The committee met at 8:30 a.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): Good morning, everyone. My name is Stephanie Higginson. I am the MLA for Ladysmith-Oceanside and the Chair of the Special Committee to Review Provisions of the Insurance (Vehicle) Act.

I’d like to start today by acknowledging that we are meeting on the territory of the lək̓ʷəŋən-speaking People, now known as the Songhees and Esquimalt Nations.

The committee is reviewing parts 10 and 11 of the Insurance (Vehicle) Act. The committee is also considering Bill M237, Insurance (Vehicle) Amendment Act, 2026.

As part of its public consultation, our committee accepted written submissions over the summer, and this week we are receiving presentations from some of those who made submissions.

I’ll start by asking members of the committee to introduce themselves. I’ll just let folks know we have a number of our committee members attending remotely for various reasons — sickness, parents in the hospital, for things like that.

I’ll start with our member who’s here in person, and then we’ll go to the people on the screen.

Jennifer Blatherwick: Good morning, everyone. I’m Jennifer Blatherwick. I’m the MLA for Coquitlam-Maillardville. I’m happy to be here this morning. Thank you for coming.

Brennan Day (Deputy Chair): Hi there. My name is Brennan Day. I’m the MLA for Courtenay-Comox and Deputy Chair of the committee.

Janet Routledge: Hi, my name is Janet Routledge. I’m the MLA for Burnaby North. I’m really sorry I’m not able to be there in person today, but I just wanted to also take a minute and say part of the reason is I’ve gotten sick as a result of lengthy travel returning from a Commonwealth parliamentarian conference on the other side of the world.

The reason I want to mention it is one of the sessions that parliamentarians participated in from around the world was on a topic I’d never heard of before — PLS, which is post-legislative scrutiny. That’s what we’re doing in this committee, so just the whole process of this may be something that will be able to be integrated into legislatures around the world.

George Chow: Good morning. I’m George Chow. I’m the MLA for Vancouver-Fraserview.

I’m speaking to you from the unceded territory of the Coast Salish Peoples.

Stephanie Higginson (Chair): Okay. Oh, did I not get Jeremy? Sorry.

MLA Valeriote, I’m sorry. For some reason I thought we had gone to you. I apologize, MLA Valeriote.

Jeremy Valeriote: Thank you, Chair.

Jeremy Valeriote, MLA for West Vancouver–Sea to Sky. Looking forward to today’s presentations.

Stephanie Higginson (Chair): Okay. Confirming that I got everyone? Okay, thank you. Sorry about that.

Presentations today. We will start with the B.C. Brain Injury Association. We have Janelle Breese Biagioni.

Janelle, you will have ten minutes for your presentation and then 20 minutes for questions from the members. If you go over ten minutes and it does not appear to me that you’re starting to wrap up, then I’ll interrupt you to ask you to please wrap up. Okay?

Thanks very much. Please go ahead.

Presentations on Parts 10 and 11
of the Insurance (Vehicle) Act

B.C. Brain Injury Association

Janelle Breese Biagioni: Good morning, committee members, and thank you for the opportunity to speak today. My name is Janelle Breese Biagioni, and I’m here representing the B.C. Brain Injury Association, which is a program of the CGB Centre.

I have submitted a written brief that goes into more detail than I’ll have time for today, so what I’ll do in the ten minutes is walk you through the heart of what’s in that submission and then speak directly to Bill M237, because I believe it needs to go further than it currently does.

[8:35 a.m.]

BCBIA, we work alongside government, health care providers and community organizations to improve outcomes for people living with brain injury and their families. Brain injury is one of the leading causes of disability in this province, and it’s a common consequence of motor vehicle collisions. What makes it different from other injuries is that it is often invisible, yet it has life-altering consequences that may span a survivor’s lifetime.

Someone can look completely fine and still struggle with memory, processing speed, attention, executive functioning and emotional regulation. Those are not small things. They’re the exact skills a person needs to manage a recovery.

I want to start by saying clearly that enhanced care has made real improvements, and we don’t take that for granted. ICBC’s disability advocacy advisory group has given organizations like ours an ongoing seat at the table on accessibility and implementation.

The brain injury training ICBC developed for recovery specialists in collaboration with BCBIA has strengthened how claimants are understood and treated. The early access concussion recovery program has meant many people get assessed and treated sooner at a critical window in recovery. And in the past year, the newly formed brain injury support and navigation pilot has shown in practice that connecting people to community-based support changes outcomes significantly. Those are genuine advances, and BCBIA’s recommendations today are about strengthening and completing that work, not starting over.

Here’s the problem that we keep coming back to. For many people recovering from brain injury, the barrier isn’t that benefits and services don’t exist. It’s that the very act of accessing them — reading correspondence, tracking deadlines, filling out forms and following up on calls — requires the exact cognitive skills that brain injury impairs.

A system that was designed around a person independently managing their own recovery will quietly fail the people whose injury makes independent management the hardest thing in the world for them to do right now. Recognizing that connection between neurological recovery and system navigation isn’t a side issue. It’s central to whether enhanced care actually reaches the people it’s meant for.

I’ll briefly walk you through our recommendations today, as the full detail is in our written submission.

First, we’re asking that ICBC make navigation support a permanent, core part of enhanced care available provincewide, not a pilot or a time-limited add-on. We’d also ask for earlier identification of claimants who could benefit and for clear referral pathways into community-based brain injury services.

Second, fund the work that makes navigation possible in the first place — community organizations spending enormous time building trust, doing intake and coordinating with families, work that sits outside what’s currently funded as navigation but is what actually makes it succeed. We’re asking enhanced care to recognize and fund the full scope of coordination.

Third, build cognitive accessibility into the system itself. That means plain language correspondence, decision notices that clearly state what’s required and what happens next and information offered in more than one format, be it written, verbal or video, so it can actually be absorbed by someone who is dealing with cognitive fatigue.

Fourth, keep investing in brain injury expertise among recovery specialists, and ensure specialized expertise is available when complex cases arise.

Fifth, measure success by more than claim resolution. Real recovery looks like returning to work or to school, staying housed, keeping relationships intact, functional independence and an overall sense of well-being and improved quality of life. Those are the outcomes that should tell us whether the system is working.

Sixth, recognize that capacity fluctuates and that brain injury can be completely invisible. Someone can look recovered and still be struggling significantly. Policy and practice need to stop reading outward appearance as a proxy for internal function. Access pathways to specialized rehabilitation need review so people with moderate and severe injuries aren’t delayed past the window when intervention matters the most.

Today I’m adding a seventh recommendation. This comes out of ICBC’s willingness to respond to challenges raised through the navigator pilot project, whose purpose was to connect people to community-based organizations. Through that project, a major challenge surfaced, and that is there is no longer a dedicated brain injury association in the Lower Mainland, which made connecting individuals to organizations difficult.

[8:40 a.m.]

ICBC recently funded a Lower Mainland service mapping project that resulted in interviews with 26 organizations. A number of them are identified as eligible to join the navigation pilot project as a result. That’s very good news for the Lower Mainland.

The mapping, which took place after we had sent our written submission, surfaced the issue behind the additional recommendation. British Columbia doesn’t have a dedicated brain injury navigator in the acute care system the way spinal cord injury does. Individual health authorities may have navigators in their own region, but that’s not the same as someone who can follow a person from acute care at G.F. Strong into community-based services and someone who can connect community providers to each other once they’re there.

The Lower Mainland is a clear example of why that matters. We therefore ask you to consider funding a provincial navigator position to bridge acute to community and community to community.

I’ll turn now to Bill M237, the Insurance (Vehicle) Amendment Act. I want to say that we think it’s a step in the right direction. But it needs to be revised, and it needs to be broader. As it stands, the bill does two things. It extends the claim window for catastrophic injury benefits for injuries sustained on or after May 1, 2021, and it amends the permanent impairment regulation so that a claimant needs one amputation instead of two to meet the threshold for a catastrophic injury designation.

Reducing that number to one from two is genuine improvement, and I don’t want to minimize that. But I want the committee to sit with what the threshold actually is. It’s a count of amputations. It is, by definition, a purely physical, visible measure of catastrophic injury, and that is precisely the gap I’ve been describing this morning.

Brain injury doesn’t show up in an amputation count. A person can have a catastrophic, life-altering brain injury — unable to return to work, unable to manage their own affairs, unable to parent the way they used to — and still not meet the definition of “catastrophic” that is built entirely around limb loss.

So our ask is this. Don’t stop at recalibrating the amputation number, but broaden the definition itself so that catastrophic injury can be established on neurological and functional grounds, not only physical ones. Extend the same claim period fairness to brain injury claimants generally, not only to those who happen to also meet a physical threshold that was never designed with brain injury in mind.

If Bill M237 is the vehicle this Legislature is using to modernize how “catastrophic injury” is defined, “brain injury” needs to be written into that definition directly, not left to qualify only incidentally.

In closing, I’ll say that enhanced care has generally improved outcomes for people recovering from motor vehicle–related brain injuries, and BCBI wants to keep building on that alongside ICBC and alongside this committee. What we’re asking for today is that navigation be made permanent and properly funded; that cognitive accessibility be built into the system rather than assumed; that outcomes be measured the way survivors actually experience their recovery; and that the legal definition under all of this, including Bill M237, be broad enough to see brain injury for what it is, which is often invisible and most definitely life-altering.

Thank you. I’m happy to answer any questions you may have.

Stephanie Higginson (Chair): Thank you, Janelle. Look at that timing. That’s amazing. I really appreciate your presentation today. It strikes a chord. I had a concussion and was left…. I was self-employed and so had no real extended benefits or anything like that and had to navigate the system on my own.

I maybe had two good hours a day that I could spend with my kids, who were two and four at the time, or I could fill out forms and advocate for myself and try to get people to take me seriously. It was tough. It was really tough. Many of your recommendations I wholeheartedly agree with but also think they should be broader, beyond just being provided by ICBC to people.

I understand why you’re saying them in this context, but I think there’s some overlap with the health authority on that as well. Thank you for that.

Jennifer Blatherwick: Thank you for your advocacy. We certainly heard…. Your submission was excellent. It was very clear about the progress that’s been made, where you want to go. Thank you for adding this next one, though, following up on the brain injury pilot and looking for funding for provincial navigators.

[8:45 a.m.]

I just want to clarify for not just me but for other people who might be listening. A provincial navigator in this case…. You want to continue that to be situated within a non-profit, or do you want that to be a separate position within ICBC?

Janelle Breese Biagioni: You know, either/or would work. And I think the piece is that community-based…. If we get into…. It would be having someone in acute care that can bring people into community but community to community as well. So it can be a partnership. That has been demonstrated with ICBC — that that has worked very well. Where that position would land — if it’s in ICBC themselves, if it’s a contracted position in G.F. Strong or someone contracted in the community….

Also, because the Lower Mainland…. That is where the problem originated, because we don’t have a dedicated brain-injury organization there anymore, but it also is a problem that we’re seeing in rural and remote communities. So having a person dedicated to that position that can be looking at the entire province….

I’ve actually had some early conversations with ICBC about doing a provincial service map because, again, the assumption is services and supports aren’t there, and yet we’re finding that there is…. So we need to do that service-mapping to find out — but then having a point person initially to begin in the Lower Mainland to start pulling those organizations together, getting people from acute connected to them and people who are in the community.

Not everyone ends up going through acute care, and then they’re self-referred to organizations, so they’re looking for that help. And certainly those are the calls that we get and emails that we get — looking for services and support.

Beginning in the Lower Mainland, because that has been an area that’s been quite problematic, and then expanding out throughout the province and to rural remote communities especially…. I will say that the Lower Mainland service-mapping that we did really was focused on Burnaby, Tri-Cities. We didn’t go to Sea to Sky, those coastal regions, so that needs to be included in the next one as well.

Jennifer Blatherwick: Thank you. That’s very helpful.

If I can do a follow-up.

In terms of coordination and how it functionally works, you’ve done a pilot. Are you aware of other organizations like, say, WorkBC — or any other larger — that do a similar provincial navigation or even a regional navigation where it’s functioning really well?

Janelle Breese Biagioni: Well, the spinal cord navigator. That’s a new project that’s happening but, so far, very good reports coming about that. What we’ve seen just in the work that we’ve been trying to do in the pilot project for brain injury is that it does work. Partly that is because we’re bringing in community organizations who have the skills and the expertise of working with someone with a brain injury and being able to….

I will say ICBC has been very good about having an open door policy with us to bring back feedback and information. But bringing in the people who have those skills and have had that working track record with individuals with brain injury to know how to build that trust, how to help them navigate what it is that they need to do.

For sure, I would say spinal cord injury…. They’re seeing great promise with the navigator project, and theirs is going from acute to community. So we’re asking acute to community but community to community as well.

Jennifer Blatherwick: That’s great. Thank you.

Brennan Day (Deputy Chair): Hi. Thanks so much for your presentation.

We’re lucky in the Comox Valley with the Comox Valley Head Injury Society. It does some absolutely fantastic work around this.

I want to get back just to something that’s become a recurring theme, in that we’ve heard from quite a few individuals that have suffered a brain injury during the accident and then struggled to access that care and, along with that, the tight time frame of 12 weeks for those initial steps to take place through the legislation. I think that’s probably something we’re certainly going to see in the recommendations as we go through.

What do you think the biggest challenges are in terms of staffing and manpower to make sure that we have that equitable navigator to help them through that process? And it wasn’t just people that were suffering head injury. Catastrophic injury — same issue, the 12 weeks. They may have just got out of hospital at that point and are having trouble accessing those services.

How do you see that working from a rural British Columbia standpoint? We need to make sure it’s equitable even up in the North.

Janelle Breese Biagioni: Yeah, and I think…. This is a question that comes up a lot in conversations I have about rural and remote communities. The assumption that….

[8:50 a.m.]

Ensuring that we have virtual services available seems to be the number one thing people want. With brain injury, virtual doesn’t always work, right? They may not have the ability to be on a screen for any length of time. But also, in those areas, Wi-Fi may be an issue — that stability — and not having access to a computer. But it needs to be one of the options.

It is looking at who can provide service and then providing some training for them. I will say that one of the projects that I’ve been involved in, that we did for four years, was the B.C. consensus on brain injury, mental health and addiction. We were able to partner with a society in Haida Gwaii that is providing service to individuals with brain injury, and then, in our connection, able to provide them some education and work with them to strengthen what it is that they’re offering the community.

It is a real challenge. But also, we don’t know everywhere that there aren’t services and provisions there. We need to explore that. It is going to take some investment to do that, but I think having a navigator to start sussing out who the partners are in the different regions will be really important.

Of course, we do have — as you’ve identified, like in Comox — great brain injury organizations, and in the north, too: the Northern Brain Injury Association, Prince George brain injury association. To begin talking to them…. The Northern Brain Injury Association — their catchment area is like two-thirds of the province. Who are they working with, and what more do they need?

None of these organizations have stable core funding. We don’t have stable core funding. You spend most of your time fundraising to get these positions going, so I think having one person to start as a navigator would be a help, to start coordinating those services, to build that provincial pathway.

I’m not sure if that answers your question, but I’m happy to explore it more.

