PUBLIC REVIEW OF NO-FAULT INSURANCE IN SASKATCHEWAN page 1
Record of Submissions
Saturday, June 10, 2000 Prince Albert, Saskatchewan Carlton Comprehensive High School
This transcript was made available through the volunteer work of Shawn Hurd CSR of Meyer CompuCourt Reporting who took down the transcript of the proceedings. The original transcript was then converted to this format for use in HTML on the Internet by Faster Than Light Communications.
Speakers Questions or comments Coalition Members Dale Collis Gordon Adair Doris Lund Claude Dupuis Dr. Reg Martsinkiw Barbara Netmaker Dr. Daryn Mintzler Dr. Daryn Mintzler Bonnie Gerow Tom Cartier Theresa Charpentier Brenda Kienas Ken Hidlebaugh Larry Zatlyn Yvonne Dagenais Trudy Langenhoff Marilyn Fabish Theresa Charpentier Carol   Kristine Fabish Joseph Hnatiw Bill   Ben Heppner Doug Miller Dan Shapiro   Dr. Gale Mrs. Anderson Mario deSantis   Joanne Person Lynn Potter Daryl Wiberg
Transcript of Hearing
(Hearing commenced at 11:10 a.m., Saturday, June 10, 2000)
PATRICIA SCHRYVER:	I'd like to welcome everyone to our third public review, and I'd like to introduce you to Yvonne Dagenais. She is the founder of the Victims of No-Fault Support Group here in Prince Albert. Yvonne?
YVONNE DAGENAIS:	Thank you, Patty. Good morning. I'm really pleased to see that the six people who started the Victims of No-Fault have been able to continue our fight for the rights of all the people here today and future victims. Four years ago SGI considered us rebels. By the size of the group here today, we consider ourselves Olympians, passing the torch to the new athletes who will continue the challenge with no-fault. As injured people, we know how difficult it is to carry that torch.
	On that note, I would like to introduce you to our moderator, Dr. Reg Martsinkiw.
DR. REG MARTSINKIW:	Thank you very much. We'll just have to lift this up. It's a real honour to be given this opportunity, and can everybody hear really well? Can you hear way in the back? There's been an excellent social response in regards to the meeting here, and we're running a bit of a tight schedule. We are a little late, but I've been able to cut down Ben Heppner's presentation, so we'll get caught up there very quickly.
	My interest in no-fault insurance started very early, and that was with the commencement of the Quebec Task Force. I followed that through for five years, and since then, since then I have worked within the structured health-care system of no-fault insurance.
	I would like to acknowledge -- I think we should acknowledge today the tremendous volunteer effort that went to organizing this day. Everything here today was done by volunteers, even our reporter here, Shawn Hurd, who's with Meyer's CompuCourt Reporting. She's volunteering her services, so I think we should acknowledge them now.
	We all know that people power prevails in a positive environment. Your participation today confirms that. Today I'm sure the volunteers that have organized want to create a public awareness in regards to no-fault. We want this to be a learning experience. We have some tremendous speakers that have come from Toronto and other parts of the country. We want this to be a learning experience so we can learn about insurance, our insurance. We want you to participate. We have four mikes set up. You'll have an opportunity to ask questions to the participants -- or to the speakers, I should say, and to the people who will be giving presentations, and we want to end the day with a positive resolution, some positive resolutions that we could offer to the government, to SGI that it's going to develop a health-care system that truly meets the needs of the residents of Saskatchewan.
	That is our accomplishment, so we want you to relax and really have a good time and learn. Have patience because I'll tell you, we're playing this agenda by ear in most cases and we are allowing the speakers to speak for about 10 minutes, and if you go over the 10 minutes, you will hear the sound of the sword. I just got that term today. It's a sword, and if you continue to speak, you will feel the sword.
	Now, this agenda -- this agenda has been modified about five times. Our first speaker today will be from Candle Lake, Saskatchewan. That's a suburb of Prince Albert, and he is going to be talking on -- in regards -- speaking in regards to the court decision overturned on the income replacement benefits. From Candle Lake, Dale Collis. Dale?
DALE COLLIS:	He's taller than me. Hello. As you know, my name is Dale Collis. I'm just going to try and go shortly through the beginning here. My accident was on July 15th, '95. At that time I was told you had a seven-day waiting period for benefits, so I told SGI I didn't need them, figured I could go back to work. Two weeks later I had another vehicle purchased. I drove taxi for a living and went to go back to work, and that's where I found out that I couldn't; went to SGI injury department, told them I wouldn't work. My adjuster told me they could pay me $50 a day for a driver, which wouldn't cover expenses, or I'd have to get rid of my taxi to receive IRB benefits. I had no choice but to turn my taxi back to the company.
	In February '96 my adjuster gave me two days to move to P.A. to enter into a small-motor course for retraining, which I was told I had to pay myself out of my IRB benefits. I went to P.A. anyhow. I was being cut off benefits the end of -- the first part of a four-part course. SGI told me I'd have -- I'd be cut off in November '96. I appealed this in July '96. August 21st, '96, I received a letter from one of SGI's lawyers stating I'd won my appeal and the reasons why I'd won it. My benefits would continue 'til at least July 1st, '97, which would allow me to finish Part 2 of the four-part course.
	In October 15th, '96, I received another letter from SGI lawyers stating I'd lost my appeal of July '96 and benefits would terminate November 30th, '96. Benefits were terminated. I asked them why -- what happened with the August letter, and they said that was sent out in error.
	I appealed again. During my appeal, Doug Moore, head adjuster in Regina, asked me why I didn't keep my taxi, put drivers in it, bring a statement of my earnings to the adjuster and they would pay the difference; told him my adjuster didn't give me that option at the time or I definitely would have as I'd still have the business. It would almost be paid off by now and then I wouldn't even need SGI, but unfortunately they ruined that too.
	Okay. I went on with the appeal, which was granted in February '97. Again, July 1st, '97, my benefits were terminated. I went through an appeal process again. Of course I was denied. I started court procedures, and we went to Court of Queen's Bench. In March of '98 Judge Wimmer of Court of Queen's Bench made a judgement in my favour. I'll just quickly read off part of it here. "The appeal will succeed to the extent that there will be an order directing Saskatchewan Government Insurance to reinstate Dale Collis's income replacement benefits from and after July '97."
	I also asked for retraining, but the judge said that's at the discretion of the insurance company. It would be in their best interest to retrain me, but it was up to them.
	Okay. So I thought it was the end. Now if SGI wanted to train me, it was up to them for retraining. I also wanted to buy the house I was living in, and I asked SGI for a letter stating my income and that it wouldn't change because they informed me that if I was retrained and I was at a lesser salary, they would have to subsidize the difference until such time as I reached the amount I was at. They sent me that letter, which obviously doesn't mean anything, but I got it.
	Okay. SGI then decided after the court they'd send me to their Fit centre to see about retraining. I started there in July '98. It was supposed to be for 12 weeks. We started five half-days per week. After eight weeks we were down to three days of approximately an hour and a half a day.
	Fit discharged me stating they were doing more harm than good and that I could not work a full-time position. Of course SGI did not like that report, so they sent me to Kinetic in November. Kinetic did a -- I believe it was about a day-and-a-half assessment, and they figured I could work an eight-hour day of light duty but I couldn't work consecutive days, so therefore I couldn't work full-time at that.
	I talked to them in May, about May 10th, and they said nothing about discontinuing benefits or anything. Sounds pretty suspicious to me. So I went to the public hearing in Saskatoon on May 13th, and on May 17th I got a letter terminating all my benefits, that they had new medical information.
	I don't know how they can go against a judgement, Court of Queen's judgement. In my mind it's supposed to be the final law. If they don't agree with it, they should have to take it back, have it overturned, not just say we're SGI so the law doesn't mean anything to us.
