Docket: T-1381-07
Citation:
2016 FC 381
Ottawa, Ontario, April 6, 2016
PRESENT: The
Honourable Mr. Justice Russell
BETWEEN:
|
THE WINNING
COMBINATION INC.
|
Applicant
|
and
|
CANADA (MINISTER
OF HEALTH) AND
THE ATTORNEY
GENERAL OF CANADA
|
Respondents
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JUDGMENT AND REASONS
I.
INTRODUCTION
[1]
This is an application under s 18.1 of the Federal
Courts Act, RSC 1985, c F-7 for judicial review of a series of related decisions
of Health Canada, and its subsidiary entities, with respect to The Winning
Combination Inc’s [TWC] product, RESOLVE. The first decision, dated July 19,
2007 [First Decision], refused TWC’s Product Licence Application [PLA] based on
safety and efficacy concerns. The second decision, dated August 21, 2007
[Second Decision], refused TWC’s PLA on the grounds that RESOLVE is a drug and
not a natural health product [NHP]. TWC also seeks judicial review of all
subsequent decisions of Health Canada and its subsidiary entities relating to
the RESOLVE PLA that were issued during the reconsideration process between
April 7, 2008 and January 30, 2012 [Subsequent Decisions].
II.
BACKGROUND
[2]
TWC markets NHPs, including RESOLVE, a smoking
cessation aid that employs a confidential active ingredient [Active Ingredient].
RESOLVE was marketed by the Applicant until July 2007.
[3]
The Respondent, Health Canada, together with
some of its subsidiaries, is responsible for administering, marketing and
approving for sale certain products under the Food and Drugs Act, RSC
1985, c F-27 [Act] and its regulations, which include the Natural Health
Products Regulations, SOR/2003-196 [NHP Regulations].
[4]
The NHP Regulations came into force in
2004. That same year, Applied Food and Specialities Inc, the company that sold
RESOLVE to TWC, filed a PLA for RESOLVE (at that time called NicCessTM
Cesteminol 350TM) with the National Health Products Directorate
[NHPD], a division of Health Canada under the Health Products and Food Branch
[HPFB]. Relying on the authoritative Dictionary of Natural Products [DNP], NHPD
initially concluded on December 2, 2004 that RESOLVE met the definition of an NHP
as set out in the NHP Regulations.
[5]
Applied Food and Specialties Inc sold and
assigned all of its rights and ownership in RESOLVE to TWC in 2006; written
notice of this exchange was provided to NHPD on April 12, 2006. TWC
thereby assumed status as the applicant for the RESOLVE PLA.
[6]
RESOLVE entered the Canadian market in 2006.
Later in December of that year, Pfizer, a competitor of the Applicant’s,
submitted allegations to Health Canada of non-compliance with marketing and
advertising standards as well as health concerns with RESOLVE, which was still
in the PLA process. This complaint triggered Health Canada’s further assessment
of RESOLVE.
[7]
Regulatory documents called Health Hazard
Evaluations [HHE] were prepared by the Bureau of Clinical Trials and Health
Sciences to then be used by the Health Products and Food Branch Inspectorate
[HPFBI] for compliance and enforcement activities. HHEs are generally prepared
to assess the level of risk from an identified problem and to inform actions to
mitigate the potential health hazards created by the product, if any. As of
April 1, 2011, these documents were known as Health Risk Assessments.
[8]
Dr. Robin Marles, the Director of the Bureau of
Clinical Trials and Health Sciences, oversaw the HHE process. As a result of safety
concerns identified in the first HHE [HHE #1], the HPFBI requested in a warning
letter sent on May 4, 2007 that TWC remove RESOLVE from the market. Based on
the evidence of HHE #1, Health Canada concluded that RESOLVE contained a
substance allegedly obtained from passionflower and that there was a likelihood
of at least temporary adverse health consequences associated with its use.
[9]
Five subsequent HHEs were issued between April
23, 2007 and July 17, 2007. TWC submitted information in response to the HHEs,
including arguments that passionflower and balsam fir extracts were absent from
RESOLVE, which NHPD alleges it considered along with the totality of TWC’s
evidence. The HPFBI issued a second warning letter to TWC on June 20, 2007.
[10]
On June 28, 2007, TWC and officials from Health
Canada attended a meeting where Dr. Marles confirmed that RESOLVE did not
contain residual passionflower. However, the HPFBI maintained that recall of
the product was necessary. On July 27, 2007, Health Canada released a Public
Health Advisory in regards to RESOLVE.
[11]
As regards the interplay and interaction of the
compliance activities of the HPFBI and the PLA-assessment activities of the NHPD,
the Respondents submit that it is not the case that they are entirely separate
and independent. The Respondents say that the HPFBI’s compliance and
enforcement activities are necessarily informed by the product classification
and HHE activities of the PLA and risk assessment bureaus of the NHPD.
III.
DECISIONS UNDER REVIEW
A.
The First Decision
[12]
TWC’s PLA was rejected by the NHPD by way of the
July 19, 2007 Notice of Rejection [NOR] (First Decision). As a result of a
designation as a Type II Health Hazard in the HHE of July 17, 2007 [HHE #6], a third
warning letter with a stop sale and recall notice was also issued by the HPFBI
on this day. A Type II health risk means that the use of, or exposure to a
product may cause temporary moderate adverse health consequences.
[13]
The NHPD refused the Applicant’s PLA pursuant to
ss 7(a) and (d) of the NHP Regulations and on the grounds that TWC had
submitted insufficient evidence to support the safety and efficacy of RESOLVE
when used in accordance with the recommended conditions of use.
[14]
Following the issuance of the First Decision,
the Applicant filed a Request for Reconsideration on July 26, 2007 pursuant to
s 9(2) of the NHP Regulations and filed its supporting materials on
August 30, 2007.
[15]
The Applicant also filed a Notice of Application
for the judicial review of the First Decision on July 27, 2007.
B.
The Second Decision
[16]
Health Canada indicated, by way of the August
21, 2007 NOR (Second Decision), that upon further review the primary basis for the
rejection of TWC’s PLA had been adjusted: RESOLVE was not an NHP, but rather a
drug and therefore subject to regulation under the Food and Drug Regulations,
CRC, c 870 [Food and Drug Regulations]. This reclassification of RESOLVE
had an important compliance consequence in that it, in effect, prohibited the
sale of RESOLVE as an unlicensed drug that had to be removed from the market,
notwithstanding its safety and efficacy or lack thereof. In order to obtain
market authorization, TWC would need to file a new drug submission for a notice
of compliance.
C.
Subsequent Decisions
[17]
As part of the Request for Reconsideration
process and in support of its PLA, the Applicant continued to file material
between August 2007 and January 30, 2012. During this period, Health Canada
maintained its position that RESOLVE was not an NHP and that efficacy had not
been established, but eventually withdrew its objections based upon safety.
(1)
First Level Reconsideration
[18]
NHPD rendered its first level reconsideration
decision on April 7, 2008 and addressed further evidence that had been provided
by TWC on the subject of the safety and efficacy of RESOLVE. NHPD ultimately
upheld its original decision that there was insufficient evidence to support
that the Active Ingredient is an NHP and advised that conclusions regarding
RESOLVE’s safety and efficacy could only be reached pursuant to a review of an
application for market authorization under Part C of the Food and Drug
Regulations. With regards to data submitted by TWC to support that the
Active Ingredient is naturally occurring, NHPD was not satisfied that the
results were reliable.
[19]
On September 18, 2008, NHPD advised TWC that the
refusal of its PLA based on safety and efficacy had been reversed on safety but
upheld based on insufficient evidence to demonstrate that RESOLVE was effective
for its intended use. TWC was also offered an opportunity to pursue further reconsideration.
It did so on October 1, 2008.
(2)
Second Level Reconsideration
[20]
In a letter sent on July 22, 2009, the NHPD gave
Final Notice on the second Request for Reconsideration for product classification
and for efficacy as per s 10(2) of the NHP Regulations. The letter
upheld NHPD’s original decision and referenced a study provided by TWC, deeming
it insufficient to establish RESOLVE as an NHP. As a result, the issue of RESOLVE’s
efficacy as an NHP was determined to be moot. The finality of this letter was
confirmed in a subsequent letter on October 19, 2009 in which NHPD indicated
that should TWC wish to pursue a product license for RESOLVE, it could do so
under the Food and Drug Regulations.
[21]
On September 20, 2011, NHPD sent another letter
to TWC stating that while it had received an August 15, 2011 Request for Reconsideration,
it was upholding its decision to refuse to issue a product license and that no
further consideration would be given to the PLA.
[22]
On January 30, 2012, NHPD sent a letter in
response to new information that had been submitted by TWC. The letter
indicated that the information had been considered but confirmed that the
Active Ingredient was not an NHP and there was insufficient evidence to support
RESOLVE’s efficacy. NHPD stated that its decision to deny the application was
final and that the letter was its ultimate correspondence relating to the
reconsideration process.
IV.
ISSUES
[23]
TWC has raised a wide range of issues which I
will summarize in a general way and deal with in detail later;
1)
The statutory interpretation of the NHP
Regulations regarding efficacy;
2)
Whether procedural fairness was afforded to TWC;
3)
Did Health Canada fail to comply with relevant
legislation, regulations, policies and standard operating procedures during the
PLA consideration and reconsideration process;
4)
Did Health Canada exhibit bad faith, bias, lack
of independence, lack of impartiality, discrimination and/or conflict of
interest in its decision-making;
5)
Whether Health Canada was functus
following the First Decision;
6)
The legal relevance and effect of the
reconsideration process; and
7)
Whether any of the decisions satisfied the
reasonableness standard.
V.
STANDARD OF REVIEW
[24]
The Supreme Court of Canada in Dunsmuir v New Brunswick, 2008 SCC 9 [Dunsmuir] held that a standard of review analysis
need not be conducted in every instance. Instead, where the standard of review
applicable to a particular question before the court is settled in a
satisfactory manner by past jurisprudence, the reviewing court may adopt that
standard of review. Only where this search proves fruitless, or where the
relevant precedents appear to be inconsistent with new developments in the
common law principles of judicial review, must the reviewing court undertake a
consideration of the four factors comprising the standard of review analysis: Agraira
v Canada (Public Safety and Emergency Preparedness), 2013 SCC 36 at para 48
[Agraira].
[25]
All of the procedural fairness issues (bad
faith, bias, lack of independence and impartiality, discrimination and/or
conflict of interest) will be reviewed on a standard of correctness and in
accordance with the tests and jurisprudence applicable to those issues.
[26]
TWC submits that the standard of correctness
should apply to the interpretation of the NHP Regulations in this case.
In the alternative, should reasonableness be applied, TWC says that should the
ordinary tools of statutory interpretation lead to a single reasonable
interpretation that differs from that adopted by the Minister, his or her
interpretation will necessarily be unreasonable and no degree of deference will
justify its acceptance: British Columbia (Securities Commission) v McLean,
2013 SCC 67.
[27]
The Respondents submit that where scientific
knowledge is a factual component of the decision, reasonableness will apply: Apotex
Inc v Canada (Health), 2012 FCA 322 at para 41. The courts have accorded
particular deference to Health Canada in drug submissions, given that the
approval process is a complex and technical area of public administration: Hospira
Healthcare Corporation v Canada (Attorney General), 2010 FC 213 at para 33.
[28]
The jurisprudence is clear that reasonableness
is the proper standard to be applied for both the Minister’s interpretation of
the NHP Regulations and the decisions regarding TWC’s PLA: Canadian
Pharmaceutical Technologies International (CPT) Inc v Canada (Attorney General),
2007 FC 708. These issues will therefore be reviewed on the reasonableness
standard.
[29]
When reviewing a decision on the standard of
reasonableness, the analysis will be concerned with “the
existence of justification, transparency and intelligibility within the
decision-making process [and also with] whether the decision falls within a
range of possible, acceptable outcomes which are defensible in respect of the
facts and law.” See Dunsmuir, above, at para 47, and Khosa v
Canada (Minister of Citizenship and Immigration), 2009 SCC 12 at para 59.
Put another way, the Court should intervene only if the Decisions were unreasonable
in the sense that they fall outside the “range of
possible, acceptable outcomes which are defensible in respect of the facts and
law.”
VI.