Brennan Day (Deputy Chair): I think that does. The inconsistency in services and the lack of a standardized inventory….

I was running a small mental health non-profit, so there was a lot of crossover with the head injury society here in town. That consistent funding across the board to allow those navigators to be in place, just to help people through their transition, is critically important.

Thank you for the work you do.

Janelle Breese Biagioni: Could I just add one more thing? I will say that there needs to be coordination within the health authorities. One of the things that has been identified — we’ve discussed this with ICBC as well, and spinal cord has identified this too — is that the information needs to travel with the person.

If you live on Vancouver Island, and you’re, for example, in a motor vehicle accident in Vancouver Coastal — you’re treated there — your information doesn’t necessarily come back. The health authorities don’t exchange that information, so that puts the person and the family in the position of proving over and over again what needs to happen.

That is a critical piece that needs to change. We need to open up those pathways for information to stay with the person and ensure that they have access to the care that they need, where they live, in a timely fashion.

Stephanie Higginson (Chair): Seeing no other questions, I’m going to jump in, then.

Do the people that you serve who overlap with ICBC talk a little bit to you about the impact of constantly changing adjusters or claims specialists or however they’re referred to now?

Janelle Breese Biagioni: There has been some feedback on that from the organizations that have been involved. Also, not being able to reach their recovery specialists…. Those are pieces that we have given feedback on to the ICBC team, and they’ve been working with us diligently on that.

The project has been highly successful. It hasn’t come without glitches. It certainly has, but that was the purpose of this — to identify where the bumps and boulders are in place that we need to get through.

That has been frustrating for them, but having the navigator to be able to help them communicate back to ICBC has been very helpful, and, as I said, ICBC having this open door for the feedback and working with us. Sometimes there are difficult conversations that we’ve had to have on behalf of clients, but ICBC has been very open to that and treating it case by case.

My hope would be that at the end of the project, there will be some themes that they’ll see that will streamline some of them.

[8:55 a.m.]

George Chow: Hello, Janelle. Welcome.

You mentioned plain-language correspondence. Does that mean the — I would say letters or whatever — emails coming from ICBC? Is it bureaucratic, obscure, or is it too technical?

Janelle Breese Biagioni: Well, for some it may be.

George Chow: Do you have any examples that come to mind?

Janelle Breese Biagioni: I don’t. I’m certainly happy to speak to some of the organizations to see if we can provide that. I think it’s really just ensuring that the information coming to the client is simplified, not long text. That would come…. It would be broken into, maybe, bullet points and something that they could take to someone to easily understand.

That processing can be really challenging if you’re reading…. That would be for you or me, too, looking at a textbook, for example, and having to digest that information. But if you’re someone who’s having difficulty reading and then processing that information…. So keeping it very light, not heavy, bureaucratic language.

Very directional. Step 1 is this; step 2 is this; this is the next thing that you do. Not having it obscure in any way. It’s just really a guideline to ensure, going forward, that that’s always in place.

George Chow: Does that mean that sometimes you would get emails or letters that are really just a repeat of a whole bunch of policies that may not be applicable to the victim’s case in that, for example?

Janelle Breese Biagioni: It may be, but one of the things — and ICBC has addressed this in the pilot project — is information coming from multiple people. For example, I’ll just say they’ve been approved for the navigator’s pilot project, right? They’ve been approved to have their claim come in. We’ve reached out to them. Then a recovery specialist…. There are two parts in that. They can have peer support, group support. They can have navigation services. But they may not get both.

For example, if I were to reach out and say, “You’ve been approved for navigation services,” but ICBC were to say, “You’re approved for this but not this,” it just gets skewed. With the information, then they think: “Oh, I’m not approved,” or “I have to go to this place.” So it is working with teams. It’s working with someone that can make sure the information is conveyed in a simple, step-by-step format, not to confuse the client.

Again, everybody at different stages of their recovery is processing and taking in information in different ways. As was mentioned before, if it’s in that 12 weeks, what’s the best time to be presenting information to someone? Those early days….

I will say that my first husband was a police officer struck by a car, on a motorcycle, and died five months later from a brain injury. In those five months…. I honestly could tell you 36 years later that I remember those five months. There wouldn’t have been a day in there that he could have processed the information coming from ICBC. That had to come through the lawyer to me because it was just too much for him. But for someone else, that doesn’t mean that two months or three months down the road they’re not able to take that in. It is a very case-by-case situation.

Janet Routledge: Thank you for your presentation. Your analysis and what you’re requesting is very, very clear. I guess the observation that I have at this point, and I would love your feedback on it, is that your presentation is part of what has become a developing pattern, examples of where the system has gotten in the way of healing, where it’s gotten in the way of meeting the objectives of this legislation.

I’m wondering. It seems to me that what we’re seeing is perhaps an imbalance in favour of accountability and enforcement at the expense of accessibility, support and healing. If we look at this in terms of the big picture, the litmus test of what enhanced care should meet, what do you think about that in terms of this committee looking at the big picture of what needs to change?

Janelle Breese Biagioni: Well, I agree, and I think, again, this goes back to brain injury. If you’ve met one person with a brain injury, you’ve met one person with a brain injury. Every brain injury is different.

[9:00 a.m.]

I understand why systems have to have the structure and guidelines of, “we’re going to progress through this, this and this,” but it doesn’t work that way with brain injury. I think there has to be flexibility built into that too. Again, that assumption is that because you look okay and it’s been six months, you should be fine. Very, very different.

I could fill this room with people for you that look really well and then share their stories and tell you how they can’t even walk into a grocery store because it’s too overwhelming — the lights, the noise, all the items lined up — or that they’re having difficulty parenting day to day the way they used to. And it’s not that the kids have changed. Mum or Dad have changed in the sense of what they’re able to tolerate.

I think that’s part of the problem, that systems are built in mind to work a certain way, and we have to have some flexibility in there.

Also, it’s looking at changing the system so it works better for people. That may mean partnerships where it isn’t just — because we’re here about ICBC — ICBC directing it. It is working with community organizations to say: “What is the best for the person that’s in recovery?”

Stephanie Higginson (Chair): Okay. I see no further questions.

I really want to thank you for your presentation, for your submission, for the time you took and for how thoroughly you answered the questions. You’re a wonderful advocate for the community that you serve.

Like I said, having suffered from just a minor concussion, it was life-altering though. I still live with the impacts of it but not in any way that has not allowed me to continue, and I can imagine the deep frustration that folks feel when they have paid for something that they expect is going to be serving them.

I think you also really clearly identified, when you talked about the metrics about claim completion, the tension that we’re seeing as a theme, as well, around an insurance company. There’s a reason why these businesses are some of the most profitable in the world. I don’t know if ICBC falls in that category or not. I’m just saying, in general, insurance companies are some of the most profitable in the world.

The need for care and recovery, there seems to be some kind of a gap happening there, and I think you highlighted that really well today. So I appreciate your time with us today, and we may reach out with further questions during deliberations.

Janelle Breese Biagioni: Yes, thank you. I appreciate being here. I hope the answers were clear and meaningful, but I am open to hearing from anybody that would like further information or to finding people that can answer that for you.

This is an opportunity for us to continue with ICBC, which has been a very meaningful connection. As I said, it isn’t that the project has been super smooth. There have been bumps and boulders, but working together with that open door policy has helped to find the pathway that’s needed for better outcomes for people in British Columbia. So thank you.

Stephanie Higginson (Chair): Thank you very much.

Our next presenter is running a little bit behind, so we’re just going to wait for them to arrive.

We’ll take a brief recess while we wait, but when they get here, we will start because, otherwise, we’ll fall further behind. We’ve already filled our break today with someone. So if people could just stay close by, that’d be great.

The committee recessed from 9:03 a.m. to 9:15 a.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): Okay, we will come back from our recess.

Our presenters are here from BrainTrust Canada Association, Amanda McFarlane and Maggie Spizzirri.

You have ten minutes for your presentation, 20 minutes for questions. If your presentation goes over ten minutes and it does not appear that you’re starting to wrap up, then I will interrupt and ask you to start to wrap up, okay? Thank you very much.

Over to you.

BrainTrust Canada Association

Amanda McFarlane: Good morning. Thank you so much for having us here from Kelowna. As you mentioned, I have my colleague Maggie with me today.

My name is Amanda McFarlane. I’m the executive director of BrainTrust Canada. I’ve spent nearly 20 years in community-based brain injury services in the Central and North Okanagan. BrainTrust is the regional lead for the ICBC brain injury navigation support pilot, which we serve. We support the Interior, Kootenay, Cariboo and northern regions. We also helped co-develop the pilot before its launch last fall.

The submission today came from us because we’ve had the luxury of seeing what service access was for people living with traumatic brain injury prior to enhanced care and post. We have observations from both sides.

I want to start by saying that a lot of things have improved for our individuals. We do support moderate to severe brain injuries. Most often when somebody is injured behind the wheel, they will seek our services, and we’ve been acting as the community navigators on navigating the guide throughout this entire time.

Some of the biggest things that we wanted to bring forward were just the scope, so sections 10 and 11 in practice. We’re not here to argue or talk about the eligibility rules. We’re here to talk about what happens once somebody is deemed eligible. Can they actually get through the process and receive what they are entitled to?

Our written submission that is publicly posted covers five themes, and we’ll move through them really quickly — one of those being navigation, the eligibility-accessibility gap, continuity, the administrative burden, rural and regional barriers.

The first theme was: navigation is essential to accessing benefits. What we have found is that with people with cognitive disabilities after an injury, even knowing where to access the enhanced-care guide and what they qualify for is, across the board, an extreme barrier to access.

Through the pilot, we saw a lot of people who were technically capable of receiving the benefits, but they simply lost that thread. They’ll miss a form, they’ll miss a call, or they may miss an appointment — not because they didn’t qualify but because nobody was walking along beside them and they were no longer able to have their community advocates there and helping them navigate that.

A gap between eligibility and accessibility. In my time trying to get services into the Kootenay and northern B.C., in a lot of cases, there just isn’t a clinical provider. We are, as the navigators, virtually offering connection and support when, in fact, they actually do qualify for SLP, OT, but they just simply can’t get that. They’re required to travel to larger centres, pay for it up front on their own dime and then get reimbursed. A lot of people after an injury don’t have that financial capacity.

Continuity. One of the biggest concerns that our clients have brought forward is that the adjuster changes very quickly and very rapidly. With people with brain injury, they rely on relationship-building and trust. When the adjuster is changing and they have to retell their story over and over again, they stop accessing because it’s no longer safe.

The administrative processes and cognitive disability. That is heavily relied on — email, repeated paperwork and a bunch of processes that do require executive functioning.

Theme five. The access and the rural and regional barriers. I’ve noticed a large amount of access in the Lower Mainland and such, where there are more OTs and PTs, whereas in the North, it is the community organizations who aren’t paid to pick up the toll there.

Sections 10 and 11 in practice. Basically, we’re talking about accommodations that are a little bit more brain-injury informed.

[9:20 a.m.]

When we look at someone that has to complete a form and then go back and continually have to say, “I’m still injured, I still need treatment, I still need this, and I probably will need it for the rest of my life,” we do believe is something that should be looked at.

Our conclusion — before I pass the mic over here and Maggie will be able to talk a little bit about the provincial lens — is that navigation is not a supplementary service. It is the bridge between injury and recovery. Without it, clients will not just magically access enhanced care. Community organizations across B.C. are ready and equipped to do so, but we need proper funding and the support and ability to be able to continue serving in that way.

Maggie?

Maggie Spizzirri: Thank you. Hi, my name is Maggie Spizzirri, and I’m coming from the Brain Injury Alliance. My organization brings together the 14 community-based brain injury associations across the province. We provide funding and support to those organizations, and we have the unique ability to hear directly from them, gather data and understand and interpret that data to look at everything from a provincial lens.

In speaking with Amanda and BrainTrust Canada here, all of these recommendations are directly in alignment with what the entire province is seeing and what all of the community-based brain injury associations are seeing across the province as well, which is why Nos. six and seven here in the list of recommendations surrounding strengthening partnerships and providing supports for rehabilitation, navigation and caregiver supports, as well as flexibility for rural and northern spaces are so incredibly important.

I think it’s easy to forget sometimes, when we’re located in big city centres, how big our province actually is. Being able to provide supports for travel and simply access for people who live in those rural spaces…. I think oftentimes there’s just so much that’s accessible here in larger communities, and we forget just the simple healing factors of living in rural spaces and being able to support the people that live there as well.

Just wanted to lend that provincial lens in the discussion in regards to…. Where Amanda brings the regional lens to it, it’s also nice to know and understand just the provincial lens of that as well, directly from the community-based brain injury associations.

Amanda McFarlane: If I will, as we have a few more minutes left, I wanted to end this with a story, a real-life story, that came across my desk.

Several months ago, we were contacted by my local MLA office, by the assistant. There was an individual going to them, asking for assistance on how to connect with MAiD.

Once she started unpacking the situation, she started to learn that this individual — a father, a business owner — had been dealing with an ICBC claim for a few years and was struggling so severely with not understanding how to get income-loss replacement, how to get ongoing counselling that he didn’t have to get pre-approved, all of these things. He had felt like a burden to his family. He was tired of watching his family fall apart because of this accident.

They contacted us. We were able to put him through the navigation program, and, piece by piece, we earned his trust back. We spent a copious amount of hours, to the point where we exhausted the pilot funding and the pilot cap. Now my organization will forever support him on alternative funding. He will forever be navigating that claim. His injury is for life. I’m happy to say that about a month ago he took himself off the MAiD list because he now feels like he’s a human again and there is a path to his recovery.

That changed the game for me. I started to realize that, for us, we can sit here and advocate that people need to be able to access their services, but in so many cases…. This is not an isolated event; it saved his life.

If we continue to just look at how we strengthen the community connective tissue, which is the navigation and the people that will learn their stories, keep their stories safe and continue to advocate for them, then I think that’s a positive step forward.

Maggie Spizzirri: These stories are what we hear all across the province. I did a tour of a lot of the associations. In speaking to survivors, the biggest messages were two things: one was they wish they had the support to walk through the doors earlier, and the second was that those associations saved their lives.

[9:25 a.m.]

Stephanie Higginson (Chair): Thank you very much for your presentation.

I will look to my colleagues for questions.

Okay, then I will ask a couple while people get their thoughts together.

You talked a lot about the rural and remote aspect of a brain injury. I know when you have an illness, there’s travel, there’s recognition that you can’t access this service in this community, and there’s also support for travel when you’re there, staying in the city, things like that. When you have a brain injury — perhaps it might be accessing an OT, and maybe there isn’t one there, so you travel — you learn these things to take back to your own community.

With an ICBC claim, is there recognition of that need to travel and then get reimbursed for it if you live in a rural or remote community where the services might not be available? Even though they seem like not a big deal to people, it’s a really big deal to the person who has the injury.

Amanda McFarlane: That’s a great question. Right now, yes, but it’s reimbursement-based.

If you think about somebody that has been working, say that they don’t have extended benefits or are an independent contractor, their ability, then, to go for what would be recommended — once a month, say, to a PT, which is about a five-hour drive — to pay up front for that and then get reimbursed is oftentimes not a thing. Their credit cards are already maxed at that point. They’re barely paying their rent.

