Canada is aware of two legal actions that have been filed by Veterans related to medical assistance in dying.

• We recognize the Veterans’ right to file the lawsuits and will continue to respect the court’s process. As there is pending legal action, it would be inappropriate for the Department to comment on the cases.

STATUS OF VAC’S INVESTIGATIVE REPORT / RELEASE TO ACVA:

• The full investigative report was released to the Standing Committee on Veterans Affairs (ACVA) and made public on March 10, 2023.
• The Department’s in-depth file analysis has clearly shown that with the exception of a single employee, VAC employees are handling these sensitive discussions with compassion and empathy for Veterans and their families, while providing relevant information about services and benefits in an appropriate manner.
VAC’S POLICY RELATED to MAiD:

• Our Government places the highest priority on ensuring Veterans and their families have the support and services they need, when and where they need it.

• The Department is not to suggest, discuss or offer assistance with medical assistance in dying (MAiD) – it’s not within its scope of work and is not a service it provides. All frontline employees have been provided with clear direction on this issue.
• VAC deeply regrets what transpired and takes this issue very seriously. VAC understands the significance of the situation and appropriate actions were taken to ensure this situation does not happen again.
• Employees are trained in situations involving Veterans who may be in crisis situations, and specific training on MAiD has been provided to employees.

BACKGROUND – MEDICAL ASSISTANCE IN DYING
On July 21, 2022, a Veteran contacted the Veterans Affairs Canada (VAC) call centre to file a complaint about a VAC employee who had inappropriately raised Medical Assistance in Dying (MAiD) to the Veteran during a phone conversation earlier that day. The Veteran indicated the employee also referred to having provided information on MAiD to another Veteran. The Department took immediate action by apologizing to the Veteran and removing the employee from working with the Veteran.

An internal organizational investigation was launched on August 9, 2022, to determine if other Veterans may have had similar experiences.

A national media outlet published an article on August 16, 2022, describing the incident where the VAC employee had inappropriately discussed MAiD with a Veteran. Understandably, Veterans, VAC employees and stakeholders were upset and concerned about the impact this situation could have on Veterans’ confidence in coming to Veterans Affairs Canada for support.

On August 19, 2022, the Minister of Veterans Affairs ordered the Department to conduct a full and thorough investigation of all aspects related to the situation and ensure all possible steps were being taken to prevent an instance like this from happening in the future.

Based on a review and analysis of the employee’s 2,153 files; a search of all 402,000 files in VAC’s databases; discussions with case managers, Veteran service agents and their managers; a review of all incoming communications to the Department on this issue; and feedback from staff training and information sessions, VAC has concluded there were four incidents completely isolated to a single employee. The employee no longer works for the Department. Further, it has concluded that this is not a widespread, systemic issue, nor is it a reflection of the work of hundreds of case managers and Veteran service agents who interact with the utmost care, compassion and respect with Veterans every single day.

The investigation brought to light a number of opportunities for improvement in how VAC manages and oversees significant incidents related to Veterans’ well-being. While the Department took action to address the specific issue raised by the Veteran and new measures are in place to prevent this type of incident from happening again, processes and procedures can be further improved. In 2023, the Department’s Audit and Evaluation Division will conduct an independent and objective review of the escalation process. This will include the processes and procedures in place in the Service Delivery Branch for the identification, reporting and following up on sensitive/significant incidents raised by Veterans (or brought to the attention of VAC). Opportunities for improvement identified in this review will be fully implemented.

The Department is committed to maintaining Veterans’ trust in Veterans Affairs
Canada. Veterans and their families should always feel confident they will receive the
care, compassion and respect they righty deserve from VAC.

VAC has referred the four incidents to the Royal Canadian Mounted Police for their
consideration. The Department will continue to review any allegations brought forward; to date, all additional allegations have been confirmed to be unfounded.
The purpose of the report is to provide an overview on what the Department’s
investigation found and what the Department has done to ensure this situation does not happen again. The report outlines:

• the details and circumstances of what happened and what actions the
Department took as new information was brought forward.
• the methodology the Department used to investigate whether other Veterans
were impacted through similar experiences.
• the steps VAC is taking to improve staff training, quality assurance and
management oversight of significant incidents, as well as plans to consult
Veterans on the issue of recording their conversations with VAC employees.

BACKGROUND Qs and As:
Q1 – How is medical assistance in dying (MAID) administered or approved?
Medical Assistance in Dying (MAID) is a deeply complex and personal medical issue that is out of the jurisdiction of Veterans Affairs Canada staff. For more information, please consult this link: Directive: Role of the Veteran Service Team (VST) Regarding Medical Assistance in Dying (MAID) - VS Toolbox - VAC@work (vac- acc.gc.ca)

Q2 – What is the role of VAC employees when it comes to Veterans requesting medical assistance in dying?