STATUTORY PROVISIONS
[30]
The following provisions of the NHP
Regulations are relevant in this proceeding:
Interpretation
|
Définitions
|
“natural health product” means a
substance set out in Schedule 1 or a combination of substances in which all
the medicinal ingredients are substances set out in Schedule 1, a homeopathic
medicine or a traditional medicine, that is manufactured, sold or represented
for use in
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« produit de santé naturel »
Substance mentionnée à l’annexe 1, combinaison de substances dont tous les
ingrédients médicinaux sont des substances mentionnées à l’annexe 1, remède
homéopathique ou remède traditionnel, qui est fabriqué, vendu ou présenté
comme pouvant servir :
|
(a) the diagnosis, treatment,
mitigation or prevention of a disease, disorder or abnormal physical state or
its symptoms in humans;
|
(a) au diagnostic, au
traitement, à l’atténuation ou à la prévention d’une maladie, d’un désordre,
d’un état physique anormal, ou de leurs symptômes chez l’être humain;
|
(b) restoring or correcting
organic functions in humans; Or
|
(b) à la restauration ou à la
correction des fonctions organiques chez l’être humain;
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(c) modifying organic
functions in humans, such as modifying those functions in a manner that
maintains or promotes health. However, a natural health product does not
include a substance set out in Schedule 2, any combination of substances that
includes a substance set out in Schedule 2 or a homeopathic medicine or a
traditional medicine that is or includes a substance set out in Schedule 2.
|
(c) à la modification des
fonctions organiques chez l’être humain telle que la modification de ces
fonctions de manière à maintenir ou promouvoir la santé. La présente
définition exclut les substances mentionnées à l’annexe 2, toute combinaison
de substances qui contient une substance mentionnée à l’annexe 2 et tout
remède homéopathique ou remède traditionnel qui est une substance mentionnée
à l’annexe 2 ou qui contient l’une de ces substances.
|
Licence
Application
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Demande
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5. An
application for a product licence shall be submitted to the Minister and
shall contain the following information and documents:
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5. La demande
de licence de mise en marché est présentée au ministre et comporte les
renseignements et documents suivants :
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(a)
the name, address and telephone number, and if applicable, the facsimile
number and electronic mail address of the applicant;
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(a) le
nom, l’adresse, le numéro de téléphone et, le cas échéant, le numéro de
télécopieur et l’adresse électronique du demandeur.
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(b) if
the address submitted under paragraph (a) is not a Canadian address,
the name, address and telephone number, and if applicable, the facsimile
number and electronic mail address of the applicant’s representative in
Canada to whom notices may be sent;
|
(b) si
l’adresse visée à l’alinéa (a) est un lieu situe à l’extérieur du
Canada, le nom, l’adresse, le numéro de téléphone et, le case échéant, le
numéro de télécopieur et l’adresse électronique du représentant du demandeur
au Canada à qui les avis peuvent être expédies;
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(c)
for each medicinal ingredient of the natural health product,
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(c)
pour chacun des ingrédients médicinaux contenus dans le produit :
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(i) its
proper name and its common name,
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(i) son nom
propre et son nom usuel,
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(ii) its
quantity per dosage unit,
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(ii) sa
quantité par unité posologique,
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(iii) its
potency, if a representation relating to its potency is to be shown on any
label of the natural health product,
|
(iii) son
activité si l’une des étiquettes du produit comporte une déclaration à
l’égard de celle-ci,
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(iv) a
description of its source material, and
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(iv) une
description de sa matière d’origine,
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(v) a
statement indicating whether it is synthetically manufactured;
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(v) une
mention indiquant s’il s’agit d’un ingrédient fabriqué synthétiquement;
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(d) a
qualitative list of the non-medicinal ingredients that are proposed for the
natural health product and for each ingredient listed, a statement that
indicates the purpose of the ingredient;
|
(d)
une liste qualitative des ingrédients non médicinaux qu’on se propose
d’incorporer au produit de santé naturel ainsi que, pour chacun de ces
ingrédients, une mention indiquant à quelle fins l’ingrédient serait
incorpore au produit;
|
(e)
each brand name under which the natural health product is proposed to be
sold;
|
(e)
chacune des marques nominatives sous lesquelles le produit est destiné à être
vendu;
|
(f)
the recommended conditions of use for the natural health product;
|
(f)
les conditions d’utilisation recommandées du produit;
|
(g)
information that supports the safety and efficacy of the natural health
product when it is used in accordance with the recommended conditions of use;
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(g) les
renseignements montrant l’innocuité et l’efficacité du produit lorsqu’il est
utilisé selon les conditions d’utilisation recommandées;
|
(h)
the text of each label that is proposed to be used in conjunction with the
natural health product;
|
(h) le
texte à utiliser sur chacune des étiquettes du produit;
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(i) a
copy of the specifications to which the natural health product will comply;
and
|
(i) un
exemplaire des spécifications auxquelles le produit devra se conformer;
|
(j)
one of the following attestations, namely,
|
(j)
l’une des attestations suivantes :
|
(i) if the
natural health product is imported, an attestation by the applicant that the
natural health product will be manufactured, packaged, labelled imported,
distributed and stored in accordance with the requirements set out in Part 3
or in accordance with requirements that are equivalent to those set out in
Part 3, or
|
(i) dans le
cas d’un produit de santé naturel importé, une attestation du demandeur
établissant que le produit de santé naturel sera fabriqué, emballé, étiqueté,
importé, distribué et entreposé conformément aux exigences prévues à la
partie 3 ou à des exigences équivalentes,
|
(ii) if the
natural health product is not imported, an attestation by the applicant that
the natural health product will be manufactured, packaged, labelled,
distributed and stored in accordance with requirements set out in Part 3.
|
(ii) dans le
cas d’un produit de santé naturel qui n’est pas importé, une attestation du
demandeur établissant que le produit de santé naturel sera fabriqué, emballé,
étiqueté, distribué et entreposé conformément aux exigences prévue à la
partie 3.
|
…
|
…
|
Issuance
and Amendment
|
Délivrance
et Modification
|
7. The
Minister shall issue or amend a product licence if
|
7. Le
ministre délivre ou modifie la licence de mise en marché si les conditions
suivantes sont réunies :
|
(a)
the applicant submits an application to the Minister that is in accordance
with section 5 or subsection 11(2), as the case may be;
|
(a) le
demandeur présente au ministre une demande conforme à l’article 5 ou au
paragraphe 11(2), selon le cas;
|
(b)
the applicant submits to the Minister all additional information or samples
requested under section 15;
|
(b) le
demandeur fournit au ministre les renseignements complémentaires ou les
échantillons demandes en vertu de l’article 15;
|
(c)
the applicant does not make a false or misleading statement in the
application; and
|
(c) le
demandeur ne fait pas de déclaration fausse ou trompeuse dans sa demande;
|
(d)
the issuance or amendment of the licence, as the case may be, is not likely
to result in injury to the health of a purchaser or consumer.
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(d) la
délivrance ou la modification de la licence ne risque pas de cause un
préjudice à la santé de l’acheteur ou du consommateur.
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VII.
ARGUMENTS
A.
Applicant
(1)
Procedural Fairness
[31]
TWC submits that this licence application has
been plagued by procedural unfairness since January 2007 and that the
RESOLVE PLA review was not conducted in a fair and impartial manner. TWC was
denied the basic elements of procedural fairness in relation to both the First
Decision and the Second Decision, including notice and the opportunity to be
heard. NHPD deviated from its standard procedure and TWC’s legitimate
expectations. NHPD’s decisions demonstrate bias, pre-judgment, a closed mind
and bad faith.
[32]
TWC references a series of procedurally unfair
actions taken and omissions made by the NHPD in relation to the RESOLVE PLA
that render the administrative decisions in question void ab initio:
−
The issuing of the May 4, 2007 warning letter
even after questioning whether it made sense to do so and without giving TWC
any prior notice or opportunity to respond;
−
Creating a “moving
target” by way of new allegations and reasons to take compliance action
or to reject the PLA every time TWC responded to allegations;
−
The admission of Mr. Gustafson, HPFBI inspector,
on June 28, 2007 that TWC was not going to get a license no matter what
information it provided;
−
Dr. Marles’ unauthorized intrusion into and
effective management of the PLA process notwithstanding his conflict of
interest as the author of the HHEs and resulting severe compliance action;
−
Setting aside the initial Safety and Efficacy
Assessment Report [SEAR] of June 19, 2007 which supported safety and should
have been the end of any safety issues;
−
Issuing both rejections (First Decision and
Second Decision) without prior information request notices and therefore not
caring what further evidence might have been available as to safety, efficacy
or classification;
−
Issuing HHE #6 based on three new and unfounded
safety allegations without giving TWC any prior notice or opportunity to
respond;
−
Disregarding a toxicology report when it
confirmed safety, without any toxicology evidence to the contrary, but then
mistakenly relying on it to allege a new safety issue;
−
Using the Adverse Reaction Reports as one of the
reasons to justify HHE #6 and the rejection decision when it was highly tenuous
and based on an erroneous assumption in regards to passionflower, without
giving TWC proper opportunity to respond;
−
Misinforming the Associate Deputy Minister,
other senior officials of Health Canada, HPFBI and TWC regarding the status of
the PLA and specifically, failing to advise that the initial SEAR had supported
safety;
−
Basing the First Decision on HHE #6 rather than
a completed SEAR in accordance with standard procedure and then issuing the NOR
before the SEAR was even complete;
−
Overzealously pursuing the classification issue
even after the First Decision and issuing the Second Decision without giving TWC
notice that classification was now an issue;
−
Issuing the Second Decision even though the
Active Ingredient was still listed as a natural substance by NHPD and by the
DNP reference as of that date;
−
Taking the unprecedented step of lobbying DNP to
remove the Active Ingredient from its list of natural substances;
−
Issuing a Public Advisory when no “imminent” risk of “serious or
irreversible” injury existed and after TWC had already agreed to recall
the product.
(2)
Classification
[33]
In addition to considerations of procedural
fairness, TWC submits that the Second Decision should be quashed on grounds
including bootstrapping, functus officio, exhaustion of discretion,
estoppel and lack of delegated authority.
[34]
TWC argues that the Second Decision was an
attempt to bolster the previous license denial in anticipation of the damages
that TWC was likely to claim.
[35]
TWC stresses that the Second Decision’s
conclusion in regards to classification did not result from any scientific
evidence or testing. The Second Decision was issued by NHPD entirely as a
result of an alleged DNP error without contacting DNP or TWC. TWC submits that
it filled the evidence gap that NHPD alleged existed by providing overwhelming
evidence, including scientific testing and reports from two different
laboratories, as well as a peer-reviewed published article. NHPD, however,
continued to criticize TWC’s evidence, filed and retained its own reports and
repeatedly refused to reverse the classification NOR of the Second Decision
throughout the reconsideration process.
[36]
The PLA was concluded subject only to TWC’s
right to request reconsideration. Therefore, TWC says that the Minister was functus
with respect to the PLA as the NHP Regulations do not provide for a
unilateral right of the Minister to reconsider a decision. The Minister was
without jurisdiction to issue a further rejection of the PLA based on
classification (as was done in the Second Decision) or on any other grounds:
Canadian Association of Film Distributors and Exporters v Society for Reproduction
Rights of Authors, Composers and Publishers in Canada (SODRAC) Inc, 2014
FCA 235 at paras 58, 68-75; CHUM Ltd v Canada (Attorney General), 2005
FCA 142; Baudisch v Civil Aviation Tribunal, [1997] 129 FTR 241.
[37]
In the alternative, even if functus does
not apply, it should be noted that as of August 21, 2007, DNP still
listed the Active Ingredient as a natural substance. DNP was adopted by NHPD as
the definitive standard for NHP classification and it is therefore submitted
that the Minister was bound by the DNP classification as it existed on July 19,
2007 and August 21, 2007 and at the time of the prior NHPD classification
decisions. The Minister was estopped or precluded from reversing these
decisions or issuing the Second Decision. Alternatively, the abandonment of the
DNP standard was discriminatory and a gross deviation from accepted procedure
and the legitimate expectations of TWC.
(3)
Safety
[38]
RESOLVE had been designated an NHP on three
occasions prior to the denial of its PLA in the First Decision. Even though the
classification of the Active Ingredient had been questioned prior to July 19,
2007, the First Decision was issued solely on the basis of safety and efficacy.
[39]
While it is clear, and Health Canada has
admitted, that safety concerns should not have been relied on in denial of the
PLA in the first place, TWC submits that it had no opportunity to address the
alleged safety concerns of the First Decision until after it was released.
[40]
Following the release of the First Decision, TWC
says it provided specific responses to each of the three safety allegations of
Health Canada, and the decision was subsequently reversed.
(4)
Efficacy
[41]
TWC says that the standard demanded by the NHPD
with respect to efficacy exceeded any reasonable interpretation of the NHP
Regulations, which do not require any substantive proof for
efficacy. The practices of Health Canada cannot create additional or more
onerous standards or tests.
