BUILDING AN INCLUSIVE CANADA: BRINGING THE
IMMIGRATION AND REFUGEE PROTECTION ACT
IN STEP WITH MODERN VALUES
Report of the Standing Committee on
Citizenship and Immigration
42
nd
PARLIAMENT, 1
st
SESSION
Chair
Robert Oliphant
DECEMBER 2017
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BUILDING AN INCLUSIVE CANADA: BRINGING THE
IMMIGRATION AND REFUGEE PROTECTION ACT
IN STEP WITH MODERN VALUES
Report of the Standing Committee on
Citizenship and Immigration
Robert Oliphant
Chair
DECEMBER 2017
42
nd
PARLIAMENT, 1
st
SESSION
NOTICE TO READER
Reports from committee presented to the House of Commons
Presenting a report to the House is the way a committee makes public its findings and recommendations
on a particular topic. Substantive reports on a subject-matter study usually contain a synopsis of the
testimony heard, the recommendations made by the committee, as well as the reasons for those
recommendations.
iii
STANDING COMMITTEE ON CITIZENSHIP
AND IMMIGRATION
CHAIR
Robert Oliphant
VICE-CHAIRS
Jenny Kwan
Hon. Michelle Rempel
MEMBERS
Gary Anandasangaree
Bob Saroya
Serge Cormier
Marwan Tabbara
Larry Maguire
Nick Whalen
Randeep Sarai
Salma Zahid
OTHER MEMBERS OF PARLIAMENT WHO PARTICIPATED
John Brassard
John Oliver
Nathaniel Erskine-Smith
Peter Schiefke
Mona Fortier
Jamie Schmale
Tom Kmiec
Non-voting member, pursuant to Standing Order 104(5)
iv
CLERK OF THE COMMITTEE
Erica Pereira
LIBRARY OF PARLIAMENT
Parliamentary Information and Research Service
Julie Béchard
Madalina Chesoi
v
THE STANDING COMMITTEE ON
CITIZENSHIP AND IMMIGRATION
has the honour to present its
FIFTEENTH REPORT
Pursuant to its mandate under Standing Order 108(2), the Committee has studied federal
government policies and guidelines regarding medical inadmissibility of immigrants and has
agreed to report the following:
vii
TABLE OF CONTENTS
SUMMARY .......................................................................................................................................................... 1
LIST OF RECOMMENDATIONS ................................................................................................................. 3
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION AND
REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES ........................................... 7
PREAMBLE ......................................................................................................................................... 7
INTRODUCTION ............................................................................................................................... 7
PART 1: MEDICAL INADMISSIBILITY – CURRENT DEFINITIONS AND
POLICIES ............................................................................................................................................. 8
A. Medical Examinations ........................................................................................................ 9
B. Inadmissibility Based on Health Grounds or Medical Inadmissibility ......... 10
C. Excessive Demand on Health and Social Services ................................................ 11
1. Basic Definitions to Excessive Demand............................................................. 12
2. Next Steps after Medical Officers Advise Visa Officers of Excessive
Demand ......................................................................................................................... 13
3. Cost-Benefit Analysis ............................................................................................... 14
PART 2: EXCESSIVE DEMAND: A MULTI-JURISDICTIONAL ISSUE ........................... 15
A. Provincial and Territorial Perspectives ................................................................... 16
B. Costs of Health and Social Services ........................................................................... 18
C. Provincial Engagement ................................................................................................... 20
PART 3: A HUMAN RIGHTS PERSPECTIVE ON MEDICAL INADMISSIBILITY ....... 22
PART 4: ISSUES WITH THE EXCESSIVE DEMAND PROVISION .................................. 25
A. Individuals Captured by the Excessive Demand Provision .............................. 25
B. Decision-making process ............................................................................................... 29
viii
1. Clarity ............................................................................................................................. 29
2. Consistency and Accuracy ...................................................................................... 30
C. Impact of the Cost Threshold and Additional Costs ............................................ 31
1. Mitigation Plans .......................................................................................................... 33
D. Excessive Demand Provision seen as Discriminatory ....................................... 34
1. Affecting Children, Low-Income Individuals and Live-In Caregivers .... 36
E. Personal Hardships Due to the Excessive Demand Provision ......................... 37
F. Deterring Potential Immigrants .................................................................................. 39
PART 5: OPTIONS FOR REFORM ............................................................................................ 39
Appendix A: List of witnesses ................................................................................................................. 45
Appendix B: List of briefs ......................................................................................................................... 47
Request for government response ....................................................................................................... 49
Dissenting Opinion of the Conservative Party of Canada ........................................................... 51
Dissenting Opinion of the New Democratic Party of Canada .................................................... 59
SUMMARY
Canada, prior to ratifying the United Nations Convention on the Rights of Persons with
Disabilities in 2010, reviewed its laws and policies to ensure that the Convention could be
implemented in conformity with the Canadian constitution. One of the laws that must
reflect this new international commitment is the Immigration and Refugee Protection Act.
Currently, section 38(1)(c) of the Act, which excludes certain people admission to Canada
based on medical or disability grounds, is out of touch with Canadians’ values.
Broadly, the medical inadmissibility provision based on what is termed “excessive demand”,
section 38(1)(c), has two components. Excessive demand is understood as a higher than
average estimated cost to the health and social services systems or a demand that would
add to existing wait lists which could result in the inability to provide timely services to
Canadian citizens or permanent residents. Human rights and disability advocates, lawyers,
immigration organizations as well as individuals argue that this provision does not respect
basic human rights and is discriminatory. This provision dates from before Confederation
and has lingered despite numerous legislative changes to Canada’s immigration system.
Although it is no longer explicitly discriminatory, the provision still has adverse effects on
people with disabilities who apply to become permanent residents in Canada. Others have
argued that the burden placed on the administrative system as well as the potential
economic loss to Canada by the exclusion of certain people or their family members could
outweigh the cost savings in medical and social services, although data on this is difficult to
find. There are broadly held concerns that, without repeal, section 38(1)(c) of the
Immigration and Refugee Protection Act and the accompanying regulatory provisions
related to excessive demand, our immigration laws unjustifiably violate human rights of
certain would-be newcomers to Canada and this is inconsistent with the modern values
Canadians associate with contemporary human rights protections.
Faced with these concerns, the House of Commons Standing Committee on Citizenship and
Immigration decided to study the federal government’s policies and guidelines regarding
medical inadmissibility, in particular the excessive demand on health and social services
provision. Immigration, Refugees and Citizenship Canada and witnesses provided detailed
information and data to help the Committee understand the current medical inadmissibility
policies and its challenges. This report provides a number of recommendations based on
the issues heard during the course of the study. Foremost, the Committee would like to
bring the Immigration and Refugee Protection Act in line with Canadian principles, and
recommends repealing section 38(1)(c) of the Act. The Committee also acknowledges that
such legislative change can take time, involves conversations with the provinces and
2
territories, and thus emphasizes the need to immediately improve the application of the
excessive demand provision in the meantime.
The Minister of Immigration, Refugees and Citizenship, in collaboration with its provincial
and territorial counterparts also recently undertook a fundamental review of the medical
inadmissibility provision based on excessive demand to ensure it is in line with Canada’s
commitments and principles. The Committee welcomes the ongoing consultation between
the federal, provincial and territorial governments on this issue, as it is of multi-
jurisdictional interest.
Canadians value diversity and inclusiveness and it should be mindful of all the abilities and
contributions of its citizens, newcomers and potential immigrants as it moves forward with
reviewing the medical inadmissibility.
To these ends, the Committee broadly recommends the repeal of section 38(1)(c) of the
Immigration and Refugee Protection Act and the relevant regulatory provisions. In the
intervening period, the Committee recommends implementing certain interim measures
to, among other things, increase the cost threshold for excessive demand inadmissibility
and modify the calculation criteria for this threshold. Furthermore, the Committee
recommends that Immigration, Refugees and Citizenship Canada follow the ruling of the
Supreme Court of Canada decision in Hilewitz v. Canada when training staff, determining
and evaluating excessive demand on a case by case basis.
3
LIST OF RECOMMENDATIONS
As a result of their deliberations committees may make recommendations which they
include in their reports for the consideration of the House of Commons or the Government.
Recommendations related to this study are listed below.
Bringing the Immigration and Refugee Protection Act in Step with Canadian Values
Recommendation 1
That section 38(1)(c) of the Immigration and Refugee Protection Act and the
exemptions to it be repealed; that the Governor in Council repeal all
corresponding regulations; and that Immigration, Refugees and Citizenship
Canada repeal all corresponding policies and guidelines. .......................................... 40
Consulting with Provinces and Territories
Recommendation 2
That the Minister of Immigration, Refugees and Citizenship continue to consult
and negotiate with the provinces and territories on a repeal of section 38(1)(c)
from the Immigration and Refugee Protection Act. ................................................... 41
Collecting Data for Better Decision-Making
Recommendation 3
Until such time as section 38(1)(c) of the Immigration and Refugee Protection Act
is repealed, that Immigration, Refugees and Citizenship Canada report to the
House of Commons annually on the use of excessive demand by the department,
including comprehensive data on: (i) the number of applications for which the
estimation for which the estimation of excessive demand exceeds the threshold
for any stage of the application; (ii) the medical cost estimates; (iii) the number of
such applications delayed by duration delay; (iv) the number of such applications
refused; (v) the number of such applications abandoned; (vi) the number of
family members whose applications are also delayed, refused or abandoned as a
result of the implication of an excessive demand process; (vii) the full costs of
implementing excessive demand and appeals; and (viii) such other information as
the department, provinces or territories determine to be relevant in negotiating
the repeal of excessive demand. ................................................................................ 41
4
Interim Measures
Recommendation 4
Pending repeal of section 38(1)(c) of the Immigration and Refugee Protection
Act, in accordance with recommendation 1, that the following interim
measures be implemented to the excessive demand regime: .................................... 42
Proper Training for Immigration/Visa Officers and Medical Officers
Recommendation 4(a)
That Immigration, Refugees and Citizenship Canada ensure that the final
decision-makers on a permanent residence application are properly trained in
assessing the reasonableness of the medical officers’ recommendations; and
that medical officers are properly trained to evaluate the individual’s entire
application. .............................................................................................................. 42
Calculating the Cost Threshold for Excessive Demand
Recommendation4(b)
That Immigration, Refugees and Citizenship Canada fundamentally review how
it calculates the cost threshold for excessive demand on health and social
services by eliminating from current definitions those services that are not
publicly funded. ....................................................................................................... 42
Recommendation 4(c)
That Immigration, Refugees and Citizenship Canada ensure that the cost
threshold for excessive demand on health and social services is calculated by
economists based on provincial, territorial and federal data. .................................... 42
Expanding the Categories of Exemptions to the Excessive Demand Provision
Recommendation 4(d)
That Immigration, Refugees and Citizenship Canada expand the list of
exempted persons from the excessive demand provision to include economic
applicants that are already working in Canada and their family members. ................ 43
5
Providing Clear and Comprehensive Information
Recommendation 4(e)
That Immigration, Refugees and Citizenship Canada provide applicants with
timely decisions and procedural fairness letters that are written in plain
language and are comprehensive in nature, including rationales, in order fully
to inform applicants of the findings they must address to overcome a finding of
excessive demand. ................................................................................................... 43
Recommendation 4(f)
That Immigration, Refugees and Citizenship Canada publish on its website, in
plain language, all operation manuals and guidelines regarding health to help
applicants understand the evidence they need to provide during their
application process................................................................................................... 43
Parliamentary Review
Recommendation 5
That should, after a thorough consultation with the provinces and territories
and analysis of all relevant data, Parliament repeal section 38(1)(c) of the
Immigration and Refugee Protection Act, a full parliamentary review of the
impact of these changes be undertaken within three years of its
implementation and that such a review include its impact on the provinces and
territories. ................................................................................................................ 43
7
BUILDING AN INCLUSIVE CANADA: BRINGING
THE IMMIGRATION AND REFUGEE PROTECTION
ACT IN STEP WITH MODERN VALUES
PREAMBLE
On 16 October 2017, the House of Commons Standing Committee on Citizenship and
Immigration (the Committee) decided to undertake a study of the federal government’s
policies and guidelines regarding medical inadmissibility in the Immigration and Refugee
Protection Act. The Committee examined medical inadmissibility through the lens of
excessive demand on health and social services provision, including the exercise of
discretion.
1
During the period of 24 October to 23 November 2017, the Committee heard from
25 witnesses and received 24 written submissions.
2
The Committee wishes to thank all
witnesses who took the time to appear and share their expertise or heart-wrenching
stories with respect to the inadmissibility of persons based on medical grounds. The
Committee also expresses its thanks to the Minister of Immigration, Refugees and
Citizenship, the Honourable Ahmed Hussen, and to officials from Immigration, Refugees
and Citizenship Canada (IRCC) for making themselves available to appear before the
Committee.
INTRODUCTION
Since Confederation, Canada’s laws and regulations governing the admission of
newcomers have evolved and were shaped by the country’s changing social, political and
economic climate. The current Immigration and Refugee Protection Act
3
(IRPA) came
into force in 2002 and sets out the core principles and concepts that govern Canada’s
immigration and refugee protection programs, including provisions relating to
requirements and selection, examination and inadmissibility.
1
House of Commons Standing Committee on Citizenship and Immigration [CIMM], Minutes of Proceedings,
1
st
session, 42
nd
Parliament, 16 October 2017.
2
CIMM, Federal Government Policies and Guidelines Regarding Medical Inadmissibility of Immigrants.
3
Immigration and Refugee Protection Act [IRPA], S.C. 2001, c. 27.
8
This report discusses one type of inadmissibility to Canada, based on health grounds.
The objectives of this medical inadmissibility provision are to ensure Canada’s
population is not: a) likely to be affected by potential danger to public health; b) likely to
be affected by potential danger to public safety; or c) likely overburdened by costs to
health and social services. During its study, the Committee focused on how medical
inadmissibility is applied to people who want to become permanent residents in Canada.
The Committee heard specifically from two individuals who shared their experience of
hardship and highlighted that, even though they could work in Canada, they could not
successfully apply for permanent residency for themselves and their families due to the
medical condition of one of their family members.
Part 1 of this report provides an overview of the current application of the excessive
demand provision in Canadian law, whereas Part 2 discusses the provincial perspectives
on this provision. Part 3 highlights domestic and international human rights law in the
context of medical inadmissibility and Part 4 analyzes the issues and specific impact of
the provision on individuals. Part 5 recommends a variety of options for reforming
medical inadmissibility provisions based on potential excessive demands on health and
social services in Canada.
PART 1: MEDICAL INADMISSIBILITY – CURRENT DEFINITIONS
AND POLICIES
There are several steps to a finding of medical inadmissibility by IRCC officers as well as
options to appeal. To be allowed to enter or remain in Canada, an individual must
submit to an examination which includes, for permanent residence applicants, a medical
examination. IRPA and its regulations set out a limited number of reasons that render a
person inadmissible to Canada.
4
Of note, if an individual is accompanying a family
member that is inadmissible, that individual also becomes inadmissible.
5
The
inadmissibility based on health grounds is provided for at section 38 of IRPA:
38 (1) A foreign national is inadmissible on health grounds if their health
condition
(a) is likely to be a danger to public health;
4
IRPA, section 34 to section 42. There are 11 grounds for inadmissibility: security, violation of international
human rights, serious criminality, criminality and organized criminality, health grounds, financial grounds,
misrepresentation, cessation of refugee protection, non-compliance with the Act and accompanying a
family member who is inadmissible.
