“Who’s on First”, OTTAWA? PHYSICIANS – where are you?

January 2013

What is now clear, crystal clear, is that on June 30th 2012 Ottawa, specifically the Ministry of Citizenship and Immigration incompetently unleashed an unmitigated, unprecedented and staggering National health care disaster affecting many, many refugee claimants.

Confusion is now rampant among both providers and refugee claimants. Administrative stumbling blocks are everywhere for doctors trying to provide healthcare to this group of new arrivals. So bad is the design of the CIC changes, that one is led to reasonably question aloud the competence, or incompetence, of those we elect and trust to govern us with reason and intelligence.

What has also become crystal clear as we at the Volunteer Clinic sort through this mess, is that many physicians have much to answer for in this crisis.

Our clinic has been flooded these past few months with IFH covered refugee claimants, with valid IFH, rejected at the door of their doctor or walk in clinic, being asked now to pay for care up front. Many report being outright dumped by their family doctor who just a few months ago was giving them healthcare. These, and other refugee claimants hearing these horror stories within their community have simply given up, stopped looking for a family doctor. and started coming to us for care. One IFH covered refugee who comes to mind tried 7 physicians to find care for her pregnancy. Rejected by all, she came to us.

What is behind this? The new CIC rules have made Blue Cross (private insurer) the administrator of the refugee claims process. The CIC determines which refugee claimants have IFH, who has the Public Safety IFH category, and who has nothing. The CIC passes this information along to Blue Cross who keeps it a secret until the doctor has to call to determine the coverage the patient has.

No one bothers to tell the providers or the patient in any timely fashion ( and often never at all) if or when their IFH coverage changes. Any providers of care to a refugee claimant is now required to stop what they are doing ( in the ER, in their clinics, leave the patients they are seeing or make them wait longer, leave their care duties to others) get on the phone, and wait to ask a Blue Cross representative if their refugee claimant patient is covered. To receive an answer, this the provider must have the patients IFH documents, numbers, procedure codes. When I called last week, it took me half an hour to determine the eligibility for 5 patients. The provider must hire additional staff, at their personal expense for the privilege of conducting these inquiries.

And, get this, Blue Cross phone lines, and live attendants close out at 430 pm and are not available at any time on weekends! Many doctors are seeing patients well past this time. And get this – some refugee claimants actually get ill, have an injury or even deliver a baby, or visit the ER – are you ready for it – after 430 pm and before 830 am. How dare they! They even have been known to do it sometimes on a weekend!!

It gets better. If the provider learns the refugee claimant they are treating is covered with IFH, that authorization is valid only for that day. We are told to call back again tomorrow if we treat them at that time. Why? Because the MoH is reclassifying claimants, and not informing them or the doctor at that time. The doctor must call Blue Cross if the patient requires further treatment the next day, or any other day. An obstetrician could see a pregnant patient on a Monday, have the patient go into labour the next day at 5 pm and never be able to know if they are covered for the delivery.

After 430 pm or on a weekend, the doctor must stop their care to other patients, log into the CIC website, and try to find out if their patient is covered. The last time we tried this it took 3 of us half an hour and we still could not log in. It then took me 2 hours to arrange for a log in by phoning Blue Cross the next day, and I must wait 5 days for my new password to arrive. Apparently Blue Cross does not issue them on a Friday, and, they don’t work over the weekend.

I have instructed my refugee claimant patients to please refrain from getting sick over these 5 days, or on weekends.

One final problem. To be able to see refugee claimants with IFH, and be paid for the care they provide, all doctors must now register as a provider with Blue Cross. Are we surprised that most doctors have not registered? This is why most refugee claimants with IFH are being turned away by doctors, or worse being asked to pay cash up front for care. It is why they have given up even trying to see a doctor, and instead are flooding our Volunteer Clinic for the uninsured.

Where are the Provincial physician regulatory bodies in all this? Where is the OMA, the CMA, the Provincial Colleges of Physicians and Surgeons, the Canadian Medical Protective Association, the Ministry of Health, the LHINs, in this tragic mess? Why are they not “reminding” their physician members of their responsibilities to provide care to IFH patients? Why are they not leading the way when their members suddenly dump patients they have been caring for into the streets? Very clear policies governing the safe and ethical transfer of patient care exist. Policies exist and laws exist to prevent the denial of care to patients with this insurance. Why the silence?

And why are they not demanding the Government fix the mess they created?

And why has the Canadian Immigration Ministry, and in particular Mr Kenney been allowed to implement such stupid and ludicrous healthcare policies, all done without democratic oversight and safeguards? Utter chaos, amidst near insurmountable administrative barriers for providers is clearly creating an environment now trampling on the human rights to healthcare for Canada’s refugee claimants?

Make no mistake. Two things are very clear amidst all this mess. Both Mr Kenney, and some doctors have cut these already vulnerable refugee claimants new to Canada loose, to fend for themselves. And 50 % of those we treat are children and youth new to Canada. Someone is going to die.

Ontario’s Hypocrisy: 3 month wait for Health Insurance as harmful as Jason Kenney’s new rules.

