All wounded Canadian military personnel—regular troops and reservists—must be guaranteed “first class” treatment when they return home, whether their injuries are physical or psychological, says a Senate committee report titled Bringing Our Wounded Home Safely.

The committee toured facilities in Afghanistan, Germany and Canada to determine how well wounded soldiers are rescued, treated and rehabilitated. The aim was to comfort families and loved ones of those serving overseas, and to point out the disparity in provincial health care systems that results in uneven treatment of the wounded once they get back home, Senator Colin Kenny said in an interview with Legion Magazine.

The report of the Standing Senate Committee on National Security and Defence, which Kenny chairs, noted that since Canada began its Afghanistan mission in 2002, about 300 soldiers have been wounded and another 400 or so sent back home for compassionate reasons, including operational stress injuries.

Fast access to first aid and evacuation is part of the “first-rate service overseas” for Canada’s wounded. The wounded are airlifted by helicopter to the Canadian-led Kandahar Airfield Hospital for stabilization and initial treatment. Those more seriously injured are sent on to the U.S.-run Landstuhl Regional Medical Center in Germany.

But once the wounded get home, says the report, they do not receive a uniformly high standard of treatment due to variations among provincial health care systems.

“The Department of National Defence (DND) must do one of two things,” says the report—either reach an arrangement with all provinces to guarantee state-of-the art treatment for wounded military returnees, or offer such treatment itself.

“Health care is the jurisdiction of the provinces,” says the report, “and every Canadian knows the quality of health care can vary dramatically from province to province.”

But disparity among provincial health systems does not affect the level of care of CF members, says Brigadier-General Hilary Jaeger, surgeon general of the Canadian Forces, because the Canadian Forces Health Services Group (CFHS) pays for services its personnel receive from facilities across the country and can augment services where necessary to ensure the best possible treatment.

“In some cases we help them supplement their resources to bring their services to the level we expect,” she said. Because CF members do not fall under the Canada Health Act, “we have a spectrum of care which applies nationally.” It’s more comprehensive than provincial health care plans, covering things like prescriptions and over-the-counter medications, extensive physiotherapy and home care services. “We are not bound in any way by provincial differences,” says Jaeger.

Senators heard from some soldiers who think there is a difference in services provided. “The committee has heard enough anecdotal evidence to understand that we’ve witnessed only the best care Canada provides its soldiers and that there have been cases in which such superb care has not been forthcoming,” says the report.

Kenny was unable to provide examples. However the report does quote several paragraphs from “an excellent article in Legion Magazine” showing the frustrations of Master Corporal Paul Franklin, who lost both his legs in Afghanistan, in getting the services he felt he needed (The Quiet Fight, November/December 2007).

Factors determining where a wounded CF soldier is treated, in order of priority, are what hospital provides the specialized care required, what region the injured soldier wishes to go to (to allow proximity of next of kin) and what CF installation is nearby to provide appropriate medical oversight, says CFHS.

“How well trained the surgeons are, what kind of technology the hospital has available, what services it can offer—that to us is critically important…but it’s often invisible to lay observers, and they’re not well equipped to make judgments about the technical quality of care,” Jaeger says.

Complaints are more often rooted in “the user-friendliness of the system,” says Jaeger. Wait times, response times, friendliness and helpfulness of staff are all affected by the current shortage of staff in acute care across the country. “The care can be perceived to be impersonal, rushed,” she says. When CFHS identifies a problem it moves as quickly as possible to fill the gap by engaging additional human resources, including extra nursing staff.

The senators noted CF personnel told them “the Glenrose (Rehabilitation Hospital in Edmonton) offers the kind of rehabilitation that all damaged Canadian soldiers should receive when they return home, (but) that kind of treatment is not generally available across the country.” The report says where top class treatment isn’t available, the Canadian military should offer such treatment itself.

That might mean building more military health care facilities, says Kenny, though not necessarily rebuilding the old military hospital system. “We do think DND should invest in facilities” perhaps under a joint federal-provincial program that would ensure that such facilities are spaced properly across the country. When not fully occupied by troops, the facilities could be made available to the communities.

Dedicated military facilities are an untenable idea, says Jaeger, because Canada has a small military and is a large country. “There’s no one place you could put a hospital that would be the right place. We don’t have the volume of patients that would make a viable hospital.”

As well “in order to be good at anything—ranging from rehabilitation for amputees to general surgery to neurosurgery—you have to do quite a few of them, otherwise your staff doesn’t maintain the level of skill you need. And we just don’t have anything like the patient volume” that would ensure maintenance of such expertise.

“I would rather purchase really good care, than be a system that runs mediocre care and does it themselves,” says Jaeger.