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11 · Wednesday, December 2, 2009 OAKVILLE BEAVER · www.oakvillebeaver.com Little chance cross-border patients will get refunds Record numbers of Ontarians are being sent to the U.S. by their government for routine health care that should be available at home. A Metroland Special Report shows thousands of others are funding their own medical treatments south of the border, at high personal cost. The numbers have been rising for the last 10 years. Government approvals for out-of-country health care funding are up 450 per cent. Should Ontarians have to use a passport to get health care? "People should be able to get the right care at the right time in the right setting from the right provider." Ontario Health Quality Council, 2009 report By Melinda Dalton, Joe Fantauzzi and Matthew Strader THIRD IN A THREE-PART SERIES former OHIP lawyer is calling for a new review of how Ontario handles out-of-country medical funding appeals, saying the court-like appeal board procedure leaves little chance patients will ever have their bills reimbursed. "People don't understand these hearings at the board are like a trial," said Perry Brodkin, adding that patients generally need to find a specialist to testify on their behalf. "If you don't, your appeal will be denied. Nobody tells anybody that." Brodkin, a Toronto lawyer who specializes in health law, was responding to Metroland's report on cross-border care, which shows a dramatic increase in OHIP spending for outof-country care. Last year, OHIP approved almost 12,000 out-of-Canada procedures, up 450 per cent from 2001. Long waits, lack of access to doctors and unavailable procedures are sending record numbers south. Thousands of Ontarians elect to go to the U.S. on their own, hoping to be reimbursed. Their appeals take place before the Health Services Appeal and Review Board, an independent body set up by the ministry to hear health appeals. Brodkin, OHIP's lawyer from 1973 to 1991, has a private health law practice that has assisted clients in appeals to the board, primarily by locating specialists who will testify on their behalf. But most people who appeal an OHIP decision to deny funds can't afford a lawyer and end up acting on their own, with limited knowledge of what is required to conduct a successful appeal, Brodkin says. Stuart Taylor of Hamilton has spent the last two years mounting his appeal for OHIP reimbursement of surgery for his son, Brandon, at the Laser Spine Institute in Florida. Their initial claim was denied because the Taylors didn't apply in advance for pre-approval and the use of lasers is considered experimental in Ontario. Taylor said his family doctor didn't know the procedure for out-of-country applications and he was told he could apply when he got home. He said he has been given no help in gathering the large amount of evidence required to prove his case and the appeal has consumed a big part of his life. "We won't win, I know that. They've just got it all stacked up against us," said Taylor, who remortgaged his house to pay for his son's $28,000 surgery. A JOHN RENNISON / METROLAND MEDIA GROUP PRIME EXAMPLE: One of Canada's most well-known cross-border care patients is Shona Holmes of Waterdown, who spent $95,000 US on brain surgery at the Mayo Clinic in Arizona. Her story later was used in U.S. TV ads against President Barack Obama's health care plan. "Mentally, I'd love to abandon it because it's dragging me down ... but I can't imagine (doing that) now after all this work." Two previous examinations of the OHIP out-of-country system have occurred in the past few years. A probe by the Ontario ombudsman into the case of Suzanne Aucoin, a St. Catharines woman denied funding for the chemotherapy drug, Erbitux, led the province to eventually reimburse Aucoin $75,000 and issue an apology. The ombudsman's probe caused the health ministry to order an independent review of the out-of-country care system in 2007. That three-month appraisal -- led by Mary Catherine Lindberg, a former assistant deputy health minister -- identified weaknesses and led to changes by the ministry. Now Brodkin says another review of the appeals process is in order: "I think the whole process needs to be looked at and reformed." Many Ontarians already know the healthcare stories of two well-known patients who have struggled for OHIP reimbursement and are now jointly suing the province. Shona Holmes of Waterdown and Lindsay McCreith of Newmarket elected to go south for what they believed was their only option given problems in Ontario. Long waits for MRIs and other diagnostics, poor access to doctors and unacceptable delays for some surgeries are, in fact, worrisome, says the 2009 report of the Ontario Health Quality Council, set up by the province to monitor the state of health care. There has been some progress, the coun- cil says, but the Ontario system is not meeting all needs. "People should be able to get the right care at the right time in the right setting from the right provider," the report says. McCreith and Holmes believe their rights to care were breached. Last month, McCreith lost his appeal to have OHIP repay the $27,600 US he spent in Buffalo in 2006 on brain cancer surgery. McCreith says he would have had to wait four months for an MRI and three months more to see a specialist if he had not gone south. Holmes -- who spent $95,000 US on brain surgery at the Mayo Clinic in Arizona -- became a darling of the U.S. Conservative movement when she agreed to be the face of U.S. TV ads against President Barack Obama's health care plan last spring. Holmes's comments that Canadian-style health care failed her set off a firestorm north of the border. That's partly because crossing the border to get U.S. care has for decades been regarded as taboo. But as waiting lists swelled, and access began to lag, out-of-country travel for medical care became more common, figures show. Natalie Mehra, a director of the Ontario Health Coalition, a public interest healthcare group, says she hopes the government's response will be to rebuild access to hospital services in the public system here. If the growth in out-of-country care continues, "I fear it will simply serve as fodder for the American media and the privateers in Canada," Mehra said. She was referring to the ongoing debate in the United States over how to provide health care, in which Holmes figured, and companies pushing for the right to offer Ontarians health care in a pay-for-service, private parallel system here. "That (private health care) would be not a solution at all, but in fact the dismantling of our public health care system." Nationwide opinion polls consistently show high levels of overall satisfaction with Canada's universal health care. Still, researchers are also finding disquiet over some of the system's vulnerable areas. More than 50 per cent of respondents cited concerns about wait times for treatment, a shortage of medical professionals or lack of government resources, according to a Nanos Research poll released this month. Critics say Ontario should fix the system here, and use the out-of-country approvals system exclusively for the reason it was set up -- to be a "safety net, allowing access to new, proven procedures and help fill gaps in provincial medical services," says a 2007 review of OHIP's out-of-country procedures.