There’s that part, but if you think about the cognitive strain: “Now, okay, I have to get into a car for five hours. I have to drive. I have to get to this clinician. I will have my treatment, and then I’ve got to drive back.” That’s not a very therapeutic situation for our individuals. It often becomes such a barrier that they stop accessing it altogether.

I’ve heard that so many times, especially in the North. The main spot is Prince George, but if you’re coming from Haida Gwaii, or if you’re coming from very, very northern areas of our province, it’s exhausting to even think about that travel. They just won’t go. We’ve uncovered a lot of individuals who are living in really scary situations in northern B.C. To be honest, we’ve had to work through, because we’ve been told through the pilot: “Just offer the virtual services.”

We have people.… We’ll call clients and say, “Yep, we’re based in Kelowna,” and they’re mad. They’re like: “That doesn’t help me. I don’t need a phone call. I need a doctor. I need a clinician. I need a neuropsychiatrist. I need these things.”

Two things: the financial upfront cost but also the cognitive strain from travelling to what’s meant to be a therapeutic solution.

Stephanie Higginson (Chair): Thank you.

Brennan Day (Deputy Chair): Thank you for the presentation. The rural piece is huge to me. I was the rural health critic, and I know that the travel is a huge barrier to care across the province. In your mind, virtual is obviously the most convenient delivery method, but we know that for lots of people that doesn’t work. Seniors are in that group as well, and people that struggle to access technology.

How do you envision delivering those services in remote communities that can’t support a stand-alone individual, a place that is not big enough to have a brain injury society functionally up and running.

How does your group envision that that could be supported, potentially partially through ICBC, to ensure those people are getting that support? Is it somebody travelling and having a rotation through those communities? I’d love to know, on the record, what you guys would suggest to bring down those access barriers.

Maggie Spizzirri: Yeah, for sure. One thing to keep in mind as well when it comes to online: it’s not necessarily just the fact that there’s not access to computers or that there’s an age barrier between it. Sometimes with a brain injury, looking at a screen is just incredibly difficult to do and incredibly draining. There is that to keep in mind as well.

I think when we’re looking at rural supports, the brain injury associations all operate a little bit differently. When we look at the Northern Brain Injury Association, they have one very small office located in Prince George. Then they have satellite offices throughout the North, and their staff travel to their clients, to visit their clients. It’s set up already for that travel and rural spaces.

[9:30 a.m.]

I think that sometimes when we think of the traditional brain injury association, it’s one big building. They have staff within there and do a little bit of travel. But when we consider rural, there are different setups and different capabilities that we can look at, and the Northern Brain Injury Association is a great example of that.

Amanda McFarlane: To just expand on that a little bit, yes, we’re in a lot of conversations. Like our brain injury…. Especially with an alliance, the membership talking about how brain injury doesn’t just live in the Ministry of Public Safety — it lives in Health; it lives in justice; it lives in all of these different ministries — and how there is a model, potentially, where we can get investment from Health, justice, ICBC and have a cost-shared travelling model where it represents all, so the burden is not just on one specific ministry to fill it but it’s a shared, collective effort.

Janet Routledge: Thank you so much for your presentation. You’ve given me a lot of food for thought in terms of how to make what is a very important, critical system more accessible and available to people. The whole urban-rural divide — it really strikes me.

I’m an urban-based MLA, but I cannot imagine what it would be like in a remote, small community to need access to supports that may not be available in any way. I think that what you’re proposing and what we can take from this is that there need to be multiple models of how injured parties can access healing and support.

One of the things I specifically would want to address that you’ve addressed, and I really want to pick up on it, is that the reimbursement model seems to be…. I mean, whether you’re accessing support from ICBC, from your employer, from WorkSafe, from any kind of government service, it is reimbursement-based — particularly with someone who is fragile as a result of what they’ve been through…. I take your point that that could be prohibitive.

What I want to take from this is exploring alternative models to reimbursement. I would think that there are probably standard expenses that can be anticipated and that one does not have to provide proof of up front but one could get an allowance and then account for it afterwards, in terms of what the actual expenses were. That may take some of the pressure off.

I’m wondering what you think about that.

Amanda McFarlane: I love that idea, and that was something I actually put forth to the enhanced-care team a number of months ago. I said: Could there be certain hotels and the cost’s already established by ICBC?” They’re open to it, and they were willing.

We even offered as our organization — which isn’t sustainable, for the record — to pay for them up front and then have us go and get the reimbursements. That would be a stopgap, because each brain injury organization has very different financial capabilities. But definitely, I think that if it was able to be done on the ICBC end, where it was already kind of pre-established and there was an allowance…. I can tell you it works well with other things.

Our clients — there’s never really a risk of them misusing something. Like, they’re not cognitively able to. They just want to get better, right?

Yeah, I think that with that one change, it could save lives, 100 percent.

Stephanie Higginson (Chair): Okay, I have another question. In your presentation, and it may have been in your submission as well…. I apologize. There were a lot of submissions. They’ve kind of all….

You talked about people who have been deemed eligible but who, because of the process, sometimes just give up. I wonder if anybody has done any studies on that or a jurisdictional scan.

It’s hard to figure out. Sometimes it might be that people decide they don’t need it, so while it could be deemed eligible, did not…. There are all sorts of grey areas between that. I’m just wondering if you’ve done any work on looking, talking to people to find out what the numbers look like around that.

[9:35 a.m.]

Amanda McFarlane: Two parts. There is a little bit of research that was done by Dr. Julia Schmidt of University of British Columbia. She kind of looked at it before. She was looking at the client outcomes, prior to our pilot.

Internally, we have been tracking everything. We can say that of the number of clients that have come through for our region, I would say that probably a good 60 percent of them are shuffled our way because they are the ones that have completely given up. They are the ones that are having arguments, in some cases, with the adjusters every day, and they’re at their wit’s end.

It’s a lot of things like…. I’ll have an individual come in, and they haven’t claimed mileage in two years since they’ve had the claim, and they didn’t even know they could. Or they had…. We’ll sit down and say, “Okay, you can claim your mileage back,” and then they get it.

Yeah, most of them, I’d say, are at the end and not accessing anymore, and it’s our job as the navigators to reopen that guide again and say: “Okay, we’re going to help you this time, and this time you have somebody that can be the bit of a buffer.”

I would imagine that if there is a study done, it would be quite shocking, I think, to see how many people aren’t accessing.

Stephanie Higginson (Chair): Okay. Thank you.

Maggie Spizzirri: I also, just to kind of build on that, think that there are the supports for the individuals as well, and then there are the supports for the organization. We’ve had some organizations come forward and say: “We’ve accessed this pilot, and we sent in an invoice and got $25 back. It took me more time to write the invoice than the money that we received back.” So I think there are two parts to the supports with this, because these associations are doing just absolutely incredible work.

Stephanie Higginson (Chair): Thank you.

Further questions from my colleagues? No? Okay, seeing none.

Thank you very much for your presentation, for your submission and for answering questions so thoroughly and for the work you do to support folks.

Maggie Spizzirri: It is our pleasure. Thank you so much.

Amanda McFarlane: Thank you so much.

Stephanie Higginson (Chair): Okay, the next person we have is Chris McBride from Spinal Cord Injury Organization of British Columbia.

Chris, you have ten minutes for your presentation, and then we have up to 20 minutes for questions. If you go longer than ten minutes and you don’t appear to be wrapping up, I will interrupt you and ask that you wrap up.

With that, I will pass it over to you to begin your presentation. Thank you very much.

Spinal Cord Injury B.C.

Chris McBride: Great. Well, thank you very much, and thank you for this opportunity for me to present. I wish I could be there in person today, but unfortunately…. Well, not unfortunately. I have an AGM to attend this afternoon, so I have to be here.

My name is Chris McBride. I am the executive director of Spinal Cord Injury B.C.

I’m joining you today from our main office in Vancouver. It’s located on the traditional ancestral territories of the xʷməθkʷəy̓əm [Musqueam], Sḵwx̱wú7mesh [Squamish] and səlilwətaɬ [Tsleil-Waututh] Peoples.

I will declare that I myself do not have a spinal cord injury, but I have been involved in the world of spinal cord injury for over 30 years now, first as a PhD student studying the cellular neurobiology of spinal cord injury. I was the managing director of the ICORD spinal-cord-injury research centre at UBC and Vancouver Coastal Health Research Institute. I was the managing director of the Rick Hansen Institute, now known as Praxis Spinal Cord Institute.

For the last 16 years, I’ve been the executive director here at Spinal Cord Injury B.C., where I also serve as the co-chair of Spinal Cord Injury Canada’s executive director’s council and a co-leader of the B.C. spinal cord injury community services network.

Spinal Cord Injury B.C. has been around since 1957, helping people with spinal cord injuries and their families adjust, adapt and thrive to deal with a new injury or struggle with the ongoing challenges of living and aging with a physical disability. Of the over 3,400 members we have in our database, many will be persons who have suffered a spinal cord injury as a result of a motor vehicle accident.

I’d say, thankfully, that those numbers annually have decreased over the years thanks to improvements in auto safety and other measures, but the impacts for those that are injured are no less devastating than they were many years ago.

[9:40 a.m.]

It’s often said that spinal cord injury is one of the most devastating survivable injuries that one can sustain, really impacting every single body function and domain, including how people are able to participate in communities following their injury.

Until the introduction of enhanced care, the outcomes and future prospects for people who had a spinal cord injury through a motor vehicle accident were highly variable and, I would say, highly inequitable, really dependent on what kind of coverage they had, whether they had somebody to sue or not, whether they were able to get a sufficient settlement or award through the former process and, also, if they had the wherewithal, if they did get an award, to use it prudently and in a forward-thinking way that took account, really, of all of the future expenses that often most people didn’t really plan for or consider at the time of their injury.

There were several of us within the disability community service community that got together and had advocated for many years to ICBC for changes to the benefits program. I guess it was with a high degree of skepticism that we entered into discussion, when invited by ICBC, on how we could explore together to improve the system. I think that the process that ICBC undertook really actually changed our minds on a lot of things, including our relationship with ICBC.

As outlined in my submission, it’s really through ICBC’s meaningful engagement that I think a lot of trust was built, not only that they were listening but that the suggestions and ideas and things we were putting forward and the issues that we were bringing forward to them were reflected in the ongoing evolution of the enhanced care program, which I think is built on a lot of really great input from the community organizations, from the other advisory groups that they had brought into this process.

I think, you know, in summary, what’s working well is that engagement piece, and that’s ongoing. I serve on two different advisory committees for ICBC and really do see the positive influence that these groups are having.

I think that one of the things that ICBC has done well is invest in training their staff. The whole culture change that’s required within ICBC requires staff to better understand the populations that they’re serving. Certainly, people with spinal cord injury present a unique subgroup of those that they will be dealing with. The creation of the advanced-care specialist role and their knowledge and, I guess, their more proactive approach to engaging with the customers who have had the spinal cord injuries has been a positive move.

Overall, I think the equitable benefits component is really the biggest change and, for us, the most important thing that we’ve seen in terms of how it doesn’t matter whether you have somebody to sue or not or whatnot. Everybody that’s injured in the motor vehicle accident and has a spinal cord injury as a result has access to the same benefits.

Obviously, there will always be room for improvement, and I think one of the things that’s overlooked, because spinal cord injury is such a small component of the number of clients that are customers that ICBC deals with…. The definition of “catastrophic injury” is actually horribly outdated.

I know there’s a bill that has been put forward to look at this, but it’s not really as broad as we would like it to be. I think it needs to bring in some expertise in terms of clinical care research and lived experience to fully explore what a new definition of “catastrophic injury” could be that’s not just based on physical limitation but understands the other impacts in terms of the impacts of the nervous system — thinking of the bowel and bladder, pain, fatigue and all these other things that seriously impact somebody’s ability to engage and participate in community.

We’re suggesting a recommendation in terms of ICBC being the first payer. I think the WorkSafeBC model has been rather successful in that. There’s been a lot of confusion from our members not understanding why they’re not getting certain benefits when they’re in hospital, for example. I think the difference between WorkSafeBC and ICBC in terms of that first-payer model is sometimes striking, and I think that there could be some improvements made there.

[9:45 a.m.]

Transitional housing is a really big issue for people with spinal cord injuries as they go through rehabilitation. With rehabilitation in a hospital setting being so short these days, there’s not full time for their new residence to be modified or a new residence to be found, but also just in terms of their psychosocial adjustment after injury. We’re pushing for and working with ICBC to look at options to create some more transitional housing opportunities with programming that supports a person’s ongoing rehabilitation and recovery.

I’ll also add that I think there’s a really important role that peer support can play in this. The brain injury group has just been talking about their navigation system, and we’re pleased to be entering into discussion with ICBC about how we could do something analogous with spinal cord injury and create better navigation, but also in connection to better supports both in community and in the health system itself.

I think I’ll leave it there and welcome your questions.

Stephanie Higginson (Chair): Okay, thank you, Mr. McBride for your presentation.

I will look to my colleagues for questions.

Jennifer Blatherwick: Thank you so much. I appreciate the presentation. Thank you for sort of giving us a holistic overview of what’s happening in this sector. I also appreciate drawing some comparisons and parallels to the previous presentations that discussed brain injury.

Certainly, we’ve heard that there are some improvements in spinal injury treatment within ICBC’s system that haven’t yet rolled out to other types of injuries, like brain injury. And you’ve discussed that the ecosystem of injury for spinal cord injuries is more, I would say, evenly supported, perhaps, and there’s less burden on the part of the person who has received the injury to advocate for themselves to make sure that they’re getting the benefits that they’re entitled to, which is one of the struggles for people who have brain injury.

You also mentioned Bill M237, which is looking at a very limited change to the definition of “catastrophic injury.”

One of the functions of this committee was intended to maybe look at a review of the overall legislation, which would encompass that. Would you support a broader, more comprehensive review of the definition of “catastrophic injury” and how it plays out within the system?

Chris McBride: Yes, that is something I would very much support. Yes.

Jennifer Blatherwick: I would say that that’s been something that we’ve heard from several groups — that the original definition was not really encompassing people’s experience or what happened to them within the system and that they would appreciate a very detailed, in-depth review of how that will work out.

For your experience across the province…. We’ve talked with other groups about delivery to rural and remote areas. Could you give us just more depth about what’s happening for the Spinal Cord Injury association and how that works for you?

Chris McBride: Yeah. We are a provincial organization, and unlike the brain injury…. Like, we are the Spinal Cord Injury Organization, and we have people in many communities throughout the province, from Fort St. John through down to Victoria. And so we do serve a lot of the rural and remote communities.

For us, it’s a huge challenge. I mean, obviously, the small numbers of people in very vast geographical areas makes it hard for us to deliver our in-person peer support services, for example. We have adapted, obviously, by doing a lot more online programming, and we get out to communities as much as we can. But this is an issue, obviously, for the health system in general.

I serve on the leadership groups of two different rehabilitation initiatives where we’re advocating for improvements to the rehab system in this province. We lack a coordinated provincial rehab strategy and program, and I think there are a lot of opportunities to create some better pathways for people through the health system.