[42]
Section 7 of the NHP Regulations, which
provides that the Minister shall issue a licence if the requirements of
subsections (a) through (d) are met, sets out a substantive test for safety.
Therefore, s 5(g) which simply requires “information
which supports safety and efficacy” should only be interpreted as
administrative in nature as it only addresses materials that should be included
in the PLA. This interpretation is consistent with the authorities on statutory
interpretation, including the “presumption of
coherence:” Bell ExpressVu Ltd Partnership v Rex, 2002 SCC 42 at
paras 26-27, 30; R v Ulybel Enterprises Ltd, 2001 SCC 56 at paras 28-30;
Gordon v Taylor, 2014 ABQB 11 at paras 9-11. Furthermore, Health Canada’s “Decision Making Framework” recognizes that
sometimes no evidence of “benefit” is necessary
for safe products, even prescription drugs.
[43]
Even if s 5(g) can be interpreted as a threshold
substantive test, it must be less onerous than the standard of proof required
for safety under s 7(d): the information required for efficacy does not have to
prove that the product “likely” is efficacious, and no minimum standard of
scientific proof is required.
[44]
TWC’s PLA simply claimed that the product “may” help with smoking cessation (not that it “will”). Therefore, any substantive test for efficacy
must be very modest and information that falls short of establishing a
likelihood that a product may help with smoking cessation should be considered
sufficient. Furthermore, even if the information provided does not support the
claims made for the product, the PLA is not automatically denied. Steps such as
market studies and/or the amending of product labels can be applied as
conditions for granting the license.
[45]
TWC submits that on the reasonable
interpretation of the NHP Regulations and of the evidence, Health Canada
had no basis to reject the PLA on efficacy-related grounds. Even if the NHP
Regulations are interpreted as requiring a substantive test for efficacy,
TWC was only required to adduce information that supported the modest claim in
the PLA that RESOLVE “may” help with smoking cessation.
[46]
The PLA complied with s 5(g) by including
information that supports efficacy, including a phase 1 human clinical study
along with university-conducted in vitro and animal studies, a
statistical analysis of phase II human clinical study, U.S. patent information
and various papers, articles and testimonials. Health Canada acknowledged this by accepting the PLA and deeming it complete.
[47]
TWC further submits that the information
provided by TWC in both the PLA and the reconsideration processes was more than
sufficient to prove even the likelihood that RESOLVE may help with smoking
cessation. Therefore, it certainly satisfied a standard less than that. NHPD
nonetheless critiqued it based on technical scientific standards, imposing a
standard that went beyond the simple “information to
support” requirement under the NHP Regulations towards one of “conclusive proof” of efficacy.
(5)
The Reconsideration Process Generally
[48]
TWC says that the reconsideration process in
this case did not constitute an adequate alternative remedy and failed to
address fundamental deficiencies of the First and Second Decisions, such as
whether procedural fairness had been afforded and whether the Second Decision
had issued after the Minister was functus.
[49]
TWC says that the Subsequent Decisions of the
reconsideration process are legally irrelevant and need not be considered by
the Court. In the alternative, it is submitted that if the reconsideration
process is relevant, then it was not fair or impartial, suffering from the same
procedural unfairness as the First and Second Decisions.
[50]
Because the review of the PLA was not done by an
independent tribunal outside of Health Canada, as requested repeatedly by TWC,
there could be no reasonable expectation that the reconsideration would occur
fairly or cure the defects present in this case. Whereas DNP was prepared to
accept evidence from TWC’s experts as sufficient proof that the Active
Ingredient was naturally occurring, NHPD held TWC to an unprecedented standard
of scientific certainty. No matter what evidence was offered by TWC, it was not
going to succeed in the reconsideration.
B.
Respondents
(1)
Procedural Fairness
[51]
The Respondents submit that TWC was afforded
procedural fairness beyond what is required by law. It was not necessary for
Health Canada to provide notice or an opportunity to be heard prior to the
issuing of the public advisory on July 27, 2007, but it did so. Furthermore,
TWC was given the chance to submit additional documents within ten days of the
June 28, 2007 meeting. Determinations of procedural fairness must be balanced
with the reality that Health Canada was addressing what could only have been
assessed as a serious and immediate safety risk based on the information
available to the NHPD at the time. Following the Second Decision regarding the
classification of RESOLVE, TWC took advantage of numerous opportunities to
continually submit further evidence to show that its Active Ingredient is an
NHP. This evidence was accepted and considered until October 2011.
[52]
The Respondents say that because TWC was regularly
engaged by Health Canada about its product throughout the regulatory decision-making
process, only a minimal amount of procedural fairness is owed with respect to
the classification decision in the Second Decision. Furthermore, when it comes
to matters of public health and safety, procedural guarantees will be adjusted
according to the degree of risk and urgency, which the decision-maker will
enjoy considerable latitude in assessing: Miel Labonté Inc v Canada
(Attorney General), 2006 FC 195.
[53]
The NHPD was in possession of information from a
reliable source relating to safety risks. It was reasonable for the NHPD to
believe this information and take corresponding enforcement measures, including
public advisories and stop sale and recall orders.
(a)
Reconsideration
[54]
Health Canada accepted new information from TWC,
including seven volumes of material plus additional supporting correspondence
in the reconsideration process. NHPD not only followed all of the prescribed
rules under ss 7 through 10 of the NHP Regulations but went beyond the
normal scope of reconsideration in granting TWC a second reconsideration. When
the evidence adduced by TWC was determined to be inadequate, the First Decision
was upheld. TWC submitted an additional request for reconsideration.
Notwithstanding the stated general practice of Health Canada to terminate reconsideration processes when a judicial review has been filed (as it
was on July 27, 2007), to give TWC every opportunity to address outstanding
issues, NHPD continued the reconsideration process.
(b)
Bias
[55]
Dr. Marles was at all material times the senior
science advisor to the NHPD. TWC accuses NHPD staff, including Dr. Marles, of
bias, pre-judgment, having a closed mind and bad faith. TWC has not submitted
any logical explanation as to why he might be antagonistic towards TWC or
RESOLVE and there is no evidence that Dr. Marles had any interest in a
competing product or was at any point entrenched in any position regarding
RESOLVE.
[56]
The Respondents say that the classification of the
Active Ingredient as a drug rather than an NHP was not, as alleged by TWC, an
attempt to bootstrap the First Decision. It was not unprecedented that the DNP was
contacted and the DNP reached its own conclusion that the Active Ingredient is
not a natural product. Contrary to what TWC suggests, it has not re-listed the
Active Ingredient as a natural substance.
[57]
The Respondents submit that its decisions to
refuse the PLA and the subsequent reconsideration applications were reasonable
and made through reliance upon valid scientific evidence with respect to the classification,
safety and efficacy of the Active Ingredient. TWC was given an exceptional
opportunity to provide fresh evidence during the reconsideration process, which
the NHPD considered even after the commencement of the judicial review
application, and has failed to demonstrate that its product is “natural.”
(2)
Classification
[58]
NHPD’s internal and external experts concluded
that there is no evidence in the peer-reviewed scientific literature that the
Active Ingredient occurs in nature. Where a product contains an active
ingredient that does not occur in nature, it does not fall within the scope of
the definition of an NHP. When this occurs, the NHPD is statutorily prohibited
from issuing a license under the NHP Regulations. While a 2005 article
may have alleged the presence of the Active Ingredient in mangoes [Mango
article], the DNP, which the NHPD considers to be an authoritative database of
natural health products, was never updated to include the Active Ingredient
subsequent to the article. The Respondents submit that it was entirely
reasonable for the NHPD to issue the Second Decision to reflect the operation
of the NHP Regulations because the Active Ingredient is a synthetic
substance that does not occur naturally.
(3)
Safety and Efficacy
[59]
The Respondents say that the NHPD, as a federal
health regulator, reasonably took compliance and enforcement measures in
accordance with the information it received concerning safety and efficacy.
NHPD’s information relating to a safety risk was from a reliable source and
included information from a peer-reviewed article as well as the HHEs
themselves. It was therefore reasonable and necessary that the NHPD took
enforcement measures like public advisories and stop sale and recall orders in
order to limit consumer risk.
[60]
The Respondents disagree with TWC’s submission
that a substantive requirement of efficacy is not mandatory under the NHP
Regulations. Subsection 7(a) incorporates the requirements of s 5,
including paragraph (g), which necessitates “information
which supports safety and efficacy.” The Respondents assert that this is
not merely an administrative requirement but also a substantive one. A
substantive review of the RESOLVE PLA was conducted under the regulations for
the various requirements prescribed by s 7 which includes information that
supports efficacy. The PLA was analyzed in light of efficacy concerns
identified in the HHE and it was determined that it did not meet the threshold
for granting a licence under s 8.
VIII.
ANALYSIS
A.
Introduction
[61]
In addition to general charges of acting unreasonably,
TWC accuses Health Canada in this application of egregious misconduct including
bad faith, lack of procedural fairness, bias, appearance of bias, acting without
authority, bootstrapping, shoring up of evidence, and acting with a closed mind
contrary to standard policy and outside the legitimacy of delegated authority.
[62]
The history of this litigation is long and
bitter and the record is voluminous. The dispute is rendered particularly
convoluted by the interactions between the HPFBI, responsible for compliance
and enforcement, and the NHPD (now the Natural and Non-Prescription Health
Products Directorate – NNHPD), both of which were called into play following
TWC’s assumption of the PLA that Applied Food and Specialties Inc had commenced
in October 2004, and after Pfizer’s submission of a trade complaint about the
sale and marketing of TWC’s RESOLVE product in December 2006. From that point
on, TWC was obliged to deal with Health Canada from both a licencing and a
compliance perspective, and it is in the interplay between these two distinct,
but inevitably related, processes that the dispute is pitched.
[63]
In order to provide some sense of direction
through the interactive maze that developed between the initial PLA in 2004 and
NHPD’s final negative reconsideration decision of January 30, 2012,
it helps to bear in mind that NHPD made two (2) major decisions with regard to
TWC’s PLA.
[64]
The First Decision occurred on July 19, 2007
when NHPD rejected TWC’s PLA outright based upon safety and efficacy concerns,
but not upon classification concerns. This decision was underscored by HPFBI’s decision
on the same day to issue a “Stop Sale, Stop Advertising and Recall” direction,
and to release a revised HHE classifying RESOLVE as a Type II health hazard.
[65]
The Second Decision by NHPD, which occurred on
August 21, 2007, rejected the same PLA on the basis that RESOLVE was not an NHP
and was thus subject to regulation under the Food and Drug Regulations and
not the NHP Regulations. In effect, this Second Decision rendered the First
Decision moot, but NHPD continued thereafter to consider and invite
reconsideration applications by TWC that questioned both decisions (one based
upon safety and efficacy issues, and the other based upon classification), thus
indicating, ostensibly at least, that NHPD was open to changing its mind on
both grounds of refusal.
[66]
TWC says that, in fact, NHPD had made the
decision long ago to deny TWC a PLA, and that NHPD’s purposes in going through
the reconsideration process was to build a case to support and shore up the two
refusal decisions that it had already made in error and in total disregard of
procedural fairness.
[67]
The two major decisions I have referred to
cannot be disconnected because TWC alleges that the classification decision of
August 21, 2007 (the Second Decision) was an unjustified and cynical ploy by
NHPD to cut the ground out from under TWC after TWC asked for reconsideration
of the safety and efficacy decision of July 19, 2007 (the First Decision), a
decision that, according to TWC, had no basis in law or fact to support it.
[68]
So, we are dealing with allegations of individual
and institutional bias and bad faith in addition to the more usual grounds for
reviewable error based upon unreasonableness and procedural unfairness.
B.
Evidentiary Issues
[69]
TWC has raised a considerable number of
objections to affidavit evidence filed by the Respondents, as well as certain
paragraphs contained in the Respondents’ Memorandum of Fact and Law. These
objections were brought as formal motions that the Court heard together with
the underlying application for judicial review.
[70]
In general, TWC’s objections to the affidavit
evidence filed by the Respondents (the Marles and Arnason affidavits) and the
report of Dr. Foster that is attached to the Marles’ affidavit of January 30,
2012, are that:
a) The affidavits filed on behalf of the Respondents, or portions
therein, contain facts outside of the deponents’ personal knowledge,
inadmissible hearsay, opinions, arguments, conclusions and irrelevant
information;
b) The affidavits filed on behalf of the Respondents, or portions
therein, contain inadmissible supplemental reasons for denying TWC a NHP
license which attempt to add to the denial reasons that are the subject of this
application;
c) The affidavits filed on behalf of the Respondents, or portions
therein, contain inadmissible opinions and conclusions from experts which lack
independence and impartiality;
d) The offending affidavits filed on behalf of the Respondents, or
portions therein, directly relate to controversial issues to be argued in this application;
and
e) The Applicant will be unfairly prejudiced by the inclusion of the
offending affidavits, or portions therein.
