Reverse “Cherry Picking”


I’ve had this thought for some time, and I’ve explained it in conversations but never posted it here.

The current process of determining when something is “excessive demand” is to take the medicals for every person in the family and then picking the one that has a condition requiring treatment and using that to declare the entire family is inadmissible.

I’m having a difficult time how this seems fair to a reasonable person.  The numeric value is computed as an average over the population.  So, how do you take the average of one group and the worst case of a second group and make any reasonable determination on such basis.

Instead, I would suggest this is a form of reverse cherry picking – you pick the worst sample of the group and then discard the entire group.

My suggestion: if you find yourself in this situation, make the argument.  Get someone at IRCC to explain why this is fair.  I’d suggest that what makes more sense is to compare average to average between groups.  So a family with three children, one of whom needs special education services, would be evaluated as a family.

Perhaps I’m wrong here.  I’m interested in hearing people’s opinions on this.

 

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Happy Anniversary!


Today marks the 3rd anniversary of my refusal letter.  It’s amazing to me that it has been that long: I really had to think about it this morning to confirm the length of time, as I’d originally thought it had only been two years.

I continue to learn more about medical inadmissibility in Canada – it continues to impact real people, often in surprising cases.  I have been able to help several people through the gauntlet.  By far the most successful path through is to demonstrate that the actual medical treatment required falls below the excessive demand threshold – it’s surprising how often CIC medical officer’s just say “it’s expensive” and foist the burden of computing costs back onto the applicant.

As for me, well I’ve turned my eyes towards the citizenship process.  With the impending changes to the process I either must apply now (and face a 3 year wait to chat with a Citizenship Judge) or wait until sometime in 2018 to apply (and face a 2 year wait…)  Life continues to be interesting.

For those of you dealing with Canadian excessive demand medical inadmissibility I wish you the very best.  While I’m not nearly so active these days, I do continue to answer questions and leave this blog as a (hopefully useful) resource for those facing it.

I do hope to read one of these days that the Federal Court has struck down A38(c)(3).  Maybe because it violates the separation of powers between Federal and Provincial governments, maybe because it violates the various UN agreements to which Canada is signatory, or because it violates the Charter rights.

Whatever the reason, it will be nice to see the morally repugnant scheme struck down.  And maybe – once I have citizenship – I’ll be more public and vocal in the political process for reform in the system.  As a permanent resident I have to worry about the criminalization of protest in Canada – after all, it only requires one brush with the law and permanent residency can be revoked.  And since permanent residents remain so by the grace of her majesty’s government it’s generally best to remain “below the radar”.

Best wishes for all in 2015!

Lee v MCI


MP Jason Kenney of the Conservative Party fiel...

Citizenship and Immigration Canada has been doing some major revisions to their website of late.  One area in which things are more interestingly laid out is the area dealing with medical issues, in particular, medical inadmissibility due to excessive demand.

I’m familiar with most of these cases, but I’d never reviewed the oldest of them: Lee v MCI.

Why is this important?  Because in the Lee decision, the court overturned the refusal because the officer failed to consider the applicant‘s request for a Temporary Resident Permit (TRP).  That request was a bit informal from what the record indicates.  Yet it reminded me that in our own original response to the visa office we asked they consider a TRP.  This was never addressed by the visa officer, nor was it raised in the application for leave and Judicial Review we filed.  In my case it didn’t matter (we obtained leave anyway) but it’s important for people going through this process to keep in mind they do have the option to request they be granted a TRP and to raise this as an issue in any legal challenge, as there is case law on-point here.

So if an officer has a concern about something in your plan – for example, perhaps she or he isn’t sure your insurance will cover the cost of prescription drugs – rather than blanket refusing you, she or he could grant a TRP for a period of time, say six to twelve months, with the understanding that in that time the applicant should be able to confirm that the insurance plan is working as intended.

