Medical
Assessment/Inadmissibility
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Authority | Assessment | Surveillance
| Examples ||
I.
Authority
(a)
Section 11 of the Immigration
Act provides as follows:
"Every
immigrant and every visitor of
a prescribed class shall undergo
a medical examination by a medical
officer."
(1.1)
"Every person, other than
a permanent resident, who claims
to be a Convention refugee and
whose claim is referred to the
Refugee Division shall undergo
a medical examination by a medical
officer."
"Every
visitor and every person in possession
of a permit who, in the opinion
of an immigration officer or an
adjudicator, may be a member of
the inadmissible class described
in paragraph 19(1 )(a) may be
required by the immigration officer
or the adjudicator to undergo
a medical examination by a medical
officer."
"For
the purposes of this section,
medical examination includes a
mental examination, a physical
examination and a medical assessment
of records respecting a person."
(b)
Section 19(1) of the Immigration
Act states in part:
No
person shall be granted admission
if he is a member of any of the
following classes:
"Persons
who are suffering from any disease,
disorder, disability or other
health impairment as a result
of the nature, severity or probable
duration of which, in the opinion
of a medical officer concurred
in by at least one other medical
officer,
(i)
they are likely to be a danger
to public health or public safety;
or (ii) their admission would
cause or might reasonably be expected
to cause excessive demands on
social or health services;
persons
who there are reasonable grounds
to believe are or will be unable
or unwilling to support themselves
and those persons who are dependent
on them for care and support,
except persons who have satisfied
an immigration officer that adequate
arrangements have been made for
their care and support"
(c)
Thus, the legal imperative for
the Medical Officer is to identify
"inadmissible persons"
according to the two principal
criteria stated above: danger
to public health or safety; and
actual or potential demand on
health or social services.
As
well, in assessing admissibility,
the Medical Officer must use supporting
criteria described in Section
22 of immigration Regulations,
1978:
"For
the purpose of determining whether
any person is or is likely to
be a danger to public health or
to public safety or whether the
admission of any person would
cause or might reasonably be expected
to cause excessive demands on
health or social services, the
following factors shall be considered
by a Medical Officer in relation
to the nature, severity or probable
duration of any disease, disorder,
disability or other health impairment
from which the person is suffering,
namely,
any
reports made by a medical practitioner
with respect to the person;
the
degree to which the disease, disorder,
disability or other impairment
may be communicated to other persons;
whether
medical surveillance is required
for reasons of public health;
whether
sudden incapacity or unpredictable
or unusual behaviour may create
a danger to public safety;
whether
the supply of health or social
services that the person may require
in Canada is limited to such an
extent that:
(i)
the use of such services by the
person might reasonably be expected
to prevent or delay provision
of those services to Canadian
citizens or permanent residents,
or
(ii)
the use of such services may not
be available or accessible to
the person;
whether
medical care or hospitalization
is required;
whether
potential employability or productivity
is affected; and
whether
prompt and effective medical treatment
can be provided."
II.
Assessment
The
Medical Officer thus has five
criteria, based on the relevant
factors in the Regulations to
the Act, on which to base his
assessment of admissibility.
In
order to give a medical opinion
in terms which are clearly understood
and accepted by both medical and
immigration authorities, and which
are consistent with the Act and
Regulations, a system of assessment
has been developed whereby an
applicant is assigned a medical
profile.
This
medical profile consists of a
coded series of letters and numbers
based on the two principal criteria
and the three supporting criteria
mentioned above. The five criteria
are:
H
- Risk to Public Safety or Public
Health
D
- Expected Demand on Health or
Social Services
T
- Response to Medical Treatment
S
- Surveillance
E
- Potential Employability or Productivity
Under
each criterion is a list of descriptive
categories. Taken as a whole,
the ratings assigned under each
criterion form the basis for a
legally binding medical opinion
regarding admissibility. This
opinion is expressed by the symbol
"M" at the end of the
profile and represents the combined
significance of the five criteria
It is indicated symbolically as
M
- Statement of Medical Status
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Ml
No health impairment sufficient
to prevent admission under Section
19(l)(a)
M2
Has a condition for which the
degree of risk to public health
or safety is not sufficient to
exclude admission under Section
l9(l)(a)(i), but which risk should
he considered in relation to other
personal and social criteria.