5
IRPA, section 42.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
9
(b) is likely to be a danger to public safety; or
(c) might reasonably be expected to cause excessive demand on health or
social services.
Ms. Dawn Edlund, Associate Assistant Deputy Minister at IRCC, explained to the
Committee that, while there are many potential reasons for inadmissibility, there also
exist ways for these to be waived: “Individuals can have their cases accepted on
humanitarian and compassionate grounds…or be provided with a temporary resident
permit.”
6
In 2016, for example, there were 21 temporary resident permits issued to
overcome medical inadmissibility out of 995 applications deemed inadmissible.
7
Per section 38(2) of the Immigration and Refugee Protection Act, section 38(1)(c) does
not apply in the case in the case of a foreign national who:
(a) has been determined to be a member of the family class and to be the
spouse, common-law partner or child of a sponsor within the meaning of
the regulations;
(b) has applied for a permanent resident visa as a Convention refugee or
a person in similar circumstances;
(c) is a protected person; or
(d) is, where prescribed by the regulations, the spouse, common-law
partner, child or other family member of a foreign national referred to in
any of paragraphs (a) to (c).
8
A. Medical Examinations
Ms. Edlund informed the Committee that “[h]ealth admissibility is determined through a
two-stage process.”
9
Immigration applicants undergo a medical examination performed
by a physician designated by IRCC. These doctors are referred to as panel physicians.
6
CIMM, Evidence, 24 October 2017, 0855 (Dawn Edlund, Associate Assistant Deputy Minister, Operations,
Department of Citizenship and Immigration).
7
Immigration, Refugees and Citizenship Canada [IRCC], Response to requests for information made by the
Standing Committee on Citizenship and Immigration on 24 October 2017 [Response], Question 12: Negative
Decisions Overturned; IRCC, Response, Question 1: Medically Inadmissible Applicants.
8
IRPA, section 38(2).
9
CIMM, Evidence, 24 October 2017, 0845 (Dawn Edlund).
10
Ms. Edlund stated: “We do quality assurance and various checks on those medical
professionals to make sure they’re going to do the immigration medical exam under the
standards we set out for them.”
10
These physicians are not necessarily accredited in
Canada.
Dr. Arshad Saeed, Director, Centralized Medical Admissibility Unit at IRCC, explained the
next stage: “Once the medical is done, it is sent to one of the four regional medical
offices that we have in Ottawa, New Delhi, Manila, and London. It’s reviewed by the
medical officers… Only the complicated cases are … sent to the specialized unit in
Ottawa, which is called the [C]entralized [M]edical [A]dmissibility [U]nit. We look at the
file again and then make our recommendation to the visa officer.”
11
The Centralized
Medical Admissibility Unit was created in May 2015 to allow for the development and
maintenance of a centre of expertise on the procedures and content for such cases, to
ensure standardization.
12
B. Inadmissibility Based on Health Grounds or Medical Inadmissibility
Under IRPA, a person may be found inadmissible to Canada for three reasons with
regards to their health, as stated above.
13
The first reason is that they may have a health
condition that “is likely to be a danger to public health.” Ms. Dawn Edlund of IRCC told
the Committee that this refers to highly communicable diseases such as active
tuberculosis or untreated syphilis.
14
The department provided to the Committee further information on treatments available
to those found with active tuberculosis or syphilis. Most individuals accept treatment
and will be able to resume their permanent residence application. Syphilis is treated
with antibiotics, usually requiring three visits to a clinic over a two-week period. There
have been no recent refusals because of this condition. For tuberculosis, there is a six-
month course of treatment and the medical officer must be satisfied that the person is
10
Ibid., 0905.
11
CIMM, Evidence, 24 October 2017, 1005 (Dr. Arshad Saeed, Director, Centralized Medical Admissibility Unit,
Migration Health Branch Department of Citizenship and Immigration).
12
IRCC, Response, Question 8: Processing of Medically Inadmissible Cases.
13
IRPA, section 38.
14
CIMM, Evidence, 24 October 2017, 0845 (Dawn Edlund). IRCC states that the classification of medical
conditions is based on the International and Statistical Classification of Diseases (ICD) 9/10 established by
the World Health Organization. (Response, Question 20: Autism Cases).
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
11
no longer infectious to others.
15
As of 27 October 2017, there were 435 cases on hold
pending completion of the treatment of tuberculosis.
16
Once such individuals are
admitted to Canada, they are referred to their provincial authority for medical
surveillance. From 2014 to September 2017, there were a total of 1,934 cases of treated
inactive pulmonary tuberculosis in persons applying to come to Canada. There were a
total of 23 refusals for permanent residence based on danger to public health for the
period between 2013 and 2016.
17
It should be noted that none of the witnesses called
for the repeal of section 38(1)(a).
The second reason that an individual may be found medically inadmissible is that they
may have a health condition that “is likely to be a danger to public safety”. Ms. Edlund
stated that “this may include certain health conditions that could result in unpredictable
or violent behaviour.”
18
It should be noted that none of the witnesses called for the
repeal of section 38(1)(b).
The third reason that triggers a finding of medical inadmissibility is if the person’s health
condition “might reasonably be expected to cause excessive demand on health or social
services.”
19
There are many elements to this particular finding of inadmissibility, which
are discussed in detail below.
C. Excessive Demand on Health and Social Services
The Immigration and Refugee Protection Regulations
20
define excessive demand as well
as health and social services for the purposes of medical inadmissibility. Ms. Edlund
informed the Committee that the total number of medical recommendations of
potential excessive demand represent, in any given year, 0.2% of all applications
(between 900 to 1000 individuals).
21
This represents savings of at least $135 million over
five years, for each year of decision,
22
not including modeling for those who already self-
deselect. The number of final refusals is even lower because the applicant may withdraw
15
There are strains of tuberculosis for which appropriate treatment can last two years or longer. IRCC,
Response, Question 17: Active Tuberculosis and Syphilis.
16
IRCC, Response, Question 18: Tuberculosis Cases on Hold.
17
IRCC, Response, Question 17: Active Tuberculosis and Syphilis.
18
CIMM, Evidence, 24 October 2017, 0845 (Dawn Edlund).
19
IRPA, section 38(1)( c).
20
Immigration and Refugee Protection Regulations (IRPR), section 1.
21
CIMM, Evidence, 24 October 2017, 0855 (Dawn Edlund).
22
Ibid., 0850.
12
their application; the visa officer may choose to accept the mitigation plan proposed by
the applicant; the applicant may be accepted under humanitarian grounds; or the visa
officer may refuse the applicant on another, non-health-related, ground.
23
It should be noted that, under section 38(2) of IRPA, Convention refugees
24
and
protected persons, as well as spouses and children part of a family sponsorship
application, are exempted from medical inadmissibility based on excessive demand.
25
It applies only to economic applicants and their family members, including live-in
caregivers, provincial nominees, parents and grandparents, students, foreign workers
and temporary residents.
1. Basic Definitions to Excessive Demand
The Immigration and Refugee Protection Regulations set out two types of potential
excessive demand: one is based on “the cost threshold” to access health and social
services and the other on “wait lists” for life saving treatments.
First, applicants are deemed inadmissible if the predicted five-year cost of the health
and social services required to treat their specific health condition would likely exceed
“the cost threshold” understood to be the average Canadian per capita cost which in
2017 was $33,275 over a five-year period.
26
The cost threshold is calculated by using the
latest per capita national expenditure on health and social services reported by the
Canadian Institute for Health Information (CIHI) plus a per capita supplement for “other
social services” not included in CIHI’s report that was determined in 2004 by the Medical
Branch of IRCC, updated annually to reflect inflation.
27
Second, applicants are inadmissible if their health could place a demand on health
services or social services that would add to existing wait lists and could potentially
increase the rate of mortality and/or morbidity in Canada as a result of an inability to
23
IRCC, Response, Context and definitions to explain IRCC data and responses.
24
A total of 26,172 Syrians were resettled in Canada between 4 November 2015 and 29 February 2016. Data
provided by IRCC on their use of the Interim Federal Health Program (IFHP) for their first year showed that
dental care (40%), drugs (28%) and medical care (11%) were the services most accessed. The total cost to
the federal government for all the health care services accessed by those individuals during their first year
in Canada was $22.3 million. IRCC, Response, Question 25: Syrian Initiative—IFHP Utilization.
25
IRPA, section 38(2).
26
IRCC, Response, Question 21: Inadmissibility Based on Costs versus Wait Times.
27
CIMM, Evidence, 24 October 2017, 0915 (Dawn Edlund); IRCC, Response, Questions 5, 11, 12—Cost
Threshold and Supplemental Social Services Amount.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
13
provide timely services to Canadian citizens or permanent residents. At this time, IRCC
medical officers only have data on wait lists for dialysis and some transplantation
services.
28
Health services that are publicly funded services include hospital care,
laboratory services and drugs, services of family physicians, specialists, nurses,
chiropractors and physiotherapists. Social services for the purposes of determining
admissibility include services such as home care, specialized residence and residential
services, special education services, social and vocational rehabilitation services,
personal support services and the provision of devices related to those services for
which the majority of the funding is through government or publicly funded agencies.
29
2. Next Steps after Medical Officers Advise Visa Officers of Excessive Demand
When an individual’s case is reviewed by medical officers in Ottawa in the Centralized
Medical Admissibility Unit, “a medical officer assesses the severity of the illness and the
degree of service that would be required to treat it.”
30
Medical officers must list the
anticipated social services and/or outpatient medication required, based on a detailed
assessment, recommendations provided by a recognized specialist in the field and the
experience and knowledge of the medical officer.
31
Medical officers are instructed to
identify the estimated costs for the health and social services related to an individual’s
medical diagnosis, generally for the five years following the medical examination.
32
Upon receiving the medical officer’s opinion, the visa officer then sends a “Procedural
Fairness” letter to the applicant. The letter’s content must include the relevant sections
of IRPA, the right to challenge the findings, and the specific social services and
outpatient medication that were identified and were the basis of the finding of medical
inadmissibility. The letter must also indicate that the applicant may provide a plan to
obtain all the services and manage the costs personally or provide an alternative plan.
33
The plan provided by an applicant deemed inadmissible because of excessive demand is
called a “mitigation plan.” Dr. Saeed explained that “[i]f they have a detailed plan, we
look at the feasibility, the practicality, and the applicability of the plan in a Canadian
28
IRCC, Response, Question 21: Inadmissibility Based on Costs versus Wait Times.
29
IRPR, section 1.
30
CIMM, Evidence, 24 October 2017, 0855 (Dawn Edlund).
31
IRCC, Instructions related to Procedural Fairness (Excessive Demand), “Instructions for medical officers”.
32
IRCC, Response, Question 3: Avoided Costs.
33
IRCC, Instructions related to Procedural Fairness (Excessive Demand), “Instructions for visa/immigration
officers”.
14
context. That is done, and then we provide our opinion to the visa officer to make the
final decision.”
34
Ms. Edlund told the Committee that IRCC, however, has “no authority
to enforce that mitigation plan once someone becomes a permanent resident.”
35
3. Cost-Benefit Analysis
Officials from IRCC told the Committee that using the data from 2014, which is the first
year when health data was consistently captured by IRCC under its new Global Case
Management System,
36
“the excessive demand provision results in avoided costs for
provincial-territorial health and social services [in] the order of $135 million over five
years, for each year of decision.”
37
For example, this amount would represent 0.1% of all
the provincial and territorial health spending in 2015.
38
IRCC uses findings from medical
officers, rather than final decisions by visa officers to establish the savings to the
province of destination.
39
Actual savings are not known and were not provided to the
Committee. However, the Committee notes that anecdotal evidence provided by the
Government of New Brunswick,
40
and no other province, highlights the dearth of
evidence to the potential increase of cost due to the repeal of the excessive demand
provision.
In response to questions from the Committee, Ms. Edlund indicated that the evaluation
process does not consider the economic benefit of having the family in Canada as
permanent residents and the contribution to the economy that would be lost should the
family be denied.
41
Australia had attempted to undertake such an evaluation.
Mr. Michael Mackinnon, Senior Director, Migration Health Policy and Partnerships at
IRCC, explained that “[Australia] found it was unworkable because it involved too many
unsupportable assumptions as to what the individual’s employment trajectory or income
34
CIMM, Evidence, 24 October 2017, 0920 (Dr. Arshad Saeed).
35
CIMM, Evidence, 24 October 2017, 1040 (Dawn Edlund).
36
IRCC, Response, Context and definitions to explain IRCC data and responses.
37
CIMM, Evidence, 24 October 2017, 0850 (Dawn Edlund).
38
Ibid.
39
IRCC, Response, Question 3: Avoided Costs.
40
The Government of New Brunswick stated that, in 2014, it had “fewer than five cases constituting an
excessive burden [which] would have resulted in costs totalling $297,000 if the individuals had been
admissible to Canada.” Government of New Brunswick, Letter, 20 November 2017, p. 1.
41
CIMM, Evidence, 24 October 2017, 0925 (Dawn Edlund).
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
15
would be over the years following their arrival, so they abandoned this approach.”
42
Additionally, IRCC provided the Committee with an estimated cost of $800,000 to
$1,100,000 per year to run the entire administrative process related to the application of
section 38(1)(c) of IRPA, especially in regards to determining excessive demand.
43
PART 2: EXCESSIVE DEMAND: A MULTI-JURISDICTIONAL ISSUE
As per Canada’s Constitution, health care and social services are under provincial
jurisdiction,
44
whereas immigration is a shared competency.
45
In October 2016, the
Minister of Immigration, Refugees and Citizenship and the department began a
“fundamental review of the excessive demand provision” by consulting with their
provincial and territorial counterparts.
46
There was an initial teleconference among all
federal, provincial and territorial ministers responsible for immigration that introduced
the review. This allowed provincial and territorial ministers to consult with their
colleagues responsible for health, education and social services on the impact of the
excessive demand provision.
47
Subsequently, the Minister of Immigration, Refugees and
Citizenship met again with his provincial and territorial counterparts who were given an
opportunity to raise specific concerns.
48
IRCC told the Committee that the department is considering a “range of possible
changes” under this review, but “has not provided provincial officials with specifics.”
49
Ultimately, IRCC has “shared potential areas of change with provinces and territories
[which include] possible adjustments to the cost threshold, changes in the groups
exempted from the provision, redefining the services under consideration, or
42
CIMM, Evidence, 24 October 2017, 0855 (Michael MacKinnon, Senior Director, Migration Health Policy and
Partnerships, Migration Health Branch, Department of Citizenship and Immigration).
43
The estimated cost includes assessments, litigation of cases and policy work related to the provision. It does
not include visa officers’ costs given the relatively small volume of cases these represent relative to overall
file volumes. IRCC, Response, Question 26: Processing Costs.
44
Constitution Act, 1867, section 92(7).
45
Constitution Act, 1867, sections 91(25) and 95. The federal law supersedes the provincial law, in case of
conflict. CIMM, Evidence, 20 November 2017, 1905 (Lorne Waldman, Barrister and Solicitor, Lorne
Waldman and Associates, as an individual).
46
CIMM, Evidence, 24 October 2017, 0850 (Dawn Edlund); CIMM, Evidence, 22 November 2017, 1220
(Hon. Ahmed Hussen, Minister of Immigration, Refugees and Citizenship, House of Commons).
47
CIMM, Evidence, 22 November 2017, 1300 (Hon. Ahmed Hussen).