Or let’s revisit Companioni – where the judge was concerned that their plan was inchoate.  To create a viable plan essentially required they be in Canada – after all, even my own plan was viable only because I was already in Canada.  Everything was set up and ready to go.  So to get out of the “chicken and egg” issue here, a TRP could allow someone to come to Canada for a short period of time – a year, for example – and set things up so she or he could show that they really wouldn’t be a burden.

After a year, the applicant could go back and apply for an extension, pointing out that the plan is working and the applicant is not a burden.  If that’s the case, the TRP can be extended again.

After three years of this, the applicant becomes eligible for permanent residency as a member of the “permit holder’s class“.  The medical inadmissibility concern is no longer an issue to CIC – but an officer had two opportunities to review the file and verify that the applicant really was complying with the terms and conditions of the application.

This underscores one more approach that a motivated applicant can pursue.

Schedule F: The Chain Link Fence to Keep Sick People Out of Canada


Permanent Resident CardI recently was discussing the issue of the cost of drugs inside versus outside Canada. One of the side-effects of the strong controls present in the Canadian system is that it forms a fence around Canada further making immigration for someone with a medical condition challenging.  This is because of the way the existing law is written.

The cost of certain drugs is much lower outside Canada.  While we can discuss the relative merits of this, such as this recent Forbes article or this recent book on the topic, the bottom line is that the cost of drugs in Canada is high – in some cases as much as 10x higher than the same drugs are from a reputable manufacturer (Cipla, Teva, etc.) in a different country, such as India, where patent rights differ.  One thing that makes this even more difficult in Canada is the blanket prohibition of the importation of certain drugs, currently on a list known as Schedule F, though this is in the process of being replaced by a similar scheme that makes it easier for Health Canada to manage the list.

The purpose of the list, however, is to prohibit the importation of certain drugs into Canada unless one is a doctor, a pharmacist or a hospital.  A patient may bring in a 90 day supply for personal use – but that doesn’t allow the drugs to be shipped.

So, how does one get around this?  Well there are a few options:

  • You can find a sympathetic doctor willing to receive the medications – essentially to serve as the “importer”.  This can be tricky, as some doctors are not willing to accept the potential liability of these non-Canadian approved drugs.  Still, some doctors are a bit more sympathetic.  It can be difficult to find such a doctor. One good thing about the new regulations is that they would extend the importation ability to anyone with the legal right to prescribe in the province.  Here in BC, for example, naturopathic doctors have prescription rights for many things and thus would be allowed to import drugs in some of these cases.  That increases the potential pool of doctors willing to assist.
  • You can arrange for delivery to the US border and then pick up a 90 day supply every three months.  Services like Kinek charge a modest fee for receiving a package for you in the US.  The US has an exception to the importation ban when the drugs are for personal use, which makes it easier to import them into the US.  Then you can bring them into Canada under the 90 day personal use exception.
  • You can try to find a Canadian pharmacy willing to sell the drugs to you.  For example, here in BC there’s a pharmacy in Surrey (Blue Sky Drugs) that indicates they will ship to Canadian addresses; whether this constitutes importation by a Canadian pharmacy or not is something that I will admit is definitely not clear.
  • You can “take your chances”.  This is what people who don’t have to worry about immigration do.  In my experience these services will reship anything that doesn’t arrive.  This is definitely a grey area, as they are exploiting the fact that CBSA cannot police every package and thus only a small fraction are actually seized.

For someone trying to convince CIC that they have a credible plan this situation can be problematic: some officers at CIC know about Schedule F and can use it as a means to refuse someone from being granted permission to immigrate.  In that case the best thing is to find a sympathetic doctor willing to allow shipments of the meds to them.  The doctor might be more willing if they know the drugs are coming from a foreign charity (NGO) rather than an internet pharmacy;  the patient may need to sign a written release indemnifying the doctor in case the drugs provided are ineffective or contaminated – after all, the doctor has no way of being able to verify the veracity of the drugs any more than the patient.  Were I trying to come to Canada and had a foreign NGO willing to provide me with expensive (or overpriced – depends upon your perspective) drugs, I’d be happy to indemnify a doctor willing to help me get into Canada in the first place!

