The investigation
Scope
On August 19, the Minister of Veterans Affairs instructed the Department to conduct a full and thorough investigation into the matter, specifically on what had transpired in this situation, how extensive the cases were and how the Department could ensure that this situation would not be repeated in the future.
To ensure the Department reviewed the situation in a comprehensive way, the investigation included:
- A review of the employee’s active Veteran client files
- A review of an additional 2,153 files connected to the VSA in question since 2016 when MAiD became legal to determine if there were other impacted Veterans
- A review of all 402,000 files in VAC’s client databases to determine the full extent of the issue, including a review of secure MyVAC Account messages (English and French files reviewed and analyzed dated back to June 2016 when MAiD legislation came into effect)
- Discussions and interviews with case managers, Veteran service agents, Veteran Service Team managers and front-line staff
- Feedback from staff training and information sessions about the new directive/guidance on MAiD
- Information obtained through the review and monitoring of all incoming communications to the Department, including MyVAC account secure messages and calls to the National Client Contact Centre (NCCN), and
- Information obtained through VAC’s new reporting process which was established to ensure when MAiD is raised in communications it gets escalated to management to determine what follow up may be required
To complement the file review and analysis, Departmental staff spoke directly to the other impacted Veterans as well as Veteran-serving frontline staff and key stakeholders. Senior officials also testified twice about MAiD before the Standing Committee on Veterans Affairs and heard testimony from others at the Committee. Veterans were asked to come forward if they had experienced a similar situation. Information from all of these sources formed part of the investigation. Throughout fall 2022, as the Department became aware of new information, steps were taken to prevent this type of situation from happening again. Specifically, new training materials on MAiD were developed and shared with new and existing frontline staff; new written guidance was shared with frontline staff to provide clear direction about MAiD; and training and information sessions were held for 750 staff to ensure the guidance was understood and to give staff an opportunity to ask questions and engage on the issue.
Review & analysis of files
Review of Veteran Service Agent’s Files
On July 22, the Veteran’s file was reviewed to ensure appropriate Departmental supports were in place. The file was reassigned to the Veteran Service Team Manager who was identified as the Veteran’s new point of contact.
Next, a comprehensive review and analysis was started on the files of the other Veterans for whom the employee was actively providing guided support services to look for indications of conversations about MAiD. These Veterans were reassigned to a new VSA. The new VSAs reached out to the Veterans to tell them they would be their new point of contact with VAC.
Finding: The analysis of the employee’s active files immediately identified a second Veteran with whom MAiD had been raised.
Veteran #2
This Veteran was receiving guided support services and was assigned to the VSA employee. During the initial screening, the Veteran had a conversation with the employee regarding their significant health issues and notes in the file indicate MAiD was introduced into the conversation. Several months later when they were speaking and the Veteran expressed continued frustration regarding his declining situation, notes indicated the VSA raised MAiD a second time.
An additional 2,153 files in which the employee had worked on since 2016 when MAiD became legal were reviewed and fully analyzed.
Finding: Two additional incidents were found in the search of 2,153 Veterans’ files, as described below.
- Third Veteran/Incident Uncovered During a Meeting with Employee on November 3
Veteran #3
A Veteran called the Department for information in 2019 and was directed to the VSA employee. The Veteran discussed their diagnosis of a terminal illness and the employee discussed MAiD with the Veteran and how their VAC benefits might be impacted. This Veteran was not assigned to the VSA, and this was the only time that they spoke.
Finding: A review of this Veteran’s file confirmed that MAiD was discussed.
- Fourth Veteran/Incident Discovered by Another Employee on November 10
Veteran #4
A Veteran sent a secure message to VAC in 2022 to request information on the Attendance Allowance benefit. The message was referred to the VSA employee for follow up. The employee conducted a screening and advised the Veteran that they were not eligible for this benefit via secure message. The Veteran expressed despair over a worsening health condition. The employee responded the same day providing empathy and also information on MAiD. The Veteran thanked the VSA for the information. This was the only interaction between the employee and the Veteran.
Finding: A review of the secure messages in the Veteran’s file confirmed MAiD was raised.
Broader review of 402,000 files
Following the review of the individual VSA employee’s files, the department engaged in a broader review of all client files to ensure no other Veterans were dealing with similar situations. VAC conducted a search and analysis of 402,000 Veterans, family or caregiver’s files across its client database systems. The search dated back to 2016 with the coming into effect of the Medical Assistance in Dying (MAiD) legislation.