48
Ibid., 1230; Government of British Columbia, Letter, 22 November 2017.
49
IRCC, Response, Question 9: Exempt Groups Expansion.
16
enhancements in how wait lists are considered.”
50
These consultations allow the
provinces and territories to evaluate the impact of these possible changes on their
health care and social services systems.
51
The Minister emphasized that “consultations
with provinces and territories have been ongoing” and that “provinces and territories
were very supportive of the review.” According to the Minister, “some provinces are little
apprehensive about the costs they think they’ll have to incur, but they do agree with the
general premise that we need to bring this provision in line with our other accepted
policies with respect to moving towards an inclusive approach towards people
with disabilities.”
52
A. Provincial and Territorial Perspectives
As part of its study, the Committee invited the provinces and territories to hear their
perspective on the excessive demand provision and its impact on their health and social
services. At the time of writing, British Columbia, Saskatchewan, New Brunswick,
Newfoundland and Labrador, Nunavut and Yukon wrote to the Committee to highlight
their concerns and recommendations.
The Government of Saskatchewan cautioned against any changes to the excessive
demand policy because it would “transfer a large and growing risk to provinces and
territories and the services they deliver.”
53
For example, there will be additional costs for
health, education and social services that would have to be borne by taxpayers and
employers.
54
These increased costs could impact the level and quality of services; wait
times; health, economic and social outcomes of all individuals; and difficulty in meeting
existing commitments as well, including for persons with disabilities and those with
additional needs.
55
As such, the Government of Saskatchewan recommended
“maintaining the current policy related to medical inadmissibility” because it “is the best
option for ensuring that Canadians continue to have timely and quality access to health,
education and social services.”
56
The Government of Saskatchewan considered that
excessive demand cases could increase with a change in policy and that public support
for Canada’s immigration system could decrease if the excessive demand provision was
50
CIMM, Evidence, 22 November 2017, 1220 (Hon. Ahmed Hussen).
51
Ibid., 1220.
52
Ibid., 1230.
53
Government of Saskatchewan, Letter, 20 November 2017, p. 2.
54
Ibid.
55
Ibid., p. 1.
56
Ibid.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
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17
repealed.
57
The Government of New Brunswick also considered that excessive demand
cases could increase with a change in policy.
58
By contrast, the Government of Newfoundland and Labrador recognized that the
excessive demand provision is an unfair and unjust assessment of all the immigrant
applicants’ long-term contributions to Canada.
59
The province indicated its support for
removing the provision, but called for the federal government to take all financial
impacts into account and collaborate with provinces and territories to address them.
60
The Government of Nunavut informed the Committee that “there is little risk of
excessive demand on health and social services” from immigrants to the territory.
61
Newcomers to Nunavut come from elsewhere in Canada “having already secured
employment” in the territory or are already Canadian citizens.
62
In addition, the
territorial government does not foresee an increase in immigration to the territory in the
near future. The Government of Yukon echoed those comments.
63
It added that the
territory recently eliminated the wait period for refugees to access health care insurance
and extended health care insurance to Syrian refugees immediately upon their arrival to
the territory.
64
This has not resulted in excessive demands to the territory’s health and
social services, but the Government of Yukon has seen the benefits of immigration
through the contributions of newcomers in the health and social service workforce.
65
The Government of British Columbia informed the Committee that they had “had the
opportunity to share [British Columbia]’s position in writing with department officials
and in-person at the Forum of Ministers Responsible for Immigration” and, as of 27
November 2017, had “no additional comments on this matter.”
66
The four provinces and two territories emphasized the importance of consultation and
collaboration on the fundamental review of the excessive demand provision led by the
57
Ibid., pp. 2–3.
58
Government of New Brunswick, Letter, 20 November 2017, p. 1.
59
Government of Newfound and Labrador, Written submission.
60
Ibid.
61
Government of Nunavut, Letter, 14 November 2017.
62
Ibid.
63
Government of Yukon, Letter, 15 November 2017
64
Ibid.
65
Ibid.
66
Government of British Columbia, Letter, 22 November 2017.
18
federal government. The Government of Newfoundland and Labrador acknowledged
that the review and consultation are “key to the development of a constructive solution
that supports the interests of all current and future Canadians.”
67
Mr. Lorne Waldman,
Barrister and Solicitor at Lorne Waldman and Associates, reiterated the importance of
collaboration because immigration is a shared responsibility and medical expenditures
are under provincial jurisdiction.
68
B. Costs of Health and Social Services
In order to ensure fairness among provinces, the federal government, through
equalization payments, attempts to guarantee that the standards of health, education
and welfare are the same for everyone in Canada.
69
The Canadian Institute for Health
Information (CIHI) reported that health care
expenditures per person vary across the country from $7,378 in Newfoundland and
Labrador and $7,329 in Alberta, to $6,367 in Ontario and $6,321 in British Columbia [as
shown in Figure 1]. This variation across the country occurs for many reasons, including
differences in population demographics and health status, prescribing practices, public
program design, and other factors.
70
67
Government of Newfound and Labrador, Written submission.
68
CIMM, Evidence, 20 November 2017, 1905 (Lorne Waldman).
69
Constitution Act, 1982, section 36.
70
CIMM, Evidence, 20 November 2017, 1845 (Brent Diverty, Vice-President, Programs, Canadian Institute for
Health Information).
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19
Figure 1: Health expenditure in Canada in 2017, by province and territory
Source: Canadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2017.
CIHI identified hospitals, drugs, and physician services as the three main drivers of
health expenditures,
71
whereas inflation, population growth and population aging are
the three main health cost drivers.
72
Of note, the share allocated to hospital spending
has been decreasing, whereas the share allocated to drug spending has increased in
71
According to the report National Health Expenditure Trends, 1975 to 2017 produced by the Canadian
Institute for Health Information [CIHI], hospitals (28.3%), drugs (16.4%) and physician services (15.4%)
account for more than 60% of total health spending. CIHI estimates that in 2017 there will be a growth
of 3% in hospital spending, a 5% growth in drug spending and a 4% growth in physician spending.
72
CIMM, Evidence, 20 November 2017, 1845 (Brent Diverty).
20
recent years.
73
CIHI also reported that even though health spending is higher for seniors
than any other demographic group, population aging is a modest cost driver.
74
Nevertheless, Professor Arthur Sweetman from McMaster University pointed out to the
Committee that there are “no good measures of actual demand or costs for such [health
and social] services by the sub-set of potential immigrants who are at risk of being
adjudicated as excessive cost or risk.”
75
He encouraged the federal government to track
the cost of its decisions and, if there are increases in costs borne by provincial
governments, to fund those increases.
76
Essentially, his comments echo some provinces’
concerns in regards to funding those potential additional costs.
77
Professor Sheila Bennett from Brock University also emphasized that the education system
distributes costs differently than the health system.
78
She pointed out that within each
province school boards distribute costs differently; some self-contain the cost, while others
extrapolate it over the entire school population.
79
According to her, “some provinces
extrapolate it across the entire province.”
80
She argued that it is important that all children
with diverse physical, cognitive, social, or emotional abilities have access to differentiated
learning and opportunities support systems. This can lead to additional costs for particular
schools but it also is an added social benefit to the entire population.
81
C. Provincial Engagement
Mr. Waldman informed the Committee that, in the past, at least some provinces covered
the costs of an individual’s needs that were deemed to create an excessive demand on
73
Ibid.
74
More specifically, “the share of public-sector health care dollars spent on Canadian seniors has not changed
significantly over the past decade—from 44.3% in 2005 to 46.0% in 2015. During the same time period, the
percentage of seniors in the population grew from 13.1% to 16.1%.” Canadian Institute for Health
Information, National Health Expenditure Trends, 1975 to 2017, p. 27.
75
CIMM, Evidence, 21 November 2017, 0905 (Arthur Sweetman, Professor, Department of Economics,
McMaster University, as an individual).
76
Ibid.
77
Government of Saskatchewan, Letter, 20 November 2017, p. 2; Government of Newfound and Labrador,
Written submission.
78
CIMM, Evidence, 21 November 2017, 0920 (Sheila Bennett, Faculty of Education, Brock University, as an
individual).
79
Ibid.
80
Ibid.
81
Ibid.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
21
health care and social services.
82
He gave the example of Manitoba, which “had a
scheme where you could pay an amount of money as a bond for future expenditures.”
83
Manitoba no longer has that bond program, but Mr. Waldman suggested it was possible
to “look for compromises in terms of people offering to pay bonds or provinces agreeing
to allow people to come into Canada.”
84
Ms. Edlund also informed the Committee that
provinces could, through an ad hoc process, support an individual that has an
application deemed inadmissible due to a finding of excessive demand through the
Provincial Nominee Programs.
85
She explained that the provinces can write a letter to
IRCC recognizing the excessive demand, but stating that they support the applicant.
86
The letter is then taken into consideration by IRCC’s
decision-making officers. Frequently at that point the family ends up with a temporary
resident permit. Once they’re on a temporary resident permit for three years running,
they can be granted permanent residency, with no further look at the medical
admissibility.
87
Ms. Edlund further noted that IRCC does not share “individual cases with the provinces”
for privacy reasons.
88
The provinces can only “become aware that there is an excessive
demand angle to the file” of its provincial nominees through the applicants themselves,
at which point they can turn to IRCC for collaboration.
89
In this context, Mr. Michael
Battista and Ms. Adrienne Smith, from Jordan Battista LLP, provided to the Committee
the example of a provincial nominee in British Columbia that was refused based on
excessive demand grounds. The province was not consulted “regarding its interest in
absorbing the cost of his health condition in exchange for his contribution to the local
economy” before the final decision was rendered.
90
Ms. Meagan Johnston, from HIV & AIDS Legal Clinic Ontario, was also concerned with
the “unfairness of the [excessive demand] provision” and the “unworkability of the
82
CIMM, Evidence, 20 November 2017, 1905 (Lorne Waldman).
83
Ibid.
84
Ibid.
85
CIMM, Evidence, 24 October 2017, 0940 (Dawn Edlund).
86
Ibid.
87
Ibid.
88
Ibid., 1035.
89
Ibid.
90
Michael Battista and Adrienne Smith, Written submission, p. 5.
22
system.”
91
According to her, provinces should not have “additional mechanisms to sort of
circumvent [the] discrimination” created by the excessive demand provision because
these will not be fairly applied throughout the country.
92
Mr. John Rae, First Vice-Chair of
the Council of Canadians with Disabilities, also warned the Committee that such
schemes “could set up a patchwork of eligibility province to province.”
93
PART 3: A HUMAN RIGHTS PERSPECTIVE ON MEDICAL
INADMISSIBILITY
Section 3(3) of IRPA states that the Act is to be applied in a manner “consistent with the
Canadian Charter of Rights and Freedoms, including its principles of equality and
freedom from discrimination”
94
and in compliance “with international human rights
instruments to which Canada is a signatory”.
95
Nevertheless, many witnesses who
appeared before the Committee or who provided written submissions argued that IRPA’s
medical inadmissibility provision based on excessive demand violated basic domestic
and international human rights.
96
The Canadian Charter of Rights and Freedoms
97
applies to everyone physically present in
Canada.
98
Section 15 states that every individual has the right to equal benefit of the law
91
CIMM, Evidence, 20 November 2017, 2010 (Meagan Johnston, Staff Lawyer, HIV & AIDS Legal Clinic
Ontario).
92
Ibid.
93
CIMM, Evidence, 20 November 2017, 1905 (John Rae, First Vice-Chair, Council of Canadians with
Disabilities).
94
IRPA, section 3(3)(d).
95
IRPA, section 3(3)(f).
96
CIMM, Evidence, 21 November 2017, 0850 (Roy Hanes, Associate Professor, School of Social Work, Carleton
University, Council of Canadians with Disabilities); CIMM, Evidence, 21 November 2017, 0925 (Sheila
Bennett); Ibid., (Arthur Sweetman).Felipe Montoya Written submission, p. 5; Michael Battista and Adrienne
Smith, Written submission, p. 6; Canadian HIV/AIDS Legal Network and HIV & AIDS Legal Clinic Ontario
[Legal Network and HALCO], Written submission, pp. 3-5; Joshua Goldberg, Letter, 13 November 2017, p. 2;
Community Living Kingston and District and PooranLaw Professional Corporation [CLKD and PooranLaw],
Written submission, pp. 1-3; Disability Positive, Written Submission, p. 2; Canadian Association for
Community Living, Written submission, p. 2; Macdonald Scott, Carranza LLP, Written submission, pp. 1-2 ;
Council of Canadian with Disabilities, Written submission, pp.8-9; Claire Kane Boychuk, Written submission,
p. 24; OCASI-Ontario Councils of Agencies Serving Immigrants, Chinese and Southeast Asian Legal Clinic and
South Asian Legal Clinic of Ontario [OCASI, CSALC and SALCO], Written Submission, pp. 3,6; Migrant Workers
Alliance for Change and Caregivers’ Action Centre [MWAC and CAC], Written Submission, p. 1; A.J. Withers
with Alex Tufford, Written Submission, pp. 5-7; Repeal 38(1)c Coalition, Written Submission, p. 1.
97
Canadian Charter of Rights and Freedoms, Schedule B to the Constitution Act 1982, Part 1.
98
Singh v. Canada (Minister of Employment and Immigration), [1985] 1 SCR 177.
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23
without discrimination based on mental or physical disability. While our immigration
system is selective, discrimination only occurs when a distinction is made in relation to
personal characteristics of an individual or a group of individuals, based on protected
grounds,
99
which imposes obligations or disadvantages that are not imposed on others.
Within this context, witnesses gave the Committee two examples where discrimination
is apparent in the immigration policies. In the first, they highlighted that individuals
found to be inadmissible on health grounds are not treated equally: they may challenge
IRCC’s findings, however an individual who cannot afford medical experts to produce
additional evidence will not be successful.
100
In the second, discrimination is seen in
access to the immigration programs. Individuals with disabilities or medical conditions
cannot put forward their application through Express Entry like most other economic
applicants. This intake system does not allow for applications based on humanitarian
grounds, which a person with a medical inadmissibility finding would need to present to
overcome the decision.
101
Mr. Felipe Montoya, professor at York University on a temporary work permit who faced
medical inadmissibility because of his son’s disability when he applied for permanent
residence for him and his family, also referred the Committee to the Canadian Human
Rights Act.
102
Among the prohibited grounds of discrimination are disability and genetic
characteristics. It is particularly relevant to Mr. Montoya’s application as his son with
Down syndrome had triggered a finding of medical inadmissibility for the entire family.
Witnesses’ human rights concerns also extended to violations of international human
rights law. In particular, they referenced the United Nations Convention on the Rights of
Persons with Disabilities (CRPD),
103
which is different from other UN human rights
conventions in that it outlines key steps and actions that Canada should take to promote
and protect the human rights of people with disabilities.
104
Professor Roy Hanes of the
School of Social Work at Carleton University highlighted to the Committee that the
99
Canadian Charter of Rights and Freedoms. Section 15(1) lists these grounds of discrimination: race, national
or ethnic origin, colour, religion, sex, age or mental or physical disability.
100
OCASI, CSALC and SALCO, Written Submission,p. 4 ; Macdonald Scott, Carranza LLP, Written submission,p. 2;
A.J. Withers with Alex Tufford, Written Submission, p. 3.
101
Macdonald Scott, Carranza LLP, Written submission, pp. 1-2.
102
Canadian Human Rights Act, R.C.S, 1985, c.H-6; CIMM, Evidence, 21 November 2017, 0955 (Felipe Montoya,
as an individual).