Of course some types of drugs are worse than others.  In January 2013, Gilead reported they had a 76% profit margin.  AIDS Healthcare Foundation has been calling for moderation of their prices, but at the present time that’s the way the system works – the laws protect the companies’ profits not the health and well being of the actual patients.  For those wishing to immigrate to Canada this creates a real barrier to entry.

Canada in turn only looks at a few diseases very closely.  I personally know of people with heart conditions (requiring multiple surgeries and hospital stays after coming to Canada) who disclosed their conditions but were not subjected to the “excessive demand” fire drill.  But this is what the Canadian public has decided to do.  Immigration is always fraught with this sort of problem – a deep-seated xenophobia.  That’s hardly unique to Canada, sadly.

It never really ends: the Permanent Resident Card


Permanent Resident CardOn Thursday I finally broke down and attempted to call the immigration call centre because I was concerned that my permanent resident card had not yet arrived.  While it’s not strictly required, it’s prima facie evidence that I’ve successfully become a permanent resident of Canada.

I’ve read stories about how people cannot get through to an agent and thus was not surprised when after going through 60 seconds of voice prompts and listening to admonishments that the agents would not tolerate foul or abusive language that I was told they were too busy and was disconnected.  I tried again a number of times with similar results.  I’ve never been a big fan of the telephone as a means of transferring information – as I like to say “it’s worth the paper on which it is written.”

Friday morning I decided to try once again and was pleasantly surprised when my call was placed in queue for being answered.  After waiting about five minutes I spoke with an agent, explained the situation and she agreed with my assessment that I should have received my PR card – published processing time is 58 calendar days and I’m coming up on three months.  She collected various bits of information from me, ostensibly to confirm my identity, though I am never sure why using public record information really does anything about authenticating someone.  But I digress.

She then placed me on hold for several minutes and upon her return she explained to me that while my card had indeed been produced, there was an issue with my paperwork and it would require that I submit an additional form requesting correction of my “Confirmation of Permanent Residency” document – something about a missing date.  She advised me they were sending out the card that very day and would also be sending me a letter telling me of the issue with respect to the landing paperwork.  She also then e-mailed me a link to the form I would need to correct the error.

I’ve gone over my copy of the COPR and I cannot find an error similar to what she described (apparently something about a date) but it does remind me that when I landed the border officer did try to give me the wrong copy back – so now I wonder if he omitted a date on the copy he kept.

I suppose the lesson here is that the adventure never really ends.

Epilogue

This morning (20 January) after traveling all day yesterday – up at 1:45 am PT and finally home at 9:30 pm PT, I found a string of comments on this post from objecting to my linking to their blog and the image on their blog post – a post that’s almost 8 years old at this point and to images that are still publicly accessible.  From the tone it sounds like they objected to the content of my blog and the fact that I didn’t remove the links quickly enough for their taste.  Sadly that sort of intolerance still seems to happen, even in a progressive country like Canada.

Thus, I’ve changed it to a different sample card and point to a different immigration blog – and like I did before using the previous image, I’ve sent a note to the registered owner of the domain advising them that I am going to link to their image. There’s this interesting issue with images: some people don’t like hot linking to them while others don’t like it if you create a separate cached copy – there’s no “right” answer.  But in either case the net effect for anyone viewing the page is the same – a copy of that image ends up on your computer, in your browser cache.   I’ve not really worried too much about it as my own blog’s following is rather small.  But just for the record, in this case, the original post material came from a US-based server and thus the use of their posted material is subject to the US Copyright “Fair Use” Doctrine. I’m confident that I fell well within the Fair Use doctrine.

Of course, I’m not in favour of allowing bigotry, but it just isn’t possible to fight every battle – you’ll leave yourself exhausted.  So the first thing I did after turning on the computer and reading this tirade is give them what they wanted – to not be associated with my own story, presumably because they found it morally repugnant.  Of course, the original image is still publicly available and it and the blog post still come up at the top of a Google image search.