[71]
As regards the objections to the Respondents’
Memorandum of Fact and Law, TWC objects to paragraphs 40, 85 and 108 on the
grounds that:
a) The Memorandum of Fact and Law in the Respondents’ Motion Record
improperly contains alleged evidence and statements not included in any
affidavit material filed with the Court;
b) The Memorandum of Fact and Law in the Respondents’ Motion Record
contains an evidentiary objection which is not permissible as a result of the
Respondents’ failure to file motion materials making evidentiary objections by
August 31, 2015, as directed by the Court; and
c) The Applicant will be unfairly prejudiced by the inclusion of the
offending alleged evidence and the untimely objection.
[72]
It is impossible to deal with the detailed
substance of these evidentiary objections separate and apart from the full
context and merits of the judicial review application. Consequently, I will
deal with evidentiary objections as they arise on the merits.
C.
Classification
[73]
The August 21, 2007 NOR (Second Decision) denied
TWC’s PLA on the ground that the Active Ingredient of RESOLVE was not a natural
substance.
[74]
The previous July 19, 2007 NOR (First Decision) was
based on efficacy and safety issues which means that, by implication, NHPD did
not regard classification as a problem at that time. Indeed, relying upon the
definitive DNP listing of the Active Ingredient as a natural substance, NHPD
had already made three classification decisions (December 2, 2004, January 25,
2007 and June 18, 2007) which accepted that the Active Ingredient in RESOLVE
was a natural product based upon the DNP listing. So what happened to make NHPD
change its mind and decide to deny the PLA on the separate classification
ground in the Second Decision? The motivation and the sequence of events here
are murky.
[75]
The issue of classification was, in fact, raised
within Health Canada prior to the First Decision based upon efficacy and
safety. Prior to the July 19, 2007 NOR, Paul Gustafson, who was the
investigator at HPFBI dealing with the Pfizer complaint, emailed Dr. Marles and
challenged the previous classification of RESOLVE’s Active Ingredient as a
natural substance. On July 10, 2007, Dr. Marles replied to Mr. Gustafson
and confirmed that the Active Ingredient was an NHP according to the definitive
DNP reference. This is why the First Decision is based solely on safety and
efficacy. And even after the First Decision, Dr. Marles made it clear in a July 25, 2007
email that “everyone internally knows it is an NHP”.
[76]
Dr. Marles’ advice, however, did not deter Mr.
Gustafson. The evidence suggests that he researched the scientific articles
that DNP had relied upon and cited to list the Active Ingredient as an NHP. Mr.
Gustafson then emailed Dr. Marles on August 16, 2007 and raised the issue again.
This time Dr. Marles was convinced that the classification could and should be
questioned and he took decisive action to ensure that it was.
[77]
It was Dr. Marles who arranged for the August
21, 2007 NOR (the Second Decision), which denied TWC’s PLA on the separate
ground of classification. The issuance of the Second Decision and the refusal
of the PLA on this new ground was a complete surprise to TWC, because
classification had never been previously raised and there was no reason to
believe that it could be a problem. The First Decision makes it clear that
safety and efficacy were the only concerns.
[78]
There are certain telling facts surrounding the
issuance of the Second Decision that give rise to serious legal issues:
a) There was no evidence before Dr. Marles or anyone at NHPD or HPFBI
that RESOLVE’s Active Ingredient was not an NHP. At the time of the NOR, it was
still listed as an NHP by DNP, which Health Canada regards as definitive;
b) All that Dr. Marles could know at the material time was that the
articles cited and relied on by DNP could be questioned and, even if these
articles, in Dr. Marles’ opinion, did not support the DNP listing, this did not
mean that the Active Ingredient was not an NHP. So, without evidence and
without even consulting with DNP over the issue, Dr. Marles took it upon
himself to make a crucial and far-reaching decision that had no evidence to
support it; and
c) Dr. Marles made this crucial and far-reaching decision that, in
effect, kicked RESOLVE out of the NHP Regulations and into the Food
and Drug Regulations without any notice to TWC that there was a
classification issue to be resolved, and without any opportunity for TWC to
address it with either NHPD or DNP.
[79]
In my view, this evidence alone supports the
allegations of a serious breach of procedural fairness and the unreasonableness
of the August 21, 2007 NOR. But there is also evidence to suggest something more
serious took place during this process.
[80]
Having made and orchestrated the decision behind
the August 21, 2007 NOR, Dr. Marles then contacted DNP and, on August 27, 2007,
he made a submission to DNP that the Active Ingredient at issue in this case
should be removed from DNP’s list of natural substances. He pointed out that an
article relied upon by DNP for the listing did not actually confirm that the Active
Ingredient was a natural substance. TWC was not informed of these submissions,
and was given no opportunity to address this important issue.
[81]
On September 11, 2007, DNP said it would remove
the Active Ingredient from the list. This gives rise to further concerns that
emerged during the reconsideration process and which I will come to later. However,
in his affidavit of July 2, 2013, sworn on behalf of TWC, Shazad Bukhari, who
is the Chief Operating Officer of TWC [Bukhari July 2, 2013], says that DNP
later agreed to re-list the Active Ingredient as a natural substance after reviewing
the expert opinions of scientists retained by TWC. In its written Memorandum of
Fact and Law, NHPD says that such a re-listing has not occurred. This remains a
mere assertion in argument and has no evidence to back it up. This is one of
the evidentiary matters raised by TWC and the Court has been asked to strike
paragraph 108 of NHPD’s written Memorandum. NHPD says that a listing, or lack
thereof, in DNP, is something of which I can take judicial notice. However,
although I agree with TWC that NHPD cannot reply upon assertions in legal
argument for which there is no evidentiary base, I do not think this
disagreement between the parties really goes to the issue before me. All the
Court knows at this point is that the Active Ingredient was de-listed from DNP
but that DNP has said it will be re-listed. The present state of thinking at
DNP on this issue is not in evidence. What is clear from the record is that the
de-listing of the Active Ingredient by DNP occurred at the instigation of Dr.
Marles, who made submissions to DNP after the August 21, 2007 NOR had
been issued and at a time when the Active Ingredient was still listed in DNP
and when Dr. Marles and DNP had no evidence to suggest that it was not a natural
substance. While subsequent evidence produced by TWC during the reconsideration
process suggests that there is ample proof that the Active Ingredient in
RESOLVE is a natural substance, TWC was never given an opportunity to produce
submissions on point before the August 21, 2007 NOR issued. As I will
discuss later, reconsideration does not correct the procedural unfairness that
TWC suffered as a result of the Second Decision.
[82]
There is no reason why Dr. Marles needed to
hurriedly orchestrate the Second Decision without input from TWC. On August 21,
2007, the PLA license had already been denied by virtue of the First Decision,
RESOLVE had been recalled and a Public Health Advisory had been issued. The
August 21, 2007 NOR was made at the instigation of Dr. Marles and was based
upon his own unsupported conclusions that the Active Ingredient should not be
listed as a natural substance. Dr. Marles also made sure that this momentous
decision, from the perspective of TWC’s interests, was made without any input
from TWC and without TWC even knowing that it was a possibility. Having made an
unreasonable and procedurally unfair decision, Dr. Marles then – and once again,
without notice to TWC – set about enlisting the support of DNP in an attempt to
legitimize an unacceptable decision he had already made. Further attempts were
also made to use the reconsideration process to legitimize a legally erroneous
decision, but the reviewable error had already occurred.
D.
Classification Reconsideration
[83]
Health Canada takes the position that it afforded
more than ample procedural fairness to TWC with respect to RESOLVE, both prior
to the licensing decision and throughout the three reconsideration decisions.
[84]
As set out above, the facts are clear that
Health Canada provided TWC with no procedural fairness at all with regard to
the classification ground for denial and the Second Decision. That decision was
hurriedly instigated by Dr. Marles without notice or warning to TWC that
classification was a concern to Health Canada, and after previous internal decisions
by Health Canada that suggest that classification was not a concern and that
NHPD accepted the Active Ingredient of RESOLVE as an NHP. I fail to see how
this can be described as “ample” procedural
fairness, as Health Canada now asserts.
[85]
If Health Canada means that the reconsideration
process undertaken with respect to classification somehow rectified the lack of
procedural fairness that lies behind the Second Decision, then I think Health Canada is mistaken on both legal and factual grounds.
[86]
Section 9 of the NHP Regulations allows
PLA license applicants to challenge license refusals by way of reconsideration,
and in this case TWC asked the Minister to reconsider both the First Decision based
upon safety and efficacy concerns, and the Second Decision based upon
classification.
[87]
It is important to bear in mind that
administrative decisions made in the absence of procedural fairness cannot be
cured by a reconsideration process. As indicated by the Supreme Court of Canada
in Newfoundland Telephone Co v Newfoundland (Public Utilities Board),
[1992] S.C.R. 623 [Newfoundland Telephone], a decision “which denied the parties a fair hearing cannot be simply
voidable and rendered valid as a result of the subsequent decision of the
tribunal” (at para 40). Administrative decisions made without procedural
fairness are void ab initio. See also Agraira, above, at paras
93-96.
[88]
Strictly speaking, then, the Court does not need
to examine the reconsideration process with regard to the August 21, 2007 NOR
for its impact upon the lack of procedural fairness behind that decision.
However, the reconsideration process does have some relevance for this judicial
review application because it throws some light upon the bootstrapping, closed
mindedness and bias that TWC alleges have characterized NHPD’s whole approach
to dealing with the PLA and, indeed, HPFBI’s compliance actions.
[89]
NHPD, relying upon and following the directions
of Dr. Marles, based the August 21, 2007 NOR upon a lack of evidence
that RESOLVE’s Active Ingredient was an NHP. Consequently, TWC set about
providing authoritative evidence that it was an NHP.
[90]
My review of the evidence on this aspect of the
reconsideration process leads me to the conclusion that NHPD was both
unreasonable in its reconsideration decisions and, once again, procedurally
unfair in its dealings with TWC.
[91]
To begin with, in violation of policy and
assurances given by NHPD to TWC, the reconsideration process significantly
involved individuals responsible for the Second Decision. In particular, Dr.
Marles was heavily involved and, in effect, defended his own prior decisions at
a time when NHPD knew it was facing legal action and possible heavy liabilities
for its negative PLA decisions. Further, it was Dr. Marles who effected HHE #6
and advised HPFBI to issue the public advisory and recall which had removed
TWC’s ability to market RESOLVE in the first place.
[92]
TWC had requested independent experts for
reconsideration, including an opportunity for its own expert panel to meet with
the panel considering its reconsideration. NHPD had initially refused to
involve outside experts but provided assurances that reconsideration would not
involve any person in the original PLA assessment, the issuance of the HHEs or
the July 19, 2007 NOR (see Bukhari December 2007 at paras 18-19, 93,
97-102 and EXHS. 40-43; Sitar November 2011 at paras 21 and 29; Marles Cross,
at 248-250 and EXHS. 35; Bukhari Cross at 116). It is true that NHPD did
enlist the services of Dr. John Arnason and Dr. Brian Foster to critique TWC
expert evidence from two laboratories. However, Dr. Foster’s independence and
qualifications for the task are somewhat in doubt because he is an employee of
Health Canada in the therapeutic drug branch and appears to have had no
experience with NHPs. Dr. Arnason, on the other hand, appears to be qualified
for the task. However, he is a biologist and not an analytical chemist. He is a
professor of Biology at the University of Ottawa and Associate Director of the
Biopharmaceutical Science Program. He has a phytochemistry lab at the
University of Ottawa and has trained over 50 graduate students in the field and
published more than 250 peer-reviewed papers. In addition, he is a former
president of the Phytochemical Society of North America and a founding member
of the Natural Health Product Research Society of Canada. These are impressive
qualifications, but the evidence also shows that Dr. Arnason has close
affiliations with Dr. Marles, Dr. Foster, Health Canada and the Federal
Government. He has received substantial grants and funding from Health Canada and its associated agencies. Significantly for this application, the Court cannot
ignore that Dr. Arnason was Dr. Marles’ post-doctoral supervisor and he has
co-authored a significant number of articles with Dr. Foster and/or Dr. Marles.