Finding: No incidents were found where MAiD was raised inappropriately during the search of the 402,000 files.
Further actions taken to determine extent of issue
Once the initial two cases were identified, VAC broadened its investigation further to determine if MAiD was being inappropriately offered to other Veterans. A number of steps were taken to ensure employees were fully aware that MAiD is not a VAC service and employees have no role or mandate to recommend it. Furthermore, Veteran-serving staff had no authority or expertise to offer such services nor to refer Veterans to explore this as an option.
- Conversations with staff: To complement the file review and analysis, management spoke with staff. The Director General (DG) of Field Operations surveyed all Area Directors across Canada on August 17 and instructed them to have conversations with frontline employees. No other cases were identified through these conversations, and it was reaffirmed that VAC staff understood they have no role or mandate to recommend or raise MAiD with Veterans. The DG reinforced to Area Directors, verbally and in writing (on August 23), that VAC employees shall not provide advice or suggestions to Veterans on the issue of MAiD. As well, if a Veteran was seeking advice on MAiD, they were to refer the Veteran to their primary care provider.
- Directive on MAiD sent to staff: Written guidance on MAiD was sent to all front-line employees on August 23. The guidance provided information about MAiD; instructed employees that if a Veteran brings up MAiD, they are to refer them to their primary care provider; and what to do when a Veteran chooses that option in consultation with their primary care provider. The guidance also stated that if MAiD was raised by a Veteran, employees were to advise their supervisors and Area Director that it had been raised so it could be escalated to senior management.
- Question & answer sessions with staff: After the written directive/guidance was disseminated to staff, question and answer (Q&A) sessions were organized to provide VAC employees with a venue to ask questions and allow managers to provide further education on how to approach a situation if MAiD is mentioned by a Veteran. A total of 750 staff participated in five Q&A sessions which were held on August 25, August 30 (two sessions), September 7 and September 14.
- Training for staff on MAiD: While VAC staff are trained in situations involving Veterans who may be in crisis situations, specific training on MAiD was developed and offered to existing and new employees in fall 2022. This training will continue to be mandatory for frontline staff. Training on how to support Veterans in crisis and VAC’s suicide awareness & intervention protocol were also reviewed with staff.
- Tracking Veterans & stakeholder feedback on MAiD: In mid-August the department started tracking MAiD related feedback coming into the Department to ensure proper follow-up and action. Channels included calls to the National Client Contact Centre; secure messages sent through My VAC Account; emails to VAC officials; and media calls and inquiries. As of January 2023, no further incidents of MAiD being inappropriately discussed with a Veteran have been confirmed through this tracking system. Only the four isolated incidents identified have been found and validated.
Between 21 July 2022 and 30 December 2022, the Department received 235 MAiD-related communications from Veterans and family members as well as others, through one of four channels: the National Client Contact Network (NCCN) calls; correspondence (letters and emails); information email requests; and MyVAC Account secure messages. All of these inquiries were responded to on a priority basis using standard approved messaging. With respect to any additional allegations raised about MAiD being inappropriately discussed with Veterans, each allegation which included a Veteran’s full name was thoroughly investigated and none of them have been validated.
- Engaging with stakeholders: The Deputy Minister and Assistant Deputy Minister of Service Delivery proactively engaged with Veterans’ organizations to discuss the issue and reiterate that the situation was unacceptable and not part of VAC’s usual practice. They explained some of the early actions VAC took to improve staff awareness of guidance about MAiD and asked for their support in encouraging Veterans to continue to contact VAC for the services and support they need.
Investigation conclusion
Based on a comprehensive analysis of files, conversations with the employee, Veterans and VAC staff, and the tracking of MAiD incidents with no subsequent cases being validated with information available, the Department has only confirmed the four cases. While additional allegations were brought forward – through appearances at the Standing Committee on Veterans Affairs, media and correspondence to the Department – VAC thoroughly investigated each of the allegations which included a Veteran’s full name and was unable to validate any allegations that inappropriate discussions related to MAiD had taken place. VAC has concluded these were four incidents isolated to one employee who is no longer employed with the Department. Further, it has concluded that this is not a widespread, systemic issue, nor is it a reflection of the work of hundreds of case managers and Veteran service agents who interact with the utmost care, compassion and respect with Veterans every single day. This conclusion has been made based on all of the information available to the Department through the period of this investigation. VAC has referred the four incidents to the Royal Canadian Mounted Police for their consideration.