	Their reasoning is that they have new medical information from the -- pardon me -- from the physiotherapist at Kinetics. I saw her for one hour in November '98. I got her report, and on her report, diagnosis accident-related whiplash disorder, and that's the report she sent to SGI. Now they're telling me in December '99 they've got another letter from her and her diagnosis is different, that it's a pre-existing condition of arthritis, and the amazing part is she hasn't seen me since November '98, so how could she change her diagnosis without having another checkup or whatever?
	So the bottom line is SGI has put themselves in a position where they're above the law. If I have a judgement against me, I don't follow it, I can be garnisheed, I can have my vehicles taken away and everything else. SGI has an injunction against them, they say too bad we missed our 30-day appeal, we can't take you back to court or we can't appeal the decision so we're going to cut you off and you've got to go back to court, so as it stands with all the letters, I can lose everything else going back to court just to get through there. Thank you.
DR. REG MARTSINKIW:	Thank you very much. We're freewheeling this agenda. I'd like to bring Yvonne back, and Yvonne says one minute. Thank you very much, Mr. Collis. Thank you. And Yvonne will be introducing the rest of the Coalition members here in Prince Albert.
YVONNE DAGENAIS:	I would like to introduce the members of the Coalition Against No-Fault. Patricia, the southern branch manager; Trudy, northern branch manager; Brenda, head of finances; Daryn, member of the Coalition.
PATRICIA SCHRYVER:	No, he snuck out the door.
YVONNE DAGENAIS:	He's right there. And Theresa, Blue Rose.
DR. REG MARTSINKIW:	And I assure you, these people have worked very hard. Let's hear it for them one more time.
YVONNE DAGENAIS:	The coffee is also ready now.
DR. REG MARTSINKIW:	Lunch is going to be served at one o'clock, and it's -- there's a slight cost to it. The money goes to support the Coalition. We want you to know that. A very important aspect, a very very important aspect that we forgot to mention when we started the morning is that the washrooms are just down the hall if anybody wants to use them.
	I let Dan speak first because we wanted to hear from a victim first because this is what it's all about. I've been asked to do a short 10-minute presentation -- and, Larry, if I go beyond the 10 minutes, you can use the sword -- and give you my impression, and this is my impression as a practitioner in regards to the management of no-fault and what we as practitioners have to deal with in -- when we work within the structured symptoms. Could you maybe close that door if people are going to talk?
	The basic care premises in the management of a musculoskeletal injury or an injury when a patient comes to our office that's injured is to do -- and believe it or not, this is the first premise of care is to do the patient no harm. The second premise is to identify the injury. Then we have to take the injury and explain it to the patient in terms of understanding so that they understand it. We treat it, we make it better, and we provide the patient with tools to keep it better.
	Care, rehabilitation, recovery may vary with each patient, varies with each patient; the extent of the injury, the age, the occupation, pre-existing conditions, psychosocial makeup, the physical state, even the time of year, even the time of year. We know that people who get injured in the summer recover a little quicker than they do in winter because here in Norway and in Canada, we're a little more active.
	Health-care professionals, particularly those involved in primary care of soft-tissue injuries, must have the skills to clinically identify -- that means to diagnose -- the problem, clinically assess the injury and recommend rehabilitation, must be able to work now in a multidiscipline environment, and they must have developed skills to manage, educate and motivate the patient.
	Patient management skills must be supported and implemented through years of studies in a faculty of health sciences in a university or accredited college setting. You know, seven years. Whether you're a medical doctor or a chiropractor, it's seven years plus our postgraduate studies plus our years of experience.
	Appropriate early intervention of soft-tissue injuries is directed to confronting the pain symptoms and maintaining the patient functional within the perimeters of that injury. The Quebec Task Force -- and management focuses on preventing chronic pain behaviour on behalf of the patient. The Quebec Task Force states that a patient who has been in pain for six months could be considered a chronic pain patient, while some academics say it's only three months. I say it varies with each patient depending on the patient's past history of pain-related conditions. Believe it or not, ladies and gentlemen, believe it or not, despite what academics say and SGI bureaucrats say, there are claimants who may never totally recover from an injury.
	As a health-care practitioner in Saskatchewan, while managing a patient who is injured in a motor-vehicle accident, we have to deal with a health-care system that is structured that now a claims officer plays a role in the provisions of health care. These people are not formally educated, nor do they possess the necessary knowledge of health-care management.
	It is usually at this level of health care that the patient becomes secondary to the demands of the insurer. Let me qualify that I'm not attempting to tar all the claims officers. In fact, I'm not even blaming the claims officers. They have been put into the system. They've been fitted into a system because a good portion of these people really do put the patients' health as a priority.
	It is usually at this injunction of patients' health care that claimants are often confronted with statements like "you should be better by now" or "our consultant --" who never examines a claimant "-- reviewed your file and no further benefits will be provided."
	This is only a small example of the inappropriate care that sets off a conflict leading to hostility. We know that when a patient in pain develops hostility, no matter what level of care this hostility occurs, this patient will not respond to care, whatever the care may be or whoever provides it. These are the patients who are very subject to develop an abnormal behaviour we call chronic pain.
	Hamilton Hall. Now, let me describe Hamilton Hall, who's a fellowship and orthopaedic surgeon. You've all heard of Dr. Hamilton Hall. You've seen him on television and he's an academic, and I'll just read his quote: "Success in the management of chronic pain syndrome relies on the patient's willingness to accept responsibility. Dismissing the pain as an imaginary complaint or as a result of emotional difficulty will only create problems."
	Has a claims officer ever did that to you? "Treatment is frustrating, recovery slow and success limited, but without appropriate guidance, the patient withestablished chronic pain syndrome has virtually no chance of returning to normal activity."
	In many cases the situation is ignited because some unqualified claims officer whose inconsideration to the patient's well-being very inappropriately said "you should be better by now" or "our consultant reviewed your claim and your benefits have been terminated."
	We now have a patient who has been injured because -- we now have a patient who has been -- and because of inappropriate bureaucratic intervention, the chance of full recovery is limited, and this patient will become a cost drain to our health-care system in many cases for life.
	The people of Saskatchewan who pioneered health care in our country deserve more than to be attended by fixed routine, more particularly in an environment that includes management by those who are not qualified.
	In our offices we constantly see patients who are in the SGI health-care system whose negative psychosocial health effects in dealing with SGI bureaucracy supercede the physical effects of the injury. Very often we see that.
	Some recommendations: Educate claims officers to avoid claimant/claims officer conflict. Claims officer should be taught to act in a thinking role rather than in a structured role. Suspicion is reason for further investigation rather than denying a claim. If people -- if you have people in a structured health system, you need people who are qualified to manage it. Avoid opinions, advice from consultants who have not examinedthe patient. That is a farce. Only exception of this is unless that consultant is God himself. I mean how could we have somebody read some reports and make a decision on a patient that's going to involve this patient's future life by just reading some reports and then having a claims officer substantiate it? Well, our consultant went through it; not even examination.
	Establish independent assessment teams. Giving the patient a choice of care can be that first important step to successful recovery, the choice of care. In dealing with health-care issues, the decision-making process has to have authority to resolve all outstanding issues on the claim. We can't have issues divided and left to be decided by different people in different places. This delay with current SGI policy is one of the greatest causes of claimants' stress. I had a patient walk into my office in November. This patient never got assessed 'til February. Awesome.
	My references -- and I've included, I've submitted it here -- are from the Quebec Task Force itself, Dr. Hamilton Hall and his presentation to the Canadian Journal of Medicine, and by Terence Ison, a professor at the Osgoode Hall Law School. Thank you, ladies and gentlemen. And now from Prince Albert, our next speaker on surveillance is Bonnie Gerow. Bonnie?