This is extremely problematic in an application where Dr. Marles’ conduct
has come under close scrutiny and the need for truly objective evidence is
crucial. In a matter like this, it doesn’t help to go to colleagues and
associates for support. This is particularly the case when, as I shall discuss,
even prior to Health Canada retaining Dr. Arnason, Dr. Marles stated that any
experts Health Canada might retain would not accept TWC’s expert evidence. The
inference is unavoidable, in my view, that Dr. Marles could say this because he
knew who those experts would be and he knew they would support him.
[93]
TWC asserts a connection between Dr. Marles and
Dr. Arnason which, in my view, would not normally call into question Dr.
Arnason’s objectivity. However, according to TWC witnesses (and I do not see
this evidence questioned or challenged anywhere) Dr. Marles himself
acknowledged that NHPD would have to conduct its own laboratory testing if it
was going to refute the evidence from TWC experts, and this was not done. In
addition, Dr. Marles indicated that any experts retained by NHPD would reject
TWC’s expert opinion (see Bukhari Cross at 116-117; Marles April 2008, EXH. P;
Supplementary Affidavit of Shazad Bukhari Affidavit, July 30, 2008 [Bukhari
July 2008], at paras 3-8 and EXH. B). This gives rise to a serious
concern that Dr. Marles knew who to go to secure the expert opinions he needed
to support his own conclusions and past decisions.
[94]
These concerns become even more troublesome when
the reports from Dr. Arnason and Dr. Foster are reviewed. To begin with, there
is no independent laboratory testing to support their conclusions and to refute
the stringent testing that supports TWC’s expert evidence. Both NHPD experts
engage in the kind of armchair sniping and speculation that is frowned upon in
the jurisprudence by straying from the duties to be fair, objective and
non-partisan. See White Burgess Langille Inman v
Abbott and Haliburton Co, 2015 SCC 23 at paras 2, 10 and 46; R v Mohan,
[1994] 2 S.C.R. 9 at para 24. Standards are asserted – and then
changed – and strategic mistakes are made. For instance, in his report of
October 7, 2008, Dr. Arnason says that he has conducted a literature search of
the American Chemical Society which he says “has one of
the most authoritative databases,” and that he has failed to find any
articles confirming the natural occurrence of RESOLVE’s Active Ingredient.
However, TWC did its own research of the American Chemical Society database and
found information in the Mango article that confirmed the Active Ingredient as
a natural substance (see Bukhari July 2013 and EXHS. A (extracts), and B-F). So
we have an article confirming the Active Ingredient as a natural substance
published in the prestigious journal that Dr. Arnason himself cites. The
article meets the standards of publication that NHPD’s expert says is required,
yet NHPD has not changed its mind on classification.
[95]
Over and above these evidentiary issues, NHPD’s
handling of the reconsideration process is, once again, fraught with procedural
fairness problems. For example, one need only look at the final reconsideration
decision of January 30, 2012, in which NHPD produces a new affidavit from Dr.
Marles, a report from Dr. Foster, and a new affidavit from Dr. Arnason – all of
which set out new allegations and new arguments relied upon by NHPD, but not
shown to TWC – all the while telling TWC that it would not consider any further
correspondence, thus foreclosing any response to the new evidence relied upon
for the decision.
[96]
In short, the reconsideration decisions on
classification are irrelevant for the reviewable errors I have found on the
August 21, 2007 NOR. However, they themselves also contain reviewable errors.
They make mistakes of fact and process that render them unreasonable, they are
lacking in procedural fairness and, I think at this point I have to conclude,
they provide evidence of a reasonable apprehension of bias in accordance with
the Baker test: Baker v Canada (Citizenship and Immigration), [1999]
2 SCR 817 at paras 45-47. Dr. Marles orchestrated the August 21, 2007 NOR
and he continued to influence the reconsideration process to an unacceptable
degree, a process in which his own earlier decision was supposed to be examined
objectively and independently.
E.
Safety
[97]
The First Decision was based upon safety and
efficacy concerns. As with the classification process discussed above, the
record shows serious procedural fairness errors and the improper interference
by Dr. Marles in the PLA process that, once again, support a finding of a reasonable
apprehension of bias.
[98]
In particular, TWC received no notice of HHE #6
which contained the new reasons relied upon to designate RESOLVE as a Type II health
hazard, and TWC was given no opportunity to respond until after the PLA was
rejected on July 19, 2007.
[99]
We also, once again, see Dr. Marles dominating
and interfering with the PLA process in ways that suggest his main objective
was to ensure that TWC would not be granted a PLA license. For example, on July
17, 2007, Dr. Marles sent an email to several NHPD staff, including Mr. Zeshawn
Awan, who was the Bureau of Product Review and Assessment [BPRA] assessment
officer who prepared the SEAR for RESOLVE. Mr. Awan’s SEAR of June 19, 2007
confirmed that safety was supported and he recommended a routine Information
Request Notice [IRN] to deal with efficacy. At this point, as Dr. Marles has
conceded in evidence for this application, a license for RESOLVE likely would
have been issued upon TWC providing further information to satisfy the efficacy
requirement (see Marles Cross at164-165). Normal procedure would mean that the
PLA would then go to the BPRA unit head and manager for approval, and then to
the NHPD Director for a final decision. This normal procedural was not followed
(see Marles Cross at 122-127, 133 and 135).
[100] Mr. Awan’s decision that RESOLVE was safe contradicted the HHEs that
Dr. Marles had been issuing to support a Type II health hazard. It is at this
point that the HPFBI complaint investigation became inextricably intertwined
with the PLA process as a result of the intervention of Dr. Marles.
[101] Dr. Marles advised BPRA of the HHE he had prepared for HPFBI. I see
no problem with Dr. Marles drawing his safety concerns to the attention of BPRA
so that they could be examined as part of the PLA process, provided the
integrity of both processes is maintained. However, that is not what happened
here.
[102] A crucial meeting occurred on June 28, 2007 at which HPFBI officials
met with TWC to deal with the HHE that had been issued as part of the
inspectorate process. Health Canada argues in the context of this judicial
review application that the meeting of June 28, 2007 provided TWC with all of
the procedural fairness required to deal with the safety concerns raised in the
PLA:
Much has been said against Dr. Marles by the
applicant in its memorandum. The meeting of June 28, 2007 between TWC and NHPD
and the [sic] afforded [sic] TWC to file additional documentation
prior to the final licensing decision conclusively proves otherwise.
[103] This assertion is not born out by the record. As TWC points out in
this application, what the record does reveal is as follows:
• TWC had requested this meeting to address the safety concerns
alleged in the HHEs and Warning Letters from HPFBI;
• Dr. Marles attended the meeting because he had issued the HHEs
for HPFBI;
• TWC was presented, for the first time, with HHE #5 dated June
27, 2007;
• TWC requested an opportunity to respond to the safety
allegations in HHE #5. No mention was made of any efficacy issues;
• Although HHE #5 referred to the Adverse Reaction Reports [ARR],
it was not, at that time, relied on as a reason for designating RESOLVE as a Type
II health hazard;
• TWC requested details of the ARR so that it might have an opportunity
to respond. It was told that such details would be provided;
• This meeting was not called for the purpose of discussing the
PLA submission and no representative of BPRA was present;
• BPRA had not issued any Information Request Notice [IRN] with respect
to the RESOLVE PLA nor had BPRA requested any information from TWC regarding
safety or efficacy. TWC has not been informed of any safety or efficacy
deficiencies in its PLA submission;
• TWC was not told that this meeting was in lieu of an IRN
pertaining to its PLA;
• TWC did not give permission for its pending responses to HHE #5
to be used for the PLA assessment. If mention of the PLA was made at the
meeting, TWC would have advised that any PLA issue should be dealt with through
its consultant Dicentra in the normal course.
(Bukhari December 2007 at paras 47-49 and
51-56, Marles Cross at 51-57, 170-187, 204-205, 209 and 210; Bukhari Cross at 65-67
and 69-76, emphasis in original)
[104] Following the June 28, 2007 meeting, TWC prepared and submitted a
binder of response materials addressing the four safety concerns alleged in HHE
#5, but it could only respond to the Adverse Reaction Reports in a preliminary
way because it did not have the details it was promised. In fact, on July 5,
2007, TWC was told that if it wanted the Adverse Reaction Reports details, it
would have to submit a formal Access to Information request. This meant that
TWC was not given an opportunity to fully respond to the Adverse Reaction
Reports before the PLA was denied on July 19, 2007. This is important because
it meant that TWC did not know until after the First Decision that the Adverse
Reaction Reports were based upon the false assumption that RESOLVE contained
passionflower (see Marles January 2008, extracts of EXH D; Marles Cross at 180-182,
186, 187, 210-211 and 227; Bukhari December 2007 at paras 51-55, 59-61, 91 and
93; Marles Cross, EXH 23).
[105] TWC points out in this application – and the Respondents have not
refuted this evidence – that, as of July 15, 2007, the status of the PLA was as
follows:
• All of the safety issues relied on in HHEs #1 to #5 (January 25, 2007
to June 27, 2007) had been addressed by TWC;
• No issues relating to efficacy has been raised in any context;
• TWC had not received an IRN or any other form of notice that
there were any concerns or deficiencies in its PLA relating to safety or
efficacy;
• The NHPD Director had advised the ADM that, as of June 28, 2007,
there was no information upon which to deny a license for RESOLVE;
• The only SEAR in existence to that point in time was the SEAR of
June 19, 2007 prepared by Mr. Awan which indicated that safety was supported
and that a routine IRN should be issued with respect to efficacy.
[106] In addition, on July 12, 2007, TWC provided HPFBI with Dr. Mike Dutton’s
report that confirmed RESOLVE to be a safe product.
[107] Against this background, Dr. Marles issued HHE #6 on July 17, 2007
which rendered HHEs #1 to #5 irrelevant and relied upon three new reasons to
designate RESOLVE as a Type II health hazard. This means that TWC had no
opportunity to respond to HHE #6 before NHPD issued the First Decision. This
would not have happened if the integrity of the licensing and the inspectorate
processes had been maintained, and it is here that Dr. Marles’ interference in
the PLA process becomes crucial.
[108] Before looking at the details of Dr. Marles’ interference in the PLA
process, the following must be borne in mind regarding the three new reasons he
gave in HHE #6 for designating RESOLVE as a Type II health hazard:
a) Dr. Marles completely disregarded the expert opinion from Dr. Dutton
that RESOLVE is a safe product in its daily dosage. Dr. Dutton is an expert
toxicologist. Dr. Marles is not a toxicologist and he has conceded in evidence
for this application that he did not consult with a toxicologist. See Bukhari
December 2007 at para 75; Marles Cross, 11, 223-227. In other words, against
the expert evidence, Dr. Marles simply decided to substitute his own opinion on
the safety of the daily dosage;
b) HHE #6 also relied on the Adverse Reaction Reports – that TWC has
not been able to respond to in full – and the Adverse Reaction Reports were
based on the false assumption that RESOLVE contained passionflower. Dr. Marles
knew about this error but failed to correct it;
c) HHE #6 also relied upon an alleged risk of hemolytic anemia referred
to in Dr. Dutton’s expert report. But Dr. Dutton’s report, as Dr. Marles must
have known, clearly states that RESOLVE is a safe product, so that Dr. Marles’
remarks about hemolytic anemia in his report are simply a misinterpretation of what
Dr. Dutton says.
[109] These are serious errors for someone in Dr. Marles’ position to make,
and they create the impression that, after TWC had satisfied all of the safety
concerns raised in HHEs #1 to #5, Dr. Marles relinquished his objectivity
and was simply grasping at anything to justify a determination that he had
already made to have RESOLVE designated as a Type II health hazard. The bizarre
aspect of this conclusion is that there is some evidence before me in this
application that Mr. Gustafson confided to a TWC representative at the June 28,
2007 meeting referred to above that TWC would not get a PLA license for RESOLVE
and “it did not matter” what information TWC
provided (see Bukhari December 2007 at para 50, Bukhari Cross at 83).
[110] The Respondents object to this evidence in their written Memorandum
of Fact and Law:
40. TWC falsely alleges that Mr. Gustafson
advised one of TWC’s representatives at the June 28 meeting that “TWC was not
going to get a license no matter what information it provided.” Mr. Gustafson
never made any such statement. TWC has not filed any direct evidence from the
person who allegedly heard Mr. Gustafson make such a statement. Such false
allegations are highly prejudicial and ought to be struck from the record as
pure hearsay.
[111] The strange thing is that it would have been very easy to refute the
disputed evidence with an affidavit from Mr. Gustafson himself. But the
Respondents have filed no such refutatory evidence and they have not given any
reason for not doing so. The denial remains a mere assertion in a Memorandum of
Fact and Law before the Court, which is not evidence at all, particularly on a
point such as this one. Health Canada must be aware that this is extremely
damaging evidence against the Respondents. It is strong support for TWC’s
position that it was dealing with a closed and biased mind and that the whole
subsequent reconsideration process was a sham.