Oh, and in case it matters, my own permanent resident card was delivered while I was gone.

The importance of a credible plan


Cerebal PalsyPeriodically I read decisions as they come out of the Courts regarding medical inadmissibility.  This case (De Hoedt Daniel) was heard here in Vancouver – I wish I’d been there to hear the arguments.  While the finding of excessive demand medical inadmissibility was upheld, the judge had some unusual words to say.  For anyone dealing with issues of medical inadmissibility there are valuable lessons in this case: be prepared, present a credible plan.  The shape of a possible plan just isn’t enough.  Indeed, this is the same lesson as Companioni – your plan must be real enough to convince a CIC officer.

Of course, even so, such a plan is not a guarantee of success.  They turned down my plan – even though it was a real, in place plan.  The final rationale offered for rejecting my plan (“we weren’t convinced that the plan would work for medication available for free from the province”) was created after-the-fact and failed on even a cursory analysis – the plan included a non-discretionary plan.  I also verified that the insurance would cover the medications by actually filling prescriptions – although that was done after the rejection.  Had the visa office expressed that concern, it would have been easily addressed. They didn’t do so however – they just rejected.

Here is the interesting comment at the end of the decision (an obiter dictum):

It is recommended by the undersigned that the number of well-intentioned individuals, organizations and entities, having come forward to assist the Applicant with the care of the said child, begin the process again and that the Canadian authorities give priority to that process, recognizing the time and effort that has already been given to the voluminous documents accompanying the application for permanent residence by all involved, including the specific individuals and entities in Maple Ridge, British Columbia.
It would seem that a viable plan requires the preparation of a practical commitment on paper to ensure that it is acknowledged and understood as such by the authorities who would then make their decision thereon.

This is an essential point for anyone involved in a fairness response: your plan needs to be real, it needs to be concrete and it needs to be clear to the decision maker that it overcomes the initial concern of excessive demand.

I cannot stress this enough: you must have a credible plan.  It needs to be in-place, workable and it must address the cost concerns – remember, this is all about money. That’s the issue you must address.

Ideally, anyone in this situation (dealing with a fairness letter regarding medical inadmissibility) should keep this point in mind: have a clear plan.  Make it concrete and real.  If it is hypothetical or the visa officer has any doubts about the viability of the plan, it will likely be rejected.  Better to do the up-front work and overcome the objection before it makes it before the court.

Landing: The Close of One Chapter


I’m writing this a week after the event. Indeed, even now it’s still a bit of a euphoric shock.  The images isn’t my landing stamp, but it’s very similar and it doesn’t have any specific identifying information.

USPS finally managed to deliver the letter.  A day late.  But it was a relief to know that they hadn’t lost it.

Thus, my company’s US office finally received the paperwork on Friday October 12.  Since I couldn’t see the paperwork, I couldn’t know 100% that they had issued a COPR. The person in the US office who put it into a FedEx envelope said “it looks like they returned the documents you sent to them.”  After all this time I must admit, I was still not 100% convinced this was going to happen, that something would “go wrong” at the last moment.  No PR, work permit rejection and – of course – I’d abandoned the challenge on my original PR application rejection before the Federal Court of Canada.  Even knowing that it was a paranoid fantasy doesn’t mean that the thought didn’t run through my head.  This in spite of the fact that my last ATIP report had been returned to me just days earlier, with complete information on it.

Case Analysis FOSS: Application for PR denied due to medical inadmissibility December 2011 (HIV Positive). Development of Relationship: Second marriage for PA, USA citizen had valid status in Canada – expired 2012/09/03. Met in 2008 via the internet, communicated   via the internet for several months prior to meeting in person in 2009. PA and sponsor continued to see each other  on a regular basis, engaged and married in 2011 cohabitation from 2010/11/15 to 2012/01/23. Eligibility:  Photos of relationship provided, copies of e-mails also provided as evidence of communication. Relationship appears to be genuine. Admissibility: FBI Clearance
provided, RCMP screening submitted. Based on  information provided, further review required due to previous inadmissibility. RPRF- Paid

Note: emphasis added.