BONNIE GEROW:	My name is Bonnie Gerow, and I am a member of the Victims of No-Fault Insurance Support Group. I was born on June 4th, 1963, in a country that I was raised to believe that a person was innocent until proven guilty. Then I was in a car accident. I found out the hard way that such is not the case and that SGI believes that you, the victim, are guilty until you can prove your innocence, which means they have hired people that they call professionals to treat and determine our injuries without ever seeing us in person. Therefore, these professionals, of course, being paid by SGI deem us ready to go back to work.
	When I bought insurance, like most people, we believed that we would be taken care of in case we happened to be in a motor-vehicle accident. Boy, was I wrong. I bought an insurance that will take care of me if they think I'm injured and if they think I need rehabilitation, and they tell me when I'll be better.
	SGI adjusters -- SGI also have adjusters that they claim that work side-by-side with the claimant. That statement is partially true, but in reality they actually hire special investigators to be right by your side. Not only were they right by my side, they followed my husband and my daughters when I wasn't even in the vehicle. They followed my parents and my daughters while I was seeing a neurosurgeon in Saskatoon. These investigators go to the grocery stores with you, they follow you in a food court and they watch you eat your lunch. These people are walking right beside you and you don't even know it. In my case, they were videotaping me right in the next vehicle at the mall, and I wasn't even aware of it.
	While I was on this insurance, the surveillance team hunted me down as though I were a criminal. I was released for rehabilitation, not the penitentiary. Yet they continued to hunt me down at friends' of mine, the bank I deal with and even the pharmacy. Their favorite spot was waiting around my parents' house. They knew sooner or later that I would show up there.
	Since this has happened to me, I have read in Martin's Criminal Code under criminal harassment Section 264 that: "No person shall, without lawful authority and knowing that another person is harassed or recklessly as to whether the other person is harassed, engage in conduct referred to in subsection (2) that causes that other person to reasonably, in all the circumstances, to fear for their safety or the safety of anyone known to them. The conduct mentioned in subsection (1) consists of, (a), repeatedly following from place to place the other person or anyone known to them; besetting or watching the dwelling house or place where the other person, or anyone known to them, resides, works, carries on business or happens to be."
	After reading this, it tells me that this surveillance is not allowed, but when it was brought to the attention of the Minister responsible at the time, he said that this had been common practice of SGI for years. The tone of the Minister's voice was that this surveillance was a very minor issue, and I took great offence to this because after being stalked for five years, it's very scary. You don't go anywhere alone and you're always looking behind you, beside you and afraid for the safety of those with you, especially my daughters.
	When I spoke to the police about this stalking, they said I could go in and get a sketch made up and that they would confront him. When I received my file from SGI and found surveillance, I called them and was very upset because of the previous stalking, and they said, Well, you don't have to be afraid 'cause our investigators aren't going to hurt you, they're only doing activity checks. Well, their so-called activity checks were documented in my file as plan of attack, and this was very -- this was very comforting after already being stalked for five years. I'm not supposed to let this bother me because these stalkers were hired by the government.
	They have spent thousands of dollars to have me followed by two investigators at one time at $20 an hour plus their meals, mileage, and then they won't pay $15 for my anti-inflammatories. SGI claims that these investigators don't look through your windows and that they're only doing what they're legally allowed to do, which is to view as the public would. I don't know about you, but I don't see too many people on my street walking their dog with a pair of binoculars in theirhand.
	I was curious as to what kind of credentials or training one must have to become a surveillance officer. I lost my page. Just a second. I lost it. Anyway, this surveillance that was ordered on me by my adjuster has caused me so much grief that I can't even begin to tell you. The pain and the paranoia that I live with is sometimes unbearable. As if it wasn't enough to lose my health while at their rehabilitation, SGI has robbed me of my independence and my right to privacy.
	SGI has proven that they will go to any lengths to try and prove that we, the victims, are somehow frauding them. What they don't realize is it's impossible to fake herniated discs, bulged discs, fybromyalgia, torticollis, etc. The only thing that we are guilty of is being forced to buy no-fault insurance.
	Recently I've discovered that another SGI client has been put under surveillance. It's because of the paranoia that I even notice them. Witnessing the radios and binoculars that -- made me relive all the emotional trauma that I went through when I found out about surveillance on me. It took me five days and about $25 in gas to figure out that it was someone in my support group and another day to work myself up to telling her that she was being watched. This was extremely upsetting for me because I knew exactly how this lady would feel, and when the police -- we went to the police and reported it following, they said that they could not help us because the surveillance was ordered by government.
	When she received her file from SGI, she shared with me that not only was I named in her file but also in her video. SGI has assured me that there are no investigators following me, but the fears that I have and the documented evidence, I don't believe them.
	Under the Charter of Rights of equality, before and under law, equality, protection and benefit of law, every individual is equal before and under the law and has the right to equal protection and equal benefits of law without discriminating including physical disability. Apparently SGI hasn't read the Charter of Rights and Freedom.
	At no fault of my own, I was involved in a motor-vehicle accident. I have never asked for anything more than what SGI has public that we, the victims, are entitled to. We have never asked for our families to be victimized by a system that was supposed to take care of us, not rip our families apart.
	Every day I live as a prisoner in a body of unseen pain that is hidden with makeup, a smile and conversation, but behind that mask is tears, frustrations and disappointments. It's difficult to become a wife, a mother and an actress all in one day.
	In closing I would like to thank my husband, Kevin, for always being my greatest support and for all his patience and understanding through all of this. I'd like to thank my family and friends and all of you here today, and before I leave, I would like to share with you a poem I wrote one morning. It's called Victim's Prayer. Now I lay me down to sleep, I pray to my adjuster my paycheque to keep. If we go to gym and then leisure ed., They'll pay us our mileage and maybe our bed. Pain is your friend, so the therapists they say, It's all in your head, so we don't have to pay. Adjusters pay money for surveillance we know, They think it's quite funny, but it's taxpayers' dough. People are injured, families are sad, Doctors are unheard and paycheques unhad. It's insurance they call it, this no-fault in place, We pray that they'll change it, It is a disgrace.
	Thank you.
DR. REG MARTSINKIW:	Thank you, Bonnie. Anybody who wants to speak, this -- when I was asked to moderate this, I told the gentleman that asked me, I'll moderate it providing all aspects of our society are given the opportunity to speak if they want to, and I was assured that would happen, so Patricia's in charge. You could -- so Patricia's in charge here. If you want to speak, you'll get her -- you talk to her, and she'll put you on the agenda.
	Our next speaker from Prince Albert, Saskatchewan, who's had some difficulty with SGI whose daughter got run over by a dangerous driver, Ken Hidlebaugh.
KEN HIDLEBAUGH:	Hello, everybody, my name is Ken Hidlebaugh as you just found out. I have been a police officer with the Prince Albert City Police for 19 years. In that time I've run into many situations involving accidents. However in this particular case, it became very personal when my daughter was run over.
	What I want to do is show you a short videotape of the footage that CKBI or CBS or whoever did the taping did at the time of the accident. I had just got off a night shift. I was awokened (sic) by a phone call and advised that my daughter was underneath this vehicle, and I'll just show you on the videotape. Can everybody see that?
	(VIDEOTAPE PLAYED)
	The last thing you expect as a police officer is to get a phone call advising that your daughter's under that vehicle. That happened at St. Mary's School. As a result of that, we've had endless endless endless grief with SGI. In regards to the accident, yes, the girl was charged criminally and pled guilty several weeks before the trial. It was set for a 2 1/2-day trial. We had numerous numerous witnesses that saw it, so even though the girl was charged criminally, my daughter was on the sidewalk where she's supposed to be at noon and the girl was guilty, of course SGI, there's nothing we can do about it.
	So what they're telling us is that if you're a pedestrian or somebody walking on the street, whether the vehicle is registered or not that runs over you, they'll cover the vehicle. They'll cover the person in that vehicle even if the person doesn't have a driver's licence.