Ontario Health Minister Deb Mathews has been busy criticizing Canadian Federal Immigration Minister, Jason Kenney. She doesn’t like that his ( and they are his ) new IFH rules leave thousands of Canadian refugee claimants without healthcare insurance. Minister Mathews is upset that this is a “download” of care that will cost MoH coffers.

We don’t like it either. Thousands of medically uninsured New Canadians hate it. They are the ones who are being physically and mentally harmed by it. And 20% are Children and Youth New to Canada.

So, Deb Mathews is right. But she is also being quite hypocritical. Ms Mathews is busy doing some serious “downloading” of her own. For over 10 years Ontario has not behaved any better – maybe worse actually. Ontario has forced hundreds of thousands of Canadian landed immigrants choosing it as their Port of Call to endure a 3 month wait for OHIP.

She and her Health Ministry quite conveniently “download” healthcare on these new Canadians themselves, and their nurses, doctors and others who are left to try to pick up the pieces . We know. Some of the landed immigrants return home because they cannot pay their hospital bills, leaving their dreams behind and broken forever. Others wrestle with huge bills – like the family of the 15 year old girl we had to admit to hospital in their 3 month wait when schizophrenia struck for the first time. That’s what schizophrenia does.

OK everyone step back – logs out of eyes, glass houses, throwing stones. As a wise leader once advised us all a long time ago, be careful about your righteousness  and anger Minister. Fix your own house first.

We are all hypocrites. It’s just a matter of degree.

National Disgrace: An Afghan child, his mother, a heartless Canadian “No”

Saaleh was 11 years old when he and his mother arrived in Canada from Afghanistan. They arrived here as legal, sanctioned immigrants. Saaleh’s father did not accompany them. He died in the war, murdered by the Taliban. Saaleh and his mother were sheltered by our soldiers and moved to safety. Saaleh is their only child.

When they arrived in Toronto they were welcomed by their neighbours. Knowing the circumstances, the neighbours got together and purchased a bike for Saaleh, a two wheeler, to welcome him. He was so excited to ride it, he fell off it.

The fall broke Saaleh’s arm. When we first treated him at the Volunteer Clinic, over a week had passed since the fall, without any treatment. His arm was now swollen to twice its size. It was red, inflamed and tender. He came in holding it on a pillow. Any movement was excruciating. Salaah was trying to hold back his tears.

As it turns out Saaleh and his mother sought care for his broken bones from their local community Hospital Emergency Room in Toronto a week earlier, on the day of the fracture. The arm was clearly broken and deformed. The ER triage informed Saaleh’s mother that Saaleh’s Ontario Health Insurance (OHIP) was not effective until 3 months after his arrival. His mother was told Saaleh’s fractured and deformed arm did not constitute “an emergency”. She was informed she needed to produce $500 up front before her son would be treated.

Not having the funds, they left, went home, and waited in their apartment – for a week. Saaleh’s mother told us she was too embarrassed to ask for help again, she couldn’t afford to pay for her son’s care and felt ashamed of that, and did not want to offend her new country. She feared they might be “sent back”. She could not bear the thought of putting Saaleh in harm’s way, again.

Saaleh was to attend school the day after his fracture, on the Monday. He didn’t. For a refugee child from a war zone, getting into school with his new friends is the best therapy of all.

Over the ensuing week, Saaleh’s pain and swelling became unbearable. That is when their worker told them about the Volunteer Clinic. We did not have the funds to pay for the ER and orthopedic care they needed. Our nurse and doctor took Saaleh and his mother to the ER. They knew the ER doc on duty. He got Saleh in the back door. X-rays were taken. A cast was applied, ironically by a healthcare worker who himself was a recent refugee claimant to Canada. There was no bill given.

Saaleh made a full recovery. When we took his cast off, he proudly kept it. All of his classmates had signed it.

If it was the job of a Canadian soldier to help Saaleh and his mother, to get him to safety, and if it was his mother’s job to get him away from the violence that claimed his father, and bring her only child to Canada for safety, then when they arrive here, it is our job when they are sick and injured -to help them. It is not our job to demand payment up front and when they can’t pay, send an 11 year old new Canadian boy with a broken arm home, untreated.

No. That is certainly not our job. Provincial and Federal policies  promote this and other cases like it. They make Canada an International disgrace on the human rights world stage. Healthcare organizations who are supposed to protect a refugee child from harm, and ensure he does not suffer needlessly, well….. there was another way.

An Afghan child survives a brutal war only to be put in greater harm’s way by the Nation he  adopted and asked for safety and sanctuary.

What has become of us?


From Forest to Farm (and tomorrow’s heroes).

November 22nd 2012

Forest to Farm is the name of a fascinating book. It describes how new Canadians, in the early 1800’s arrived from England, Scotland, Ireland and some regions of Europe into Upper Canada to start a new life. They were given 50 acre parcels of land, mostly dense old growth forest. Handed a pick and shovel, when they cleared those 50 acres, they were given 50 more to clear. They cared for their new home that cared for them.

This story was repeated all across Canada.