These individuals — this is a lifetime journey for them. They’re not just in the health system and then exiting the health system. They’re basically in the health system for the rest of their lives with ongoing and secondary health complications. Also, we can look at it more proactively in terms of the things we can do to maintain health and not just be reactive to when health issues arise.

[9:50 a.m.]

Jennifer Blatherwick: If you don’t mind, can I just ask you to go into depth a little bit more about what you mean by…? How would a coordinated provincial strategy work?

Chris McBride: Well, for example…. Spinal cord injury is a little bit different than brain injury and stroke and others because of the smaller number, and then there’s a more centralized expertise that’s located at the G.F. Strong Rehab Centre, but we also know that more and more people are not going through that centralized pathway and are maybe not getting access to that specialized treatment.

With the health authority structures, everybody’s getting a different delivery. They’re not necessarily accessing all the expertise in those regions that is available. Somebody who’s getting…. Even physiotherapy somewhere in the Kootenays is not going to be getting the same access to someone with expertise in dealing with somebody with a spinal cord injury, and the equipment that is available to them will also look very different, for example.

Brennan Day (Deputy Chair): Hi. Thanks for the presentation. This came up in a couple of earlier discussions with the head injury groups. I notice here that you have the SCI navigation service. One thing that came up, obviously, building off of the rural access piece, is: what are the main limitations of your group in delivering those services in rural areas? What success do you have, in terms of attachment numbers, doing it virtually versus…? What are your main limitations there, and what sort of supports would you be looking for to expand those services for rural British Columbians?

Chris McBride: The main limitation is people power and distance and so travel costs. As valuable as it is to go from Prince George, where we have an office, to somewhere…. Even to get out to Prince Rupert, for example. It’s just such a long distance to see a couple of people. We can’t afford it, basically, so we try to piggyback on other initiatives that are going on as much as we can, and we bring in volunteer mentors that we provide an honorarium for to host coffee groups in smaller regions and things like that.

The in-person connection is really, really important, but the online connection is proving to be as effective in slightly different ways, with slightly different outcomes and purpose in terms of just making connections rather than getting people out into community. Getting people out into community is a really important piece of our work because social isolation is such a big part of the condition for a lot of people with spinal cord injuries.

I think we are having a lot of success with the online piece, but it is limited in terms of the outcomes that we can achieve. I mean, there’s no easy solution for the low numbers of people in these vast geographical areas.

Brennan Day (Deputy Chair): I guess my follow-up question is regarding your comment on expanding the definition of “catastrophic injury.” Do you have specific sections that you would like to see expanded, or could you elaborate? Or you could follow up with those later. That’s possible too.

Chris McBride: Actually, I would go the other way. I would actually remove the definition completely because I think it creates some artificial barriers for people to access certain types of benefits, for example. We’ve heard this from our members. It’s kind of strange to…. Somebody who maybe has an incomplete spinal cord injury, who has a lot of limitations in their life but it’s not considered catastrophic — to them, their injury was pretty catastrophic and life-changing. So there’s just that aspect to it too.

Brennan Day (Deputy Chair): Interesting. Thank you.

George Chow: You mentioned about transition housing. I’m kind of interested in that. Can you describe it more? Of course, people who, for example, had to transition to using a wheelchair will need modification to their housing. What is the transition housing that you were mentioning?

Chris McBride: It has, I think, a couple of components. Part of that is just allowing people to get out of the rehab centre and not have to wait forever to start their transition back into community. There’s such a shortage of accessible housing in general in this province. One of the main reasons people call our toll-free info line is around housing-related issues.

[9:55 a.m.]

But there’s the other part of somebody’s rehabilitation. With rehabilitation stays so short these days, they’re just getting the basics. When you’re in the rehab centre, you’re getting great care. You’re being really well supported. It’s when you go back to community that the real challenge begins. A lot of people describe it as dropping off a cliff. They feel completely abandoned. They haven’t had the time for their psychosocial adjustment, let alone their physical adjustments, to be prepared to get back into community and living on their own or in a supportive family environment or whatever it might be.

So there’s an opportunity. And a number of jurisdictions in other parts of the world have transitional housing. It’s like a step down from the rehab centre, where you’re not just moving to a place that’s accessible and trying to figure out things on your own but there is some programming attached to that. You’re receiving some physiotherapy, some supports for daily living and other things that are helping you learn how to transition back to more independent living within community.

George Chow: Do you have any in the urban centre, particularly…? I assume that it’s very challenging to have that kind of facility outside of a big urban centre. So any in Vancouver, for example?

Chris McBride: I mean, there are one or two units that aren’t consistent with….

George Chow: Specifically, transition housing for people who suffer a spinal injury.

Chris McBride: Yeah, there are a couple, but I wouldn’t say it’s built into the programming for everybody. And I think it well could be. I know there were discussions with some of the social housing developers. The challenge is just to build the units, but it’s also a challenge in programming the units.

One of the challenges — and this is part of this jurisdictional issue around rehabilitation — is that G.F. Strong is within the Vancouver Coastal Health region. There was an opportunity to build some transition housing with programming in the Fraser Health region. The developer created the space and had the units, but the hardest part was figuring out how to do the programming from Fraser Health rehabilitation services. Who’s paying for what in that rehab pathway there? So that’s one example of a challenging coordination on top of the transitional housing issue.

Stephanie Higginson (Chair): I don’t see any other hands. Do we see any other hands? No? Okay.

Thank you very much, Mr. McBride, for your presentation, for your submission and for answering questions so thoroughly. We can circle back if we have more questions for you at a later time.

Chris McBride: I appreciate the opportunity. Thank you.

Stephanie Higginson (Chair): Our next presentation is from Fair Roads. It’s Charles He.

Mr. He, you have ten minutes for your presentation and 20 minutes for questions, and I appreciate your flexibility to be able to present today.

Fair Roads

Charles He: Thank you. I apologize for the disorganized and unorthodox nature of the speech I’m about to give. This hearing was moved up because the Legislature and this committee are expected to be dissolved for an election sometime today.

Fair Roads is an organization I helped create in 2024 to help injured MVA victims and, in a principled, non-partisan way, help reform the government monopoly insurance system that treats them. The organization included Sarah Wheatley, a wonderful person who was also an MVA victim. We’ve been in contact to try to support people like Julia Kwan, who presented yesterday.

My background is that I have a PhD in economics and I’ve worked on self-funded projects with collaborators from ivy league institutions. I’ve been paid and flown out to conferences. My projects have been featured in Vox and the New York Times. I presented at a Cambridge lab the morning of my collision, on August 16, 2023.

What I want to convey in my presentation is how enhanced care has given ICBC a kind of wraparound access no one else in your life has. ICBC pays for your therapist and can make you sign forms that they can call your therapist at any time, as many times as they would like. ICBC can set your income, so they can cut it off and cause you to, for example, engage in work you don’t feel comfortable doing. They can hold your file and decide on what you get to see.

When this is all used at once on one person, the level of power can produce very bad outcomes.

As mentioned, August 16, 2023, I presented at a Cambridge AI lab remotely. In that afternoon, I was going down Johnson Street Bridge, just in the area you can see from this building. I was in a bike lane when a car went through the bike lane and caused a collision. I suffered a concussion and major back injuries, and I broke my teeth. For months, I needed a cocktail of oxycodone and Ambien.

[10:00 a.m.]

There was nothing I could have done to stop the collision, by the way. The design of the road was bad, and I think the city effectively admitted it. That’s a separate story that I encourage you to ask about.

Because of my injury, I needed RMT. After some time, after the 12-week initial period, ICBC decided that I was getting too much RMT. ICBC announced this by assigning a new adjuster to me without notice, one of whose first emails was to declare that I was getting eight more sessions. I needed to handle all the pain myself afterwards.

At the same time, concurrently, ICBC called my RMT and caused her to stop writing treatment plans. For reference, treatment plans are sort of the medical justification and documentation you need to get RMT approved. Here, ICBC did not contest medical evidence. They simply declared by fiat that the treatment was over and that the evidence production would cease. There was no basis for this at the time.

I was very confused about this, and I took a large effort to try to fight this. The RMT then sent another treatment plan as a result of my efforts. Almost immediately afterwards, ICBC sent a special request to their clinical advisory group to get a report about this. The report, I later learned, said almost entirely general things, such as that there was no evidence that RMT or massage improves concentration. It was very unclear how the report applied to my case. For example, it seemed like it could deny RMT to every MVA victim in the province using similar logic.

On that basis, ICBC called my therapist a second time and told me that this would be the final approval. When I asked for the report, it was refused. I asked who wrote the report of the special clinical advisory group. That was also refused. I obtained it later by a freedom-of-information request for the report. Identity was redacted, illegally, I believe, because I was able to reverse that later on.

Note that in order to do this process where ICBC called my RMT multiple times to express denials and try to corroborate their denials, ICBC months earlier had me sign a form called a CL237A. At the time, months earlier, when I was injured and confused, I was given contradictory information about this form, including why I should sign it. Even the adjuster seemed uncomfortable, trying to explain what the form was doing.

I signed the form, actually, because they specifically dangled my permanent impairment benefits. So for my broken teeth, they said that I would get the benefits if I signed the form. It would help me get them.

Over time, my RMT was very supportive of me. She later made statements that were very troubling to me, such as: “I don’t want to lose my career for fighting a patient.”

Just to sum up what I said, because it’s a long story, ICBC targeted me and my RMT benefit by fiat in an email without medical evidence, concurrently calling my RMT to cease medical treatment plans. When I resisted, the clinical advisory group generated a generic explanation, then concealed the author of that report, even from a freedom-of-information request.

Throughout this, they called my RMT several times in a way that I think was intimidating to her, and she said things like: “I don’t want to lose my career over a patient.” To make these phone calls, ICBC obtained authorization from me, called CL237A, which gave them unprecedented access to make these calls. They got the authorization by dangling my benefits in front of me.

There are other things that are troubling. They ignored a doctor’s note at the same time. When I tried to cancel and pull back the form because my providers were being intimidated, ICBC began terminating my benefits, which has succeeded five separate times now, and included demands, like that I provide that medical diagnosis for autism and ADHD. This happened after I created Fair Roads.

A separate thing. I think what I just described is what many people experience. Unfortunately, they’re maybe not as articulate or well-documented to explain this to you now.

Something else that’s consequential and affects other people in this province is ICBC’s handling of income replacement. Something you should know is that the law, by design, has something called a category of employment or the use of NOC codes. For example, when a self-employed person is self-funding or has just started their business and gets hurt, they get this backstop, this income from their NOC-coded category of employment. This is very important.

For example, if someone loses all their limbs and is crippled for the rest of their life, that income from the NOC code could be all they have to save themselves from nothing. It is in the legislation. It’s one of the reasons why…. The legislation wouldn’t get passed without it.

In my case, I was self-funded, and just by happenstance, I got a tiny income in the year before on my tax return. Just to be clear, I have a PhD. I’ve earned hundreds of thousands of dollars in tech jobs, and I can still get rates like $300 an hour. ICBC set my income replacement at $330 a week, using an annualized figure of $20,000 a year from that tax return.

When I try to describe the NOC code or the category of employment code, let me just tell you what ICBC was like, by using ICBC’s own words….

Stephanie Higginson (Chair): Sorry, Mr. He. We don’t allow props of any kind, photos or recordings or anything like that. I’m sorry.

Charles He: Okay. Just to say clearly, that recording is an ICBC recording where they’re telling me that they don’t use the NOC codes or the category of employment, in direct violation of the law and in direct violation of other information they give, like in pamphlets there.

[10:05 a.m.]

In that recording, they also criticize me for asking it many times, when of course they set my income at $330 a week. Six months before that recording, ICBC had a private, internal calculation where they used the NOC code and calculated my income replacement benefits on the basis of $189,000 a year.

Something I want to point out, which I wasn’t able to point out in the phone call, was that there’s a sort of tradecraft in the phone call. There was a kind of annoyance that I was pestering them.

There is also this device they used, which was that they say in the phone call: “It doesn’t really belong to me. It belongs to a separate team.” That’s another tactic I experienced many times when I tried to discuss issues. They said that this belonged to this other team, and it was inexplicably unclear why I couldn’t contact them.

What I’m trying to say through all of this is that I think that people suffer a lot and come here and speak about their experiences. I think sometimes it might not seem credible to you, or they say things that describe things like difficulty or unfairness or slowness of access. There’s substantially more here that you could learn if you dug into what people experienced and found things that are well documented.

What I want to recommend here is that this committee establish a special investigations unit, analogous to B.C.’s IIO, the independent investigations office over the B.C. police, which investigates police misconduct.

The people in this room are very excellent. The MLAs here are great people. Certainly, I hope and expect that many of you will get elected again and again. But even if you are elected many times with a long career, you will never last as long as ICBC, which has been here since some of you have been born and will be here when all of us are gone.

I fear that no reform that comes out of this committee or a future committee will have teeth; it will only look at reality through the straw of what ICBC presents or piece together what victims are able to document as they are operated on.

It’s important to know how destructive this behaviour is. I think if ICBC said simply: “You’re not going to get much of anything, Charles….” This is a facade where we’ve used the cost centre of the MVA-injured for a variety of political purposes, which has happened over the decades.

If I’d been told that plainly, I think I might have been much better off, because I wouldn’t have been exposed to this very intimate, continuous behaviour over years. Throughout the time, I reasonably acted to try to resolve. Ultimately, I was defeated by ICBC, essentially escalating in increasingly exhausting and hostile ways.

I apologize for the…. That’s my main presentation.

Stephanie Higginson (Chair): Thank you, Mr. He. I really appreciate your ability to be flexible on your timing.

I’m going to look to my colleagues for questions.

Brennan Day (Deputy Chair): Thank you, Charles. I know we had a lengthy discussion a few months ago when the committee was first forming.

One of the things I want to dig into is the freedom-of-information requests that were required to access your own medical history and history with ICBC. I think that has come up a couple of times from several individuals that were struggling. Could you just describe to the committee the limitations that that placed on your ability to advocate for yourself and what barriers ICBC placed in terms of accessing those records?

Charles He: Just enumerating what happened, actually…. Often there are devices where questions like, “Can I please see the medical evidence you produced, that you’re denying my benefits…?” They would say that you’d want a freedom-of-information request, for example, for how my income was calculated.

When I made the freedom-of-information request — which is, I think, relatively easy for me, but probably difficult for 95 percent of people in the province — ICBC, I think, in each instance, gave it irregularly late. I’m worried that they wouldn’t have given it at all if I hadn’t followed up.

In each of the instances there, there were clear redactions — for example, the name of the entity or doctor who wrote the report. There were omissions altogether of, for example, how they calculated my income, how they calculated the $300 figure. I had to dig in and find out that they actually calculated separately an internal document with $189,000, which they did not give to many of the freedom-of-information requests.

There are also other very troubling issues about concealing their meta-behaviour in their documents. They have a case note system, and many large sections of the document were removed. After contesting it, I was able to remove some sections.

Those documents…. I apologize. I don’t have them today. I can’t read them verbatim. But the document sections that were redacted included things like: “We need to get Charles off his benefits here. Here are all the strategies that we’re going to try. We need to show that he’s autistic or has ADHD, and that would justify why he can’t work now.”