So while I think the review might have been timely, I suspect it was pushed to the front in order to get it done quickly – and thus provide CIC with some sort of plausible defence against my JR application.  The emphasized section is what I was expecting and normally this would mean it goes into the “cases needing more attention” pile.  That normally adds months onto the processing time.  But just five days later:

Reviewed file and case analysis: FOSS: PA previously refused SW application on A38, medical inadmissibility for  excessive demand. That file currently has application for leave for JR pending with Federal Court. Current medical result is Passed (M39 – EDE). No other eligibility or  admissibility concerns noted on previous file. PA residing in Canada on WP since 2009, recently applied to  extend. PA currently has TRP appln in process in Seattle. Based on evidence on file, I am satisfied the relationship is  genuine and has not been entered into primarily to gain immigration status in Canada. Eligibility passed. [redacted section on Security] Criminality: No concerns, passed. All requirements met: File RFV. File forwarded to Los Angeles for finalization.

This is what makes me think the file was being pushed.  The case notes don’t tell me who actually reviewed the file, but each officer is identified by initials and numbers.  The first entry I listed was done by ND01111.  The second one was done by SO0213.  From reviewing these files, I’ve noticed that the lower numbers generally appear to correspond to more senior individuals.  I suspect this is coincidental – that they may be sequential numbers assigned by the database, with people having been in the organization longer (or at least in the computer system longer) having lower numbers. But at any rate, the point is that SO0213 did this last review – someone more senior than ND01111.  That’s my theory, at least.

The most recent entry is from Los Angeles:

E-mail to sent to SEATTLE once visa issued, so that they may close their TRP application for subject.

This one was entered by DV00073.  If my theory is correct, this is someone very senior that added this note.  Of course, this is consistent with what the VO in Seattle had told me – she said that they’d close out the file once the COPR was issued. The actual paper file was logged into LA two days after this notation (by MY04934).

It is easy to overanalyze these notes however, and I will state right here that I’ve put forward a lot of conjecture.  Maybe some of it is right, but it’s likely I’ve mis-guessed here as well.  Nevertheless, the facts are that I appear to have been processed in record time – before more than two dozen other people I know, all of whom applied in March 2012.  Second in the group (after someone from the London Visa Office) and the first in the Ottawa/LA group.

At any rate, it doesn’t show the PPR on 26 September, even though that’s the date on this last ATIP report. Thus, i suspect it was extracted earlier in the day.

Of course, I had plenty of time to go over this both when I got it and once again on Saturday, October 13.  I also dutifully checked the CIC website. Instead of the “In Process” it had shown for the past three weeks it said “Decision Made”.  That was enough for me to jettison the paranoid fantasies – I knew the Confirmation of Permanent Residency was included in the overnight package – a relief.  I obsessively checked the FedEx website throughout the morning, so I could see the letter had made it to Memphis, then later it made it to Vancouver, then it cleared customs and finally, just before 9 am, it was loaded on a truck for delivery (by 5 pm, their service commitment).  Before heading to work my spouse asked me if I still planned on heading down to the border. Naturally I said yes – after waiting this long, I really wanted to have this matter settled once and for all.

The morning slipped away and I frittered away my time by reading the news, checking facebook and spending my time answering questions in an online immigration forum (an obsessive trait that had worsened in the previous month). I have learned quite a bit about the Canadian immigration process, and I’ve been sharing bits of that experience with others – hopefully it’s been right more often than not!

I even took the time to write my previous blog post.

I finally decided to shower and get ready to go – taking the phone with me (I wasn’t going to risk not getting that package) and quickly rushing through the process.  Still nothing…  In many ways, that morning seemed every bit as long as the months and years leading up to that point.