103
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) was ratified by Canada in
2010. It is binding, creating obligations for Canada.
104
Julian Walker, The United Nations Convention on the Rights of Persons with Disabilities: An Overview,
Publication No. 2013-09-E, Library of Parliament, Ottawa, 27 February 2013, p. 1.
24
Preamble offered the only definition of disability in the Convention: “disability is an
evolving concept and that disability results from the interaction between persons with
impairments and attitudinal and environmental barriers that hinders their full and
effective participation in society on an equal basis with others.” Witnesses
105
referred to
Article 3 which outlines the key principles of the CRPD such as non-discrimination; full
and effective inclusion in society; respect for difference and acceptance of persons with
disabilities as part of human diversity and humanity; and equality of opportunity. They
also referred to Article 4 that lists the obligations that Canada has undertaken “to ensure
and promote the full realization of all human rights and fundamental freedoms for all
persons with disabilities without discrimination of any kind on the basis of disability.”
These include adopting legislation and policies, or abolishing those that are
discriminatory, as well as to refrain from engaging in any act or practice that is
inconsistent with the Convention. Ms. Claire Kane Boychuk pointed to Article 5 on
equality and non-discrimination that specifically applies to non-citizens engaging with
the immigration system. It captures indirect discrimination, such as a decision based on
costs, as in reality persons with disabilities are disproportionally impacted by such
legislation.
106
Mr. Maurice Tomlinson, of the Canadian HIV/AIDS Legal Network, told the
Committee that the UN has a formal mechanism to monitor Canada’s progress in
implementing the CRPD
107
and the Committee expresses its support for Canada’s full
implementation of the CRPD.
In the United Nations Convention on the Rights of the Child
108
the principle of non-
discrimination on the basis of disability is provided for at Article 2, while it is specified
that the best interest of the child must be a primary consideration in all state actions
(Article 3). Witnesses focused on Article 9, which states that children should not be
separated from their parents, whereas IRPA’s caregiver program and temporary foreign
worker program often create this situation.
109
Witnesses also underlined Article 24,
which enshrines the right for children to attain the highest standard of health, and not to
be deprived access to health services.
110
105
Disability Positive, Written Submission, p.2; Legal Network and HALCO, Written submission, pp. 3-5.
106
Claire Kane Boychuk, Written submission, pp. 24-26.
107
Maurice Tomlinson, Senior Policy Analyst, Canadian HIV/AIDS Legal Network , Speaking Notes, p. 1; UN
Committee on the Rights of Persons with Disabilities, Concluding observations on the initial report of
Canada, 8 May 2017, CRPD/C/Can/CO/1. In relation to Article 5 on equality and non-discrimination, the UN
Committee suggests Canada include legislation with remedies for migrants with disabilities.
108
The Convention on the Rights of the Child was ratified by Canada in 1991.
109
A.J. Withers with Alex Tufford, Written Submission, p. 6.
110
Ibid.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
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25
Mr. Macdonald Scott, of Carranza LLP, also emphasized that Article 12 of the
International Covenant on Economic, Social and Cultural Rights
111
establishes an
obligation for Canada to recognize everyone’s rights to the “highest attainable standard
of physical and mental health” as well as to assist them in that goal.
112
PART 4: ISSUES WITH THE EXCESSIVE DEMAND PROVISION
A number of witnesses indicated to the Committee the serious consequences of a
medical inadmissibility finding, especially when immigrating as a family.
113
The
Committee also heard that challenges persist within Canada’s immigration law,
particularly in regards to people with disabilities.
114
Part 4 provides an overview of the
individuals captured by the excessive demand provision as well as the specific impact of
this provision on their ability to enter or reside in Canada.
A. Individuals Captured by the Excessive Demand Provision
In response to a question from the Committee about what triggers a finding of medical
inadmissibility based on excessive demand, IRCC commented that “there is no specific
medical diagnosis that renders a case as medically inadmissible. Medical assessments for
each individual applicant are done on a case-by-case basis.”
115
This individual
assessment obligation stems from the 2005 Supreme Court of Canada decision in
Hilewitz v. Canada, where the court “held that immigration and medical officers have an
obligation to assess a family’s ‘ability and intent’ statement”
116
in the case of a finding of
excessive demand.
117
This statement or mitigation plan provides proof to the decision-
maker that alternatives to the public resources will be used.
111
The International Covenant on Economic, Social and Cultural Rights came into force in Canada in 1976.
112
Macdonald Scott, Carranza LLP, Written submission, p.1.
113
Canadian Bar Association, Written submission, November 2017, p. 1, Legal Network and HALCO, Written
submission, p. 7; CIMM, Evidence, 21 November 2017, 0950 (Felipe Montoya), CIMM, Evidence,
20 November 2017, 1955 (Mercedes Benitez, as an individual).
114
Centre for Israel and Jewish Affairs, Written submission, p. 1; CLKD and PooranLaw, Written submission,
p. 1; CIMM, Evidence, 20 November 2017, 1835 (Lorne Waldman); CIMM, Evidence, 20 November 2017,
1840 (John Rae); CIMM, Evidence, 21 November 2017, 0950 (Felipe Montoya), CIMM, Evidence,
20 November 2017, 1955 (Mercedes Benitez).
115
IRCC, Response, Question 23: Excessive Demand cases refused by medical diagnoses, immigration category
and amount over the cost threshold.
116
Claire Kane Boychuk, Written submission, p. 8.
117
Hilewitz v. Canada (Minister of Citizenship and Immigration); De Jong v. Canada (Minister of Citizenship and
Immigration), [2005] 2 S.C.R. 706, 2005 SCC 57.
26
IRCC officials informed the Committee that between 2013 and 2016, 3,960 medical
examinations triggered a medical inadmissibility finding – the majority (78%) of those
examinations were for permanent residence applications.
118
Of the 3,960 cases deemed
inadmissible, 557 were for asymptomatic HIV positivity, 500 for chronic renal failure and
447 for intellectual disabilities.
119
It is important to note that cases deemed inadmissible
at the medical evaluation stage are not yet considered refused. After receiving a
procedural fairness letter, the applicant can, for example, submit a mitigation plan or the
visa officer making the final decision can accept the applicant on humanitarian grounds.
As such, from 2013 to 2016, a total of 1,444 permanent residence applications were
refused based on the excessive demand provision.
120
More specifically, 224 were for
chronic renal failure, 163 for intellectual disabilities and 133 for asymptomatic HIV
positivity.
121
Figure 2 provides this information for the top 10 primary medical diagnoses
recorded by IRCC between 2013 and 2016.
118
IRCC, Response, Question 1: Medically Inadmissible Applicants.
119
The total of cases for each year were 1,237 in 2013; 1,060 in 2014; 668 in 2015; and 995 in 2016. IRCC,
Response, Question 2: Diagnosis of Medically Inadmissible Cases.
120
The total of cases for each year were 593 in 2013; 455 in 2014; 206 in 2015; and 190 in 2016. IRCC,
Response, Question 23: Excessive Demand cases refused by medical diagnoses, immigration category and
amount over the cost threshold.
121
IRCC, Response, Question 23: Excessive Demand cases refused by medical diagnoses, immigration category
and amount over the cost threshold.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
27
Figure 2 – Top 10 primary medical diagnoses: cases deemed inadmissible
during Immigration Medical Examinations for all types of immigration
applications versus refused cases for permanent residence applications
(based on medical assessments conducted in 2013 to 2016)
Source: Chart created by the authors using Immigration, Refugees and Citizenship Canada’s response to
requests for information made by the Standing Committee on Citizenship and Immigration on
October 24, 2017 (Question 1: Medically Inadmissible Applicants, Question 2: Diagnosis of
Medically Inadmissible Cases and Question 23: Excessive Demand cases refused by medical
diagnoses, immigration category and amount over the cost threshold)
According to witnesses, it is the prospective economic class immigrants that are most
affected by the excessive demand provision.
122
Noting that the final number of
permanent residence applications refused based on the excessive demand provision
totaled 1,444 from 2013 to 2016 (for an average of 361 per year), witnesses argued that
this represents a statistically insignificant fraction of the future users of health and social
service and that these individuals will have an insignificant impact on wait times or
122
Legal Network and HALCO, Written submission, p. 6.
557
500
447
250
233
158
137
124
117
108
133
224
163
124
118
68
51
30
39
31
0
100
200
300
400
500
600
Number of Immigration Medical Examinations found inadmissible for all types of immigration
applications
Number of permanent residence applications refused based on health grounds
28
morbidity rates.
123
However, Professor Sweetman warned that a small number of users
can make a great deal of difference to total costs.
124
He provided as an example the fact
that 1.5% of Ontario’s population represents 5% of those with the highest health costs
because they incur about 61% of the total hospital and home care costs.
125
Witnesses argued that people with disabilities and medical conditions are captured by
the excessive demand provision because a disability lens is not applied to Canada’s
immigration policy. Ms. Kane Boychuk noted that IRPA and the federal government’s
policies and guidelines regarding medical inadmissibility
are informed by a medical
model of understanding disability.
126
According to her, under a medical model, “persons
with disabilities are seen as objects of charity, medical treatment and social
protection”
127
or, as other witnesses articulated, as a burden to society.
128
She, along
with other witnesses, advocated for a “social model of disability” where persons with
disabilities are socially included and empowered, which leads to a sense of belonging as
an individual and valuing their contributions to society.
129
Additionally, two witnesses
highlighted that attitudes of exclusion and segregation and their associated policies
towards persons with disabilities are maintained by the medical model applied in the
legislation and “are the antithesis of Canadian values.”
130
For these witnesses, Canada
should no longer maintain an excessive demand provision under IRPA.
Some witnesses provided how other countries have been successful in repealing the
excessive demand provision. Specifically, Mr. Tomlinson informed the Committee that
123
CIMM, Evidence, 20 November 2017, 1840 (John Rae); CIMM, Evidence, 20 November 2017, 1905 (Lorne
Waldman); CIMM, Evidence, 20 November 2017, 1920 (Brent Diverty); Claire Kane Boychuk, Written
submission, p. 29; Disability Positive, Written Submission, p. 2.
124
CIMM, Evidence, 21 November 2017, 0905 (Arthur Sweetman).
125
Ibid.
126
Claire Kane Boychuk, Written submission, pp. 20–21; The Canadian Association for Community Living in their
written submission added that “the focus in the medical model is to ‘fix’ the persons with a disability so that
they will function more ‘normally’ in society.”
127
Claire Kane Boychuk, Written submission, pp. 20–21.
128
Claire Kane Boychuk, Written submission, p. 17; CIMM, Evidence, 21 November 2017, 0850 (Roy Hanes);
Macdonald Scott, Carranza LLP, Written submission, p. 2; Felipe Montoya, Written submission, p. 2;
Canadian Association for Community Living, Written submission, p. 2; MWAC and CAC, Written Submission,
p. 2; OCASI, CSALC and SALCO, Written Submission, p.3.
129
Claire Kane Boychuk, Written submission, pp. 20–21; Joshua Goldberg, Letter, 13 November 2017, p. 2;
Chun Chu, Letter, 17 November 2017, p. 2; CLKD and PooranLaw, Written submission, p. 1; Disability
Positive, Written Submission, p. 2; Canadian Association for Community Living, Written submission, p. 2;
MWAC and CAC, Written Submission, p. 2; OCASI, CSALC and SALCO, Written Submission, p.3
130
CLKD and PooranLaw, Written submission, p. 3.
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AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
29
the United Kingdom’s all party parliamentary group on AIDS “concluded that the UK
government cannot look to exclude individuals on the basis of poor health.”
131
The
Council of Canadians with Disabilities reassured the Committee that “there is no
evidence to validate” the concern of an increase in applications if the excessive demand
provision is repealed.
132
B. Decision-making process
The Committee heard there are a number of challenges with the current decision-
making process surrounding medical inadmissibility. The Council of Canadians with
Disabilities qualified the current process as having an “ableist bias.”
133
Other witnesses
raised issues of clarity, consistency and accuracy.
1. Clarity
Mr. Mario Bellissimo, from the Canadian Bar Association, commented on the challenges
faced by individuals when interacting with IRCC’s excessive demand process. He noted
that the language found “in fairness letters can be presumptive [and] unclear.”
134
The information found on IRCC’s website also does not offer much assistance for
understanding the process.
135
He underlined that a lack of clarity is “contrary to the
Courts’ instruction [in Hilewitz v. Canada, which required] that the letters set out
relevant concerns in clear language to allow all applicants (including those not
represented by counsel) to understand the case against them, and how to meaningfully
respond.”
136
As such, the Canadian Bar Association recommended that the IRCC website
clearly detail, in plain language, what is involved in excessive demand assessments and
what information is required from individuals.
137
131
CIMM, Evidence, 20 November 2017, 1945 (Maurice Tomlinson, Senior Policy Analyst, Canadian HIV/AIDS
Legal Network).
132
Council of Canadians with Disabilities, Written submission, p. 8.
133
Council of Canadians with Disabilities, Written submission, p. 7.
134
CIMM, Evidence, 21 November 2017, 0955 (Mario Bellissimo, Honourary Executive Member, Immigration
Law Section, Canadian Bar Association).
135
Ibid.
136
Canadian Bar Association, Written submission, November 2017, p. 4.
137
For example, the Committee received a letter from Mr. Simeon Hanson for its study on medical
inadmissibility, although his issue dealt with medical examinations of non-accompanying children. This
shows the lack of clear information provided by the department on its website. He stated his frustration in
not being able to speak to an immigration officer in order to clarify the situation.; Canadian Bar Association,
Written submission, March 2017, p. 8.
30
The Canadian Bar Association also remarked that there are challenges in the decision-
making process, especially in regards to instructions for medical and visa or immigration
officers.
138
According to the Canadian Bar Association,
IRCC’s guidance to officers confuses their roles, and medical officers in certain cases are
still not undertaking an assessment of all factors, including financial information. This is
due, in part, to a failure to acknowledge the Supreme Court and Federal Court of Appeal
instruction in the cases on excessive demand. Revisions to the guidance prepared by
IRCC for these officers are required.
139
In order to improve the decision-making process, witnesses recommended that more
training should be offered to medical and visa officers, including training offered by
disability rights advocates.
140
2. Consistency and Accuracy
The Ontario Councils of Agencies Serving Immigrants, the Chinese and Southeast Asian
Legal Clinic and the South Asian Legal Clinic of Ontario have observed that decision-
makers do not take into account all the humanitarian factors found in an application that
could justify, for example, a waiver of the excessive demand provision.
141
They also
noted that waivers for medical inadmissibility are granted on a case by case basis
without any consistency. As such, there could be similar circumstances that end with
different results.
142
Ms. Chantal Desloges, from Desloges Law Group, also drew the Committee’s attention to
the lack of consistency and accuracy in the decision-making process. She added that she
often saw no explanation in the fairness letter that supported the decision of the
officer.
143
She stressed that it was important for individuals to get a thorough and fair
assessment.
144
As the Canadian Bar Association noted, an erroneous decision has
serious consequences for the individual and their family, but also for Canada because it
138
Canadian Bar Association, Written submission, November 2017, p. 4.
139
Ibid.
140
Council of Canadians with Disabilities, Written submission, p. 10.
141
OCASI, CSALC and SALCO, Written Submission, p. 2.
142
OCASI, CSALC and SALCO, Written Submission, p. 2.