VAC employees shall not provide advice or suggestions to Veterans on the issue of MAID. If a Veteran is seeking advice or assistance with MAID, the employee must refer the Veteran to their primary care provider. If a Veteran has chosen to pursue MAID with their primary care provider and shares this information with a member of the Veteran Service Team (VST), VAC employees can support the Veteran in navigating VAC benefits and services available. Support can include resource coordination and navigation such as connecting a Veteran and their family to community resources, mental health practitioners, grief counsellors, pastoral outreach or other local resources]

Q3 – Have there been discussions with the employee in question and are they still employed at VAC?

For privacy reasons, we cannot speak to internal processes involving an employee; however, we can confirm that the employee is no longer employed at Veterans Affairs Canada.

Q4 – What did the report conclude?

The Department has only confirmed four cases of MAiD being raised inappropriately with Veterans.

• VAC has concluded these four incidents are isolated to one employee who is no longer employed with the Department.

• While additional allegations were brought forward, VAC thoroughly investigated each of the allegations which included a Veteran’s full name and was unable to validate any allegations that inappropriate discussions related to MAiD had taken place.

• Further, it has concluded that this is not a widespread, systemic issue, nor is it a reflection of the work of hundreds of case managers and Veteran service agents who interact with the utmost care, compassion and respect with Veterans every single day.

• The investigation has also brought to light a number of opportunities for improvement in how VAC manages and oversees significant incidents related to Veterans’ well-being.

Q5 – How can the public trust the investigation was comprehensive?

On August 19, the Minister of Veterans Affairs instructed the Department to conduct a full and thorough investigation into the matter, specifically on what had transpired in this situation, how extensive the cases were and how the Department could ensure that this situation would not be repeated in the future.

To ensure the Department reviewed the situation in a comprehensive way, the
investigation included the following:

• A review of the employee’s active Veteran client files;

• A review of an additional 2,153 files connected to the employee in question since 2016 when MAiD became legal to determine if there were other impacted Veterans;

• A review of all 402,000 files in VAC’s client databases to determine the full extent of the issue, including a review of secure My VAC Account messages (English and French files reviewed and analyzed dated back to June 2016 when MAiD legislation came into effect);

• Discussions and interviews with case managers, Veteran service agents, Veteran Service Team managers and front-line staff;

• Feedback from staff training and information sessions about the new directive/guidance on MAiD;

• Information obtained through the review and monitoring of all incoming communications to the Department, including MyVAC account secure messages and calls to the National Client Contact Centre (NCCN); and

• Information obtained through VAC’s new reporting process which was established to ensure that when MAiD is raised in communications it gets escalated to management to determine what follow up may be required.

To complement the file review and analysis, Departmental staff spoke directly to the
other impacted Veterans as well as Veteran-serving frontline staff and key stakeholders.

Veterans were asked to come forward if they had experienced a similar situation.

Information from all of these sources formed part of the investigation.

Q6 – What is the Minister doing to ensure this never happens again?

Although they were isolated to just one employee, the Department understands the seriousness of these incidents and wants Veterans to trust that VAC employees are available to support their needs in a respectful and compassionate manner.

While early actions have been taken to ensure this type of incident does not happen again, further actions aimed at maintaining Veterans’ trust will be taken.

Throughout fall 2022, as the Department became aware of new information, steps were taken to prevent this type of situation from happening again.

Specifically, new training materials on MAiD were developed and shared with new and existing frontline staff; new written guidance was shared with frontline staff to provide clear direction about MAiD; and training and information sessions were held for 750 staff to ensure the guidance was understood and to give staff an opportunity to ask questions and engage on the issue.

Moving forward, the Department will:

• strengthen and deliver mandatory and clear employee training and materials on MAiD for new and existing frontline staff.

• establish enhanced reporting procedures immediately that will ensure that significant incidents are raised to the Assistant Deputy Minister and Deputy Minister levels more quickly where appropriate.

• increase monitoring for issues and trends.

• conduct a review of the escalation process — to be led by the Department’s Audit and Evaluation Division.

• consult with Veterans and stakeholders on recording telephone conversations with case managers and Veteran service agents.

Q7 – Is the employee involved still working for Veterans Affairs?

VAC has concluded these four incidents are isolated to one employee who is no longer employed with the Department.

Q8 – Were the findings of the report provided to the RCMP?

VAC referred the four incidents to the Royal Canadian Mounted Police for their consideration, prior to the report being completed. The Department has no additional details on the RCMP’s investigation.

BACKGROUND – LITIGATIONS

Two legal actions have been filed against Veterans Affairs Canada by Veterans related to medical assistance in dying. The claims were filed on 10 October, 2023 and 5 March 2024, respectively.

GENERAL BACKGROUND:
Considerations for medical assistance in dying (MAID) are the subject of discussions between a patient and their primary care providers to determine appropriateness in each individual context. It is covered through the provincial and territorial health authorities and is administered by a physician or nurse practitioner directly to the individual. Dying with Dignity website Get the facts on MAID | Dying With Dignity Canada can provide more information.