But it did eventually arrive.  I buzzed the driver into our building and at 1:31 pm I signed for that precious envelope.  I opened it up and found that in addition to what I expected – my passport and the COPR – they actually returned a number of the documents that I had sent along – my birth certificate, the certified copy of our marriage certificate, the photos we had sent and a couple other documents.  I must admit, I was rather surprised, since I didn’t expect to get any documents back.  But nestled in the pile was the precious COPR. Two copies, actually.  Almost identical except at the bottom where one said “CIC Copy” and the other said “Client Copy”.  Both had my picture affixed (something that confused the border officer later – he seemed to expect only his copy to have the picture on it.)

Then the frenetic activity started.  I pulled out just what I needed to land (passport, COPR copies) and realized I needed to walk the dog before I could actually go anywhere.  So I’m scrambling around, walking the dog, trying to book a zip car, text my spouse, etc.  After juggling everything we agreed that I wouldn’t book the zip car, that we’d drive to the border together after my spouse finished work.

And that’s what we did.  We picked Peace Arch (“Douglas”) because it had the lighter traffic load. Being a US Citizen, I had to get my passport stamped (a non US Citizen could have requested an “administrative refusal” which means they stamp the date on a piece of paper saying you weren’t admitted to the US.)  That’s because, as a matter of law, a US Citizen had a legal right of entry into the United States.  So we had to park the car, go inside, stand in line, all so I could get my passport stamped that I had been in the US.  I did not confirm that this is still necessary, but a friend of mine from the US had to make an extra cross-border trip to get his passport stamped several years ago in order to land, so I thought it safest.  The border guards had no problems with any of this – the primary inspection officer wrote “flag pole” on a referral slip even.

The “return to Canada” lane was barracaded, so we had to talk our way out of the secondary inspection area (since I didn’t have a slip) and then go through a pair of round-abouts (rotaries for those from New England or maybe even traffic circles for others.)  Then we were lined back up heading into Canada. I was driving (my spouse was funny – “I don’t know what to say to them at the border”) which is very unusual.

Let’s put it this way. we’ve owned this car for 13 months and this was the second and third time I’ve ever driven it!  This time we took the Nexus lane.  Practically the first thing the officer asked was “what’s your status in Canada”, to which I replied “well, until 30 minutes ago I was living with implied status on an expired work permit, but if you don’t mind I’d like to go over to the office to resolve that, because I have this COPR…” I’m pretty sure I rattled it off like that, modulo punctuation.  So he wrote “Landing” and “B” on a referral slip, called it in, handed me everything back and off we went to the Canadian immigration building.

Both the US and Canadian buildings are very new, having been completely rebuilt in the past two years.  They’re quite nice actually, so it makes the experience a pleasant one.  We pulled over, the CBSA officer in the parking area told us to go inside and we went and stood in Line B.  Two minutes later I was at the counter, giving the passport and COPR to the officer, explaining that my goods were already in Canada, and that I had no goods to follow – albeit with him prompting me for some of this information – and then he said “go sit down and I’ll call you up when I’m done.”

I posted an announcement on Facebook:

Becoming a permanent resident of Canada. Only took 3 years, 3 months and 17 days.

And just after I posted that, the officer called my name. I went up, he went over the forms, paying particular attention to the criminal charges and the undeclared dependents section.   He had me initial both places on both forms and sign along the bottom.  He kept one – he actually tried to keep the wrong one, but I corrected him.  He stamped my passport, wrote an I with the line next to it – that means “admitted as an immigrant with no departure date”, added “no goods to follow” as well, stapled my copy into my passport, folded it all up nicely and handed it back to me.

The entire process took no more than 10 minutes.

And thus, on Saturday October 13, 2012 my status in Canada changed from “foreign national” to “permanent resident”.  As I write this a week later, I still feel the euphoria.  The process was long and painful.  But it’s over now.  Time to start looking forward.