	I've had many discussions with adjusters, and probably be a good idea -- it kind of scares the heck out of them. They all figure dad was interrogating them, which I was, but I took a tape recorder with me, and they said, Is that necessary, is it really necessary that you tape this conversation? I said, Well, are you going to lie to me? Okay, well, you can have the tape recorder, you know, so if you go into these meetings and you think that these guys are going to shaft you, take in the tape recorder, tape them, and then if they're going to fool you or try and fool you, they can't.
	My daughter as a result of this accident has sustained many injuries. Maybe back to the accident, the speed estimated by the RCMP officer at the scene, the minimum impact speed was 64 kilometers an hour. My daughter was hit on the sidewalk. In reality, I spoke to him later, and he said she was probably hit more towards 75k. There was no braking. It was all acceleration. She's lucky to be here.
	She sustained separated shoulder, torn cartilage in her knees, internal bleeding in her legs, shattered broken teeth. She's in the process of having root canals done. She's got a splint in her mouth because of a misaligned jaw. She's got blurriness in her right eye, detached retina, loss of hearing, and the most severe that we're dealing with right now is her personality change due to brain trauma.
	Now, she's attended the Fit program in Saskatoon, and they were the ones that assessed her and took her from mild brain trauma to severe. This is where they -- she has problems with managing numbers or having -- she's not able to -- to reason. That's the reasoning part of her brain. Her marks have went -- slid from nineties to some cases 40%.
	She wanted to be a vet. She wanted to get a scholarship in hockey. That's -- we're hoping that's not over, but it doesn't look very good at this point. We're hoping that down the road she gets a little better. She's kind of like living with a schizophrenic in our house. Like she can -- her personality changes from one moment to the next. She's good, and then the next moment she's bad.
	We've had problems with adjusters telling us that they know everything. We've had adjusters -- I've had adjusters tell me that the reason for the no-fault system is because of lawyers raked the coals over their financial state. My answer to that was if you can legislate no-fault insurance, you can legislate how much a lawyer will receive in an accident claim. Why are you blaming the lawyers? I mean there is no problem with legislating no-fault, so you can control that. You can control what the lawyers make.
	So the excuse they always make and they try and make it bad for the lawyers is they try and blame. It's easy to blame a lawyer 'cause in a lot of cases it's lawyers that are speaking, but today it's a policeman, and if you think policemen aren't for you people, I have 65 policemen in Prince Albert that had their eyes opened this day.
	Am I going to get gonged?
PATRICIA SCHRYVER:	Pretty quick.
KEN HIDLEBAUGH:	Okay. One thing it does, no-fault opens the door for -- for criminals. If you can't be accountable for your driving actions, I mean a criminal knows that, he can do whatever he wants with a vehicle. It's funny. This girl that hit my daughter, they covered the car. Right away they covered the damage, they covered everything, but we had a hard time even getting them to cover her clothing. We had to fight to get them to cover -- she got blown right out of her -- she got hit so hard that her running shoes were left right where they were, so it leaves -- it leaves a bad taste in my family's eyes, that's for sure.
	All we're asking for for my daughter, myself, my family -- we don't want to make millions of dollars off this thing, but I want my daughter covered for the rest of her life. I want her medical and I want her covered for whatever she needs. That's why we pay liability insurance. If we don't pay a liability, why are we buying it?
	One adjuster said, Well, you might go across the border. Then we should be able to buy private insurance. If you want to go to -- how many farmers out there drive grain trucks that have liability insurance? Will they ever claim? You can't be sued, can't be taken to court, can't -- I mean why would they have liability insurance on a grain truck? Makes no sense to me. I guess in closing, that's basically all I got to say. I'm going to get the -- it looks like a crayon there.
DR. REG MARTSINKIW:	You folks come right in. Marilyn Fabish from Prince Albert, the effects that an accident have had on her family. Marilyn? And following Marilyn will be her daughter Kristine Fabish, from a child's perspective.
PATRICIA SCHRYVER:	Kristine, could you come on down?
MARILYN FABISH:	Good morning. I'm here today to share our story so people may hear of the impact that no-fault insurance has had on our lives. On January 1st, 1995, my husband and I were involved in a motor-vehicle accident. Our van was totalled. My husband received injuries that included over six broken ribs, a punctured lung, lacerations to the head and ear and whiplash. He was hospitalized for nine days with these injuries. I had whiplash, strained lumbar, multiple bruising to the right hip, laceration to the head and memory problems.
	Our children at the time of the accident were 6, 10 and 11. From this day on, our lives would never be the same for any of us. My memory was gone, past and present. I had to relearn how to do everything, all over again just like a baby. The simplest task that we all take for granted was difficult for me like eating, talking, bathing, washing my hair, moving my limbs, tying my shoelaces, making meals, helping my children with homework and keeping appointments.
	I relied a lot on my children and friends for help. I had to ask everyone how to do things. I had notes all over my house to remind me of things. I didn't even know how to cook porridge or boil eggs. My brain signals were all mixed up. I was very confused, frustrated and angry at myself. It was very hard for me to understand and cope with what was happening to me, my family and, on top of that, dealing with SGI.
	This kind of stress happens often and is hard to deal with. Every day is a challenge for all of us to face. It tears me apart to think that my children had to raise themselves and I'm not the mother I used to be. I would give anything I had to bring back my children's childhood that they missed because of the accident.
	We were given three weeks of child care. After three weeks -- 24 days to be exact -- it was cut off. It was difficult for me to perform everyday duties. I begged SGI to help. I asked them to help us in any way that they could. It was denied. Our children became our caregivers, looking after us as well as themselves, making meals, lunches for school, getting themselves off to school and being my memory.
	Seeing and knowing the stress it put my family under, I appealed. Within 24 days of the appeal, we were put under surveillance. SGI spent thousands of dollars following us. It breaks my heart for when I was only a block away from home, my mind went blank. I didn't know where I was or where I was going. I pulled off to the side of the road confused and crying. Where was the surveillance team then? They knew where I lived. I didn't.
	My husband and I were eventually sent to the tertiary rehab in Saskatoon, Fit. I walked in, and when I left rehab six weeks later, I could barely walk out. By this time I had full-blown fibromyalgia, which my general practitioner said had advanced 10 to 15 years.
	In 1996 our economic status was a disaster. We were both cut off our wages and forced on Social Services. Our medical conditions were such that we could not work. Our children were forced to feel the abuse of other children while they could not partake in certain school activities due to our financial situation. Our children's self-esteem in school by now had fallen greatly. More than ever we relied on our children to help us.
	My husband was sent to SIAST for a vocational assessment. They said he should take upgrading course first and then take a GED course. SGI said no to the upgrading course but they would pay for the GED course. Some of the tests he failed, and when Stan requested more funding to rewrite the test, SGI said no. We eventually came up with the money for Stan to rewrite the test. Stan's boss, recognizing that he was not in physical shape necessary to handle potentially dangerous equipment, did not allow him to return to his previous employment.
	SGI recognizes our injuries by paying for our medications to date including the odd massage or acupuncture for me but no financial benefits or home care whatsoever. We were told by Jon Schubert and Clay Serby that they would not pay travel expenses because it was an everyday expense.
	This is but a small summary of our experiences with no-fault insurance. It has been very stressful, degrading, devastating and an emotional roller coaster for all of us. We do not believe that we are alone as far as the impact that SGI has made on our lives, but we as a family feel very alone. When you take your wedding vows and it says in sickness or in health, it does not prepare you for an accident or in dealing with SGI. Over the past five years, our marriage and family have been stretched to the limit.
	Thank you for giving me this opportunity to share our story. We can only hope that there will be changes made to a system that is destroying families and lives.
DR. REG MARTSINKIW:	Kristine Fabish. Kristine, you're the oldest in the family?
