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Government of Canada Response to Accessibility for All
Detailed responses to the recommendations
Recommendation 3:
The Subcommittee recommends that the Department of Public Works and Government Services Canada establish in 2005 an ongoing audit program of the compliance of federal buildings with technical standard CAN/CSA-B651-04, as formulated by the Canadian Standards Association. A progress report should be tabled in 2007, and all federal buildings must be audited by no later than 2009.
Response:
Public Works and Government Services Canada (PWGSC) is developing an auditing strategy, electronic database system, and training tools to establish a program to audit the accessibility of all its facilities, both owned and leased. The audit program will simultaneously follow twin tracks. Firstly, it will audit for compliance with the Treasury Board Accessibility Policy. Secondly, it will audit for compliance with the Canadian Standards Association's technical standard, CAN/CSA-B651-04 Accessible Design for the Built Environment. The federal government is the only jurisdiction in Canada, so far, to adopt this rigourous standard.
The approach PWGSC has chosen for its audit program will help identify gaps between the requirements of Treasury Board policy and the 2004 version of CAN/CSA-B651-04, and provide valuable information for future investments in renovations and acquisitions. A further benefit of the audit will be the opportunity to optimize the department's monitoring and reporting on accessibility within its inventory.
The audit program will comply with, and be guided by, the Treasury Board Accessibility Policy. PWGSC will work with Social Development Canada to ensure that the offices of the latter and its Ministers are among the first public spaces to be audited for accessibility. A progress report on the audit program will be tabled by December 2007, for completion by December 2009.
Since PWGSC is responsible for accommodating the activities of more than 210,000 federal employees across the country, the department's audit program will address facilities visited by people who want to do business with the federal government. The department is also exercising its leadership role by meeting with fellow custodian departments to encourage them to undertake a similar audit program for their own facilities. PWGSC will share the auditing tools it is developing, along with the expertise it has gained on accessibility issues. In early discussions, other large departments including National Defence, Correctional Services Canada and Agriculture and Agri-Food Canada have expressed a willingness to share their experiences with auditing and retrofitting their own facilities for accessibility.
Recommendation 4:
The Subcommittee recommends that no application for disability benefits under the Canada Pension Plan be rejected for medical reasons without this rejection being a decision made by a physician.
Response:
About 60,000 individuals apply each year for Canada Pension Plan Disability (CPPD) benefits. Social Development Canada is responsible for reviewing these applications and ensuring that those who meet the eligibility criteria are granted benefits.
Eligibility for CPPD benefits requires applicants to adhere to a test that some do not meet, despite having a significant medical condition. The test specified in the legislation is that the applicant must have a "…severe and prolonged mental or physical disability," that renders him or her incapable of performing any job, not just his or her own job.
Eligibility is based on the person's capacity to work, which often involves obtaining information from sources other than physicians, such as employers, vocational rehabilitation experts, physiotherapists and occupational therapists. Non-medical factors, such as age, education and work history are also taken into account in assessing the capacity to work. Decisions on eligibility must be consistent with both the letter and intent of the legislation. Decisions of the Federal Court provide additional direction, which is incorporated into written policy guidelines.
Medical adjudicators with nursing backgrounds determine CPPD eligibility at the initial application and reconsideration stages. Adjudicators have the combination of skills and knowledge required to determine eligibility for CPPD benefits and receive specific and extensive training on the CPP legislation and policy framework. They have medical knowledge of physical and mental impairments, of the effects of medication and treatment, and of the expected outcomes of therapy. This knowledge is essential to properly assess reports received from medical practitioners, both family physicians and specialists, and from other professionals such as psychologists, chiropractors, physiotherapists, and occupational therapists. In addition, medical adjudicators with nursing backgrounds have been trained to assess functional limitations and how they affect individuals in their daily and work activities.
In recent years, client contact by telephone was introduced as a standard part of the application and reconsideration processes. The objective is to ensure that clients understand the eligibility determination process, are afforded every opportunity to provide information to support their claim, and are personally advised of a decision to deny benefits and the reasoning behind it.
Medical adjudicators with nursing backgrounds have extensive training and professional experience in interpersonal communication and are very effective at this important aspect of client service.
Physicians also have detailed medical knowledge of physical and mental impairments, however, their training is much more focused on medical conditions and disease processes. While medical doctors could no doubt be trained in the criteria of the program and develop the additional skills necessary to adjudicate CPPD applications, this would not be cost-effective since medical doctors have very high salary levels compared to medical adjudicators. Physicians are also in short supply in certain regions and sectors of the health care system and asking them to perform functions which other professionals with medical training can perform equally well, if not better, is of questionable value.
CPP does have physicians on staff who are involved at the last level of appeal for CPP cases. Their role is to serve as expert witnesses in support of the department's position at Pension Appeal Board hearings. Appellants often bring forward more complex medical data at these hearings than in their initial applications, and these require interpretation. The CPP physicians provide medical expertise to the judges relating to medical conditions and advise on difficult disability determinations, when the difficulty arises from the interpretation of medical reports, medical investigations, prognosis and treatments.
Prior to 1989, regulations specified that all adjudication decisions on CPPD applications were to be made by a two-person board comprised of a physician and an adjudicator. This sought to ensure consistency in decision-making at a time when there was little administrative precedence in Canada for adjudicating disability entitlements and no written guidelines existed.
The two-person board resulted in lengthy delays in decisions because the process required a full review and sign-off by two different individuals. The regulation was therefore repealed in favour of the current system. Medical adjudicators with nursing backgrounds were hired and trained to make decisions on CPPD applications. Written guidelines were developed to provide direction on legislative requirements and medical factors that must be taken into account when adjudicating applications.
After an initial adjudication, denied clients have three opportunities to have their cases re-examined, with or without presenting additional evidence:
- at reconsideration, an administrative review within the Department;
- upon appeal to the Office of the Commissioner of Review Tribunals; and
- by requesting an appeal to the Pension Appeals Board.
In light of the significant incremental costs that would be involved, the Government does not consider that introducing an additional process to have denied applications reviewed by a medical doctor is necessary.