[10:10 a.m.]

Again, I’m a person who may or may not have those conditions there, but I have a PhD, and I was very successful before. It seems pretty troubling to me that it has gotten to the point where they’re writing their own strategy of how to deny benefits to somebody and concealing that in the information request.

Overall, I would say, something else is that I think what I described in getting that information…. It took five or six iterations, including escalations to the freedom-of-information act’s office, and it was pretty difficult. I basically had to file something that was like a contest or the equivalent of sort of a lawsuit to get them to review that at all.

This wasn’t straightforward at all. Not only did I make multiple freedom-of-information requests; I had to go through a process where I had to fight to get my information, and only after this was I able to get this stuff revealed, which is very consequential to me.

Stephanie Higginson (Chair): Do you have a follow-up, MLA Day?

Brennan Day (Deputy Chair): Yeah.

Thanks, Charles. I mean, that’s obviously extremely troubling when you’re trying to navigate a system that seems to be working against you and not in the best interest of the patient. From your standpoint, what would have improved your outcome in your dealings with ICBC in regards to information-sharing back and forth between you and ICBC? Where do you think that process could be improved to put the needs of the patient first, with reasonable limitations, obviously, in terms of freedom of information?

We’ve run into this quite a few times in this committee, and I think that’s an important avenue this committee needs to investigate.

Charles He: That’s hard to answer for several reasons. I try to answer for myself, who, again, was privileged. I have tools and people who can help me try to navigate this. And through that process, ICBC simply escalated their behaviour, as I’ve sort of described in these anecdotes.

For the average person, I don’t know. There’s no way of…. For example, some of the behaviour was just that when they got a bad result in an email or a subthread, they would simply rotate an adjuster, in a timing that was extremely convenient, to get a new outcome. You had to re-explain the reality to a new adjuster, who seemed to have a very different understanding there.

There are other things, like direct contradictions in emails, in violation of the law; direct contradictions to the previous messages; ignorance of medical advice. I don’t know. The truth is that for the average person, I don’t know how they would do well using those tactics. That’s what I have to answer.

I appreciate the time here. If you wanted to ask more questions, you could ask me about what happened with the road and how the enhanced-care law affects the road design.

You could ask me what happened to Fair Roads, the organization I helped create and had many great people working for.

You could ask me about my interaction with the Ombudsperson and what happened when I tried to interact with them.

You could ask me who has expressed other concerns of strategic behaviour, from very credible people who have expressed concerns about ICBC’s strategic behaviour toward them.

You could ask me about, for example, the non-profit ecosystem, an ecosystem where ICBC, for example, can buy ads in the Vancouver Sun, can fund organizations who do very good work and work very principally or cause special treatment to other organizations who are more nascent or maybe have a larger population of injured people.

Stephanie Higginson (Chair): Mr. He, I’m just going to interrupt you for a second because we do have two other questions. I think MLA Chow has a question, and MLA Blatherwick has a question for you.

Okay. I’ll start with MLA Chow.

George Chow: Mr. He, sorry to hear about your experience. Certainly, I could empathize and sympathize with your predicament here.

Can you put it briefly? Based on your experience, what are your recommendations for the committee in terms of improving the process for people?

Charles He: This committee has been very generous in allowing me to speak, and unfortunately, I was disorganized. As we all understand, this committee will probably be dissolved, so I was less focused on what structure and recommendation is proposed.

[10:15 a.m.]

The short answer is a special investigations unit. There are institutions that in every, even First World, country can exist for a long time and have problems. One example is the police force, where a large, long-lasting institution can get entrenched and have cultural issues that are hard to resolve through a committee that can only investigate anecdotes or what reports that institution can create. Again, the police reform is a good analogy. There are institutions like the IIO which investigate that and, I believe, over time improve those institutions culturally.

I recommend the creation of a well-funded, organized, independent investigations organization in a principled way that looks at the facts and the truth about the true practices that go on inside of ICBC.

George Chow: What would this special investigative unit that you just mentioned do in terms of…? Relative to ICBC’s actions and procedures and policies, is there some kind of a special inquiry that you are talking about?

Charles He: Again, the truth is…. I apologize. I didn’t research all the details here. Off the top of my head, just as I’m speaking here, it might get reasonable employee-level access to databases and anonymized cases in a reasonable way. A lot of the practices I’ve experienced seem like extremely gross violations that would show up in a basic scan of what ICBC does.

It seems like there must be systematic policies that are happening in place inside of ICBC that produce these outcomes, which cannot just be the accidental outcomes of a few negative employees. It seems very intentional and organized.

And it seems like an organization that was given, for example, employee-level access, access to databases or access to interviews of employees or a secure whistleblowing system which guarantees the careers of people who spoke up would make progress.

Jennifer Blatherwick: Your presentation was excellent, I think. I wish we had more time to dig into some of the things that we’re discussing here.

Some of the other presenters have also talked about things that could have been helpful to them in the process, and one of the recommendations that we’ve heard before is about having some kind of advocacy, independent advocacy that would have both legal knowledge but also some kind of medical knowledge so that they’re helping people navigate through the available benefits of the system but also the bureaucracy of the system. Do you feel that’s something that would have been helpful in your case to maybe prevent some of the situations you encountered?

Charles He: Again, that’s a complicated question. For example, the B.C. Ombudsperson seems to occupy that securely and my interactions with them…. I think they’re good people, and they produce great work. That would be difficult practically and logistically for a bunch of institutional reasons. So if you made a brand-new organization focused on ICBC, I think that is promising. I want to note that it would take a significant effort and well-grounded, concrete knowledge to do so.

Jennifer Blatherwick: Yeah, I appreciate that reflection. I think what we’ve heard from other organizations, too, is having more dedicated navigators to help people through so that people were preventing some of the challenges that people are seeing, especially when they’re in the worst moments of trying to deal with their injury and pain and possible brain injury, all of the things that are resulting from that — that it’s very difficult for them to engage with the complex and Byzantine bureaucracy that exists for some of these systems.

The other recommendation that was made was that…. People felt that when they were at the beginning, they weren’t given a clear menu of: “Here are your possibilities. Okay, you have this. Here are the services that we provide.” Would that have been helpful to you in the beginning, do you think?

Charles He: To tell the truth, my first adjuster was randomly assigned. They gave me the person without knowing anything about me or my accident. That person was reasonably nice, and I feel like if I stuck with that person, that would have been strange but maybe okay. So that didn’t really affect me.

The strategic behaviour began after I began my income replacement benefits, so the answer is that I don’t know if that would have helped me very much. Also, I’m in the top 1 percentile, honestly, of capability to do that. Even with a concussion, I’m sort of strong. I think that would help many people.

[10:20 a.m.]

It’s not clear how that strategic behaviour that happened afterwards would be resolved by that or that sort of being able to say what reality is to you or in an email would be helped by a menu.

Stephanie Higginson (Chair): Do we have any more questions from people? No? Okay.

Mr. He, I appreciate your time today. Your submission is really clear, concise and easy to comprehend. I appreciate you taking the time to come present to us and answer questions.

Charles He: Thank you very much.

Stephanie Higginson (Chair): Best of luck. Thank you.

Okay, our next presenter is virtual. It is Carol Paetkau from the Fraser Valley Brain Injury Association.

Carol, you have ten minutes for your presentation and then 20 minutes for questions from the committee members. If your presentation goes over ten minutes, I will interrupt and ask that you start to wind it up. Okay?

We will turn it over to you.

Fraser Valley Brain Injury Association

Carol Paetkau: Thank you very much.

Good morning, Chair Higginson and members of the special committee. Thank you for the opportunity to speak with you today.

My name is Carol Paetkau. I’m the executive director of Fraser Valley Brain Injury Association, or FVBIA, as you’ll hear throughout this presentation. We’re a community-based organization providing support for people with acquired brain injuries and their families for almost 30 years.

I am also an injured motorist, and I’m currently under ICBC’s enhanced-care system. I’m also a person with lived experience and a family member of a brain injury survivor. So while I’m here representing Fraser Valley Brain Injury and bringing forward the experiences of individuals and families we support, I also understand firsthand the importance of families and injured motorists to receive assistance while navigating the system.

FVBIA currently participates in ICBC’s disability advocacy advisory group, the injury recovery advisory panel and other consultation processes. This also includes the option to escalate specific claims and issues to upper management within ICBC.

My experiences may not be reflective of the majority of customers. I can only speak to the ones that I’ve supported over the years. However, these forums do allow us to bring forward the experiences of injured motorists who are both having challenges and also successful interactions with ICBC.

I also want to acknowledge that the ICBC senior management and leadership have been approachable, collaborative and open to feedback and new ideas throughout this process. I’ve been involved for five years since enhanced care came into place and for approximately ten years prior to those discussions around part 7 benefits.

As such, there have been several initiatives that have benefited motorists with brain injuries, which include the early concussion recovery program, development of enhanced-care information for people with cognitive and learning challenges, counselling support for family members, brain injury training for ICBC staff and ongoing accessibility planning.

It was great news to hear that the brain injury pilot project is now a permanent program of ICBC, recognizing that people living with brain injuries may require specialized support to navigate this system.

We have seen the positive impact of responsive case management and coordinated rehabilitation, but we’ve also seen the consequences when communications are delayed, treatment is interrupted and people are expected to manage their recovery without the support they need, particularly those with cognitive impairments.

I find that these challenges can be particularly apparent for those that are considered mild or moderate. Brain injury does not always fit neatly into these categories, so while they may be considered less severe from an administrative perspective — as a tick box on a piece of paper as mild, moderate or a concussion — they may still be experiencing significant cognitive, emotional and functional difficulties which can prevent them from managing their care effectively.

[10:25 a.m.]

The system is built in a way that has put the onus on the customer, or the injured motorist, to manage their care, find their rehab team and coordinate communication, and not everyone is able to do that.

Being expected to independently apply for CPP disability, which is a requirement in many cases, or navigate other insurance carriers, such as WorkSafeBC, as they may overlap, can become an overwhelming or even insurmountable barrier for individuals.

Without family, friends or community supports to assist them, they might be at risk of losing income benefits or ICBC rehab at a time when they’re already struggling to manage their recovery. Community agencies that can provide this assistance often have long wait-lists, and that leaves these individuals without the support they need when they need it most.

Recovery is also very individualized. It can be influenced by pre-existing issues, brain injuries, trauma, mental health, age, pre-injury function, occupational, financial circumstances, etc. The same concussion in one individual as another can have very different consequences, depending on a person’s circumstances, responsibilities and their available support system.

While I’ve seen many improvements since the implementation of enhanced care, there are several concerns we continue to hear from injured motorists, families and health care providers, including challenges with dispute resolution; support for self-employed customers; access to counselling that respects customer privacy; awareness of available rehabilitation services, particularly those that direct-bill to ICBC, as that can be a significant financial barrier for people having to pay expenses up front and wait for reimbursement; treatment delays due to communication issues; inconsistent decision-making between staff; staff training; and accessibility barriers.

We also hear of injured motorists expressing suicidal thoughts that they attribute in part to the challenges with ICBC processes and their privacy concerns. In order to address these issues, we recommend that ICBC:

One, strengthen person-centred communication, navigation and support. Ensure that proactive, compassionate, person-centred and trauma-informed care is a core part of enhanced care. Recognize that injured motorists may be dealing with brain injuries, trauma, pain, loss of income, changes in independence and significant uncertainty about their futures.

Continue improving communication so that it’s timely, consistent, proactive, empathetic and responsive to each person’s needs and abilities. Improve accessibility to information by providing it in a variety of formats that are easy to understand, process and remember.

Provide proactive case management and system navigation for customers with brain injuries, concussions and other complex care needs, particularly those who may have difficulty managing their own claims, coordinating services or communicating with multiple providers.

Continue to strengthen and adequately resource the ICBC brain injury program, including the full scope of community-based navigation, service coordination and rehabilitation support provided by brain injury organizations.

Improve timely access to counselling — trauma-informed mental health supports that recognize the psychological impact of injury, trauma, loss and prolonged recovery. Services should respect privacy, individual circumstances, cultural needs and a person’s readiness to engage in the support.

Two, strengthen collaboration, staff training and continuity of care. Lots of recommendations, sorry. Continually engage with health care providers, community organization and people with lived experience. Ensure all ICBC staff receive ongoing training to recognize and accommodate the diverse needs, barriers and complexities experienced by injured motorists, using the principles of trauma-informed care.

Establish processes that are consistent, accessible, seamless and responsive, regardless of injury type and perceived severity. Minimize interruptions to treatment and rehabilitation caused by communication gaps or administrative barriers. Implement safeguards to ensure that no injured motorist is left without adequate care, support or access to rehabilitation services while decisions are being made or issues are being resolved or because they’re unaware of what’s available to them.

Three, improve equity and support for complex and longer-term recovery. To recognize that recovery from brain injury and other complex injuries can be lengthy, unpredictable and non-linear, which may require specialized and flexible support over a long period of time. People may come back. Things may resolve. If a situation recurs, the complexity of their recovery becomes an issue again.

[10:30 a.m.]

Identify and remove barriers related to remote and rural communities, accessibility issues, digital literacy, language, financial circumstances and regional gaps in brain injury services.

Provide access to care and support that reflects a person’s functional needs, rather than relying primarily on a diagnostic label or perceived level of injury.

We encourage a review of how catastrophic injury is defined under the permanent injury regulation to ensure the individual with significant functional issues and needs can access supports and services required.

Review and address gaps in enhanced care affecting self-employed customers, recognizing that even an injury considered minor can have significant consequences for a person’s business, family and income.

Recognize the important role of family and caregivers and strengthen supports available to them, as they often provide essential practical, emotional and financial support and are an important part of the recovery process.

In closing, FVBIA recognizes the progress ICBC has made and appreciates the willingness of senior leadership to learn, collaborate and continue improving. We encourage ICBC and this committee to build on the positive initiatives already underway and continue working towards an enhanced-care system that meets people where they are at in their recovery and provides the support they need to move forward.

Thank you for listening, for your continued engagement and your willingness to work with community and people with lived experience to build a system that better supports injured motorists and their families.

Stephanie Higginson (Chair): Thank you, Ms. Paetkau. You were right on the ten-minute mark. Amazing.

Carol Paetkau: A little bit of practice.

Stephanie Higginson (Chair): I’m going to turn it over to my colleagues for questions.

Do we have questions?

Jennifer Blatherwick: Thank you so much. Yeah, you were very timely. It was very impressive.

There was a lot, and I was furiously writing as you were talking, but I thank you for thoroughly engaging with the process. I think that organizations that see dozens or hundreds of people…. You have a view into the system that is unmatched because you get to see many cases over long periods of time.

One of the things we’ve been talking about, also, is retention rates for people. How do we do better at ensuring people stay with the services to which they’re entitled and continue to pursue them, especially in rural and remote areas? That can be hard because travel can be very challenging. Or accessing or the thought of getting reimbursement…. There are many practical barriers.

Now, your organization serves people that are in…. I’m sorry. I’m just looking up your organization.

Carol Paetkau: Fraser Valley.