KRISTINE FABISH:	Yeah. Hi. I'm really not a good speaker, but I'll try anyways, okay? Okay. I never got asked how did -- how did the accident affect you as a child, so how can SGI say that it didn't affect me? Just because my parents were affected physically doesn't mean that I wasn't affected mentally. When my parents were in the accident on January 1st,1995 --
PATRICIA SCHRYVER:	I was only 11 years old. My brothers and I had nowhere to stay while my parents were in the hospital and my parents had no money for a hotel room, so we were pawned off to different relatives, first to my aunt's, then to grandma's, then to a different aunt's and finally grandma again. These were all the people who tried to take care of us children while my mom was trying to take care of my dad who was still in the hospital.
	When my parents were finally released from the hospital, they got to take us home, and I thought they would be fine and I would -- and they would be just like they were before, but I was wrong. They weren't the parents I knew. It was as if I was part -- it was as if I was put into a foster home with new parents. They couldn't do all the things they did before. They couldn't do any of the things they did before, and they got even worse after the Fit program in Saskatoon.
	They would come home on the weekends, and every time they came home, more and more of their health was disappearing. At the end of the so-called rehabilitation, there was no more of their health left, and all their strength was gone.
	Ever since the accident, my whole life has changed. I had to go from a child to adult, skipping adolescence. I felt scared, lonely, and I felt like I was pushed into the situation, like I had no choice. I had no choice.
KRISTINE FABISH:	I felt like I had to do everything. I had to get up in the morning and make breakfast and lunches. I had to check my brothers' homework in the morning to make sure they did it all for school, send them to school, and I also had to look after my parents, check on them in the morning to make sure they -- to make sure that they were still okay.
PATRICIA SCHRYVER:	And watch them to make sure that they didn't get hurt. Trying to help them out, it was as if they were babies and had to learn everything over again. Don't get me wrong. They really tried to do the things they did before, but they couldn't. Their health didn't permit it. Then if it wasn't bad enough, my mom has a memory problem and can't remember very much stuff, so I have to keep track of her life and mine. I remember one time my mom couldn't remember how to boil eggs.
	I tried to be the perfect daughter so -- so that my parents wouldn't worry about me. Somehow I was able to balance my schoolwork, home life and a job, and I was even able to keep one friend. There was only one who would stick beside me. All the rest fled.
	When the stress got to me, I would cry at night. I cried a lot at night. Sometimes I'd cry because my family had no money. Sometimes I'd cry because I knew my parents were in pain and that there was nothing I could do about it. I couldn't stay -- I couldn't stop their pain. Children should have a chance to be children. They shouldn't have to grow up overnight. I should not have to have -- I should not have had to take over my parents' role.
	My mom and dad are still not the same people that they were before the accident. It is very hard to remember what life was like before the accident. If I had one wish, I would wish that my mom and dad would have no pain and would be healed physically and mentally. Thank you.
DR. REG MARTSINKIW:	We'd like to inform you also that Shawn Hurd here is preparing a transcript that will be forwarded to all the MLAs in the province of Saskatchewan. Coffee and doughnuts. We believe -- correct me if I'm wrong -- all the MLAs were invited to attend here today. Is that true?
PATRICIA SCHRYVER:	Yes.
DR. REG MARTSINKIW:	It is true.
AUDIENCE MEMBER:	All of them?
DR. REG MARTSINKIW:	All of them?
PATRICIA SCHRYVER:	Yes, every one.
DR. REG MARTSINKIW:	We did get a call -- we did get a call and we couldn't say no to him from Rosthern, Saskatchewan, and a few minutes before we hear Dr. Gale, Ben Heppner.
BEN HEPPNER:	Good morning. It's -- in a way it's good to be here. It's good to be here because so many of you people are here. I've attended the other two meetings that took place, and each meeting is considerably different because there's different sorts of people giving different ideas and different things that have happened and different experts presenting different bits of information.
	I asked the Minister in the house within the past week -- we had quite a number of questions that came up dealing with SGI, and he got up and he said, well, I should just sit down and mind my own business and show up at the government's own, and I said I had been at every review committee meeting they'd had to that date -- and that was none but I'd been at all of them -- and that I'd been at every one that the Victims of No-Fault had had and that was three and I haven't seen him at a single one.
	I think today is by far the most emotional meeting that I've been at, and I wish he could have been at today's meeting because I'm sure it would have changed some of his -- his thinking on some of these particular issues.
	I recall the meeting in Regina, and there was an expert there that talked about some of the research that had gone into SGI's thinking, and one of the amazing little pieces that I remember -- and I forget a whole lot of information that I hear -- was that one of the bits of research that had taken place and where they'd taken a rabbit -- a number of rabbits and they'd twisted their joints, and after a period of time they checked the joints with a microscope and said, guess what, some healing's taken place. This was six weeks later. So what's the conclusion from that? Some healing took place. I guess that same thing happens in people, and so after six weeks or four weeks they can also go back to work because healing's taken place. They forgot one thing. They never asked the poor little bunnies if they still had any pain, and that's basically the way the victims of no-fault are treated, very much the same sorts of ways.
	Numbers of months ago Dr. Reg and I met, and that's before the Victims of No-Fault had really taken place the way they have now, and we discussed the concerns that we had, and we said, well, we should start some sort of a committee and do some research and get some ideas from across the province, and I dragged my feet and I didn't do anything and I felt guilty about it day after day, and all of a sudden the Victims of No-Fault came into action, and I think it's impressive. It's impressive when every meeting I go throughout the province there are people like you and very seldom the same people, always different people with different stories, and I think at some point, government's going to have to listen.
	They've set up their review committee, but as you well know, two of the top people resigned not long ago because they didn't see that this committee's going to accomplish anything and they didn't want to work within it. The Minister then picked two other people. Now we find out these other two people that have been put on that committee in the leadership roles have previously made statements that they are in favour of no-fault insurance, so how much objectivity can you have when they've come out in favour of no-fault in the past? In fact, one of them's even written a book on it.
	This whole review shouldn't have been that difficult. In my mind, if they would have gone to the legal community, which has also opted out, and said, what exactly will it take to have you people on-side -- and I've talked with them in the past. We met with them, and I don't think it would have been very hard to have them on-side, and it wouldn't have been very hard I don't think to have had the Victims of No-Fault on-side. In fact, the least they should have done is had at least one or two people on that particular committee because had that happened -- had that happened, at the end of the time and the research would have been done and the committee would have made its report, you would have had people from your organization that could have been there to make sure that all the information was presented and also to make sure that no odd decisions were made behind closed doors because you would have been there, you would have heard all the discussion, and I'm not going to take very much more of your time except to say that these meetings should never have taken place because there shouldn't be this many victims of no-fault.
	Any insurance will always have some victims and some people that fall in the cracks. That will always happen. You will never have a perfect system. It would be nice if we could, but that will never happen, but when you have the numbers of people that exist as victims of no-fault throughout this province, there is a problem. There is a problem, and that needs to be taken care of.
	I appreciate the opportunity to work with the Victims of No-Fault, and I can tell you you have a very active group. If I don't get up every single day in the house and ask a question, they're on my back, and I'm sorry we can't do that. There's just that many issues in the province that have to be dealt with, but we give it every chance we can, and your committee people do an excellent job, and I see the gentleman rising means I'm just about done.
	I want to thank you for the opportunity of being here. I'm squeezing this between two parades this morning which got rained out and a funeral this afternoon, but I always leave these meetings very thankful. Every member of my family's been involved in a car accident. None of them have ever been hurt, and when I hear the stories that you people come up with, I always leave these meetings a very very thankful person. Thank you.
DR. REG MARTSINKIW:	We started this meeting by saying people power will prevail, and we will prevail.