M3
Has a condition for which the
potential demand on health or
social services is not sufficient
to exclude admission under Section
19(1)(a)(ii), but which risk should
he considered in relation to other
personal and social criteria.
M4
Has a condition which is likely
to endanger public health or safety
to such an extent that the applicant
it is at present inadmissible
under Section 19(1)(a)(i). but
for which the expected response
to treatment is such that future
admission could be considered.
M5
Has a condition which is likely
to cause demand on health or social
services to such an extent that
the applicant is not at present
admissible under Section 19(1)(a)(i).
But for which the expected response
to treatment is such that future
admission could be considered.
M6
Has a condition which is a danger
to public health or safety and
which is not likely to respond
to treatment in such a way as
to allow admission in the foreseeable
future. Inadmissible Section 19(l)(a)(ii)
applies.
M7
Has a condition which could cause
excessive demand on health or
social services, and which is
not likely to respond to treatment.
Inadmissible as Section 19(l)(a)(i)
applies.
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III.
Surveillance Notice To Provinces
(MS 1035)
General
This
form identifies the disease for
which public health surveillance
is considered necessary, such
as inactive pulmonary tuberculosis,
positive serology (VDRL or HIV),
or leprosy. The appropriate Provincial/Territorial
Health Authority will then determine
the nature and frequency of periodic
evaluation.
Note:
This procedure is carried out
by the Ottawa office on]y.
Surveillance
Notices
Original
and one copy addressed to the
Provincial/Territorial Epidemiologist.
One
copy kept on file at the Ottawa
office.
Additional
copies as determined by regional
requirements may be sent to other
authorities.
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IV.
Examples of Medical Assessment
NOTE:
Medical assessment is done on
a case by case basis, taking all
aspects of an applicant's condition
into account. The references below
should be taken only as general
guidelines, and not as absolutely
applicable in all cases.
Endocrine,
Nutritional and Metabolic Disease
and Immunity Disorders (240-279)
These
conditions are fairly straightforward
and will not be discussed in detail.
In regard to diabetes mellitus,
the presence of glycosuria alone
is not sufficient to substantiate
a diagnosis of diabetes mellitus.
(a)
Persons with glycosuria shall
be clinically investigated and,
when indicated, the investigation
should include the results of
a glucose tolerance test.
Similarly,
the medical officer may request
various tests of thyroid function
in an applicant suspected of thyroid
abnormality.
(a)
Of course, tests performed for
reasons other than the immigration
medical examination may be accepted
if the results are diagnostic.
(b)
In general, a diagnosis of hyper-
or hypo-function of the thyroid
(and of most of the endocrine
system) should not be made without
adequate laboratory investigation.
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Categorization
of Tuberculosis
Active
Pulmonary Tuberculosis
Active
pulmonary tuberculosis will be
assessed M4, inadmissible as a
danger to public health.
In
all cases of active tuberculosis,
both the exact definition of the
five criteria and the narrative
reports are exceedingly important.
They
will all be H6 (suffering from
a readily communicable disease)
and T3 and S2 (treatment effective
but expected to continue; public
health surveillance required).
The
D category may be either 2, 3
or 4 depending on the radiological
and bacteriological pictures.
This and the E categorization
(usually E2) may require detailed
discussion in the narrative statement
to clarify the problem for Employment
and Immigration.
Inactive
Pulmonary Tuberculosis
Inactive
pulmonary tuberculosis may be
generally profiled as H5, D2,
T3, S2, El and M2 (conditionally
admissible subject to public health
surveillance). Occasionally applicants
with inactive pulmonary tuberculosis
who have had complications or
who have had surgery, may have
a disability which limits employability.
Such applicants may require a
different E criterion and may
be assessed M3 in addition to
M2.
Extrapulmonary
Tuberculosis
Although
not normally considered infectious,
such cases should be placed under
surveillance and profiled: H5D2T3S2E1M2