Jennifer Blatherwick: In the Fraser. This is certainly…. You’re going to have people that are farther away from services than somebody who’s, say, living in downtown Vancouver. But you’re still in kind of what I would say is the middle distance, right? I wouldn’t say it’s not way, way out there, but there are still challenges.

Could you maybe speak more specifically to what people who are living in that kind of middle space are experiencing?

Carol Paetkau: Yeah, I can speak to some of the experiences for individuals, particularly out in Chilliwack, who are looking for health care providers that meet their needs, many of whom live…. Their businesses are in, say, Surrey or further in towards Vancouver.

Some of the challenges that I’ve heard from them are…. I mean, transportation is a huge issue. When you have an acquired brain injury, in particular, fatigue becomes a big deal. So if you’re spending an hour, in some cases two hours, to travel to an appointment because that’s the health care provider that directly bills ICBC that meets your needs and that you’re comfortable with, it’s a half-day, full-day event for you which, in somebody with a brain injury, can mean the next two days are a write-off for them.

I’ve heard from individuals that getting reimbursement can be a challenge because they can’t necessarily understand how to navigate the client or the customer portal — and keeping track of those expenses, those receipts. Have they been reimbursed? Have I gotten that money back? Did I submit that? Those can be significant challenges.

Some of the more high-functioning individuals that maybe have more capacity, or have an occupational therapist on their team or have a supportive family member or friends, develop spreadsheets to track these complex kinds of back-and-forth interactions with ICBC.

As rural, even though we’re cities out here, we don’t necessarily have the practitioners that are available to us.

[10:35 a.m.]

Speaking for my colleagues in other communities that are much more remote, they don’t have any practitioners. For them, it’s a trip to Vancouver to get any type of support. So it is a big challenge and a huge barrier for individuals, brain injury or otherwise, I think.

Stephanie Higginson (Chair): I just want to pick up on something that you mentioned. I’ve got two questions.

One is about — it actually gives me nightmares to think about this — the WorkSafe overlap. It never dawned on me the possibility of getting into a car accident while travelling for your work and what that maze of hell would be like. I just wonder if you could comment a little bit on if there is sort of a brain injury focus on the navigating of those two competing systems.

Carol Paetkau: I can speak to that from personal experience. I’m currently in both systems. Actually, ICBC was somewhat supportive — that was the first point of contact — in telling us what steps needed to take place. So the communication from ICBC in my situation has been proactive and supportive, and they have helped guide me to some degree.

It’s not always the case, and I think from a brain injury perspective, I have a concussion. If you’re dealing with much more complex brain injury issues, I think, as you say, it would be hell to try and navigate both.

Trying to remember who’s doing what, who has approved what and getting communications from one system to the other is a significant challenge. Dealing with one corporation is bad enough, but dealing with two is extremely difficult.

Stephanie Higginson (Chair): Thank you. Do we have more questions? No?

Okay, my second question. You talked about counselling that respects privacy. I mean, we’ve heard from a number of people about their medical records being in the control of other folks. It never dawned on me that what you say in a counselling session might not be, that privacy might not be subject.… Can you explain what you meant, a little bit, by that, please?

Carol Paetkau: Yeah. I’ve spoken with counsellors and customers who are concerned that ICBC has requested all of the counsellor’s files, regardless of whether the information in there is specific to the crash. We all know that people come into every situation with their own personal experiences, past traumas, whatever is going on in their personal life at the time.

I think a lot of people are quite concerned. They don’t want to give ICBC carte blanche to look at all of their counselling records with all of their history and to start trying to attribute their recovery process to some of those other perhaps related, perhaps unrelated things — because they do have an impact on recovery; let’s face it — that have gone on in their past and use that as some reason to terminate their access to recovery benefits.

Or, “Well, you’re not dealing with the crash. Now you’re dealing with something that happened in your teens. Therefore, we’re cutting off access to your counselling services,” whereas it may have some relevance to what’s going on in the current situation due to the crash. Maybe they had dealt with it previously, and now the crash has brought up all these previous traumas and issues.

Does that make sense?

Stephanie Higginson (Chair): Absolutely. Thank you.

Brennan Day (Deputy Chair): I just want to circle back to the ICBC and WorkSafe interplay because I’ve had to deal, as an employer, with the maze of WorkSafe, and even that alone was one of the more frustrating exercises in patience I’ve had to go through. I’m not slighting anybody that works there, but that is clearly a bureaucracy that needs a considerable bit of reform in terms of the way they deliver services.

Could you just describe to me the interplay between the two in regards to the specific roadblocks that have been communicated to you in getting those claims through?

[10:40 a.m.]

If you have any specifics, it would be great to just get them on the record here so that we can potentially add WorkSafeBC to the list of people to come in and present. I think that might be a very useful thing for this committee to do as we continue our deliberations.

Carol Paetkau: Well, I think one of the challenges that I’ve encountered is that everything WorkSafe does is through their customer portal or whatever they call it. There’s no indication, no email notification, nothing sent to say: “Hey, documents have been uploaded to your claim.” It relies on the injured worker to go into this portal — can’t remember what it’s called — to look at their information. Each document has to be downloaded before you can look at it. You can’t just click and see a preview and have a quick glance.

There’s no proactive communication, at least in my experience, from WorkSafe to have discussions. Apparently, they left a voicemail. I have no idea. I haven’t seen that.

I find that is challenging, so actually, in my experience working with ICBC, they’ve been much more proactive. However, I am at a certain level, I think, where the claim has a dedicated recovery specialist. So perhaps that’s why.

Yeah, WorkSafe is a bit of a challenge, so I can’t imagine navigating it with a cognitive impairment or even realizing that anything’s going on, on that end.

Brennan Day (Deputy Chair): Yeah, as somebody that is not struggling with a cognitive impairment, it was a challenge with WorkSafe all by itself. I know the entire system is cumbersome and, you know, bureaucratically frustrating, as we’ve seen at ICBC.

So I’d just like to, for the committee Chair, maybe perhaps make a note for follow-up on this discussion because I think it’s an important one.

Stephanie Higginson (Chair): Thank you. We’ll do that.

I don’t see any more hands. Okay, thank you so much for your submission, for your presentation and for answering questions.

I did note you said that you were in the middle of navigating a concussion yourself. I’ve been there. It gets better, and good luck with that. Also thank you so much for your advocacy for the people that you’re supporting right now. Have a good day.

We’re going to take a five-minute recess — little bio break. We will be back here, let’s just say — what time is it? — 10:50. Okay? Thanks, everyone.

The committee recessed from 10:42 a.m. to 10:51 a.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): We’ll call the committee back to order. We have a presentation from Phil Sweeney of the G.F. Strong Rehabilitation Centre.

Phil, it’s nice to see you virtually. You have ten minutes for your presentation and then 20 minutes for questions from the committee members. If your presentation goes over ten minutes and you don’t appear to be wrapping up, I will interrupt you and ask you to wrap up your presentation, okay?

Over to you.

G.F. Strong Rehabilitation Centre

Philip Sweeney: Perfectly fine. Hopefully we won’t take that long. Thank you very much.

As was mentioned, my name is Phil Sweeney. I am the operations director and site lead for G.F. Strong, the rehabilitation centre here within Vancouver Coastal Health. G.F. Strong is part of the Vancouver acute community of care, obviously sitting within Vancouver Coastal Health.

I just wanted to share some positive aspects in regards to the enhancement or the changes that have happened with the insurance B.C. act from the clinician and physician side of things here at G.F. Strong. In general, we have found that ICBC has been very responsive to the changes and has been very helpful to work with since these changes were implemented.

I do just want to provide a shout-out to the enhanced recovery managers Ron Floen and Catherine Tkachuk, who have been fantastic to work with since these changes have come into place.

Something that we have done in terms of working with them — just, again, some more kudos to the team — is we have had regular touchpoints with them. Since the changes came into place, there were obviously differences, questions, issues that arose. We’ve had regular meetings with them, and they’ve been great to help work through those and implement things.

We’ve also had an ICBC liaison person come on site every Friday to deal with questions from clients, family and staff. It happens every Friday, and it has been very well received. And we have a good relationship with the various advanced recovery specialists.

In general, we’ve found that the equipment funding and procuring process has been very good for us as we try to support patients getting back to the community. The other thing which we found very helpful is that, in general, the recommended therapies that we are requesting are usually funded, which is very appreciated.

As you have my letter that I submitted to the committee, I just wanted to move on to some of those issues that have arisen. What I hear mostly from our staff and our physicians are the challenges around the criteria that are used for determining a catastrophic classification of a patient. They’re usually based on the injury, diagnosis or the classification around the ASIA impairment scale.

I provided an example in my letter of a patient with an incomplete high spinal cord injury, which would be deemed on the ASIA impairment scale as a C category, a partial injury — high spine being the fourth vertebrae in the spine, so fairly high up — an individual who would have limited hand function, minimal trunk control and require a power wheelchair for all mobility.

[10:55 a.m.]

If we compare that to someone who would have a complete injury of the T10 — so an ASIA A or an ASIA impairment scale A…. That’d be the thoracic spine down the bottom of the rib cage, the tenth vertebrae. They would have everything above that level of injury completely intact. They would have full use of their arms, great trunk control, and they would be independent with all their transfers and use a manual wheelchair for all mobility.

Unfortunately, with the way that the system is being implemented right now, we’ve noticed that patients like the second incident example I gave of the ASIA-A patient would be eligible for more supports in the community — but they have less disability, one could argue — than the person who has a partial injury and requires much more supports in the community.

One of the pieces of feedback that we wanted to offer the committee for consideration is, in making these determinations, being able to include the functional ability of the individual. We recognize that spinal cord injury is a very serious and life-changing injury. It will ultimately create dependence on the health system for future care. So our concern is that the current setup risks underfunding patients or clients for the future, which will then put extra stress on the health system in the future.

The next issue that I raised, which is commonly coming forward, is just in terms of the timing of classification and the resulting impact on benefits. It’s more common, or it’s very common, for our traumatic-brain-injury clients to have an extended period of time to, what we call, declare themselves. That is, they reach a plateau, what will be considered their new normal in their recovery as a result of their injuries.

So it’s understandable that there needs to be a delay in determining: “Okay, has this been catastrophic, and is funding required for this situation? Or what level of funding is required for this situation?” This period usually extends well beyond the acute rehabilitation phase. They continue to make gains, and so it’s understandable that a decision may be made down the road once they’ve actually left G.F. Strong and they’re back and more closer to their community.

Where we’re finding it challenging is that, because there is a prolonged period of time, there is some uncertainty around what the clients are able to have access to, what resources they’re able to tap into and whether those resources are going to be available long term. For us and our clinicians, the challenge that we’re facing is that we use the time that we have with them to teach and support the clients to live independently and work within the resources that they’re going to have. But because of these question marks around this, it’s uncertain as to what we should be working with.

I don’t really know how this could be done earlier, but the request is to just consider seeing if we could make this…. Either having a more stable benefits package until the determination has been made, or seeing if there’s a way to make that catastrophic decision-making…. Bring it forward so it can be done as soon as possible.

Those are the main points that I had. I do have a couple of other feedback items that were not in my original submission. Would the committee like me to share those with you now, or do you want me to hold those since they weren’t originally submitted?

Stephanie Higginson (Chair): You can absolutely present them now.

Philip Sweeney: Thank you.

One area which has been mentioned to me is around concussion management. The changes have been advantageous in that there’s a focus on patient preference, which is great. What we’re noticing is that there is great variability in the skill set of the providers that are providing care for concussion management, so it would be ideal if there could be some sort of validation process around the skill set of individuals.

We’re not sure exactly what the best approach to that would be, whether it’s creating a preferred provider network or something similar. But that does become problematic because we have patients that are going into the private sector to get therapy from where they would prefer to be receiving the therapy, which is fantastic, but not all therapists are created equal, and not all therapists have the same skill set, so there is variability in the type of care that they’re receiving.

Another change which was noticed is the responsibility for doing certain things. I’m told that prior to the changes to the Insurance Act, both nursing care and therapy care could be either done in the public setting or in the private setting. Since these changes, the nursing care needs to be done within the public health sector.

[11:00 a.m.]

Ordinarily, this wouldn’t be a problem. However, we have noticed there tends to be some communication challenges that have arisen as a result of this, because wound care is typically managed by nursing. That’s done in the public sector. But seating and other supports are done in the private sector, and there just seems to be a barrier for some reason. In our opinion, it feels like the system worked better when nursing could also be done in the private sector. It just had a better, seamless flow of information between people.

The last aspect which has come up is transitional housing for patients. Often patients, they have some sort of injury, and they come to us. Whether they’re going home or going somewhere else, their home is not necessarily set up to receive them, so they often need to have renovations done in their home space.

That then results in a situation where the patient is ready for discharge; however, they have nowhere to go. Their home is not set up to take them, and there’s no interim place for them to actually head to, to stay, short of trying to get them admitted into a long-term-care facility — which, as you’re probably all well aware, we’re very stretched for long-term-care beds in the system currently.

We do have some potential options or something we’d recommend. St. George’s Place, which is run by a charity, I believe, has a couple of temporary lodgings for people to stay short term for this exact reason. We tap into this for other patients when it’s appropriate, but there are just simply not enough of these resources available.

In a perfect world, if there could be an emphasis on transitional housing to help support these patients when they are leaving an acute care facility or a rehab facility when their own home is not ready for them to take back, that will afford them some time to be in a safe environment and an accessible environment while the renovations are being completed in their own space.

That is all the feedback that I have for the committee. Thank you for taking the time to listen to me.

Stephanie Higginson (Chair): Thank you, Mr. Sweeney.

I will turn it over to my colleagues for questions. MLA Blatherwick and then MLA Day.

Jennifer Blatherwick: Thank you so much. I think that we’ve heard a lot of references to G.F. Strong in other presentations as being a standard of care, so have been looking forward to hearing from you.

I appreciate you taking the time to add things on to your submission. Could you talk to us a little bit more about the St. George’s model? What is the capacity? What is the level of care? What are the conditions of care that make it such a good model?

Philip Sweeney: Sure. We have two accessible units there. I think one of them is a one-bedroom suite and the other one is a two-bedroom suite. The two-bedroom suite can obviously allow for a family to be able to stay with them if needed. They’re fully accessible, but our requirements are that the patients need to be either independent or be sufficient with community services coming in to support them, like nursing supports. Outside of that, I’m not sure what else you would want to know.

The biggest limitation is we have two units. Sometimes renovations can take three to six months to be completed. We have to also be very careful due to tenancy requirements or laws because, if they stay for too long, then they’re considered an actual tenant. Then we can’t move them on, and we can’t use that space for someone else, so it becomes a little bit problematic.

Yeah, it’s fully accessible — accessible bathroom, showering, beds. I believe there is a floor lift in the space, should it be needed for care workers to support with. But, as I said, we generally try and have the patients be independent in their care or independent with support from their family to go into those spaces.

Jennifer Blatherwick: Yeah, I think you’ve answered my question that I wasn’t as direct about as I could have been. My question was more one of: was it like a clinical space, or is it like a home space? But what you’re saying is….

Philip Sweeney: It’s an apartment.