	In the afternoon and right after lunch -- before we hear Dr. Gale, a very renowned speaker -- we'll start the afternoon off with a question and answer period, and after we have lunch, of Dr. Gale, and we'll start the afternoon with Barbara Netmaker and Tom Cartier, and at this time it gives me great honour and a pleasure. It was really coincidental that I saw Dr. Gale appearing as a speaker today, this very talented person, because it was just about two months ago that I referred a patient to him, and here he is from Toronto, Dr. Gale, who is the clinical director at the Rothbart Pain Management Clinic in Toronto. He began his medical career as a family practitioner in England back in 1958. That's hard to believe. He looks so young. He became qualified as an anaesthesiologist in 1968 and a Fellow of the Royal College of Physicians in 1973. Since 1995 he's confined his work to a clinical pain -- in clinical pain management. In 1997 he was elected as vice president of the Chronic Pain Section of the Ontario Medical Association, and in '98 he was vice president of the North American Cervicogenic Headache Society, an organization concerned with headaches originating from the neck. In the same year he received a diploma from the American Academy of Pain Management. He is a member of the American Academy of Pain Medicine and of the International Association for the Study of Pain. At present he is developing research interests in the management of chronic nonmalignant pain. Ladies and gentlemen, Dr. Gale will speak on whiplash and its aftereffects plus the Quebec Task Force approach to rehab. Ladies and gentlemen, please welcome Dr. Gale.
DR. GALE:	Thank you for inviting me here today to speak to you. I have a couple of reflections. Can you hear properly, by the way? Am I too close to the mike or too far away?
AUDIENCE MEMBER:	Just fine.
DR. GALE:	Okay. I have two reflections before I start the main part of what I want to say. The first one is how society treats minorities is a reflection of the quality of the society, and it appears to me that the way Saskatchewan treats its injured victims is a reflection on that society itself so that this -- this is a question for society as a whole to decide how the victims of injuries should be treated since the government has taken over the insurance for injuries so that it's up to society to fix that problem.
	My second reflection is on members of the medical profession. Our first motto should be first do no harm or primum no nocere in Latin. The second is in medical school we're taught diagnosis comes before treatment because if you fail to make the right diagnosis, you probably are going to give inappropriate treatment with harmful effects and therefore you're going to do harm so that the doctors need to pay attention to making the right diagnosis.
	So could we put the first slide on? So I'm going to say a few words about whiplash injuries now. The -- the IASP, the International Association for the Study of Pain produced a classification of pain conditions. The editors were Merskey and Bogduk so that this is their definition of whiplash injury. It's an acceleration/deceleration injury of the neck or cervical sprain. The terms are synonymous.
	The incidence is -- has been a matter of some debate. In the JAMA study, it was quite common in women workers at 14.5 per thousand, whereas in the Australian study, it was only one per thousand. The incidence appears to be lower in studies connected with insurance companies. Next slide.
	The question of whether whiplash symptoms clear up or become chronic has also been a matter of some debate, but the three studies that I quote here, which were all perspective studies, found that 80 to 90% of whiplash injury patients had the symptomatology clear up within a few months, certainly within the year, but the problem was the remaining 10 to 20% because they didn't appear to clear up, and, in fact, the -- if they didn't get better in the first year, they persisted indefinitely. So that Bogduk, the Australian investigator, described the situation as dichotomous; that is, they get better or they have permanent symptomatology. Next slide.
	This is the result of four perspective studies of whiplash. The left-hand column and figures are the numbers of patients in the study. The centre column is the number of months the patients were followed for, and the right-hand column is the proportion of patients not recovered at the end of the year so that from these perspective studies, the incidence of nonrecovery in the year varied between 14% and 67%. It -- it is, however, clear that it's definitely more than 10% so that, in fact, the figures were wide for whiplash injuries, seem to leave at least 10% of the victims with chronic symptomatology.
	We are thinking of doing our own study in Ontario to find out perspectively what the incidence is, so we're going to take the police reports over a number of months and then follow the patients for a year and see how it turns out. Next slide.
	There's also been a lot of debate about the cause of whiplash injuries, and this is taken from a paper by Nikolai Bogduk, and he stated that on impact the shoulders move forwards while the head is static and the neck is extended; thus the neck acts as a lever and the head is accelerated forwards into flexion. At an impact speed of 20 miles an hour, the head reaches a peak acceleration of12g during the extension, and then compressive and tensile forces are applied to the neck with extension, flexion or lateral flexion injuring cervical structures. Horizontal forces apply shearing forces to the neck.
	Since this was written, some studies were performed in Japan using volunteers. The volunteers were put in a car. They would have X-ray CA radiography used so that an X-ray of the neck was done while they were whiplashed, and then the volunteers were whiplashed. The new information from this showed that the first movement in the whiplash is that the body rises up. This is a consequence of the shape of the seat in a car because there's a backward slope to the seat, so if you push the car from the back, the body rises up on the seat, and this produces a compression of the cervical spine so that in addition to these changes, there's an initial compression of the spine producing an S-shape abnormality as the first stress of the injury. Next slide.
	Symptoms of the injuries that occur in a whiplash injury occur to musculoskeletal neck structures such as the zygapophyseal joints, the discs, the muscles, the ligaments, the brain, which has been extensively investigated in nonhuman primates by Ommaya and Gennarelli, the TMJ, other soft tissues such as the esophagus and the spinal cord.
	When Bogduk wrote his paper on whiplash injury, he stated very succinctly that in a whiplash injury there's injury to two structures connected with the cranium but not firmly attached to it, so the first one is the brain so that you should look for brain problems in a whiplash. The second one is the temporomandibular joint in the jaw, so for every case of whiplash that one sees, you should look for problems of cognitive function and other cerebral function as well as TMJ problems
	The TMJ problem, however, remains rather controversial, and my nephew, who's an oral surgeon, described it as the TMJ is a can of worms. What he really meant by that was if there is a TMJ problem, it's difficult to fix, and TMJ surgery has had very -- very divided results. Next slide.
	The injured tissues leading to prolonged pain in the unfortunate 10%t of patients who don't recover from the whiplash in the first few months, the -- 50% of the pain comes from the zygapophyseal joints. Bogduk in Australia has done studies with the objective diagnostic test of diagnostic nerve blocks and has proved that in 50% of cases, it's injury to the zygapophyseal joints that cause the cervical pain in whiplash, so if one sees a case of whiplash, the probability is that the commonest cause of the pain is coming from the joints in the neck, although there may be other structures involved such as intervertebral discs and upper cervical ligaments. Next slide.
	This is a slide showing the different parts of the joints in the neck that may be injured, and so that these -- these are all numbered, but they include the discs between the joints, the ligaments both in front and behind the cervical spine and the interspinous ligaments of the left-hand side and the various other structures so that there are many parts of the cervical spine that may be injured. Next slide.
	The acceleration/deceleration injuries are the musculoskeletal neck injuries, the TMJ injury, post-traumatic syndrome and radiculopathy of the arms.
	The brain injury that I referred to earlier has been a matter of medical controversy for a long time. The first two cases -- and for that reason we don't call it brain injury or minor brain injury. We call it post-traumatic syndrome because the patients get a constellation of symptomatology which may be as many as 20 or 28 symptoms which seem to result from having the acceleration/deceleration forces applied to the brain, so I'll say a bit more about that later.
	The fourth point, radiculopathy of the arms, is -- it presents as pain, numbness, tingling, weakness and sometimes temperature change in the arms, and this is probably due to damaged nerve supply to the arms so that the -- the C6 nerve root supply is your thumb, for example; C7, the index and mid fingers and half of the ring finger; and C8, the little finger, so if you get symptomatology in these two fingers, you've probably got a nerve root injury of the C8 nerve root. If it's these two fingers, it's C7. If it's your thumb, it's C-6, and in a violent whiplash injury, it's my opinion that at the extremes of movement of the neck, the nerve roots get tugged on and then they'll never be quite the same again, which accounts for the odd symptomatology.
