# 2011-087 Pay and Benefits, Allowances and Benefits, Medical Treatment, Universality of Service Principle

Allowances and Benefits, Medical Treatment, Universality of Service Principle

Case Summary

F&R Date: 2011–12–22

As a result of an accident, one of the grievor’s legs was amputated above the knee. After receiving prostheses from Canadian Suppliers that the grievor found to be inadequate, the grievor obtained, and was authorized in arrears, five prostheses from a supplier in the United States of America (USA). Subsequently, the grievor lost weight and required new sockets and liners for the prostheses. Although not pre-authorized by the Canadian Forces Health Services (CF H Svcs), the grievor nonetheless obtained them from the USA supplier and paid out-of-pocket for them. When the grievor sought reimbursement of costs, the CF H Svcs authorities refused to reimburse the grievor because the grievor failed to follow the proper protocol despite having been advised of the requirement previously.

The grievor contended that the CF H Svcs actions were a denial of basic health care and support. The grievor also complained that certain health professionals working for the CF H Svcs had been insulting and had interfered with the care plan already established by the grievor’s own personal health care team.

As redress, the grievor requested reimbursement of the expenses already incurred for the new sockets, liners and related travel expenses. The grievor also requested that the civilian physician engaged by the grievor be recognized by the CF H Svcs as the official assessor for all prosthetic requirements and that certain CF H Svcs health professionals be recused from further involvement in the grievor’s health care.

There was no initial authority decision, however, the medical subject matter expert (SME) indicated that CF H Svcs would be willing to meet with the grievor and discuss the reimbursement of the grievor’s expenses and the way ahead for future requirements.

The Board concluded that the grievor had not been denied basic health care or support by the CF H Svcs.

The Board also found that there was no evidence that the health professionals working for the CF H Svcs had been insulting to the grievor or had improperly interfered with the grievor’s care plan.

Finally, the Board found that Queen’s Regulations & Orders article 34.07 provides that the medical care of CF members is the responsibility of CF commanders under the advice of CF medical authorities and that this responsibility cannot be relinquished or delegated to an individual member. The CF H Svcs has a responsibility to not only provide health care and support, but also to ensure that the available funding is managed properly. The Board found that the grievor, as a CF member, must comply with the established policy and procedures for healthcare within the CF.

The Board recommended that the Chief of the Defence Staff (CDS) partially uphold the grievance.

The Board also recommended that the CDS direct the Chief of Military Personnel / Director General CF H Svcs and the grievor to cooperate in the setting up of a case management team to assess and manage the grievor’s prosthetic needs, including the work and expenses claimed in the grievance.

CDS Decision Summary

CDS Decision Date: 2014–03–21

The CDS agreed with the Committee's findings and recommendations that the grievance be partially upheld.

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