VAC staff have no mandate or role to recommend medical assistance in dying to Veteran clients. MAID is not a VAC service and is not within their scope of work. However, VAC may be approached by Veterans following their decision to pursue medical assistance in dying. In those cases, VAC’s employees can help the Veteran and the families understand their benefits, as well as any other support or services that might be relevant in the Veteran’s circumstances. VAC’s employees are also trained to serve and assist Veterans who may be in crisis situations and ensure they have access to the support they need when and where they need it.

Guidance around medical assistance in dying has been in place for all of VAC’s employees since medical assistance in dying was legalized. Reminders about this, and other important items for VAC staff, are shared regularly. In light of these unfortunate incidents, VAC has and continues to communicate specifically about medical assistance in dying with all of its client facing management and staff. All of VAC’s frontline staff were provided with training to reinforce the expectations and the available programs and services offered by the Department to support the health and well-being of Veterans.
VAC always encourages Veterans who are dealing with mental health concerns to reach out to the Department to ensure that they are getting the help they need.

According to the 2019 Life After Service Study survey, which surveyed Canadian Regular Force Veterans released between 1998 and 2018, Veterans were more likely than the general Canadian population of the same age and sex to rate their mental health as “fair or poor” (28% vs 6%). Veterans were also more likely to report certain chronic conditions such as:
1. depression (26% versus 7%)
2. anxiety (21% versus 6%)
3. post-traumatic stress disorder (24% versus 1%)

Source: “Well-being of Canadian Regular Force Veterans, Findings from LASS 2019 Survey” https://publications.gc.ca/collections/collection_2020/acc-vac/V3-1-7-2020-eng.pdf

STANDING COMMITTEE ON VETERANS AFFAIRS (ACVA) MOTIONS FOR PRODUCTION OF PAPERS:

ACVA MOTION – DATE RECEIVED Date Remitted Details
December 12, 2022 –

1) That, Pursuant to Standing Order 108(1)(a), the committee order:

A) That all briefing notes, memos, emails, and text or other electronic messages from Veterans Affairs Canada (VAC) officials prepared for or sent to the Minister of Veterans Affairs regarding Medical Assistance in Dying (MAiD), including related to the internal investigation into the matter, be provided to the Committee within 45 days of the adoption of this motion.

B)That all internal memos, emails, and documents distributed by Veterans Affairs Canada (VAC) to Veterans Service Agents and Case Workers regarding the department’s policy on discussing Medical Assistance in Dying (MAiD) between January 1st, 2019, and December 7th,2022 be provided to the Committee within 45 days of the adoption of this motion.

2)That Veterans Affairs Canada provide the committee with the training materials and training modules that were distributed to Veterans Affairs Employees to clarify the department’s policy on discussing Medical Assistance in Dying (MAiD).
January 26,
2023 A thorough and complete compilation of 773 pages in English and 826 pages in French were provided. Light redactions were made to the compilation for reasons of Personal information, Client Solicitor privilege and/or Operations of government.
February 2, 2023 –

That, Pursuant to Standing Order 108(1)(a), the committee order:

Whereas Veterans Affairs Canada had reasons to believe that the entire request for documents made by the committee in its motion of December 12, 2022 was subject to the date range contain in paragraph (b) of the motion, specifically January 1, 2019 to December 7, 2022, the Committee order that all briefing notes, memos, emails, and text or other electronic messages from Veterans Affairs Canada (VAC) officials prepared for or sent to the Minister of Veterans Affairs regarding Medical Assistance in Dying (MAiD), including related to the internal investigation into the matter, be provided to the Committee within 7 calendar days of the adoption of this motion.
Package #1: February 9,
2023

Package #2: February 14,
2023 A thorough and complete compilation of 92 pages in English and 104 pages in French were provided.
Light redactions were made to the compilation for reasons of Personal information, Client Solicitor privilege and/or Operations of government.

A thorough and complete compilation of 67 pages in English and 77 pages in French were provided.
Light redactions were made to the compilation for reasons of Personal information, Client Solicitor privilege and/or Operations of government.
February 13, 2023 –

That, Pursuant to Standing Order 108(1)(a), the committee order:
That Veterans Affairs Canada provide, and if necessary, create, a transcript of the recorded telephone conversation of July 21 referred to on page 230 of the documents submitted to the committee on January 26, 2023, within 14 calendar days of the adoption of this motion; furthermore, that Veterans Affairs Canada redact from the transcript any personal identifiable information of the veteran or Veterans Affairs Canada employees, and any personal medical information that would identify a veteran. February 27,
2023 The requested transcript of the recorded telephone conversation was provided in 4 pages in English and 4 pages in French. Light redactions were made to the compilation for reasons of Personal information.