	However, unfortunately this does not show in EMG or nerve conduction studies because these primarily test the large nerve fibres in the arms, whereas the sensory fibres, which cause the pain and numbness in the arms, are small C fibres, which are sensory and I think more easily damaged than the large motor fibres, so that one often reads in medical reports that although the patient has pain, numbness, tingling and weakness in the arm, the EMG studies were negative and therefore there is no arm injury. This is incorrect. The IASP classification of pain conditions defined radiculopathy as a clinical condition, and if the patient has the symptomatology, it fits the definition and therefore it's an appropriate diagnosis. Moreover, there -- it's never been documented what the false negative result rate is for EMGs in the arm, so nobody can prove that if the patient's got the symptomatology, the nerves are not injured. Next slide.
	So some of the commoner symptomatology after whiplash are neck pain, headache, visual disturbance, dizziness, weakness and heaviness, paraesthenia, tingling and numbness in the arms, problems of memory and concentration and psychological symptoms which get labelled as post-traumatic stress disorder, so if someone is having flashbacks and reliving the accident or afraid to go near the scene of the accident, this is usually diagnosed as post-traumatic stress disorder. It's a diagnosis that we normally leave to the psychologists, however, but the other symptomatology in this slide is part of what I call the post-traumatic syndrome, which has been increasingly recognized in the last 10 years as a consistent entity after whiplash or head injury and is probably a physiological injury due to stressing the brain. Next slide.
	The treatment of whiplash injuries is difficult because the -- often clinical diagnosis doesn't show anything. You can't see pain. It's a symptom that the patient tells you of that. Also the X-ray, the CAT scan and the MRI are often negative even with significant neck injuries in whiplash. For this reason, a lot of doctors write that although the patient was whiplashed and has some pain, there's no objective sign of injury, therefore there's no disability, and therefore there's no compensation needed to be paid.
	Well, my response to this is if you do the wrong test and you don't get an answer, then of course nothing shows, so the chiropractor that I use for the X-rays of the neck almost always shows problems after a whiplash injury, and the reason is he's a good chiropractor, he's done his homework, he's read the papers and so have I, and he knows what to look for and he knows which X-rays to take, so what we -- the X-rays we take to demonstrate biomechanical abnormalities with a whiplash, we take the erect lateral view and measure whether there is anterior carriage of the head or normal posture. Then we do flexion and extension views and see which joints move in flexion and extension. Then we do the oblique views, which -- and we look at the foramina to see if there's any encroachment on the cervical nerves.
	The literature supporting this investigation is very long. Dr. George did the -- wrote the first paper on it in 1918. He was an American army radiologist who wanted to get the maximum information out of the X-rays, so he introduced the concept of George's line, which is looking at the biomechanics of the neck, at the way -- the posture, at the way the head is held. This was later modified with the use of the gravitational line so that the -- the line we use is the gravitational line, which in the erect lateral view of the neck is a vertical line drawn through the odontoid process which is at the centre of the C2 vertebra. We drop the line vertically down. In humans with normal posture, the line should fall over the body at the C7 vertebra. In other primates who walk on their hands as well as their back legs, they have a more anterior carriage of the head and a more posterior position for the foramen magnum. It's like they're in the position you would be in if you were riding a bicycle, and therefore they normally have anterior carriage of the head, but in the humans since humans started walking on two legs, their head is held in a balanced position on their shoulders over the body at C7, and therefore there's not a great deal of muscle tension normally when the patient is standing erect. However, after neck injury, the head is held in a more anterior position and the muscles at the back of the neck are under constant tension to stop the head following forwards. Why injured patients hold their head in this position I've never read, but my own speculation is that it's a method of transferring weight from the zygapophyseal joints to the discs because the axis of rotation in flexion and extension is in front of the zygapophyseal joints but behind the centre of the discs, so if you hold your head forwards, there's more weight resting on the disc and less on the joints.
	Nevertheless, these measurements that we do produce some results which have been shown by Porter in an article in the British Medical Journal 1989 to -- to be associated with prolonged pain after whiplash injuries. Next slide.
DORIS LUND:	Dr. Gale, do you think you could go back two slides, please, for a minute?
DR. GALE:	Okay. Go back two slides.
DORIS LUND:	Right there.
DR. GALE:	Yes.
DORIS LUND:	Thanks.
DR. GALE:	So that we try to -- in my practice we try to look for objective evidence of injuries so that we start off, in fact, with some good X-rays of the neck, and I don't think I've ever found a patient come to our clinic whose ever had such good X-rays taken anywhere in North America, and my radiologist, Marshall Deltoff, was one of the authors of the book on radiology for chiropractors, and that may have something to do with it. Okay?
DORIS LUND:	Thank you very much.
DR. GALE:	So the investigations that we're going to do to find objective evidence for neck injury after a whiplash are we start with the X-rays, we do a clinical history and examination, and if the patient's exquisitely sensitive over the cervical joints in the neck, it rather suggests that that might have been the origin of where the pain's coming from, and also we find restricted neck movements and that is additional confirmation of a neck problem, and therefore we send the patient for diagnostic facet blocks. With this technique, a small amount of local anaesthetic is put close to the zygapophyseal joints, and if the -- if that takes away the pain for one hour after it's put there, it is considered proof that the pain is coming from that joint, and therefore it's objective evidence of the injury.
	In other words, what we're doing is we're relating pain to pathology. We're not just looking at morphology. The regular X-rays, MRI and the CAT scan merely look at morphology. They only look at the shape of things, but we as pain specialists want to know where the pain's coming from, and therefore we want tests that relate pain to pathology, and that's why we find objective evidence for things that a lot of other people don't.
	The next test that we do is the C2 nerve diagnostic block because the -- the -- sometimes we find the diagnostic blocks done in C3 to 6 are negative, so if the pain originates in the upper neck in the distribution of the C2 nerve, then the C2 nerve diagnostic block will demonstrate that, so in this case, a needle is put in from the posterior approach close to the occiput-atlas joint, and when the anaesthetic's put in and it takes the pain away for an hour, that proves that the pain is coming from that position, and the C2 -- if the pain generator is in the C2 nerve distribution, it may be in the atlas-axis joint and the nearby ligaments, and the pain that it causes the patient is in this sort of area, in the temple, the forehead often, the back of the head.
	Should the pain be coming from injured discs of the neck, the best test for showing that is called the provocative discogram in which a needle is put obliquely into the front of the disc with an anterior approach and a small amount of contrast medium is injected, and if you get concorded pain, that is pain in the same distribution as the regular pain, then that pain is probably coming from that disc, and indeed many headaches can originate from the 2-3 disc or the 3-4 disc or even the 4-5 disc. There was one patient who had radiculopathy in the arm so the 4-5 disc was removed, and the headache also disappeared when that disc was removed, suggesting that the nerve supply of the 4-5 disc was causing a cervicogenic headache in that patient.
	So the principle behind our investigation is the principle of precise diagnosis of spinal pain. In other words, we want to find out where the pain generates or is, and then we may be able to provide the most appropriate treatment.
	Other clinical tests that we can do for the pain are occipital nerve blocks, and if that removes the pain or the headache, then the pain is probably coming from the C2 nerve in the neck, and that's additional confirmation, or a paravertebral nerve block at the 2-3 facet. If that takes away the pain, then it's probably a C3 nerve pain, and if neither of those work, it's probably a C1 nerve pain from the occiput-atlas area. Okay. Next slide.
	I'm just moving on now to the post-traumatic syndrome. These are -- this is some of the symptomatology that you get in the post-traumatic syndrome. I won't go through the entire list, but we find after a whiplash injury even with anti-direct blow to the head but it may also occur with a direct blow to the head that the patients for a long time afterwards seem to have a constellation of problems with memory, concentration, mood, sleep problems, dizziness, light-headedness, difficulty hearing, unsteadiness, staggering, change in the handwriting, so this symptomatology was ignored for many years because it's so so widespread, so many symptoms that doctors ignored it.