Jennifer Blatherwick: Yeah, it’s an apartment, so basically this is just an accessible apartment for people to stay in while they’re waiting for their own home to be adapted.

Philip Sweeney: Correct.

Jennifer Blatherwick: So it doesn’t require the building of a new facility. It could be a retrofitted….

Philip Sweeney: Correct, absolutely.

Jennifer Blatherwick: Okay. That’s very helpful.

I see that MLA Day has a question, so I’ll come back.

Brennan Day (Deputy Chair): Obviously, your organization is doing some amazing work. I do have some questions regarding how many individuals that come through your facility are from the Lower Mainland and how many are from outside of the Lower Mainland.

We know across rural B.C., access costs and medical travel costs are quite high. Obviously, for the length of rehabilitation that’s required for some of these catastrophic injuries, that can put a fairly huge stress on rural British Columbians. Do you have any idea of sort of the ratio that you see there in your facility?

[11:05 a.m.]

Philip Sweeney: Yeah, I will be able to get specific numbers for you at a later date if you would like them, but I can give you a rough outline of what we do and who we see.

The only program that we run here that is truly provincial in nature is our spinal-cord-injury program. We take patients from across the province. There isn’t really anywhere else that will support patients like that. We do have partnerships with Queen’s Park Care Centre and Fraser Health and Holy Family, where lower-level injuries can go to. Anything that is a higher-level injury or has any complexity that comes with it, they come to us for their inpatient stay.

We generally try to keep our rehabilitation stays less than three months and ideally shorter if we can because, obviously, that facilitates flow of patients. We’re looking at a very short duration, to the point where we’re teaching them how to manage themselves, how to be safe, how to advocate for themselves from a spinal-cord-injury perspective. This goes for all the other patient populations we see, as well, before we send them on to the next place, wherever that may be.

The other programs that we have — we typically see patients from within the VCH catchment — would be our neuromusculoskeletal patients. That could be anything from Guillain-Barré recovery, multitrauma, burns patients. We do have our lung transplant patients come through that program as well and acquired brain injury, which is another unit, again, through the Lower Mainland.

What we will also do is recognize that we have, I guess, a locus of expertise here, and it’s not necessarily readily available in other areas. Whilst primarily we take in those other areas, not excluding the spine…. We primarily take from Vancouver Coastal Health. We will take any patient from anywhere in the province if their local rehabilitation facility is not able to offer them what they need so that we’re not leaving anyone in the lurch and getting substandard care.

I would hazard a guess that if we exclude the spinal cord group, we’re probably looking at in excess of 80 to 85 percent of our clients that come through would be from the Lower Mainland, particularly in the VCH catchment, so just a small percentage from outside of that.

When it comes to the spine patients, it is still predominantly just based on population. Most people live in the Lower Mainland, so you’re talking 50, 60, maybe 65 percent of them would be coming from the Lower Mainland, and then the rest coming from around the province.

Stephanie Higginson (Chair): MLA Blatherwick, you had another question?

Jennifer Blatherwick: No, actually. It was answered.

Philip Sweeney: Perfect.

Stephanie Higginson (Chair): There you go.

I just wanted to ask you a little bit about…. I don’t know if I’m going to say this properly, but you sort of talked about professional standards for concussion specialists.

Philip Sweeney: Yes.

Stephanie Higginson (Chair): Could you expand a little bit more on sort of what you’re seeing that’s making you make a call for this and your suggestions on how something like that could be implemented?

Philip Sweeney: Sure. What we’re seeing is that…. I’m going to be quite candid, so I apologize for that.

It’s easy to advertise oneself as having a skill set in something. It’s another thing to actually have that skill set. That’s one component. There are people saying: “I have concussion management.” They may have taken a course. They may be aware of how to do things. They may have a very primitive skill set in managing something.

The other aspect which we’re noticing is that when clients are seeing therapists and the therapists are working with our therapists as part of that transition and handover, our therapists are noticing that the skill set of the individual therapist is maybe not where we would expect, for someone who has expertise in concussion management, it could or should be.

It just creates a system where we’re relying on the individual therapist to put their hand up at some point and say: “I don’t have the skill set necessary to do this. Maybe I’m not the right person.” Because of the private nature of things, it takes a very confident person to be able to do that, and it doesn’t always happen.

I’m not sure if I’m giving you as much detail as you would like, but that’s kind of where our concern is coming from. It’s people putting their hands up saying, “Yes, I can do this,” but not necessarily having the insight as to whether they can actually provide the level of care that would be required to get the person to where they should be.

Stephanie Higginson (Chair): Maybe some suggestions on how you could create standards…. Maybe it’s not standards of practice. I’m just wondering what it would look like for you to help solve this issue. I think this is an issue beyond just ICBC, to be honest.

Philip Sweeney: Yeah, I agree.

Stephanie Higginson (Chair): I think concussion protocol varies everywhere. I’m intrigued by the suggestion in this case as it applies to ICBC, because I think when it comes to care, ICBC can have suggested providers.

In the broader sense, as well, what would it look like for us to be able to say you are certified in this level of concussion care for these types of patients? How do you see that working?

Philip Sweeney: I would imagine it’d be similar to, say…. I’m a physiotherapist by background, so I’m just going to use this as an example. This is just an example. It’s not the be-all and the end-all, so please take that with a grain of salt.

In the world of physiotherapy orthopedics in B.C., there are certain levels that you can take, which would give you your orthopedic skill set. There is a standardized education that can be done, and you can then utilize that as having your levels — I think level 1 and level 2 is what they’re called — which guarantee that you have a certain skill set. So people, if you were looking for an injury…. So because you’ve had an orthopedic injury, you would look for a therapist that has A and B certification because they’re formalized, certified through a body, and then you get to know that that’s a minimum standard. I would imagine something similar to this would be appropriate.

We have a concussion certification that can be offered that people can take, which is going to guarantee you a minimum standard.

I offer the preferred provider network with reservation, because I’m aware of how those things can go in other circumstances. Sometimes they can get very restrictive, and then you end up with a bit of an exclusive hub that other people can’t get into.

I think there are two routes. You have the preferred provider network, where people can demonstrate they have the certification. Or you just have a certification that is expected, that if you want to provide X level of care to a patient with concussion, you have said certification and, therefore, you can be on the referral list for someone that can be providing care to those patients.

Stephanie Higginson (Chair): That’s great, thank you so much.

Any other questions for my colleagues? Okay.

Mr. Sweeney, thank you for taking the time out of your day to present, to answer questions and also for the submission by G.F. Strong. We really appreciate the work you do.

Philip Sweeney: You’re very welcome.

May I just ask a question to MLA Day?

Stephanie Higginson (Chair): Sure.

Philip Sweeney: I just wanted to validate if the information I provided was sufficient. Or are they looking for more specific numbers?

Brennan Day (Deputy Chair): Obviously, it would be helpful to the committee just to understand the distribution of services across the province. I think that’s something you may have unique access to. I think whether it is spinal or head injury…. I know from the presentations from the head-injury groups that it was very intermittent or not even measured. It was done by non-profits.

It would be great to see what that distribution looked like, what services you guys are providing to rural B.C., because I think it ties in pretty handily with the rates being paid, in terms of travel costs and things like that, that need to be considered in that reimbursement model.

Philip Sweeney: Absolutely. We can break it down by health authority. We can potentially go even further down by that. Would that be helpful?

Brennan Day (Deputy Chair): That would be amazingly helpful, yes.

Philip Sweeney: Okay. I’ll see how granular I can get it for you.

Brennan Day (Deputy Chair): Fantastic. Thank you so much for the presentation.

Philip Sweeney: You’re very welcome.

Stephanie Higginson (Chair): Thank you.

Mr. Sweeney, just the pragmatic nature of myself, I would hold doing any more work until we know what is happening today on the broader scale of politics in British Columbia. I don’t want to send you off to do work that may or may not be used. The Clerks will reach out to you if that remains a possibility. Okay? Thank you for your time.

Philip Sweeney: Perfect, thank you very much. I will wait until further instruction.

Stephanie Higginson (Chair): Thank you.

Our next presenter is virtual, and they are ready to go and with us. We have Angela Wignall.

Angela, it’s nice to see you. I know we’ve been trying to connect in another version of this world, I believe, in my role as parliamentary secretary. So it’s nice to see you.

Angela is from the Nurse and Nurse Practitioners of B.C.

Angela, you’ve got ten minutes to present. Then we have 20 minutes for questions from the committee. If your presentation goes over ten minutes and you don’t appear to be wrapping up, I will interrupt and ask you to wrap up. Okay? Over to you.

Nurses and Nurse Practitioners of B.C.

Angela Wignall: Thank you so much, Chair and Members of the committee. Thank you for the opportunity to appear before you today.

I’m joining from Treaty 1 territory, in what is today Winnipeg. I’m happy to be joining you across the country.

[11:15 a.m.]

My name is Angela Wignall, and I’m the Chief Executive Officer of the Nurses and Nurse Practitioners of British Columbia, the professional association representing all nurses and nurse practitioners in this province.

The committee has been asked to review parts 10 and 11 of the Insurance (Vehicle) Act and to consider a Bill M237. Our submission approaches that mandate from a nursing and health systems perspective.

NNPBC supports the principal underlying enhanced care. A system that provides injured people with care, rehabilitation and income support without requiring them to establish fault through lengthy and costly litigation is a sound one. But for us, part 10 is more than an insurance framework. It establishes a system of health, rehabilitation and income-support entitlements. Its success should therefore be assessed not only by whether benefits are defined in legislation but by whether injured people can access those benefits in a timely, clinically appropriate and equitable way.

Nurses see the effects of motor vehicle injuries across the full course of recovery, from emergency and acute care through rehabilitation, primary care, mental health services and longer-term community-based support. We see what happens when care is timely and coordinated, and we also see what happens when administrative requirements interrupt treatment, delay recovery or shift costs to the publicly funded health system, families and communities.

Our submission recommends that the committee assess parts 10 and 11 through five tests: clinical appropriateness, timeliness and continuity, person-centredness, equity and accessibility, and transparency and accountability.

I’ll begin with the health care and rehabilitation entitlements established by sections 123 and 124. Section 123 provides an entitlement to reasonable expenses for necessary health care services, equipment and medication. Section 124 authorizes rehabilitation measures that ICBC considers advisable. These provisions create an important foundation, but their effect depends heavily on how terms such as “reasonable,” “necessary” and “advisable” are interpreted and applied.

We’ve recommended that the committee clarify, through amendments to part 10 or through recommendations under the regulation-making authority in section 169, that standardized treatment pathways are guides to care, not fixed limits where a person’s clinical circumstances require a different approach. Where a qualified treating professional provides a clear clinical rationale for continued additional or different care, that evidence should receive meaningful consideration.

ICBC should, of course, retain responsibility for determining entitlement, but its decision should be grounded in the individual clinical circumstances and the evidence before it. When ICBC declines, reduces or ends a health care or rehabilitation benefit, the claimant should receive written reasons identifying the evidence considered, the applicable eligibility criteria and the clinical basis for the decision. This would make the operations of sections 123 and 124 more transparent and enable a claimant to understand whether and how to challenge the decision.

The committee should also consider how section 167, which addresses disputes with ICBC, could provide a more timely and clinically informed mechanism for resolving disagreements about treatment, prognosis and functional capacity or returning to work. Where there is a genuine clinical dispute, the claimant should be able to obtain prompt review by an independent, regulated health professional with relevant expertise. When interrupting treatment could reasonably cause deterioration or a significant setback, clinically necessary care should continue pending that review.

This would not create the former litigation-based system all over again. It would create a focused, proportionate safeguard within the existing benefits model.

The review would also provide an opportunity to ensure that the implementation of sections 123 and 124 properly recognizes nursing expertise. Nurse practitioners in British Columbia are regulated, autonomous health professionals. They independently diagnose conditions, order and interpret diagnostic tests, prescribe treatments and medications, make referrals and manage complex care. They do not practise under physician supervision.

The act and its supporting regulations must, therefore, recognize nurse practitioner diagnoses, referrals, functional assessments and treatment plans without requiring unnecessary physician confirmation. Requiring duplicative confirmation can delay access to care and entitlement under part 10 without adding any clinical value.

[11:20 a.m.]

That same framework should also enable services provided by registered nurses, registered psychiatric nurses and licensed practical nurses to be funded when those services are clinically appropriate and fall within the professional’s scope of practice. Nursing services may be directly relevant to all steps of care and safe transition back to work and into community.

Section 169 gives you considerable authority to prescribe eligible services, expenses, providers and decision-making requirements. We strongly encourage the committee to recommend that this authority be used to ensure that the regulatory framework recognizes the full range of professionals available to support recovery.

There is a valuable role for nursing in another function. Nursing brings expertise in assessment, recovery planning, health systems navigation and coordination across multiple providers. There is an opportunity to introduce nursing recovery coordinators within ICBC to help it fulfil its section 120 duty while supporting more integrated and efficient recovery.

At the same time, ICBC’s statutory duty to advise and assist should be distinguished from its independent rights advice. ICBC is the funder, administrator and initial decision-maker. Claimants should therefore have access to independent information and navigation support when they need help understanding entitlements or deciding whether and when to use the dispute mechanisms under section 167.

When income replacement benefits are inadequate, incorrectly calculated or delayed, income replacement benefits under divisions 6 through 10 of part 10 must also be understood as part of a recovery framework. Folks may struggle to meet basic needs, obtain medication, travel to treatment or participate consistently in care. Financial instability can directly undermine the recovery that part 10 is intended to support.

We recommend that the committee examine whether the statutory categories and associated regulations adequately reflect non-standard, temporary, part-time or precarious employment as well as unpaid caregiving responsibilities. Return-to-work decisions must reflect the actual functional demand of a person’s lived experience. The framework should support gradual and accommodated returns to work, whatever a person’s work looks like, allowing timely reconsideration if a plan is unsuccessful or a person’s condition changes.

Switching now to Bill M237. NNPBC supports the bill’s proposed recognition of single-limb amputation under the catastrophic injury criteria and its extension of the period for making a claim in relation to catastrophic injuries sustained on or after May 1, 2021. If these changes proceed, implementation should support the purpose of the amendments, with ICBC proactively identifying potentially affected claimants, notifying people who may now qualify and assisting them in accessing the applicable part 10 benefits. This is consistent with ICBC’s duty under section 120 and would ensure that retroactive eligibility is meaningful in practice and on the ground.

Bill M237 also points to a broader question — the operation of the catastrophic injury provisions in sections 162 through 166 and the corresponding regulation-making power under 169. Automatic diagnosis and impairment criteria remain important. They provide clarity and consistency.

However, the committee should consider recommending an additional individualized pathway for people whose cumulative functional impairment and long-term support needs are catastrophic in effect but are not adequately captured by prescribed diagnosis or numerical threshold. The framework should also permit reassessment when serious or long-lasting effects emerge over time, as recovery is not often linear and the full consequence of an injury or harm may not be apparent within the initial claim period.

Public reporting and independent evaluation should also examine how parts 10 and 11 operate in practice. Relevant measures should include time to treatment, interruptions in care, approval and denial patterns and dispute outcomes, sustained functional recovery and claimant experiences as evidence and as differences in access across populations and regions emerge. This is not an argument for returning to a litigation-based system. It’s an argument for ensuring that the statutory entitlements, duties and dispute mechanisms within non-adversarial models work as intended.