[112] Even stranger is the fact that on July 24, 2015, Prothonotary Aalto
directed that either party wishing to raise evidentiary objections must file a
Notice of Motion to that effect by no later than August 31, 2015. TWC filed and
served its motion on August 28, 2015. The Respondents did not file any motion.
Motion Records were to be filed by September 30, 2015 and Responding Records
were to be filed by October 30, 2015. In accordance with Prothonotary Aalto’s
Direction, TWC filed its Motion Record with respect to its motion regarding
evidentiary objections on September 30, 2015. Accordingly, the Respondents were
to have filed their Responding Record by October 30, 2015. At the close of
business on Friday, October 23, 2015, TWC received the Respondents’ Memorandum
of Fact and Law for the judicial review which was the only material provided to
TWC in the Respondents’ Record. Upon initial review, it was noted that certain
paragraphs, specifically paragraphs 40, 85, 106, 107 and 108, contained factual
allegations which do not appear in any affidavit or other evidence filed with
the Court. Furthermore, the paragraphs contained an objection to TWC’s evidence
despite the Prothonotary’s Direction that the parties must file motions to make
evidentiary objections on or before August 31, 2015.
[113] This is an important issue that, on TWC’s evidence, weighs heavily
against the Respondents. It confirms TWC’s position that it was dealing with
bias, a closed mind and bootstrapping. It is evidence that would have been
extremely easy to refute with direct evidence from Mr. Gustafson, and it is
obviously evidence that the Respondents should have addressed in accordance
with Prothonotary Aalto’s Direction. Yet, the Respondents have done none of
these things and have not offered the Court any explanation as to why.
[114] I agree with the Respondents that none of this prevents them from
pointing out to the Court that TWC’s evidence is hearsay. It is clear, however,
that I can consider hearsay evidence using the principled approach clearly
established in the jurisprudence. See R v Smith, [1992] 2 SCR
915; R v Khan, [1990] 2 S.C.R. 531 at paras 35-36, 42, 48-49 and 61; Eli
Lilly Canada v Apotex Inc, 2015 FC 875 at para 195; Ottawa Athletic Club
Inc v Athletic Club Group Inc, 2014 FC 672 at paras 117-119. Hearsay
excludes evidence that cannot be tested, but the fact of Mr. Bukhari
having heard that Mr. Gustafson had made such comments was testable, and Health
Canada could easily have refuted the truth value of the evidence by having Mr.
Gustafson provide direct evidence on point. And the Respondents could easily
have objected in the way directed by Prothonotary Aalto.
[115] Pointing out that this evidence is hearsay does not allow the
Respondents to assert in their written Memorandum that “Mr.
Gustafson never made any such statement,” or that “such false allegations are highly prejudicial and ought to
be struck from the record as pure hearsay,” because there is no evidence
before me that the hearsay evidence is false or that Mr. Gustafson never made
such a statement. Consequently, these bald assertions by the Respondents in
their Memorandum are struck, but I take the point that I am dealing with
hearsay evidence on this issue.
[116] In adopting a principled approach to this evidence, I think I have
to pay particular note to the fact that the Respondents have made no attempt to
file refutatory evidence on a crucial factual issue and have failed to explain
to the Court why not. They have also failed to object to the evidence in the
way directed by Prothonotary Aalto. I think I have to draw an adverse inference
from these facts that this is not evidence the Respondents can refute. Having
been given the opportunity and direction by Prothonotary Aalto to object to
this evidence, they chose to leave it on the record for the review hearing. Any
hearsay objections should have been raised in accordance with the Court’s
directions. However, even if I were to exclude this piece of evidence, I would
still reach the same conclusions on reasonable apprehension of bias.
[117] It is against this background (the problems associated with HPFBI’s
process and Dr. Marles’ role in that process) that we have to examine Dr.
Marles’ overwhelming intervention in the PLA process and the First Decision.
[118] The starting point is that, before that intervention, Mr. Awan, a
BPRA assessment officer, had not only confirmed that RESOLVE met the regulatory
definition of an NHP but also, on June 19, 2007, had prepared the initial SEAR
for RESOLVE confirming that there were no concerns regarding safety, and
recommending a routine IRN for efficacy. See Marles Cross, 122-127, 133-135 and
164-165 and extracts of EXH.14.
[119] It was at this point that Dr. Marles intervened and advised BPRA of
the HHEs he had prepared for HPFBI, which were then used by NHPD in reaching
its conclusions that there were safety concerns with RESOLVE. NHPD did not,
however, conduct its own investigation into this issue. It simply took what Dr.
Marles said at face value and, in fact, allowed Dr. Marles to direct that Mr.
Awan’s SEAR be set aside and substituted with a SEAR that was consistent with
his own HHEs.
[120] It is worth repeating that, at this point, TWC had not been able to
respond to the three new reasons relied upon in the July 17, 2007 HHE #6. Dr.
Marles says that BPRA used HHE #6 – which TWC had not seen – as well as the TWC
July 3, 2007 binder response to HHE #5 – no longer relevant on its PLA
assessment. See Marles Cross, 185-187 and 199.
[121] As I have said above, I see no problem with Dr. Marles communicating
that the Inspectorate had safety concerns to NHPD, but if NHPD simply adopts
those concerns and allows its own processes to be subsumed, it must realize
that it inherits all of the reviewable errors that I have identified were made
as a result of Dr. Marles’ role in the HPFBI process. We can see the extent of
Dr. Marles’ role in the PLA process from the July 17, 2007 email he sent to
NHPD staff members, including Mr. Awan, in which he says that the NOR will be
ready for signing “tomorrow morning” and that
Mr. Awan should ensure that the NOR “adequately
captured” the reasons set out in HHE #6, which TWC had not seen. BPRA
simply followed Dr. Marles’ instructions and drafted the SEAR and the July
19, 2007 NOR, and neglected to follow the normal process of first issuing an
IRN. An email of July 18, 2007 confirms that the NOR was ready on that date.
[122] The evidence placed before me in this application reveals that it
was really Dr. Marles’ decision to ignore the IRN process and to go directly to
a NOR. He did this fully aware of the problems with his own HHE #6 outlined
above, and that TWC had been given no opportunity to respond to HHE #6. In
other words, I think we have confirmation here of Mr. Gustafson’s reported
words that a decision had already been made that TWC was not going to get a PLA
license, and we see Dr. Marles intervening in the PLA process to ensure that
this occurs. Mr. Awan and his colleagues were rushed into preparing the
SEAR and July 19, 2007 NOR to reflect the safety concerns in the HHE #6 and to
support a decision that Dr. Marles had already made in error.
[123] Dr. Marles has admitted that what occurred was contrary to standard
policy because he says that PLAs and HHEs are separate processes. See Marles
Cross at 122-127, 133 and 135.
[124] Another email of July 18, 2007 which was sent to everyone concerned
(including the NHPD Acting Director) shows Dr. Marles directing the steps to be
followed. He directs the BPRA manager to sign off on the SEAR and the Acting
Director to sign off on the NOR, which are required formalities. The Acting
Director signed the NOR on July 19, 2007, and the NOR was served on TWC
together with HHE #6 and a new stop sale and recall notice. See Marles Cross,
238-240 and EXH 30; Bukhari December 2007 at paras 63-65 and EXHS 25 and 26.
[125] This meant that, as far as HPFBI was concerned, TWC had received no
prior notice of the three new safety concerns that were used to justify HHE #6,
and as far as NHPD was concerned, TWC had received no prior notice of any
safety or efficacy concerns raised by BRPA.
[126] Yet NHPD continues to allege that TWC was afforded procedural
fairness beyond the requirements of the law and that Dr. Marles behaved
appropriately throughout the process. Apart from these general assertions,
however, the Respondents have not addressed the detailed points of fact raised
by TWC concerning the PLA process and the HPFBI process which, in my view,
establish procedural unfairness, unreasonable decisions and, at the very least,
a reasonable apprehension of bias. The Respondents, however, assert that:
TWC has not put forward any logical
explanation why Dr. Marles would be antagonistic towards TWC or RESOLVE. Dr.
Marles has had a long and distinguished career at Health Canada, there is no evidence of [sic] with no prior complaints of bias or bad faith
by any other license applicants or industry stakeholders.
[127] This kind of assertion is irrelevant and unhelpful. It does not
answer the detailed points of evidence referred to above, or much else
contained in TWC’s judicial review application. TWC does not have to establish mens
rea to prove procedural unfairness, unreasonableness or a reasonable
apprehension of bias. The strange thing is that the Respondents have done so
little to explain or justify the detailed points of evidence that support TWC’s
application.
[128] The Respondents also say that:
The Refusal Decision and Classification
Decision were based on transparent communications between Health Canada and TWC. At each step of the way TWC was notified of the reasons its PLA was subject
to refusal and provided with participatory rights to be heard.
[129] Yet the evidence is clear that TWC was never given any opportunity to
respond to the three new safety reasons alleged in HHE #6 that were the basis
for the compliance decision, and TWC received no prior notice that there were
any safety or efficacy concerns in relation to the PLA and the July 19, 2007
NOR. As regards classification, TWC was given no prior notice of classification
concerns in the July 19, 2007 NOR, and was given no prior notice of
classification concerns prior to the August 21, 2007 NOR. The bald assertions
of the Respondents in this application are not evidence to the contrary.
F.
Safety Reconsideration
[130] As with a lack of procedural fairness and/or bias behind the Second
Decision, the First Decision cannot be cured by the reconsideration process.
See Newfoundland Telephone, above, at paras 38-41. The decision is void
ab initio. The Respondents have not acknowledged any defects in either
decision. Once again, therefore, the reconsideration process on the issue of
safety has little relevance for my decision. In any event, Health Canada has subsequently conceded that there are no health and safety concerns with RESOLVE.
G.
Efficacy
[131] The First Decision also denied TWC a license on the basis of
efficacy. As with safety, the handling of the efficacy issue gives rise to
concerns about procedural fairness, the appearance of bias, and the
reasonableness of the First Decision. Because safety and efficacy were both
cited in the July 19, 2007 NOR to deny the license, it is difficult to separate
reviewable errors related to efficacy from reviewable errors related to safety.
[132] The evidence is clear that TWC did not receive prior notice from
NHPD about either efficacy or safety concerns under the PLA process. The first
notice was the July 19, 2007 NOR (First Decision) itself. It also has to be
remembered that TWC did not receive the routine IRN recommended in the initial
SEAR and that, under Dr. Marles’ direction, NHPD went directly to the July 19,
2007 NOR. So there was no opportunity for TWC to respond to efficacy concerns
before the NOR was issued. It also appears from the evidence before me that
this was a deviation from standard procedures. There is also the troubling
issue of Mr. Gustafson’s admission at the June 28, 2007 meeting that TWC would
not be granted a license. However, even without this admission, I think TWC has
established procedural unfairness and a reasonable apprehension of bias with
regard to the efficacy issues. That finding is reinforced by what occurred during
the reconsideration process when it became clear that Health Canada was
demanding “conclusive proof” of efficacy in the
form of unimpeachable human clinical studies. As TWC points out, this extremely
high standard has been rejected by this Court as a minimum mandatory requirement
for drug submissions. See Wellesley Therapeutics Inc v Canada (Health),
2010 FC 573, at paras 40-45, 61-62, 66-69, 72; Epicept Corp v Canada
(Health), 2010 FC 956 at paras 13-14, 41-46, 67-72. So it is difficult to
see why Health Canada would insist upon such a standard for RESOLVE in the
context of the more relaxed regime under the NHP Regulations. Even more
significant, the Respondents have placed no evidence before me that Health
Canada has ever used this standard in any other PLA. This gives rise to issues
of procedural fairness, apprehension of bias, legal errors in interpretation,
and reasonableness. These issues are significantly complicated in the present
case by a lack of clarity in the governing regulations and a lack of
jurisprudence on the applicable standard for efficacy under those regulations.