143
CIMM, Evidence, 21 November 2017, 1005 (Chantal Desloges, Lawyer, Desloges Law Group, as an
individual).
144
Ibid.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
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31
“could lead to the admission of individuals whose medical conditions result in excessive
demands on Canadian health and social services.”
145
In addition, Mr. Bellissimo raised the issue of “transparency and accuracy of pricing” the
cost threshold, which does not fully reflect the variations in the cost of health and social
services among provinces and territories.
146
For example, the Canadian Bar Association
noted that those with medical conditions requiring prescription drugs cost the
government different amounts depending upon the province in which province they
reside.
147
The issue around pricing the cost threshold was also raised by Mr. Battista and
Ms. Smith, who noted that it was important for IRCC to obtain updated information from
provinces regarding the cost of treatment because it would reduce inefficient
immigration processing.
148
C. Impact of the Cost Threshold and Additional Costs
The Committee questioned IRCC about the number of applicants refused entry to, or
residence in, Canada because the needs described in the mitigation plans were costed
above the threshold set out by IRCC. The department responded that, in 2014, 391 cases
were refused due to estimated costs over the annual cost threshold, which was of
$31,635 over five years.
149
IRCC provided the Committee with a table that showed in
increments of $500 the costs that were above the cost threshold, which ranged from
$3,001 to $729,500 over the 2014 threshold of $31,635 for 391 cases.
150
The Committee
has concerns that the data provided by the department was not full enough to base
decisions upon.
Even if individuals captured by the excessive demand provision prepare mitigation plans,
they would be refused if their plans are costed higher than IRCC’s threshold.
151
Mr. Battista provided the Committee with the “example of an investor with significant
assets [who] was refused because of the cost of his spouse’s medication, which only
exceeded the annual excessive demand threshold by $700.”
152
The witness argued that
145
Canadian Bar Association, Written submission, November 2017, p. 1.
146
Ibid., p. 3.
147
Canadian Bar Association, Written submission, March 2017, p. 4.
148
Michael Battista and Adrienne Smith, Written submission, p. 2.
149
IRCC, Response, Annex – Question 7: Inadmissible cases close to cost threshold.
150
Ibid.
151
CIMM, Evidence, 20 November 2017, 1940 (Adrienne Smith, Barrister and Solicitor, Jordan Battista LLP).
152
Michael Battista and Adrienne Smith, Written submission, p. 5.
32
costs could be absorbed by the system, but there was no assessment of “whether this
applicant’s investment or contribution to the Canadian tax base would outweigh the
relatively small amount by which the cost of medication exceeded the average Canadian
per capita cost of health care.”
153
Two witnesses wrote to the Committee that “the focus
should not be on whether the dollar value of the immigration policy is set at the correct
level to trigger medical inadmissibility.”
154
The focus should be on creating a more
inclusive Canada that is accepting of the economic, social and cultural contributions of
all persons of diverse abilities.
155
Currently, witnesses pointed out that there is no
mechanism by which the potential abilities, contributions, skills and talents of
individuals captured by the excessive demand provision, as well as their support
network, are recognized.
156
Witnesses also questioned the calculation of the cost threshold and the fact that the
cost threshold is understood to be the average Canadian per capita cost for publically
funded health care and social services.
157
Mr. Waldman claimed that the average
calculation “was based upon fictitious information; there was no actual true calculation
of the cost of the average person.”
158
He stressed that the government’s estimates are
incorrect because the average cost should be based on the average cost of a person of
the same age group as each age group incurs different costs.
159
CIHI, which provides part
of the data for the cost threshold calculation, does disaggregate its data by age
groupings;
160
however, that is not the data used to calculate the cost threshold. In
addition, witnesses argued that IRCC relies on outdated and inaccurate cost assessments
of disability supports and medical conditions.
161
Professor Hanes, of Carleton University,
commented that the excessive demand provision is “kind of dated” as it was already in
place with similar wording in the former Act and its regulations.
162
153
Ibid.
154
CLKD and PooranLaw, Written submission, p. 3.
155
CLKD and PooranLaw, Written submission, p. 3; Disability Positive, Written Submission, p. 2; Ameil J. Joseph,
Letter, p. 3.
156
Canadian Association for Community Living, Written submission, p. 3; Michael Battista and Adrienne Smith,
Written submission, p. 5.
157
CIMM, Evidence, 20 November 2017, 1835 (Lorne Waldman); Michael Battista and Adrienne Smith, Written
submission, p. 5; Alex Tufford and A.J. Withers, Written submission, p. 2.
158
CIMM, Evidence, 20 November 2017, 1835 (Lorne Waldman).
159
Ibid., 1910.
160
CIMM, Evidence, 20 November 2017, 1920 (Brent Diverty).
161
Disability Positive, Written Submission, p. 2; OCASI, CSALC and SALCO Written Submission, p. 4.
162
CIMM, Evidence, 21 November 2017, 0945 (Roy Hanes).
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Ms. Johnston argued that IRCC is also over-estimating the actual cost savings to the
health and social services of the provinces as a result of the excessive demand
provision.
163
It seems that “that the cost-savings estimate [of $135 million over five year]
is coming from the procedural fairness letters.”
164
However, those letters can be
inaccurate; individuals can switch to a cheaper generic medication available in Canada
after receiving the procedural fairness letter or can receive waivers of medical
inadmissibility.
165
The department does not factor into any revisions to the cost
estimates.
166
Witnesses also remarked that IRCC’s cost savings estimates do not take into
account the cost of actually administering the excessive demand program.
167
1. Mitigation Plans
The Committee heard that mitigation plans are an additional burden of proof for
individuals captured by the excessive demand provision.
168
They are also costly and not
enforceable.
169
For Mr. Battista, that is part of a systemic injustice and unfairness,
because not everyone can afford the legal fees to fight the determinations by preparing
a mitigation plan.
170
He pointed out that his legal fees for a medical inadmissibility case
are about $4,000 to $5,000.
171
His estimate does not include expert opinions “from
doctors, specialists, psychologists, or autism specialists” that are often required to
develop a mitigation plan.
172
Mr. Battista argued that if the department wants to have the ability to enforce mitigation
plans, it would have to “establish a mechanism for the provinces to report on individuals
who create mitigation plans to track their health and social service spending in every
163
CIMM, Evidence, 20 November 2017, 2010 (Meagan Johnston).
164
Ibid.
165
Ibid.
166
Ibid.
167
CIMM, Evidence, 20 November 2017, 1835 (Lorne Waldman); CIMM, Evidence, 20 November 2017, 1935
(Michael Battista, Barrister and Solicitor, Jordan Battista LLP); CIMM, Evidence, 20 November 2017, 2010
(Meagan Johnston).
168
CIMM, Evidence, 21 November 2017, 0950 (Felipe Montoya); Peter Larlee, Larlee Rosenberg, Barristers and
Solicitors, Written brief, pp. 1-3.
169
CIMM, Evidence, 20 November 2017, 2005 (Michael Battista).
170
Ibid.
171
Ibid.
172
Ibid.
34
province.”
173
That would require additional resources and raise privacy concerns, which
would be costly for both levels of government.
174
However, witnesses argued it would
also create two classes of permanent residents because, currently, after becoming a
permanent resident, individuals have access to health and social services as is the right
of any permanent resident.
175
Mr. Montoya remarked that individuals who have to prepare mitigation plans and
demonstrate the availability of alternatives resources are being twice charged for what
they have already contributed to through their taxes.
176
Other witnesses qualified the
excessive demand provision as “a tax on all disabled people”
177
or “as a ‘head tax’ on the
unhealthy.”
178
D. Excessive Demand Provision seen as Discriminatory
Witnesses qualified the excessive demand provision as discriminatory because it
distinguishes individuals with different characteristics or needs from others and imposes
additional administrative and financial burdens on them that are not imposed on
others.
179
As such, individuals captured by the excessive demand provision have to
overcome an additional hurdle by, for example, preparing a mitigation plan in order to
be accepted to Canada, facing a burden of a proof that is not placed on healthy
applicants.
180
Mr. Rae considered the excessive demand provision as inequitable because
“temporarily able-bodied” individuals that put their health more at risk because of their
lifestyle, such as heavy smokers, are not captured by the excessive demand provision.
181
Witnesses also found the provision discriminatory because it is based on predicting the
development of a health condition, which is associated with estimating “likely future
173
Ibid., 2010.
174
Ibid.
175
Michael Battista and Adrienne Smith, Written submission, p. 2.
176
CIMM, Evidence, 21 November 2017, 0955 (Felipe Montoya).
177
Alex Tufford and A.J. Withers, Written submission, p. 2.
178
Michael Battista and Adrienne Smith, Written submission, p. 3.
179
CIMM, Evidence, 21 November 2017, 0950 (Felipe Montoya); Peter Larlee, Larlee Rosenberg, Barristers and
Solicitors, Written brief, pp. 1-2; Alex Tufford and A.J. Withers, Written submission, p. 2.
180
Claire Kane Boychuk, Written submission, p. 8; Michael Battista and Adrienne Smith, Written submission,
p. 3; Council of Canadians with Disabilities, Written submission, p. 6.
181
CIMM, Evidence, 20 November 2017, 1855 (John Rae).
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
35
costs over time.”
182
It requires individuals to defend themselves by developing, for
example, mitigation plans against something that has not yet occurred and may not
occur.
183
As Mr. Battista and Ms. Smith pointed out, other inadmissibility provisions in
IRPA that deal with misrepresentation or crime are based on past facts.
184
In addition,
Professor Sweetman remarked that even the government cannot confirm how well it
can predict, at the time of screening new immigrants, who will incur higher than average
costs to the health system.
185
According to Mr. Rae, the medical inadmissibility system is discriminatory because
“when a particular disability is identified” the process does not take into account “the
particular degree of that disability nor a person's background, attributes, and how they
deal with the realities of their particular disability, nor does it speak to the contributions
that person might make if they come to Canada.”
186
As such, witnesses reasoned it is
stereotyping all individuals captured by the excessive demand provision as a burden on
society.
187
The Canadian Association for Community Living argued that the stereotypes
and assumptions in the immigration system are based on the medical model of disability
that sees the “inherent defects” of individuals with disabilities as a burden on society
and the threat of increased costs for health and social services.
188
Mr. Montoya agreed
and added that this is based in an underlying stigma against people with disabilities.
189
Ms. Toni Schweitzer, from Parkdale Community Legal Services, testified that “while the
language of the [excessive demand] provision is in terms of cost, the way in which it is
applied and interpreted is solely on the basis of a person’s disability.”
190
182
Council of Canadians with Disabilities, Written submission, p. 7; Michael Battista and Adrienne Smith,
Written submission, p. 1.
183
Alex Tufford and A.J. Withers, Written submission, p. 2.
184
Michael Battista and Adrienne Smith, Written submission, p. 1.
185
CIMM, Evidence, 21 November 2017, 0905 (Arthur Sweetman).
186
CIMM, Evidence, 20 November 2017, 1910 (John Rae).
187
CIMM, Evidence, 21 November 2017, 0850 (Roy Hanes); Claire Kane Boychuk, Written submission, p. 17;
Macdonald Scott, Carranza LLP, Written submission, p. 2; Felipe Montoya, Written submission, p. 2;
Canadian Association for Community Living, Written submission, p. 2.
188
Canadian Association for Community Living, Written submission, p. 2.
189
Felipe Montoya, Written submission, p. 2.
190
CIMM, Evidence, 20 November 2017, 2000 (Toni Schweitzer, Staff Lawyer, Parkdale Community Legal
Services); Felipe Montoya, Written submission, p. 2.
36
1. Affecting Children, Low-Income Individuals and Live-In Caregivers
IRCC explained that medical inadmissibility findings are tied to the cost of services and not
to the identified health condition. As such, no specific medical diagnosis during the medical
evaluation process renders a case automatically inadmissible because each individual’s
medical needs are considered individually on a case by case basis.
191
Ms. Smith, however,
questioned IRCC’s premise, in particular children with disabilities.
192
She provided, as an
example, the case of a 14-year-old teenager who was found inadmissible because she was
deaf.
193
She argued that children should not be seen as a burden on society because given
the right set of circumstances they can bring positive change and impact to their
communities and contribute to their society in the long-term.
194
Other witnesses “argued
that applying medical ineligibility to children is a contradiction of the legislated
requirements to consider the Best Interests of the Child.”
195
Witnesses also argued that the excessive demand provision creates additional obstacles
for low-income individuals. The provision is “economically biased toward those who can
afford the legal fees to fight the determinations.”
196
Professors Withers and Tufford
wrote that it “is prohibitively expensive for low-income people, regardless of the
ultimate finding with respect to the permanent residency application.”
197
Often
individuals have to incur additional costs either by hiring a lawyer, which can help them
navigate the complex immigration system, or by seeing additional specialists to prepare
a mitigation plan.
198
Individuals that are low-income and disabled face “an uphill battle
not only to win [their] application, but to obtain medical care.”
199
Witnesses pointed out
that a request for exemption from medical inadmissibility is possible under section 25 of
IRPA, or under a temporary residence permit, but “these forms of relief are highly
discretionary and do not address the fundamental unfairness resulting from the
application of medical inadmissibility criteria.”
200
Mr. Scott provided the example of a
191
IRCC, Response, Context and definitions to explain IRCC data and responses.
192
CIMM, Evidence, 20 November 2017, 1940 (Adrienne Smith).
193
Ibid.
194
Ibid.
195
OCASI, CSALC and SALCO, Written Submission, p. 6.
196
CIMM, Evidence, 20 November 2017, 2005 (Michael Battista).
197
Alex Tufford and A.J. Withers, Written submission, p. 3.
198
Alex Tufford and A.J. Withers, Written submission, p. 3; MWAC and CAC, Written Submission, p. 2.
199
Macdonald Scott, Carranza LLP, Written submission, p. 2.
200
Michael Battista and Adrienne Smith, Written submission, p. 7; MWAC and CAC, Written Submission, p. 2.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
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37
client that made an application under section 25, but had his medical condition set
against his application’s humanitarian and compassionate factors.
201
The witness argued
that his client experienced other obstacles because of his low-income status and his lack
of resources to propose a plan to cover potential future costs.
202
Other witnesses, such as Ms. Schweitzer and Mrs. Mercedes Benitez, spoke about the
discrimination experienced by many live-in caregivers: they are deemed good to work in
Canada but not good enough to remain and establish themselves with their families
because one of their family members has been deemed medically inadmissible.
203
Mr. Scott
wrote that it is unfair that migrant “workers give their labour, are separated from their
families, and then subjected to discrimination when it comes time to apply to stay in
Canada.”
204
The Migrant Workers Alliance for Change agreed and underlined that the
excessive demand provision “fails to account for the net benefit and contributions by
migrant workers to Canada before they apply for permanent residence.”
205
E. Personal Hardships Due to the Excessive Demand Provision
Two individuals shared their experience of hardship with the Committee after being
deemed inadmissible to Canada due to the medical condition of one of their family
members. Mr. Montoya told the Committee that, because his son was deemed medically
inadmissible, the permanent residence application for the whole family was delayed for
more than three years.
206
During that time, there was great uncertainty and additional
costs in time, energy and money.
207
He specifically spoke of the numerous medical
evaluations his son, at the time 11 years old, had to go through.
208
201
Macdonald Scott, Carranza LLP, Written submission, p. 2.
202
Macdonald Scott, Carranza LLP, Written submission, p. 2; OCASI, CSALC and SALCO, Written Submission,
p. 4.