	However, it's been known for a long time -- there was a case in 1694 where a woman was hit on the head with a pole and six months later she still had significant symptomatology and she couldn't think straight. The French surgeon Pare described another case in the middle of the 17th Century. By the 1970s and '80s, however, there was further discussion about it, and an American neurologist called Steve (ph) said -- described this symptomatology and used the term post-concussion syndrome, and so in the last 10 years, this syndrome has become better recognized, and three papers have been written on it by Sadwin, Young and Packard and Saper, who's an American neurologist, all describing it in the last 10 years so that it's in the literature.
	Now, leading up to this, the question arose does the patient have concussion. Traditionally concussion was considered to be a state in which there was loss of consciousness. However, the -- the Practice Parameters Committee of the American Society of Neurologists produced some clinical guidelines for the diagnosis of a concussion in sports, and they said that to have a Grade 1 concussion by their definition, all you have to have was to be hit on the head and be confused for a period of less than 15 minutes. If it -- and then you could get back to playing the game. If you were mentally confused or dazed for a period of more than 15 minutes, they called that a Grade 2 concussion. If you were unconscious, it was a Grade 3 concussion, so that when you take a careful history from whiplash injury patients, they're often confused afterwards for a period of more than 15 minutes, and therefore by these criteria, it's a Grade 2 concussion, but you won't see that in print very much unless you read one of my reports.
	Secondly, there's an American neurologist called Michael Alexander who wrote a paper describing mild brain injury, and he gave some criteria for the diagnosis of a mild brain injury, which was diagnosed on the immediate effects of the injury in relation to being confused, being dazed or being unconscious, so for the mild brain injury, the patients must not be unconscious. That is, they must have a Glasgow Coma Scale of 15 out of 15, but they may be confused or dazed for more than 15 minutes, and by definition they don't have a fractured skull or focal neurological injuries so that by the same criteria of concussion, a lot of them qualify on Michael Alexander's criteria of brain injury. However, authors have disagreed with this and said, well, if there's no objective evidence of brain injury, they haven't had a mild brain injury, so it's still an open question, but I follow Michael Alexander's views and also the other three authors that I quoted in the diagnosis of post-traumatic syndrome, so we avoid the controversy of a mild brain injury by diagnosing symptomatic patients as post-traumatic syndrome because if they've got the symptomatology, it's hard for anybody to deny it. Next slide. Next slide.
	This may not focus very well. Okay. So briefly this describes the mechanics of head injury according to Ommaya and Gennarelli, who experimented on nonhuman primates so that you start at the left upper corner of the diagram and you finish at the bottom right so that the way to injure the brain is through static pressure impact, which is a sudden blow, or an impulse with inertial loading so that this is probably what leads to the post-traumatic syndrome, and it causes, in my opinion, damage to the brain with axonal shearing. Next slide.
	This is a description of the hypothesis of the syndromes of cerebral concussion, and the Grade 1 you see as confusion and then a return to normality. Grade 2, there's confusion, and then it may be associated with amnesia, retrograde, and then the patient may be left with the post-concussion syndrome, and with the more severe injuries, you get coma and then death. Next one.
	This is a summary now of the papers of the Quebec Task Force, the British Columbia initiative and the no-fault study by Cassidy in Saskatchewan. The -- the Quebec Task Force was a study which showed that there was recovery in one year of 93.1 percent of patients from whiplash injuries. However, what they've done is they've dropped out a large number of patients and said these patients were recovered because they defined recovery as when they cut off the insurance payments. However, after having done that, they found that some patients were still complaining of pain, and therefore these were defined as recurrence, so if you put the recurrences in, the failure to recover is 12.4 percent and not 2.9 percent. Also they produced guidelines for management by consensus because there was not good evidence for this, and the guidelines were based on the -- on the flawed recovery rate, and therefore they were based on the assumption that almost all patients will recover spontaneously in a year. This is incorrect, so it really makes nonsense of their findings.
	The British Columbia initiative was a copy of the Quebec Task Force study. It made the same errors, ignored new evidence and attributed the failure of the patients to recover to psychological problems and personality problems, and it considered that pain was a poor marker of injury. They also misquoted the definition of pain which Dr. Merskey wrote.
	Then on the right-hand column Cassidy wrote a study comparing tort with no-fault insurance in Saskatchewan, and he found that whiplash injuries recovered 50 percent faster under no-fault and also the claims were immediately reduced by 30 percent on introducing no-fault legislation so that there are problems with his methodology there. Next slide.
	Now, just to leave you with a little bit of optimism, this is a study we did on palliative nerve blocks for chronic nonmalignant pain usually after whiplash so that before the nerve block, the pain levels were something like 8 out of 10. After the nerve blocks, they dropped to something like 2 out of 10 and lasted the better part of a week. Next slide.
	The depression was similarly reduced. Next slide. And anxiety similarly reduced. Next slide. The quality of life was -- the activities of daily living were universally improved, and there was a 90% improvement in activities of daily living. Next slide. And the quality of life was over 90% better.
	I'm just going to finish the slides there, and I'll show you a couple of transparencies about how we do the diagnostic nerve blocks. Can you put on the -- down at the bottom. Yeah, the bottom one. Can you hear? When we do diagnostic nerve blocks --
DR. DARYN MINTZLER:	Grab that mike.
DR. GALE:	Okay. When we're doing diagnostic nerve blocks the needle is put in from the side. Now, you can see three needles there in the upper neck. The middle one of the three needles is pointing to the 2/3 zygapophyseal joints.
DR. DARYN MINTZLER:	It's not on.
DR. GALE:	Is that better? The three needles are seen there in the neck. The middle needle is pointing to the 2/3 zygapophyseal joint. The needle above is pointing to where the nerve comes in from above, and the needle below is pointing to the trapezoid C3 below so that this -- from this -- these needle insertions, we do the 2/3 zygapophyseal joints diagnostic block with half a cc of local anaesthetic put in through each needle, and that totally anaesthetizes the C3 nerve supply to that joint, so if that takes the pain away, that proves where the pain's coming from. Can you show the other -- the other part of the slide?
	This shows the needle insertion at the lower joints in the neck with one needle above and one needle below each joint so that with the lower joints of the spine, you have to anaesthetize the nerves entering the joint from above and below so that this is how we do the lower ones, but I don't have an X-ray showing the -- the C2 nerve diagnostic block, but this gives you some idea of how we do the diagnostic blocks.
	I'm just going to stop there. I think I'm running out of time. I don't want to incur the sword, so I'll stop there.
DR. REG MARTSINKIW:	Thank you -- thank you. Thank you very much. I just have to make a little correction, and here comes the boss and I know I'll make another correction here. We want to remind you good folks that lunch is going to be served in about five minutes here or it's ready. There's pizza for two bucks, pop, doughnuts, coffee, T-shirts, bumper stickers, and we just want to remind you that this money goes to support the coalition group that's run by volunteers, so please help support those who help support you, and if you want to write a cheque or leave a donation, they'll -- I feel like Jerry Swaggart here. Yes, we'll take your money 'cause it goes to a good cause.
	We're going to start the afternoon off with Gordon Adair. Then we're going to go to Barb Netmaker. That's the correction. I forgot about Gord. How could I forget about big Gord? So -- but before we do that, is Hamilton still on for four minutes?
PATRICIA SCHRYVER:	No.
DR. REG MARTSINKIW:	He's not. So we could go into lunch now.
PATRICIA SCHRYVER:	For half an hour.
DR. REG MARTSINKIW:	She's the executive manager director in charge of operations today and I respect her when she looks at me like that, so we're going to have a half-hour lunch break, come back in one-half hour. We're starting with a question period. We're going to have some question periods this afternoon too. Thank you.
	(Hearing adjourned at 1:05 p.m.)