[133] As regards efficacy, the NHP Regulations provide as follows:
5. An
application for a product licence shall be submitted to the Minister and
shall contain the following information and documents:
|
5. La demande
de licence de mise en marché est présentée au ministre et comporte les renseignements
et documents suivants :
|
…
|
…
|
(g)
information that supports the safety and efficacy of the natural health
product when it is used in accordance with the recommended conditions of use;
|
(g)
les renseignements montrant l’innocuité et l’efficacité du produit lorsqu’il
est utilisé selon les conditions d’utilisation recommandées;
|
[134] Section 7 of the NHP Regulations then provides as follows:
Issuance
and Amendment
|
Délivrance
et Modification
|
7. The
Minister shall issue or amend a product licence if
|
7. Le
ministre délivre ou modifie la licence de mise en marché si les conditions
suivantes sont réunies :
|
(a) the
applicant submits an application to the Minister that is in accordance with
section 5 or subsection 11(2), as the case may be;
|
(a) le
demandeur présente au ministre une demande conforme à l’article 5 ou au
paragraphe 11(2), selon le cas;
|
(b) the
applicant submits to the Minister all additional information or samples requested
under section 15;
|
(b) le
demandeur fournit au ministre les renseignements complémentaires ou les
échantillons demandes en vertu de l’article 15;
|
(c) the
applicant does not make a false or misleading statement in the application;
and
|
(c) le
demandeur ne fait pas de déclaration fausse ou trompeuse dans sa demande;
|
(d) the
issuance or amendment of the licence, as the case may be, is not likely to
result in injury to the health of a purchaser or consumer.
|
(d) la
délivrance ou la modification de la licence ne risque pas de cause un
préjudice à la santé de l’acheteur ou du consommateur.
|
[135] TWC has put forward detailed submissions as to how these two
sections should be interpreted:
128. As discussed, the first position of TWC
is that the Regulations do not provide any substantive test for efficacy. The
requirement under section 5(g) for “information that supports” efficacy is
administrative only. Alternatively, even if the Regulations can be interpreted
as creating some sort of threshold substantive test, that test should be less
onerous than the “likely” test expressly set out for safety in section 7(d).
129. Section 5(g) does not call for evidence
to prove but rather information to support. This indicates that the information
can come in many forms and need not rise to the level of evidence. Unlike the
new drug regulations, the NHP Regulations do not specify the need for any
clinical evidence. It must also be kept in mind that the information to support
efficacy must be assessed in relation to the product claims set out in the PLA.
In this case, the only claim in the PLA is that it “may” help with smoking
cessation. Accordingly, TWC was only required to adduce information which
supported that modest claim even if that information fell short of proving the
likelihood that it may help.
130. In this case, the PLA did comply with
section 5(g) by including information that supports efficacy. Health Canada acknowledged this by accepting the PLA and granting it a submission number. Under
Health Canada’s own policy, this PLA was deemed to be complete otherwise it
would have been rejected at the outset or in 2006 under the new backlog policy.
The efficacy information in the PLA included a phase I human clinical study
along with in vitro and animal studies all conducted by Purdue
University, a statistical analysis of a phase II human clinical study, U.S.
patent information and various papers, articles and testimonials.
131. TWC submits that this information was
more than sufficient to prove even the likelihood that RESOLVE may help with
smoking cessation. Therefore, it certainly satisfied a standard less than that,
whatever the standard might be. The sufficiency of this efficacy information is
confirmed by the evidence including statements made by a former NHPD Director
at sessions held for industry.
[footnotes omitted]
[136] Health Canada, on the other hand, argues that a substantive
requirement for efficacy can be made out from the NHP Regulations:
86. Contrary to the applicant’s
submission, the Regulations do impose a substantive requirement of efficacy in
subsection 5(g) and s.7. Section 7 sets out the requirements for a licence to
issue. Paragraph 7(a) incorporates the requirements of section 5 in full,
including the requirement in paragraph 5(g) of “information which supports
safety and efficacy”. This is not merely an administrative requirement but
rather a substantive requirement. All of the information required by section 5
for a PLA must be reviewed and considered in order to determine whether a
licence will issue. This is the plain and obvious meaning of subsection 5(g)
and s.7. Here, the review bureau conducted a substantive review of the RESOLVE
PLA submission for the various requirements prescribed by section 7, including
information which supports efficacy. The information in the PLA submission was
examined in light of the concern as to efficacy identified in the HHE, and it
was determined the application did not meet the threshold for granting a
licence under section 7.
87. The review bureau conducted a review of
the RESOLVE PLA submission for the various requirements prescribed by section
7, including information which support efficacy. The information in the PLA
submission was examined in light of the concern as to efficacy identified in
the HHE, and it was determined the application did not meet the threshold for
granting a licence under section 7[.]
[137] I think it has to be acknowledged that the appropriate standard for
efficacy under the PLA regime has not yet been authoritatively determined.
There is no guidance in the NHP Regulations themselves and there
is no jurisprudence on point to assist. However, in my view, the standard
cannot be the excessively high standard that Health Canada eventually decided
to impose in this case. Besides arguing that s 5(g) imports a substantive
requirement for efficacy, Health Canada has provided no evidence or authority
for the standard that was applied in this case under the First Decision or for
the “conclusive proof” standard that it
eventually articulated, nor has Health Canada provided evidence of the standard
that has been used in other PLAs. This lack of an established standard, and the
application of a strict test to TWC’s PLA, lends credence to the argument that
Health Canada was simply applying any standard that would deny TWC’s PLA.
[138] TWC’s argument is that, because s 7 expressly sets out a substantive
test for safety, s 5(g) should not be interpreted as creating a substantive
test. TWC says that this means that s 5(g) requires an applicant to provide
only materials supporting efficacy, which TWC did in this case. In other words,
TWC says it provided a complete application in this case, so that the Minister,
under the s 7 language (“shall”), was obliged to
issue the license, provided, in accordance with s (g), it was not likely
to result in injury to the health of a purchase or consumer.
[139] On the face of it, the ordinary meaning of these two regulations
suggests that this is the appropriate way to read them together, except that it
still leaves open the issue of what, even in an administrative sense, is needed
to support efficacy under s 5(g), and what discretion does NHPD have under s
5(g) to assess any information provided.
[140] It seems to me that the use of the term “information” requires an
applicant to provide some meaningful and acceptable documentation that
“supports” efficacy and that, if this is not done – either because no
information is provided or because the information provided is not adequate to
support some degree of efficacy – then, even from an administrative
perspective, an application would not be complete and NHPD would, in the normal
course, notify an applicant of the deficiency and allow a reasonable time for a
response.
[141] In the present case, TWC was never notified that its efficacy
information was deficient in any way before the First Decision was issued, and
it was certainly never informed as to why its efficacy information was
deficient, or what would be required to rectify the situation. In this regard,
the efficacy aspect of the July 19, 2007 NOR was procedurally unfair and, in
the full context of the evidence presented in this case, it also gives rise to
a reasonable apprehension of bias. No standard was articulated to TWC at the
material time, and no reason was given as to why TWC’s “information” did not
“support” efficacy.
[142] It seems to me, then, that under s 5(g), an applicant is required to
provide “information” that, reasonably speaking, supports some degree of
efficacy in terms of the product claims set out in the PLA which, in this case,
were that RESOLVE “may” help with smoking cessation. Health Canada has put
forward no argument as to why the information submitted by TWC in its PLA did
not meet this test. Instead, Health Canada, as revealed by the reconsideration
process, has simply adopted a very strict test that would appear to be higher
than that required under the Food and Drug Regulations. No legitimate
reason has been put forward by Health Canada as to the need for such a strict
test in the context of NHPs and there is no evidence of Health Canada ever
applying such a strict test for any PLA other than TWC’s application for
RESOLVE. In my view, the test applied by Health Canada was both incorrect as a
matter of statutory interpretation and unreasonable in the full context of the manner
in which efficacy was dealt with. My own review of the information submitted by
TWC with its PLA is that it does provide some objective and legitimate
authoritative “information” to “support” that RESOLVE “may” help with smoking
addiction. On a plain reading of the NHP Regulations in their full
context, it seems to me that TWC clearly satisfied the efficacy requirement,
and the decision to reject the PLA on this basis was both contrary to the legal
requirements and unreasonable.
H.
Efficacy Reconsideration
[143] As with classification and safety, the reconsideration process with
regard to efficacy could not cure the First Decision that, because of a lack of
procedural fairness and a reasonable apprehension of bias, was void ab initio.
See Newfoundland Telephone, above, at paras 38-41.
I.
Other Issues
[144] TWC has raised a number of other issues in its submissions which I
do not reject. However, I do not think that an exhaustive analysis is required
to deal with this application. A finding for TWC on the issue of, for example, functus
would not change the result or the remedies that I think are appropriate for this
application. On the basis of my review and my findings so far, it is clear that
the application must be allowed for lack of procedural fairness, a reasonable
apprehension of bias, and unreasonableness.
J.
Motions on Evidence
[145] As I mentioned above, both sides have raised objections to some of
the evidence filed in this application. I have referred to what I regard as
some of the more important points of evidence in the body of my reasons. For
the most part, I think that the facts that establish procedural unfairness,
incorrect statutory interpretation, unreasonableness and a reasonable
apprehension of bias are clear and the Respondents, while making general
assertions, have not really answered the specifics of the evidence that support
the reviewable errors that occurred in this case.
[146] By formal motion, TWC asks that paragraphs 40, 85 and 108 of the
Respondents’ Memorandum of Fact and Law be struck. For the reasons given by
TWC, I agree that, for the most part, these paragraphs must be struck. However,
as indicated in the body of my reasons, I have noted the hearsay aspects of Mr.
Bukhari’s evidence on the issue of what Mr. Gustafson said at the June 28, 2007
meeting. As previously stated, what I find most troublesome is the fact that
the Respondents have filed no denial by Mr. Gustafson and have provided no
explanation as to why such a denial could not have been filed. At the same
time, they have failed to challenge this evidence as directed by the Court, and
so have left it on the record.
[147] As regards paragraph 85, I think that the first sentence can be
supported by the record, but the sentences that refer to the DNP have to be
struck for a lack of supporting evidence. I have indicated in my reasons what I
think can be ascertained about the DNP from the records.
[148] Paragraph 108 must be struck in its entirety for reasons given by
TWC.
[149] As regards the affidavit evidence of Dr. Marles, I think the reality
has to be acknowledged that he was the prime decision-maker of the decisions
that are at the heart of this application. I have already indicated in my
reasons that the integrity of both the PLA process and the enforcement and
compliance process was compromised by the role that Dr. Marles took upon
himself to play and, to be fair, that those who should have been overseeing the
process and making the decisions, allowed him to play. Normal PLA processes
were abandoned and those with the authority and responsibility to make the decision
simply followed Dr. Marles’ directions, whose directing mind appears to have
lost all sense of objectivity and procedural fairness as he attempted to shore up
his own misconceived conclusions. For example, Dr. Marles has conceded that he
had no evidence that the Active Ingredient in RESOLVE was not an NHP. All he
had was his own opinion that the articles relied upon by DNP to support the
listing did not, in fact, support it. And yet Dr. Marles actively sought to
have the Active Ingredient de-listed from DNP without giving any notice to TWC
that classification was a problem and without giving TWC the opportunity to
provide him and/or DNP with expert evidence to show that the Active Ingredient
does, in fact, occur in nature. In my view, a reasonable person knowing the
facts of this case would conclude that Dr. Marles was not acting fairly or
objectively and that his aim was to thwart the TWC PLA. I must conclude that
there is a reasonable apprehension of bias in this case.
[150] Because he was the prime decision-maker for the decisions under
review and directed others to do what was needed in a way that led them to abandon
standard practices, Dr. Marles probably does have more direct knowledge than
anyone else as to how and why these decisions were made. However, and as TWC
points out, the fact that he can play the managing role in providing the
overall picture from Health Canada’s perspective is itself an indicator of the
extent to which Health Canada’s own practices and procedures relating to TWC’s
PLA were overrun and abandoned by the actions of one man with the result that
procedural fairness and reasonable decision-making became impossible.
[151] This also leads to problems with Dr. Marles’ evidence for this
application. He is in the position of the effective decision-maker defending
his own actions. This means that he is the sole fact witness put forward by
Health Canada, but a fact witness who is defending his own decisions. He is an
advocate for himself. Health Canada remains firmly in the hands of
Dr. Marles and is apparently unwilling to provide the Court with reliable
factual evidence from others in the system who were involved. As a consequence,
although he is put forward as a fact witness, there is a great deal in his
evidence, as TWC once again points out, that must be considered inadmissible
opinion evidence, inadmissible arguments, inadmissible supplemental reasons
and/or inadmissible conclusions, and bootstrapping.