203
CIMM, Evidence, 20 November 2017, 1955 (Toni Schweitzer); CIMM, Evidence, 20 November 2017, 1955
(Mercedes Benitez).
204
Macdonald Scott, Carranza LLP, Written submission, p. 2.
205
MWAC and CAC, Written Submission, p. 2.
206
CIMM, Evidence, 21 November 2017, 0950 (Felipe Montoya).
207
Ibid.
208
Ibid.
38
For Mrs. Benitez, her permanent residence application process took more than seven
years.
209
Five years after submitting her application, she was informed that her son was
deemed medically inadmissible.
210
She stated:
I was devastated. It hurts me to feel that Canada thought we were not good enough. The
months of uncertainty since we received the letter have been some of the hardest months
of my life. I had chest pains; at times I thought I was having a heart attack from the stress.
There were so many sleepless nights worrying that any day I could be refused and sent back
home after working so hard for so many years. I was afraid. Who would provide for my
family? Sometimes it was too much to bear, and I thought of giving up, but my family relies
on me for support. I am the sole breadwinner. I needed to be strong.
211
She eventually got legal assistance to build her case and, two years after receiving the
procedural fairness letter, was approved for permanent residence in Canada. However,
the process of hiring lawyers and experts and undergoing “years of repeated medical
testing and years of delay is exceedingly unfair and hurtful to the applicant and his [or
her] family.”
212
The Committee acknowledges that medical assessments impose
hardships on applicants because they can often take too long.
Mr. Peter Larlee, of Larlee Rosenberg, stressed the delay and uncertainty of the process
as the most difficult part for individuals because “IRCC is not accountable for the delays
and resulting pain and frustration caused to families.”
213
The Committee received
testimony that other individuals are going through similar hardships and find it physically
and mentally draining to fight the medical inadmissibility determinations made by the
immigration or visa officer.
214
Witnesses also emphasized that racialized communities often experience hardship when
they cannot sponsor their parents or grandparents. As they explained, for many
racialized communities, reuniting with their parents and grandparents in Canada is of
equal priority to sponsoring their child or spouse.
215
It is emotionally very hard for
individuals that will have to care for parents from afar.
216
209
CIMM, Evidence, 20 November 2017, 1955 (Mercedes Benitez).
210
Ibid.
211
Ibid.
212
Peter Larlee, Larlee Rosenberg, Barristers and Solicitors, Written brief, p. 2.
213
Ibid., p. 3.
214
Chun Chu, Letter, 17 November 2017, p. 2.
215
OCASI, CSALC and SALCO, Written Submission, p. 5.
216
CIMM, Evidence, 20 November 2017, 1835 (Lorne Waldman); Ibid., 1945 (Maurice Tomlinson).
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
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39
F. Deterring Potential Immigrants
Witnesses also highlighted the fact that Canada is competing for the best and brightest
immigrants with other countries that do not have the same medical inadmissibility
requirements.
217
Witnesses suggested that Canada’s excessive demand provision hinders
our ability to attract the most highly-skilled immigrants over the long term,
218
but the
Committee did not receive any quantitative data. It was argued that economic
immigrants might not want to establish themselves in Canada in the long term if they
are separated from their family members, such as children, parents or grand-parents.
219
Witnesses noted that reuniting families is beneficial for communities because it
increases support networks, promotes productivity and reduces stress.
220
Ms. Johnston raised the specific case of international students who become infected
with HIV during their studies in Canada. According to her, most of them will have their
applications for permanent residence refused due to the possibility of excessive
demand. This is “despite the fact that these students have skills that are in demand in
Canada and, given the opportunity, would contribute to the economy, culture and
society of Canada in many ways, including by paying taxes.”
221
PART 5: OPTIONS FOR REFORM
The Committee mostly heard testimony from those who would like to see section
38(1)(c) of IRPA repealed and less from those who would keep it, but would like to see
improvements to IRCC’s application of the excessive demand provision.
The Committee notes that only two witnesses, including the province of Saskatchewan,
were adamant that the excessive demand provision should remain in place. However,
the overwhelming majority of witnesses asked the Committee to take action and
recommended its repeal.
The Committee acknowledges that Canadian society values diversity and inclusiveness,
often coming together as communities to help others. The entire discussion on costs,
which does not take into consideration the contributions of individuals deemed
217
CIMM, Evidence, 20 November 2017, 1855 (Lorne Waldman); Ibid., 1945 (Maurice Tomlinson).
218
CIMM, Evidence, 20 November 2017, 1910 (Lorne Waldman); Centre for Israel and Jewish Affairs, Written
submission, p. 2.
219
Legal Network and HALCO, Written submission, p. 7.
220
Ibid.
221
Ibid.
40
medically inadmissible, or the contributions of the entire family, does not reflect
Canadian principles. Although some witnesses recommended improvements, others
were categorical that the excessive demand provision was discriminatory and any fix
would be too arduous.
The Committee realizes that IRCC effectively bars a truly small number of individuals
with its excessive demand provision. However, the Committee notes that there has not
been modeling completed for the cost increases on health and social services if the
provision is repealed. Witnesses indicated that other countries, such as the United
Kingdom, had repealed their excessive demand provision without spurring an increase in
applications from individuals that would have been barred previously.
222
The Committee
is cognizant of the competitive nature of global immigration and witnesses have
indicated that highly skilled individuals may be deterred from applying to Canada
because of the excessive demand provision. Discretionary measures, such as temporary
resident permits or applications on humanitarian and compassionate grounds, are not
an adequate remedy when basic human rights are infringed upon.
Taking stock of all these various issues with the excessive demand provision, the
Committee makes the following recommendation:
Bringing the Immigration and Refugee Protection Act in Step with Canadian Values
Recommendation 1
That section 38(1)(c) of the Immigration and Refugee Protection Act and the
exemptions to it be repealed; that the Governor in Council repeal all
corresponding regulations; and that Immigration, Refugees and Citizenship
Canada repeal all corresponding policies and guidelines.
However, the Committee acknowledges that there are ongoing consultations with the
provinces and territories and that additional data would be helpful to inform the
department’s fundamental review of the excessive demand provision. As such, the
Committee recommends:
222
CIMM, Evidence, 20 November 2017, 1945 (Maurice Tomlinson); Council of Canadians with Disabilities,
Written submission, p. 8.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
41
Consulting with Provinces and Territories
Recommendation 2
That the Minister of Immigration, Refugees and Citizenship continue to consult
and negotiate with the provinces and territories on a repeal of section 38(1)(c)
from the Immigration and Refugee Protection Act.
Collecting Data for Better Decision-Making
Recommendation 3
Until such time as section 38(1)(c) of the Immigration and Refugee Protection Act
is repealed, that Immigration, Refugees and Citizenship Canada report to the
House of Commons annually on the use of excessive demand by the department,
including comprehensive data on: (i) the number of applications for which the
estimation for which the estimation of excessive demand exceeds the threshold
for any stage of the application; (ii) the medical cost estimates; (iii) the number of
such applications delayed by duration delay; (iv) the number of such applications
refused; (v) the number of such applications abandoned; (vi) the number of
family members whose applications are also delayed, refused or abandoned as a
result of the implication of an excessive demand process; (vii) the full costs of
implementing excessive demand and appeals; and (viii) such other information as
the department, provinces or territories determine to be relevant in negotiating
the repeal of excessive demand.
The Committee recognizes that the Minister will need time to complete his fundamental
review of the excessive demand provision. For that reason, the Committee recommends
a number of immediate improvements to IRCC’s application of the excessive demand
provision. Recognizing that IRCC officials work within the legislative and regulatory
framework that has been established for them and that decisions from the courts add
interpretative guidelines, this creates a complex structure to the excessive demand
provision. Witnesses stated, however, that there is difficulty in applying them in a
consistent manner.:
The Committee also heard that the cost threshold used by IRCC is problematic on a
number of levels. First, it would appear that the health services and social services listed
in the Regulations may not reflect the current publicly funded services across Canada.
Second, the costing for these services could benefit from experts such as economists,
especially when at present IRCC adds an amount for social services that was calculated
in 2004, indexed to inflation, to what the Canadian Institute for Health Information
provides on costs for an average Canadian per year.
42
The Committee learned that some applicants, on the basis of humanitarian goals as well
as family reunification, were exempted from the excessive demand provision at section
38(2) of IRPA. These are Convention refugees and protected persons, as well as spouses
and children. However, parents and grandparents, as well as all economic applicants,
even those applying from within Canada, are subject to the excessive demand provision.
IRCC officials assured the Committee that as part of their modernization agenda, they
were addressing the issue of plain language in the procedural fairness letter. The content
of the letter has been described as legalese and opaque when it comes to the specific
findings that an individual would need to challenge. The Committee heard that
information available on IRCC’s website is also incomplete and not as helpful as it could
be. As such, the Committee recommends the following interim measures:
Interim Measures
Recommendation 4
Pending repeal of section 38(1)(c) of the Immigration and Refugee Protection Act,
in accordance with recommendation 1, that the following interim measures be
implemented to the excessive demand regime:
Proper Training for Immigration/Visa Officers and Medical Officers
Recommendation 4(a)
That Immigration, Refugees and Citizenship Canada ensure that the final decision-
makers on a permanent residence application are properly trained in assessing
the reasonableness of the medical officers’ recommendations; and that medical
officers are properly trained to evaluate the individual’s entire application.
Calculating the Cost Threshold for Excessive Demand
Recommendation4(b)
That Immigration, Refugees and Citizenship Canada fundamentally review how it
calculates the cost threshold for excessive demand on health and social services
by eliminating from current definitions those services that are not publicly
funded.
Recommendation 4(c)
That Immigration, Refugees and Citizenship Canada ensure that the cost
threshold for excessive demand on health and social services is calculated by
economists based on provincial, territorial and federal data.
BUILDING AN INCLUSIVE CANADA: BRINGING THE IMMIGRATION
AND REFUGEE PROTECTION ACT IN STEP WITH MODERN VALUES
43
Expanding the Categories of Exemptions to the Excessive Demand Provision
Recommendation 4(d)
That Immigration, Refugees and Citizenship Canada expand the list of exempted
persons from the excessive demand provision to include economic applicants
that are already working in Canada and their family members.
Providing Clear and Comprehensive Information
Recommendation 4(e)
That Immigration, Refugees and Citizenship Canada provide applicants with
timely decisions and procedural fairness letters that are written in plain language
and are comprehensive in nature, including rationales, in order fully to inform
applicants of the findings they must address to overcome a finding of excessive
demand.
Recommendation 4(f)
That Immigration, Refugees and Citizenship Canada publish on its website, in
plain language, all operation manuals and guidelines regarding health to help
applicants understand the evidence they need to provide during their application
process.
Parliamentary Review
Recommendation 5
That should, after a thorough consultation with the provinces and territories and
analysis of all relevant data, Parliament repeal section 38(1)(c) of the Immigration
and Refugee Protection Act, a full parliamentary review of the impact of these
changes be undertaken within three years of its implementation and that such a
review include its impact on the provinces and territories.
45
APPENDIX A
LIST OF WITNESSES
Organizations and Individuals
Date
Meeting
Department of Citizenship and Immigration
Dawn Edlund, Associate Assistant Deputy Minister
Operations
2017/10/24
78
Caitlin Imrie, Director General
Migration Health Branch
Michael MacKinnon, Senior Director, Migration Health Policy
and Partnerships
Migration Health Branch
Arshad Saeed, Director, Centralized Medical Admissibility Unit
Migration Health Branch
As individuals
Mercedes Benitez
2017/11/20
84
Lorne Waldman, Barrister and Solicitor
Lorne Waldman and Associates
Canadian HIV/AIDS Legal Network
Maurice Tomlinson, Senior Policy Analyst
Canadian Institute for Health Information
Brent Diverty, Vice-President
Programs
Christopher Kuchciak, Manager
Health Expenditures
Council of Canadians with Disabilities
James Hicks, National Coordinator
John Rae, First Vice-Chair
HIV & AIDS Legal Clinic Ontario
Meagan Johnston, Staff Lawyer
46
Organizations and Individuals
Date
Meeting
Jordan Battista LLP
Michael Battista, Barrister and Solicitor
2017/11/20
84
Adrienne Smith, Barrister and Solicitor
Parkdale Community Legal Services
Toni Schweitzer, Staff Lawyer
As individuals
Sheila Bennett, Faculty of Education, Brock University
2017/11/21
85
Chantal Desloges, Lawyer
Desloges Law Group
As individuals
Felipe Montoya
2017/11/21
85
Arthur Sweetman, Professor
Department of Economics, McMaster University
Canadian Bar Association
Mario Bellissimo, Honourary Executive Member
Immigration Law Section
Council of Canadians with Disabilities
Roy Hanes, Associate Professor
School of Social Work, Carleton University
Department of Citizenship and Immigration
Hon. Ahmed Hussen, C.P., M.P., Minister of Immigration,
Refugees and Citizenship
2017/11/22
86
Dawn Edlund, Associate Assistant Deputy Minister
Operations
Michael MacKinnon, Senior Director, Migration Health Policy
and Partnerships
Migration Health Branch
Arshad Saeed, Director, Centralized Medical Admissibility Unit
Migration Health Branch
47
APPENDIX B
LIST OF BRIEFS
Organizations and Individuals
Hanson, Simeon
Joseph, Ameil J.
Larlee, Peter D.
Montoya, Felipe
Scott, Macdonald
Tabbara, Marwan, M.P., Kitchener South — Hespeler
Tufford, Alex
Withers, A.J.
Canadian Association for Community Living
Canadian Bar Association
Canadian HIV/AIDS Legal Network
Caregivers' Action Centre
Centre for Israel and Jewish Affairs
Chinese and Southeast Asian Legal Clinic
Community Living Kingston and District
Council of Canadians with Disabilities
Disability Positive
Government of British Columbia
Government of New Brunswick
Government of Newfoundland and Labrador
Government of Nunavut
Government of Saskatchewan
48
Organizations and Individuals
Government of Yukon
HIV & AIDS Legal Clinic Ontario
Jordan Battista LLP
Migrant Workers Alliance for Change
Ontario Council of Agencies Serving Immigrants
PooranLaw Professional Corporation
South Asian Legal Clinic of Ontario
49
REQUEST FOR GOVERNMENT RESPONSE
Pursuant to Standing Order 109, the Committee requests that the government table a
comprehensive response to this Report.
A copy of the relevant Minutes of Proceedings (Meetings Nos. 78, 84, 85, 86, 87, 91 and
92) is tabled.
Respectfully submitted,
Robert Oliphant
Chair
51
Dissenting Report of Her Majesty’s Official Opposition
The Conservative Party of Canada
Federal Government Policies and Guidelines Regarding Medical Inadmissibility of Immigrants
Larry Maguire, Member of Parliament for Brandon – Souris
Michelle Rempel, Member of Parliament for Calgary Nose Hill
Bob Saroya, Member of Parliament for Markham – Unionville
1.) INTRODUCTION
The Standing Committee on Citizenship and Immigration undertook a study on the medical
admissibility and excessive demand regulations for potential newcomers. In particular, the
Committee reviewed clause 38(1)(c) of the Immigration and Refugee Protection Act, which
states that a foreign national is inadmissible on health grounds if their health condition might
reasonably be expected to cause excessive demand on health or social services; or if their
health condition would add to existing waiting lists and would increase the rate of mortality and
morbidity in Canada as a result of an inability to provide timely services to Canadian citizens or
permanent residents.