From a nursing perspective, financial sustainability and person-centred care are not competing objectives. We encourage the committee to preserve the strength of enhanced care while strengthening the accountability safeguards and the models underneath them to ensure they are clinically sound, accessible and worthy of public confidence.

I look forward to your questions. Thank you so much.

[11:25 a.m.]

Stephanie Higginson (Chair): Thank you, Angela. Thank you for how you framed your presentation, so connected to the legislation. I really appreciate that. It makes your recommendations clearer in terms of our work, which is focused on the legislation. I really appreciate that.

I’ll look to my colleagues now for questions.

Jennifer Blatherwick: Yes, echoing MLA Higginson’s thank-you for tying it so closely to the legislation. I appreciate that it’s not an easy thing to do, because the legislation can be very opaque to members of the public. I appreciate the work that’s gone in here.

We’ve received lots of recommendation and discussion around the idea of having care coordination improved within the system. I’ll say the Nurses and Nurse Practitioners of B.C. are the first ones to say: “Let us do it.” Thank you for volunteering to throw yourselves on that one. I appreciate, though, your engagement with it, because it’s a valid point that nurses and nurse practitioners’ scope of practice encompasses many of the fields and therapies and situations in which clients find themselves.

I think, in a practical sense, you did mention that there had to be some kind of independent advocacy. I wasn’t exactly clear how that was interacting, if they were the same recommendation or slightly separate for care coordination. Were you thinking that care coordination would be an independent operation rather than, say, directly employed by ICBC? Was I wrong? Was that two separate things, or was it one thing together?

Angela Wignall: Thank you. I really appreciate the question as well as the kind words.

It is, in fact, two separate things. One is an integration of care coordination within the work of ICBC, and that is a space where nursing can shine. That is what we do every day through every system that health care happens in. There is an opportunity to create a new team grounded in the expertise and skill of nursing that does that work to support claimants in navigating through the process from a clinical perspective.

The second recommendation we made is separate, and it is to acknowledge that when evidence around clinical necessity of care comes forward, it not be physician exclusive, that there’s opportunity to recognize the ways in which British Columbians access care today. That is through the expertise and skill of nurse practitioners. It’s through registered nurses, registered psychiatric nurses and licensed practical nurses.

One is the opportunity to enliven and make more person-centred the process of navigating a claim, and the other is considering whose clinical voice counts when we’re presenting evidence for clinical care.

Jennifer Blatherwick: If I can follow up. I certainly appreciate that. I think that when some of these systems are established, nurse practitioners were not as, shall we call it, vibrant, numerous a practice as they are now. I don’t think the original legislation encompassed a future where we would see such a healthy practice for nurse practitioners.

If I can, I would also really like to thank you for specifically saying that financial resources are a part of medical recovery, that having steady, predictable financial resources are a part of any person’s healthy process to getting back to whatever their normal is going to be after an accident.

You also did a really good job of centring client care as part of client-centred care. Now, when we’ve been talking about this, one of the pieces we have been trying to follow a little bit is statistics around people who successfully continue to connect to care until recovery and people who fall through the process and do not continue their full course of care.

Do you have any reflections on that, or any data that the nurses and nurse practitioners are keeping on that?

Angela Wignall: Yeah, absolutely. First, to your point about resourcing, I appreciate that feedback about the absolutely critical nature of income assistance. I would add that you are also considering the ways in which we define a replacement vehicle.

[11:30 a.m.]

I would suggest that replacement vehicles are also critical resources, particularly for those living with disabilities or those living in rural and remote areas whose vehicle is not only something that can be quantified through the dollar value of a car but which may have adaptive technology in it, which may be their lifeline, which may be the way that they get to care. Those considerations of what it means to replace a vehicle is another way of thinking about resources.

In terms of commitment to care and completion of a care trajectory, nursing is widely recognized around the world as being grounded in relational practice that ensures people stay connected to care. As navigators, as care connectors, that is actually something where the creation of nursing roles and the introduction of nursing work within care pathways dramatically improves what we call “adherence to care” or “clinical compliance to care” — in language that we’re not super fond of — and seeing people complete their trajectory of care.

If you can imagine the difference between somebody who is perhaps cognitively impaired as well as physically impaired after an accident for an extended period of time…. They’re living in a rural or remote location, and they have an opportunity to see a primary care provider or a specialist for 15 minutes, one time. That is not the delivery of care. That is not what continuous care means.

Where nurses come in is in the space between those critical appointments, between that visit with the specialist, to ensure that people in their homes, on the ground, are staying faithful to their care pathway but also adjusting it when it’s required.

What we imagine at the initiation of care or the creation of a claim isn’t often what happens nine months, 12 months, 18 months later. There are ways in which nursing evidence and practice meaningfully inform the changes in the care trajectory as well, ensuring that people stay faithful to the care pathway that they are supported in being on and don’t end up in emergency departments, don’t end up in other areas of the health care system.

I’d be happy to provide you with evidence around that from a global nature anytime you’d like it.

Jennifer Blatherwick: Thank you so much. I think you’ve done an excellent job of answering the question.

Brennan Day (Deputy Chair): Thanks for the presentation. Again, I’ll echo that I fully agree with my colleagues in that nurses are uniquely situated across the province to help with a bunch of concurrent problems we have here.

I just wanted to dig in a little bit more to the rural health challenges of assisting with home supports for people with significant injuries. My focus has mostly been on seniors but certainly, very similar challenges across the province.

Getting the nursing groups involved…. What do you see as the major barriers, as they exist right now, to improving that home support for injured patients?

Angela Wignall: Thank you so much. I think there are several challenges that nurses in home and community support face.

One is access to meaningful models of employment that allow them to be flexible in the communities where they’re needed. Whether that’s nurse practitioners who do not have access to contracts that allow them to engage in employment in a municipality, for example, that really wants to see them or in a rural area that really wants to have a nurse practitioner as their primary care provider….

There are currently no mechanisms for employment or compensation, which is how we get to having an NP in community. Nurse practitioners, of course, are a unique aspect of the nursing family. They are primary care providers, but they’re often a nexus for where other members of the nursing team also sit.

Those opportunities for NP-led community health centres, for example, where the NP is a primary care provider, are not models that are currently enabled under the compensation and employment frameworks for nurse practitioners in the province. That is a very significant barrier and a very significant challenge.

When we talk about home visitation and our RN, LPN and RPN colleagues, we’re talking about nurses who are often travelling great distances, especially in rural remote locations, to see clients and patients and families over the course of a day. Of course, there is a workforce challenge in the sense that there are not enough nurses in those spaces. We know we’re facing a global nursing shortage, and British Columbia is no different.

There’s also the reality that the practice environment within which those nurses are practising is often not safe, and it’s often not supported. We’re talking about a 91 percent female workforce who are sitting in cars, travelling hundreds of kilometres in a day into rural and remote areas by themselves and providing care where they’re needed.

[11:35 a.m.]

There are safety concerns. There are concerns around even getting mileage for their cars reimbursed. There is a huge range of issues in those spaces.

When it comes to continuing education and continuing competence to be able to provide high-quality care across the province, we know that nurses and nurse practitioners are disabled from accessing continuing professional development, education and training. There are no dollars for it. There is little support for it because it requires not being in direct patient care for periods of time while you’re learning, and those systems are not existent for nurses and NPs.

That is a significant concern when you’re alone. You are the primary provider in a space where you perhaps have a satellite phone — or a flip phone, in some instances — where you’re trying to connect with colleagues. The infrastructure underpinning your practice, that continuing professional development, that professional practice support, that access to colleagues — all of that infrastructure doesn’t exist.

Brennan Day (Deputy Chair): Thank you. So some pretty substantial challenges.

I’ll just follow up with one other question. I know this is…. It has come up multiple times, which is why I’m going to ask it, and you’re uniquely positioned to sort of give us a high-level comment on it.

I think what has been presented over multiple occasions is the challenge with accessing health care records across various providers and to the patients themselves. When the health care privacy protections bump up into the ICBC privacy protections, it seems that people get into quite a bit of a quagmire that really delays them getting efficient responses and reasonable access to care.

I’m just wondering if you could add some comments around that.

Angela Wignall: Oh, what we would give for unified patient records in British Columbia. Hear, hear. I hear you loud and clear.

When we talk about electronic health records, or EHRs, or EMRs, we’re talking about a constellation of systems that are working. As somebody who has worked in health authorities, I’ve worked with the Cerner products. I’ve worked with Panorama, with PARIS. I’ve gone into public health and worked again in a completely different system. And I have the privilege of speaking to LPNs and RNs, in particular, whose entire job is moving information from one system to the next in a manual way to maintain that care continuity. So this is a world that we know pretty darn well.

I would say, at a high level, that B.C., and Canada as a whole, has taken some significant steps in this direction, and credit is due as we move towards sort of the digital Health Infoway work at a federal level and some of the work that I know digital health teams are doing here on the ground in British Columbia.

At the end of the day, a patient needs a unified record, because I, as a nurse, receiving a printout of a Cerner chart…. I’ll tell you. When I hold that in my hands, I’m holding 700-plus pages, and I’m trying to figure out the last time that patient got Tylenol. It is a functionally impossible task to be able to manually work between these systems.

I would support, and nurses across the province support, unified patient health records and any steps that we can take to maintain continuity of information across transitions of care.

Brennan Day (Deputy Chair): Thanks. That’s a fantastic response. I know it has come up a lot in my critic role work. And I think the application to ICBC in terms of how that works…. They are two very different groups that should have different ranges of access. However, trying to streamline that into a place where we can have that data shared in a more meaningful way, I think, is a huge barrier to people accessing service.

So thank you for that, and thank you for the presentation.

Jeremy Valeriote: Good morning, Angela. Thank you for a really thoughtful and well-organized presentation and also the written submission. There are a lot of things to talk about. I want to key in on one piece.

We’ve heard a lot about delays and bureaucratic congestion, I guess, and I think you answered it in part when it comes to remote communities. But in the submission, you talk about diagnoses, assessments, treatment plans, the duplicative physician confirmation that has to happen. Is that a systemwide issue or is there…? Do you know of some way that we could make a recommendation specific to ICBC that could reduce some of that?

I think you’ve been a really good advocate for what nurses and nurse practitioners can do without requiring supervision or confirmation. I’m just wondering if it’s broad across the system or if there’s some area where we can suggest a solution to that duplication.

[11:40 a.m.]

Angela Wignall: Absolutely. I think it is a common misconception that nurses and nurse practitioners in British Columbia are under some sort of delegated authority or some kind of supervision of another health profession. That is unequivocally not the case. Nurses and nurse practitioners are self-regulating, autonomous professionals with unique scopes of practice, a unique foundation of nursing knowledge. We often say there’s a misconception that we practise medicine. We don’t. We practise nursing, which is an entirely different form of health care.

When we put our clinical recommendations forward, what we are putting forward are informed, clinically appropriate care recommendations or, in some instances, prescriptions or referrals. Nurse practitioners are, for all intents and purposes, equivalent to physician services as outlined in the interpretation letter from Minister Mark Holland in January 2025.

There are important steps that need to be taken — I recognize not necessarily by this committee directly — from a legislative perspective in ensuring that that physician equivalency is named in our legislation here in British Columbia. That is a very first and very critical step that needs to happen for nurse practitioners.

Additionally, anywhere where you see within your work a suggestion that nurses’ or nurse practitioners’ evidence, care directives or work needs physician confirmation, you can say: “That’s from the past. That is not the case here in British Columbia.” You have the opportunity to amend it to count the wide range of health care evidence, health care practice and provider nature as equal, because we are.

George Chow: Thank you, Angela. Just following up on that, basically, your comments are: “Whose expertise counts?” You, obviously, were answering an MLA’s question. Are you suggesting that there should be…?

Of course, to the legislation on nurses and nurse practitioners, what they can do, I take your point in terms of…. You’re not practising under the supervision of physicians or medical doctors. You practise nursing.

Are you advocating in general that the nurse should be given more responsibility and recognition on this, or is it to do with how ICBC accepts expertise or testimony from people like the nurses and doctors and specialists?

Angela Wignall: What we’re not suggesting is that every recommendation automatically be approved. That is not what we’re suggesting. ICBC, we know, has responsibility for making appropriate funding decisions and weighing clinical evidence as part of those decisions. What we are saying is that decisions need to be clinically grounded, responsive to the individual patient and representative of how British Columbians access care in this province.

There are many British Columbians whose primary care provider is a nurse practitioner, and there is no one else involved in their care. There are many people in rural and remote areas whose only access to care is through a certified practice registered nurse in an outpost nursing position.

When we talk about equitable access to care and equitable access to process that’s predicated on that care, we have to talk about the reality of care on the ground. If a qualified treating professional provides a rationale for continuing or new or different care, that evidence should be considered in the context of whether or not they are a recognized care provider in the province, of which nurses and nurse practitioners are.

Of course, if ICBC reaches a different conclusion about that care or about the evidence that’s submitted, the person should receive clear reasons explaining why that clinical evidence for the basis of the decision was discounted.

What we are saying is today, the way that the legislation and the regulations are created reflects a different time. It does not reflect the reality of care on the ground, where it is a real barrier for those who do not have access to a physician and who are accessing primary care and other kinds of care through nurses and nurse practitioners. It discounts them by discounting our profession.

[11:45 a.m.]

George Chow: You’re saying ICBC is not taking nurses’ and nurse practitioners’ recommendations seriously.

Angela Wignall: That’s right, yeah. There’s a misalignment between that and how people are actually receiving care on the ground.

George Chow: Mm-hmm. I think we have heard from many presenters about ICBC coming to conclusions and actions without actually giving a lot of evidence or expertise, expert evidence on that. You’re talking about…. But that would apply to the general health care field too, not just ICBC accident victims’ cases, right?

Angela Wignall: Absolutely. This is a systemic issue. It’s relevant here, which is why we’re naming it, but it does transcend this particular issue, certainly.

We would add there that some of what we’re suggesting is that when there are clinical review panels, when there is a dispute process, there is also an opportunity, as we’ve named in our written submission, to include nurses and nurse practitioners in those review boards, in those processes, because, once again, the process needs to reflect the reality of care on the ground.

George Chow: Okay, thank you.

Stephanie Higginson (Chair): Thank you very much for your presentation, Angela, for your thoughtful submission and answering questions so thoroughly. We appreciate the work you do, and we look forward to seeing you again.

Angela Wignall: Thank you so much. Have a wonderful day.

Stephanie Higginson (Chair): Okay, folks, that’s the last presenter before lunch. I understand that the Premier is at Government House right now.

I want to thank everyone for their contributions to the committee. I’m going to ask the Deputy Chair to please stay behind after we adjourn for lunch.

I’m going to ask for a motion for adjournment. MLA Blatherwick.

Motion approved.

Stephanie Higginson (Chair): Is there any objection to adjourning?

Seeing none, the committee is adjourned.

I’m going to ask MLA Day to stay behind. Thank you.

The committee adjourned at 11:46 a.m.