[152] I accept TWC’s submissions that the following portions of the affidavits
of Dr. Marles and Dr. Arnason should be struck:
A. Affidavit
of Robin Marles, January 22, 2008
|
Reasons for
Striking
|
Paragraph 14
|
Argument, and interpretation of
legislation
|
Paragraph 15
|
Hearsay and argument
|
Paragraph 16
(sentences 2 and 3)
|
Hearsay, opinion, argument and improper
expert opinion
|
Paragraph 17
(sentences 1 and 2)
|
Hearsay, opinion and argument
|
Paragraph 30
(sentences 2 and 3)
|
Hearsay
|
Paragraph 33
(sentences 1 and 2)
|
Argument and hearsay
|
Paragraph 34
(sentences 2, 3, 4, 5, 6, 7, 8, 9 and 12)
|
Hearsay, opinion, argument, improper
expert opinion and bootstrapping
|
Paragraph 35
(sentence 3)
|
Hearsay and argument
|
Paragraph 38
|
Hearsay and argument
|
Paragraphs 39 and 40
|
Hearsay, argument and opinion
|
Paragraph 43
|
Hearsay, argument and opinion
|
Paragraph 44
|
Hearsay, argument and opinion
|
Paragraphs 47 - 50
|
Hearsay and argument
|
Paragraphs 51-53
|
Hearsay
|
Paragraph 54
|
Hearsay and argument
|
Paragraph 56
|
Hearsay and argument
|
Paragraphs 58-63
|
Hearsay and argument
|
Paragraphs 64-68
|
Opinion, argument, interpretation of
legislation, improper expert opinion and bootstrapping
|
Paragraphs 69-71
|
Hearsay and bootstrapping
|
Paragraph 72
|
Hearsay, argument, interpretation of
legislation and bootstrapping
|
Paragraph 73
(sentences 1 and 2)
|
Hearsay, argument and bootstrapping
|
Paragraph 74 (the
word “erroneously”)
|
Hearsay, argument, opinion and
bootstrapping
|
Paragraphs 75-77
|
Hearsay, argument, opinion and
bootstrapping
|
Paragraph 78
|
Opinion, argument, hearsay, improper
expert opinion and bootstrapping
|
Paragraph 79
|
Hearsay, argument and opinion
|
Paragraph 80
|
Hearsay and bootstrapping
|
Exhibits C, H, I, J,
K, N and O
|
Hearsay and bootstrapping
|
B. Affidavit
of Robin Marles, April 10, 2009
|
Reasons for
Striking
|
Exhibit P
|
Hearsay (not admissible to prove truth of
content), improper expert opinion and bootstrapping
|
C. Affidavit
of Robin Marles, October 7, 2008
|
Reasons for
Striking
|
Exhibit Q
|
Hearsay (not admissible to prove truth of
content) and improper expert opinion)
|
D. Affidavit
of John Arnason, October 7, 2008
|
Reasons for
Striking
|
Entire affidavit and
Exhibit B
|
Bootstrapping, hearsay and improper
expert opinion
|
E. Affidavit
of Robin Marles, January 30, 2012
|
Reasons for
Striking
|
Paragraphs 4 and 5
|
Argument
|
Paragraph 6
|
Argument, hearsay, opinion and improper
expert opinion
|
Paragraphs 7, 8 and 9
|
Hearsay, opinion and argument
|
Paragraph 10
|
Argument, opinion and bootstrapping
|
Paragraphs 11 and 12
|
Argument, hearsay and bootstrapping
|
Paragraphs 13-15
|
Hearsay, argument and opinion
|
Paragraph 16 and 17
|
Hearsay, bootstrapping, improper expert
opinion and argument
|
Paragraphs 18-20
|
Hearsay and argument
|
Paragraph 21
|
Hearsay, argument, improper expert
evidence and bootstrapping
|
Paragraphs 22 and 23
|
Hearsay, argument and opinion
|
Exhibits C and D
|
Hearsay
|
Exhibits E and F
|
Hearsay, improper expert opinion and
bootstrapping
|
F. Affidavit
of John Arnason, January 27, 2012
|
Reasons for Striking
|
Paragraphs 3-6
|
Bootstrapping and improper expert opinion
|
[153] As I indicate in my reasons, the essential facts for procedural
unfairness, incorrect statutory interpretation, unreasonableness and reasonable
apprehension of bias are clearly established in this case.
K.
Remedies
[154]
Remedies are problematic in this case. The usual
remedy for judicial review is to quash the decision at issue and to return the
matter for reconsideration by a differently constituted tribunal that will pay
attention to the reasons and avoid similar mistakes in its decision-making. It
is not clear that such an approach is even possible in the present case.
[155] Much of what I’ve said about reviewable error has focussed upon the
conduct of Dr. Marles, but Dr. Marles was supposed to be no more than a
scientific advisor in a whole system that had its recognized procedures and
checks and balances. That system did not function as it should have in this
case, and there is no evidence that it is likely to if this matter is returned
for reconsideration. As the record shows, the reconsideration that TWC went
through was far from impartial or fair. Information was deliberately withheld
from TWC, targets were moved, standards were changed and, despite promises,
personnel were involved who had given rise to the problems, thus preventing any
true independent assessment. TWC has not been able to market RESOLVE for eight
years while this dispute has dragged on, for no justifiable reason that I can
find. To simply return the matter for reconsideration to a system that has
shown itself to be so dysfunctional might simply plunge TWC back into the
quagmire and trigger more litigation.
[156] For these reasons, TWC argues that if reconsideration is ordered
then it should be conducted by an external panel whose compensation and
procedure will be agreed upon and settled by the Court or, alternatively, by
individuals within Health Canada who will be totally free of association with
the present dispute. TWC also requests detailed directions from the Court
concerning what facts and information, and what law, will govern the
reconsideration process.
[157] In my view, TWC’s suggestions in this regard are extremely
cumbersome and are likely to lead to further Court involvement as disputes
arise over the proper interpretation of the Court’s direction. Also, it is by
no means clear that totally independent people with the necessary
qualifications can be found within Health Canada, or that an independent panel
could be given the necessary authority under the governing legislation. This
Court cannot usurp the Minister’s legislative authority to administer the Act
and the NHP Regulations. So this approach looks like another
quagmire to me.
[158] On the other hand, the evidence before me in this application
suggests that there is really very little to be gained from ordering a full
reconsideration process. Both sides have been involved in a protracted and
bitter dispute and I see no point in directing reconsideration when the
evidence clearly established the following:
a) There are no outstanding safety concerns over RESOLVE. Health Canada accepts that the product is safe for its prescribed uses and we have Dr. Dutton’s
objective expert report that confirms this.
b) I have settled what I believe is the appropriate efficacy test under
the NHP Regulations and I have satisfied myself that information
submitted by TWC to support efficacy meets that test. If Health Canada disagrees with me then it can appeal this decision and the Federal Court of Appeal
will correct any mistakes I have made and direct accordingly. If Health Canada accepts my ruling on efficacy, then there is no efficacy dispute between the
parties.
c) As regards classification, there is evidence before me that the
Active Ingredient is an NHP. This evidence is found in the Mango article of
2005 that appeared in the Journal of Agricultural and Food Chemistry, a copy of
which was provided to Health Canada in Mr. Bukhari’s affidavit. Health Canada has not before questioned or objected to confirmation of what this article provides.
This is the journal that Dr. Arnason, Health Canada’s own expert says provides
the kind of standing needed in the circumstances. Hence, I cannot see how
Health Canada can disagree with its own expert and not accept the Mango article
as establishing the Active Ingredient as an NHP.
[159] In legal terms, what I am saying is that, on the evidence before me,
I see nothing that could justify withholding a PLA licence for RESOLVE, and
that the conditions for mandamus are satisfied. Under s 7 of the NHP
Regulations, the Minister “shall issue… a product
licence” if the conditions under ss (a) to (d) are satisfied. In my
view, those conditions are satisfied here and have been for some time, and yet
the Minister has refused to issue the licence. On the evidence before me, it
would be pointless to return this matter for further reconsideration and, given
the protracted and bitter nature of this dispute, I see no point in further
wasting public and private resources.
[160] This is not an interference with the legislative powers and
discretion given to the Minister under the legislation to ensure that NHPs are
safe and efficacious. If conditions change in the future and the Minister is
provided with new evidence that calls into question classification, safety or
efficacy, the Minister is free to take whatever action is necessary and
allowable under the statutory scheme.
L.
Costs
[161] TWC has asked for enhanced costs and feels that solicitor and client
costs are justified:
36. With respect to costs, TWC respectfully submits
that it should never have been put through the reconsideration process in the
first place. Nor should it have been required to prosecute these judicial
review proceedings. It asserts that the fundamental defects, including lack of
procedural fairness and functus officio, ought to have been obvious to
the Minister at the outset. Accordingly, the Minister should have immediately
rescinded both NORs and either granted the license or ordered a completely fresh
PLA assessment with all of the safeguards necessary to ensure that TWC received
a full and fair consideration of its license application and that appropriate standards
and tests were adopted in accordance with the Regulations. Instead, TWC was
subjected to multi-year reconsideration and Court proceedings which involved
continually moving goal posts and enormous expenses including expert fees. For
these reasons, TWC respectfully requests payment of all its costs for both
proceedings on a full indemnification basis.
[162] The Respondents naturally take a different view:
33. The award of costs is governed by Rules
400 and Tariff B according to the Federal Courts Rules. The Supreme
Court of Canada recognizes that full indemnification or solicitor – client
costs are awarded only on very rare occasions, for example when a party had
displayed reprehensible, scandalous or outrageous conduct. The Federal Court of
Appeal has found that because of the exceptional nature of solicitor – client
costs, a trial judge should generally provide some explanation as to why such
an award is made. The record does not demonstrate that the circumstances of
this case warrant such an exceptional award.
[footnote omitted]
[163] My own feeling is that TWC has been subjected to a dysfunctional
licensing process during the course of which normal and procedurally fair
safeguards were abandoned and Dr. Marles was allowed to pursue a course of
action aimed at denying a PLA licence to TWC on spurious grounds. Any safety
concerns with RESOLVE were put to rest in September 2008, when Health Canada
finally accepted that safety was not an issue. Health Canada was provided with
an article published in 2005 which was authoritative evidence (the Mango
article) that the Active Ingredient in RESOLVE occurs in nature and has not
sought to question the validity of that evidence in these proceedings. As
regards efficacy, Health Canada has provided no evidence that would suggest
that the high standard used to deny TWC a licence has ever been used before or
since, or that Health Canada truly believes that such a high standard is
required for an NHP. With some objectivity and supervision, any concerns that
arose under TWC’s original licence application either were resolved, or could
easily have been resolved, years ago. Instead, Health Canada has allowed
Dr. Marles, who was primarily responsible for the original problems and
who, as I have found, demonstrated a closed mind and a reasonable apprehension
of bias in his interventions in the PLA process, to in effect use the public
purse to defend his own conduct (by making himself the principal fact witness
in this case) which, in my view, should have been objectively assessed by
Health Canada itself. This has also put TWC to tremendous trouble and expense
to bring conduct before the Court that Health Canada should have questioned and
rectified instead of wasting public and private resources in a vain and
misguided attempt to further shore up inappropriate conduct by the officials
involved in dealing with TWC.
[164] As the Respondents point out, solicitor-client costs are awarded
only in exceptional circumstances. The jurisprudence tells us that such costs
should only be granted when a party or parties have demonstrated reprehensible,
scandalous or outrageous conduct. In this context, reprehensible behaviour
means acts deserving of censure or rebuke; scandalous means causing general
public outrage or indignation and outrageous means behaviour that is deeply
shocking, unacceptable, immoral and offensive: Louis Vuitton Malletier SA v
Singga Enterprises (Canada) Inc, 2011 FC 776 at para 56; Hamilton v Open
Window Bakery, 2004 SCC 9 at 26; Microsoft Corp v 9038-3746 Quebec Inc,
2007 FC 659 at para 16.
[165] Based on what is now before the Court, it can be said that Health
Canada engaged in behaviour that rises to the level of reprehensible. The
evidence that has been adduced has described incidents and actions on the part
of Health Canada that not only repeatedly denied TWC procedural fairness, but
also led to a protracted and convoluted dispute during which TWC was forced to
keep its product off the market, while incurring substantial costs as it
pursued reconsideration and judicial review.
[166] Health Canada strayed from its established processes, demonstrated
bias and pre-judgment and prevented TWC from ever fully comprehending the
standard to which its NHP was being held. Both the PLA and HHE processes were
carried out without TWC being permitted the ability to fully and fairly
participate and make its case for RESOLVE. This essentially disallowed a
reasonable decision from ever occurring. All of this should have been obvious
to Health Canada without the need for these judicial review proceedings.
[167] Here, the Respondents’ behaviour is worthy of rebuke and merits an
award of solicitor-client costs against them. However, I am dealing solely with
the judicial review application. I agree with TWC that it should never have
been required to prosecute these judicial review proceedings and that it should
be reimbursed for the costs of having to do so, on a full indemnity basis.