We agree with many components of the Committee’s report. In particular, we agree that the
evidence presented to the Committee showed serious problems that caused hardship with the
use and application of the excessive demand provision, and that change needs to occur.
Two main policy options emerged from witness testimony to address these problems
Repeal Section 38(1)(c) of the Immigration and Refugee Protection Act, or
Make significant reforms to the process by which Section 38(1)(c) of the Immigration
and Refugee Protection Act is applied.
In spite of attempts by the Committee to obtain quantifiable data regarding the potential costs
and economic impact of these policy options, the Committee found that in many instances this
data simply didn’t exist or had significant gaps in its collection methodology. We wish for the
reader of the Committee’s report to note that the Committee’s recommendations were made
while lacking quantifiable data in several areas, including:
Actual cost increases that may result from repealing 38(1)(c)
The actual costs related to administering the system in its current form as opposed to
the costs associated under a repeal scenario
The actual costs related to administering the system should reforms be implemented
The economic impact of immigrants who may not be eligible to enter Canada or who
self-deselect from applying to enter Canada as a result of the existence of 38(1)(c)
If a repeal of 38(1)(c) would result in an increase of applicants with high medical and
social service needs
52
Additionally, at time of writing only four provinces and two territories provided briefs to the
Committee during the study. Given that delivery of health and social services falls within their
jurisdiction, we note this lack of input could impact both federal and provincial/territorial
governmental ability to successfully implement the changes suggested within the Committee’s
report.
2.) CHANGE MUST OCCUR
We wish to emphasize that the overwhelming burden of evidence brought before the
Committee suggests that there are serious problems with the use and application of Section
38(1)(c) of the Immigration and Refugee Protection Act. We encourage the government to take
action to overcome these problems, in the context of the concerns raised below.
3.) TWO POLICY OPTIONS
Two main policy options emerged from witness testimony to address the problems identified
with the current system.
The first was an outright repeal of Section 38(1)(c) of the Immigration and Refugee Protection
Act
1
.
The second option is to make significant reforms to the process by which Section 38(1)(c) of the
Immigration and Refugee Protection Act is applied.
We note that these policy proposals may be mutually exclusive. If the government choses the
former option, it would likely be wasteful to put resources into improving the current system,
as the latter policy option is premised on the view that the current system can be improved and
that repeal is not necessary. That said, implementing the repeal of Section 38(1)(c) will likely
take time and resources that have not adequately been studied by the Committee, and
applicants will continue to be adversely affected during the period between deciding to repeal
the provision and full implementation of this new policy.
The Committee’s report only entertained the option to repeal Section 38(1)(c). As the
Committee’s report does not consider ways to improve the current system, the following
section will outline those possibilities. Potential reforms include, but are not limited to:
Improving the accuracy of IRCC’s costing as it relates to the concept of excessive demand
Improving the timeliness of the department in processing all aspects of the finding of
medical inadmissibility
Simplifying the Procedural Fairness Letters to make rulings more clear and rationale more
transparent for the applicant, and
Clarifying the purpose of mitigation plans in order to for them to provide actual process
utility
1
CIMM, Evidence, 1st Session, 42nd Parliament, 20 November 2017, 1840, (John Rae, First Vice-Chair, Council of
Canadians with Disabilities).
53
On the topic of improving the accuracy of IRCC’s costing as it relates to the concept of excessive
demand, the Canadian Bar Association (CBA) provided the Committee with two briefs and
appeared in person to provide recommendations. They outlined the challenges associated with
how IRCC calculates the costs to determine if someone is projected to cause an excessive
demand on health and social services.
2
The difficulties in estimating the costs for special education needs were brought to the
Committee’s attention. As education is a provincial jurisdiction, no two provinces that are
identical in how they determine funding levels to assist students with special education needs.
For example, Ontario’s Inclusive Education Model funding is different than how Manitoba
supports special education needs as every school division is unique in how support is provided
for students with special needs.
3
There is also a discrepancy between provinces with financial support for prescription drugs. In
some provinces medically required services are covered in full while outpatient drug costs are
not automatically covered.
4
There are also disparities in the amount of what each province
reimburses residents for various prescription drugs.
5
The CBA noted that the IRCC’s Central Medical Accessibility Unit, which was recently
introduced, might alleviate some of the challenges in determining the actual financial costs in
determining if one will cause an excessive demand. However, they are urging IRCC to improve
its Medical Officer’s Handbook and to work with provincial and territorial governments to get
the most up-to-date and accurate costing information available for the intended place of
residence of the applicant. Denying applicants based on irrelevant information is not acceptable
and all steps must be taken to ensure the accuracy of cost estimates.
Second, there were circumstances where IRCC took so long to review a medical assessment
that it was deemed out of date. Due to IRCC’s wait times for processing excessive demand
applications, 886 applicants needed a new independent medical assessment.
6
If the
government chooses system reform as the path forward, in our opinion this is unacceptable
and IRCC needs to improve its service delivery if medical assessments are not being reviewed in
a timely manner.
2
CIMM, Canadian Bar Association, Submission on Excessive Demand on Health and Social Services Under
Immigration and Refugee Protection Act, Written Submission, p. 4.
3
CIMM, Canadian Bar Association, Submission on Excessive Demand on Health and Social Services Under
Immigration and Refugee Protection Act, Written Submission, p. 4.
4
CIMM, Canadian Bar Association, Submission on Excessive Demand on Health and Social Services Under
Immigration and Refugee Protection Act, Written Submission, p. 4.
5
CIMM, Canadian Bar Association, Submission on Excessive Demand on Health and Social Services Under
Immigration and Refugee Protection Act, Written Submission, p. 4.
6
IRCC, Response, Question 19: Average Processing Time.
54
Third, many witnesses reported that IRCC has failed in some instances to provide specific cost
estimates in Procedural Fairness Letters. The Federal Court of Appeal has ruled that a Medical
Officer who is assessing medical inadmissibility has an obligation to provide the costs of the
expected health and social services. Without providing this information, it would be next to
impossible for the applicant to properly respond to IRCC’s concerns.
It was brought to the Committee’s attention that Procedural Fairness Letters can often be
confusing and do not provide enough information for the applicant to in a meaningful way.
78
In
many circumstances the language used in the letters is overly bureaucratic and is difficult to
decipher.
Further, because IRCC mails Procedural Fairness Letters, the time it takes for the physical letter
to arrive cuts into the already short 60 days that applicants are given to provide an answer. We
were informed due to the time delays with mailing a letter to various parts of the globe and to
gather the necessary information, it is difficult for an applicant to respond within the
timeframe. Digitization would ameliorate some of these problems.
While the CBA is recommending that applicants retain legal counsel to respond to the
Procedural Fairness Letter, it our desire that changes are made to simplify the process, make
the language clearer and be explicit in the information that is sought. Seeking legal counsel
should not be the de facto response for an applicant who has received a Procedural Fairness
Letter.
9
Finally, every applicant who has been given a Procedural Fairness Letter is given an opportunity
to submit a mitigation plan to convince IRCC they will not cause an excessive demand on
Canada’s health or social services.
An IRCC officer is then tasked with reviewing the mitigation plan, verifying the authenticity of
the plan as well the applicant’s cost mitigation strategy. IRCC must be also satisfied that the
applicant has the ability and intent to mitigate the cost of the required health (i.e., outpatient
medication) and social services.
10
While only one template mitigation plan was reviewed at Committee, it was discussed in broad
strokes what one might include. We believe that should the government choose system reform
as the path forward, it would be helpful to review how IRCC communicates what is expected in
an applicant’s mitigation plan.
7
CIMM, Evidence, 1st Session, 42nd Parliament, 21 November 2017, 1000, (Mario Bellissimo, Honorary Executive
Member, Immigration Law Section, Canadian Bar Association)
8
CIMM, Evidence, 20 November 2017, 2010 (Meagan Johnston).
9
Peter Larlee, Larlee Rosenberg, Barristers and Solicitors, Written brief, p. 2.
10
CIMM, Evidence, 1st Session, 42nd Parliament, 22 November 2017, 1310, (Dawn Edlund, Associate Assistant
Deputy Minister, Operations, Department of Citizenship and Immigration)
55
Once IRCC is satisfied that the applicant or applicant’s family member will not cause excessive
demand on health and social services, their declaration of ability and intent is retained on file
along with detailed case notes.
We were surprised to hear that once IRCC accepts a mitigation plan, mitigation plans do not
need to be adhered to or enforced.
1112
This calls the purpose of the mitigation plans into
question; because once an applicant is a permanent resident they have no obligation to update
IRCC on compliance with their mitigation plan.
If the government chooses to make these improvements, we note that it would be imprudent
to seek repeal of Section 38(1)(c) prior to seeing if the effects of these changes improved the
system for the applicant.
4.) LACK OF QUANTIFIABLE DATA TO SUPPORT WAY FORWARD
There were several areas in which the Committee had difficulty finding data to support
assumptions being made in witness testimony in the argument of either policy option outlined
in Section 3 above. This was in spite of many attempts by the Committee to bring in witnesses
to provide this data. The following data gaps were particularly noteworthy.
Some witnesses claimed that our current system was having an impact on Canada’s ability to
attract and retain immigrants, but the Committee did not receive supporting data for this
claim.
13
Despite this, the Committee maintained this argument in its report.
The Conservatives understand that IRCC gave the provinces a list of clear options that are being
considered regarding ways to change the immigration system as it pertains to medical
inadmissibility, yet the Committee has not been provided with a detailed list of these options.
This may have caused some confusion in the Committee’s correspondence with the provinces,
as they may not have been sure who to communicate to.
The Committee also heard testimony repeatedly referencing international and domestic laws
that witnesses felt Section 38(1)(c) contravened, but no evidence to this effect was presented.
In fact, medical inadmissibility has been the subject of numerous court decisions, including a
Charter challenge in Deol v. Canada where the policy was found to be Charter compliant
because it is based on individual assessment.
Should the government elect to immediately repeal Section 38(1)(c), based on testimony
provided to the Committee, it would be doing so without proper modeling on projected
increased financial costs. While the Committee has an understanding of the current avoided
11
CIMM, Evidence, 1st Session, 42nd Parliament, 21 November 2017, 1020, (Chantal Desloges, lawyer, Desloges
Law Group, As an Individual)
12
CIMM, Evidence, 20 November 2017, 2005 (Michael Battista).
13
CIMM, Evidence, 20 November 2017, 1910 (Lorne Waldman); Centre for Israel and Jewish Affairs, Written
submission, p. 2.
56
costs, that calculation does not take into consideration how that might change with the repeal
of the policy. To date, none of that data is available and must be flagged as an unknown
financial risk.
Concerns were raised that if the excessive demand clause was to be eliminated, it will lead to
higher costs than originally forecasted. As IRCC has not done any analysis nor has any
information available on how many prospective applicants are deterred due to the current
regulations, if the government moved to immediately eliminate the clause, it would be doing so
without projecting what those increased costs would be.
The Provinces of Saskatchewan and New Brunswick also highlighted to the Committee the
concern that individuals who are currently inadmissible could start applying to immigrate to
Canada and the original projected avoided costs of $135 million per year would need to be
revised upwards.
14
5.) LACK OF PROVINCIAL / TERRITORIAL INPUT TO SUPPORT WAY FORWARD
The Committee’s recommendations were made without significant input from provincial and
territorial governments. At time of writing, only four provinces and two territories provided
briefs to the Committee during the study.
Every provincial government who submitted a brief to the Committee had reservations about
eliminating the clause or had qualms with repealing it without financial compensation, as the
costs of eliminating the excessive demand clause will be exclusively borne by provincial and
territorial governments.
Changing the excessive demand policy without a deeper understanding of the costs involved
and without discussing how provinces will pay for the same will effectively download costs onto
another level of government in an unplanned fashion. Should the government elect to repeal
Section 38(1)(c), this issue would need to be addressed. The Committee’s report does not
adequately address this issue.
The Province of Newfoundland and Labrador said in their brief to the Committee:
“[they are] experiencing significant health-related expenditures, as a result of numerous social
and demographic factors. Given Newfoundland and Labrador’s current financial outlook, it is
not possible for the province to support assuming additional expenses from the Federal
Government, without considerations of solutions that take into account the financial impacts of
changes to the policy.”
15
14
Brief to the Standing Committee on Citizenship and Immigration from the Government of New Brunswick on
December 5th, 2017 and Letter to the Standing Committee on Citizenship and Immigration from the Government
Saskatchewan on November 20, 2017.
57
The comments that Newfoundland and Labrador made in their brief were also echoed by the
Province of Saskatchewan as they stated in their letter to the Committee that the excessive
demand policy, “helps protect provincial services from above-average costs and reduced the
burden on provincial health, education and social services systems.”
16
While the Committee only received briefs from a minority of provincial governments, this may
be the result of the Minister of IRCC having already presented them specific options on ways to
change the excessive demand clause. It is important to note that none of those options the
Minister of IRCC presented to the provinces and territories to date were shared with the
Committee.
While the Minister informed the Committee he discussed the matter with the provinces and
territories, he did not indicate that IRCC presented specific options on how the policy can be
amended. For example, correspondence obtained by the Conservatives showed that IRCC
presented an option to increase the cost threshold and continue to base the value on an
objective data source for health and social services costs. Another proposal that was presented
was for the excessive demand clause to be waived for economic immigrants / provincial
nominees working or operating a business in Canada.
While we welcome the Minister consulting the provinces and territories, it is unfortunate he did
not table with the Committee the options that he presented. Having a parallel discussion with
the provinces and territories and not informing the Committee of the particulars only denies
our final report from containing all the necessary information needed for such a multifaceted
issue.
6.) CONCLUSION AND RECOMMENDATIONS
Given the rationale outlined herein, we recommend the following:
1. As there are serious problems with the use and application of Section 38(1)(c) of the
Immigration and Refugee Protection Act, we encourage the government to take
action to overcome these problems, in the context of the concerns raised within this
dissenting report
2. That the dignity and human rights of those applying to enter Canada play a central
role in the selection of a policy path forward
3. That the integrity of Canada’s immigration system be maintained in the
implementation of changes to the excessive demand policy and process
16
Letter to the Standing Committee on Citizenship and Immigration from the Government Saskatchewan on
November 20, 2017.
58
4. That the federal government select a path forward in full consultation and with the
consent of provincial and territorial governments
5. In addition to the testimony provided to the Committee during the course of this
study, that the data outlined above be obtained and utilized to justify and
implement any policy change that the federal government selects in this regard, and
that this data be made available to the public
6. That given the lack of data provided to the Committee during the course of this
study, the federal government develop a more accurate system of evaluating the
cost-benefit analysis of a policy change to the excessive demand provision
7. That the federal government ensure that additional costs related to the delivery of
health care services resulting from any policy change to the excessive demand
provision is considered in federal-provincial health transfer discussions
8. That any increased costs, as calculated in the context recommended within this
dissenting report, be accounted for within a balanced federal budget
9. That the government develop and table a fully costed implementation plan for any
changes made to address concerns with the excessive demand provision, which
included data related to cost and utilization assumptions as outlined in this
dissenting report
10. That any changes made by the government to address concerns with the excessive
demand provision be studied by Parliament two years after implementation
59
Dissenting Opinion of the New Democratic Party of Canada
Introduction:
New Democrats are staunchly opposed to discrimination in all its forms. The NDP fully
supported the Standing Committee on Citizenship and Immigration undertaking an in-depth
study on the federal government’s policies and guidelines regarding the medical inadmissibility
of immigrants. Through the compelling and near unanimous views of of the witnesses, this
study has cemented in the opinion of New Democrats that section 38(1)(c) is legislated
discrimination against individuals with disabilities and that it needs to be recognized as such.
New Democrats, therefore, whole-heartedly support Recommendation 1 of the main report
which clearly states:
“That section 38(1)(c) of the Immigration and Refugee Protection Act and the
exemptions to it be repealed; that the Governor in Council repeal all corresponding
regulations; and that Immigration, Refugees and Citizenship Canada repeal all
corresponding policies and guidelines.”
i
However, New Democrats feel obliged to express dissent to the main report because the report
also recommends inconsistent half-measures which allow for the continuation of this
discrimination. With no recommendation for a timeline to make the repeal, and no timeline
announced for the Minister to finish his consultations, New Democrats cannot support these
half-measure fixes to such a serious issue. These additional recommendations are contradictory
to the fact that nearly all the witnesses shared the perspective there is no such thing as an
acceptable threshold to allow for discrimination. It was clearly expressed by all but two
witnesses that attempts to reduce the number of people subject to the discrimination is
insufficient and the only option is to eliminate this legislated policy of discrimination.
Section 38(1)(c)
Section 38(1) of the Immigration and Refugee Protection Act (IRPA) states:
38(1) A foreign national is inadmissible on health grounds if their health condition
(a) Is likely to be a danger to public health;
(b) Is likely to be a danger to public safety; or
(c) Might reasonably be expected to cause excessive demand on health or social
services
ii
60
As the main report notes, Canada ratified the United Nations Convention on the Rights of
Persons with Disabilities in 2010. Additionally, the Canadian Charter of Rights and Freedoms
applies to everyone physically present in Canada, and Section 15 states that every individual
has the right to equal benefit of the law without discrimination based on mental or physical
disability.
iii
Based on witness testimony, it is apparent that a vast majority of the witnesses believe that
section 38(1)(c) of IRPA contradicts the Canadian Charter of Rights and Freedom not to mention
Canada’s commitment to the international community about the rights of persons with
disabilities. Simply put, section 38(1)(c) is legislated discrimination against individuals with
disabilities.
Even the Minister of Immigration, Refugees and Citizenship, in his appearance at the committee
stated, “From a principled perspective, the current excessive demand provision policy simple
does not align with our country’s values on the inclusion of persons with disabilities in Canadian
society.”
iv
A fundamental review of a policy that does not align with Canada’s values is not an exercise in
playing with dollar figures of a threshold, or adding more classes of newcomers who are
exempt from this policy. This sentiment was echoed nearly unanimously amongst both
witnesses and committee members during this study. This study produced a unique situation
where sometimes the preambles to questions from the members of the committee were nearly
as compelling and strongly worded as the responses from the witness.
The Opinion of Committee Members:
The Member for Scarborough-Centre echoed views of Professor Sheila Bennett who discussed
the emotion and financial stress that families are put through when a member of the family is
flagged under section 38(1)(c). This was because she knew from experience, as the Member’s
family had gone through that situation when sponsoring her husband’s parents in 2002.
v
The Member for St. John’s-East declared his opposition to this policy stating to the Minister, “I
must say that at this point in time I do not see how raising the threshold and excluding fewer
people changes the fact that excluding anyone is prima facie discriminatory and violates
Canadian values”
vi
The Member for Surrey-Centre also spoke to his change of opinion about this policy, and
evoked a strong and harsh image when he compared this policy to the mindset of the slave
trade:
61
“I would say that initially I thought it was a good policy, because that would perhaps be
a big burden on Canadians, but then I looked back – and I don’t want to equate it to this
– and it’s no different from the slave trade, in which only those selected as the strongest
and the most able-bodied were brought from Africa. It’s not that the whole policy is
good at all, but I’m saying it is akin to discriminating when we’re picking only people
who are healthy, fully functioning, with no intellectual disabilities and no physical
disabilities.”
vii
The Member for Surrey-Centre had previously summed up the views of the committee when he
said, “As you can tell, almost all of us have an inclination that this policy is discriminatory. We
already can see that even within immigration there’s a two-tiered policy.”
viii
In addition to the opposition to the policy on grounds of discrimination, the committee also
heard early in the study that section 38(1)(c) is used to deny the applications of under 1,000
people a year.
ix
Members of the committee expressed in their exchanges with witnesses,
department officials, and the Minister, a difficulty in reconciling the point of such a
discriminatory policy, given its little savings impact in the grand scheme of the immigration
system and the healthcare system.
The Member for St. John’s-East, in an exchange over the cost on the healthcare system asked,
“It seems like a drop in the bucket? Why should we even care about the cost at all? Human
rights can cost money. It’s part of living in a free and democratic society. Why are quantifying
this at all…?”
x
It is clear to the New Democratic Party that the majority of committee members view this
policy as discriminatory.
Furthermore, the committee’s acceptance of recommendations in the main report around
significant increases in data collection appears to directly contradict the views expressed by the
Member for St. John’s-East. Following his comments around the thus far quantified minimal
additional costs associated with repeal of section 38(1)(c), he went on to say,
“If it’s a trivial amount, why should we even measure it? It may cost more to measure it.
It may cause more unseemliness in the whole process than simply saying, ‘Here,
provincial government, is a transfer of $36 billion.’ Notionally, $135 million of that is
going to be associated with paying for the health care costs of about 5,000 immigrants
over a five-year period, among almost 1.5 million immigrants, who are also going to be
users of the health care system but paying taxes, but it all comes out in the wash.”
xi
62
The Opinion of the Witnesses:
Witnesses referred to the significant investigative journalism that Global News had undertaken
which brought to light a range of significant concerns regarding Section 38(1)(c) and its
application. Witnesses and department officials spoke about the issues raised by Global News.
Of particular note, significant concerns were raised about the flaws in the calculation and
determination of the medical and social cost threshold were raised by witnesses. As well, the
inconsistency in which the policy was applied and the fact that the policy in and of itself is
discriminatory were also observed by witnesses. Witnesses also highlighted the fact that there
is no recognition of the benefit aspect of IRCC’s cost/benefit analysis of the applications.
Nearly every witness who appeared before the committee was clear in the opinion that section
38(1)(c) needed to be repealed.
Immigration lawyer Adrienne Smith firmly stated her opposition to the policy saying, “We’re
questioning the implementation of this law. We’re urging the committee to repeal it. You’ll
hear from other witnesses, and we’ve heard from the panel before us, that this is a system that
discriminates against persons with disabilities.”
xii
Parkdale Community Legal Services representative Toni Schweitzer pointed to repeal as being
the only way forward when asked if not repeal, could anything be done:
“I don’t have any suggestions actually. I think that the law discriminates, and the
numbers that have been provided as a justification are arbitrary and inaccurate. It
appears even that senior officials are not aware of some of the things that are being
done by decision-makers. That’s a situation that is unacceptable. I don’t know what else
I could say to that. I can say that the system as it stands is unacceptable and shouldn’t
continue.”
xiii
Canadian disability advocacy groups were loud and clear. John Rae of the Council of Canadians
with Disabilities opened his testimony with “We recommend in the strongest possible terms
that the excessive demand clause in the immigration act be repealed”.
xiv
Canadian HIV/AIDS advocacy groups were united in their opinions as well. Meagan Johnston of
HIV&AIDS Legal Clinic Ontario urged the committee to “show leadership and recommend
removing excessive demand inadmissibility by repealing paragraph 38(1)(c) of the IRPA.”
xv
This
was followed by Maurice Tomlinson of the Canadian HIV/AIDS Legal Network’s view that,
“Quite simply, we have to repeal this section. It is in complete violation of our
international obligations, and any reasonable assessment would prove that. It is a
violation. What is ironic is that we ratified the UN Convention on the Rights of Persons
63
with Disabilities at the start of the Vancouver Paralympic Games, when we welcomed
the world of disabled individuals to Canada. You could play here; you just couldn’t stay
here. That’s the message that was sent.”
xvi
Individual cases of findings of medical inadmissibility under section 38(1)(c) of the Immigration
and Refugee Protection Act (IRPA) have, over the past two years made national headlines and
caused significant concern in the Canadian public. Two of the individuals that were gravely
impacted, Professor Felipe Montoya, and Mercedes Benitez, appeared as witnesses before the
Committee to share their story. Their individual stories have shone a spot light on the
discriminatory nature of the medical inadmissibility provision and its unfair application.
Both Professor Montoya and Mercedes Benitez had gone through the experience of a loved one
being deemed medically inadmissible under section 38(1)(c). Thankfully for these families,
successful resolutions were found, allowing them to remain in Canada united with their
families. However, that their situations were resolved was not enough for them.
Mercedes Benitez is a caregiver who came to Canada in 2008. After nearly a decade of
separation from her family while she cared for Canadian families, she was informed her son was
medically inadmissible due to an intellectual disability. While she was happy to have received
the support, assistance, and ultimately intervention that addressed this injustice, she said that,
“Even though my case is already resolved, I think the excessive demands should be repealed. I
still feel the pain when they say I’m good to work, but not good enough to stay because of my
son.”
xvii
Professor Felipe Montoya was a high profile case in the Canadian media when his son’s
intellectual disability was going to force the family to leave. This was despite having all been in
Canada for years and making significant contributions to the community around them, and his
son showing no evidence of placing an excessive demand on the health or social services in
Canada. Professor Montoya addressed several reasons why this policy should be repealed:
“It does not make sense on social grounds because social services considered for
calculating excessive demand are a narrow selection of services, precisely those used by
persons with disabilities, making the disabled community a burden to Canadian social
services by definition. Second, paragraph 38(1)(c) implies that social services used by
disabled persons are a burden, implying by extension that the disabled community of
Canadian citizens and permanent residents is also a burden to Canadian society. Third,
paragraph 38(1)(c) ignores the potential contributions of immigrant working families to
Canadian society, in spite of, and sometimes even because of, the presence of a
disability in the family, as has already occurred on countless occasions in Canada.
It does not make sense on moral or ethical grounds because foreign immigrant workers
are, in fact, Canadian taxpayers, and by signing a declaration of ability and intent, they
64
are subject to being twice charged for what they have already contributed to through
their taxes. Second, the attempt to resolve the inherently flawed paragraph 38(1)(c) of
the IRPA by offering the option of signing a declaration of ability and intent simply adds
another layer of discrimination, this time against people with lower incomes. Third,
there already exists a moral precedent of offering exemptions to the clause of excessive
demand to refugees, for example, so it is not inconceivable to extend an exemption to
the category of temporary workers who have already been accepted into Canada and
pay Canadian taxes. Fourth, reducing persons to what they cost the state rather than
valuing them for what they can contribute can lead us down a dark path. The targets are
the elderly and infirm. Fifth, it is beneath the dignity of the Canadian state, which is
recognized the world over as a beacon of inclusion, to keep paragraph 38(1)(c) of the
IRPA on the books when it is flawed on so many counts.”
xviii
It should be noted that during the course of this study, the Migrant Workers Alliance was
circulating an open letter calling for the repeal of section 38(1)(c). As of November 22, 2017
that open letter had been signed by 1,001 individual persons, 396 individual endorsers with
organizational affiliations, and 54 organizational endorsers.
Of those who did not directly recommend repeal, most noted the discriminatory elements of
the policy and the difficulty in reconciling this policy with Canada’s values and obligations
regarding human rights. When asked if this policy constituted a violation of our basic human
rights, Professor Arthur Sweetman stated, “Clearly, it does.”
xix
Mr. Mario Bellissimo, on behalf of the Canadian Bar Association acknowledged that this
provision can “absolutely”
xx
be applied in a discriminatory fashion.
Ms. Chantal Desloges, arguably the most in favour of keeping section 38(1)(c), acknowledged
serious issues with the administration of the provision in her opening remarks stating, “If these
laws were properly applied by decision-makers, which they absolutely are currently not, our
system would be functioning a lot better.”
xxi
Brent Diverty, representing the Canadian Institute for Health Information, while avoiding policy
recommendations, noted the limited impact repeal could possibly have. He noted that, “based
strictly on averages, it’s hard to imagine how 900 people in 35 million could affect our average
health care per capita of $6,600.”
xxii
The answer was made clear and obvious. Section 38(1)(c) has no place within Canadian
immigration law.
In addition to the discriminatory nature of the policy, immigration lawyer Lorne Waldman
spoke to high costs of administrating this policy not being worthwhile. He believes:
65
“We should probably just eliminate medical inadmissibility because the number is so
small, the costs associated with it are very high, it impedes our ability to compete for
the immigrants we need, and it creates a lot of hardship.”
xxiii
Recommendations:
This study has made it abundantly clear, that the only way forward is to repeal section 38(1)(c).
Any attempt at a policy fix regarding this provision is changing the threshold for acceptable
discrimination. It is the opinion of New Democrats that there is no such acceptable threshold.
Therefore, the NDP recommends:
Recommendation 1:
“That section 38(1)(c) of the Immigration and Refugee Protection Act and the exemptions to
it be repealed; that the Governor in Council repeal all corresponding regulations; and that
Immigration, Refugees and Citizenship Canada repeal all corresponding policies and
guidelines.”
xxiv
While it was also made clear that there was little to no risk that repealing this provision would
lead to a significant increase in formerly inadmissible individuals attempting to migrate to
Canada, for those that do, there could be associated costs, as discussed in the main report. It is
of the utmost importance that Canada’s health and social services are adequately funded.
There are significant intersections of jurisdictional powers between the provinces, territories,
and the federal government in the funding and provision of health and social services, and the
immigration system. Given this, the NDP further recommends:
Recommendation 2:
That the federal government work with provinces and territories to determine any increased
costs to social and/or health services as a result of repealing section 38(1)(c), and to increase
CST and CHT funding appropriately.
Conclusion:
New Democrats agree with the Minister, those impacted by the policy, immigration lawyers,
disability advocates, committee members, and the general public: section 38(1)(c) is out of line
with Canadian values. However, New Democrats cannot support the report tabled for this study
due to the fact that it included recommendations that while acknowledging discrimination is
occurring, provide avenues to allow it to continue. As the main report states, consultations by
the Minister of Immigration, Refugees and Citizenship regarding this policy have been ongoing
since October 2016 as part of a “fundamental review of the excessive demand provision”
xxv
.
66
The time has come for action to be taken. It is therefore the opinion of New Democrats that
the only way forward is full repeal of this provision.
i
Building An Inclusive Canada: Bringing the Immigration and Refugee Protection Act in step with Modern Values
ii
Immigration and Refugee Protection Act, http://laws-lois.justice.gc.ca/eng/acts/I-2.5/section-38.html
iii
Building An Inclusive Canada: Bringing the Immigration and Refugee Protection Act in step with Modern Values
iv
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 22 November 2017 12:20
v
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 09:35
vi
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 22 November 2017 12:55
vii
Ibid.,
viii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 09:35
ix
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 24 October 2017 08:56
x
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 09:10
xi
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 09:13
xii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 19:40
xiii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 20:25
xiv
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 18:40
xv
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 19:51
xvi
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 20:19
xvii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 20:22
xviii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 09:55
xix
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 09:29
xx
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 10:33
xxi
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 21 November 2017 10:05
xxii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 2017 19:22
xxiii
CIMM, Evidence, 1
st
session, 42
nd
Parliament, 20 November 201719:02
xxiv
Building An Inclusive Canada: Bringing the Immigration and Refugee Protection Act in step with Modern Values
xxv
Building An Inclusive Canada: Bringing the Immigration and Refugee Protection Act in step with Modern Values