Last week driving across Canada in November, minus 30 degree temperatures and 40 cm of snow on the prairies closed the Trans Canada Highway. Looking out the motel window I could only wonder what it was these pioneers were leaving, what was it that made them to come to this frozen land, to see this as a better place, a brighter future?

The answer of course is mixed. Some were leaving debt, many more were leaving conflict, famine, poverty, religious and other persecution. It was freedom they sought, a better life for their children, the chance for security from their hard efforts.

Have things changed? Have we?

In a recent clinic we treated Priya, a pregnant patient and her family from South Asia. There, the family was threatened with death because they changed religions. The children were threatened with kidnapping and death. Other children in their neighbourhood have been kidnapped, and never seen again.

So, they did what our heroes from the 1800’s did. They left their unsafe country and came to Canada, seeking the same safety. They have effective IFH medical coverage until their refugee hearing. Priya has diabetes and needs help with the pregnancy. Many doctors turned them down because they had IFH. This discrimination is all too common. It is worse since June 30th 2012. Others ignored the IFH and never even made the inquiry to determine if they were covered.  Several physicians demanded up front money before seeing them. One doctor, a specialist, a very special doctor took them in and cared for them, then referred them to us for ongoing care.

Canadians often look back fondly, and with reverence on those earlier newcomers to Canada from the 1800’s. We regard them as heros who left their homelands and enriched and built  ours. They braved the elements. We are all connected to somewhere else.

Priya, her husband and two children were hard not to like as they waited patiently in the clinic with their two young children. It was late before we could get to them. Both girls waited quietly at their parents side. Their father has already taken under the table work – not clearing 50 acres of land and then another 50, but clearing 50 dirty dishes and washing them, and then clearing 50 more. He was an engineer back home. Just like in the 1800s, he is doing the work we won’t.

How different then is he, his family from those earlier hero pioneers we reminisce on? When his wife needs a doctor for her pregnancy, why won’t many of us accept Priya for care?

She is tomorrow’s hero.


Some Physicians have much to answer for in this sordid mess!

November 20, 2012 ( updated Nov 21, 2012)

This evening’s uninsured free clinic brought clarity to confusion, and more confusion.

More refugee claimants denied access to care by family doctors. This failure to provide care because of only a “perceived” lack of IFH insurance, is stunning. It is unacceptable professional irresponsibility.

One patient had chest pain and valid IFH. Another, a child of 7 with a cleft lip and palate that had become infected, had valid IFH. Another, a 28 year old diabetic is 10 weeks pregnant. Her 2 children were with her tonight. She lost her last pregnancy, and her unborn child, due to high blood pressure at 5 months gestation, brought on by religious violence and threats to kidnap and kill her family in an Asian country.

They fled to Canada and were provided with IFH upon their refugee claim. That IFH is valid. The IFH of all the above persons is valid.

So why did they all come to a free volunteer clinic for medical care? They can get care from other family doctors, right. Apparently not.

The family of the pregnant diabetic lady tried 8 family physician offices in the past 48 hours, seeking medical care. They were turned down by all. At several of the offices they were told to pay $50 up front if they wanted care.  This is in spite of having valid IFH medical coverage. Extra billing is illegal.

No one checked their IFH papers. None of the doctors bothered to call Blue Cross to determine if the IFH coverage was valid. It was.

Here is what we are now seeing.  Patients, refugee claimants new to Canada with medically urgent problems, with valid IFH medical coverage, are being denied care and in some cases asked to pay more, by area family doctors who refuse to undertake their care because of the confusion and additional paper work the new IFH – Blue Cross – CIC created. We also experience horrible problems obtaining their prior files. Physicians who drop their care then charge them for care, and the file transfer to us so we can care for them.

The Ontario Medical Association, The College of Physicians and Surgeons of Ontario and The College of Family Physicians of Canada should strongly remind their members of their professional responsibilities when it comes to refusing care, safely and professionally transferring community care of their ill patients, and charging money in these cases for care and chart transfer when the physician refuses care.

The CIC and Mr Kenney should issue statements that once and for all clear up the confusing mess their ill conceived policies and mis-managed roll out have created.

Preferably before another medically uninsured someone is injured, or dies.



Just Tell us the Truth

November 15, 2012

As Canadian citizens, at whose behest you serve, we are owed that by our Governments.

This is not a diary story. But it explains why we have so many new refugee diaries. It verifies what we have all suspected and have been saying. Finally someone who knows has admitted that the cuts to refugee healthcare were made” behind closed doors”, without consultation, minus the democracy. The following appeared in the Ottawa citizen in November 2012

OTTAWA —  A controversial decision to strip certain refugee claimants of supplementary health benefits was apparently made behind closed doors without consultation, the government now admits.

Rick Dykstra, the parliamentary secretary to Immigration Minister Jason Kenney, revealed this week that the cuts were actually part of the government’s budget tabled in March. But because budget deliberations are subject to secrecy, there was no option to get input from stakeholders, many of whom have vocally opposed the decision.”

Refugee claimant health, their lives, are now secret  “budget items”.

This is now how Canada is governed. It is how social justice and our values as a Nation are determined, for us. If we let this go by, we let everything go by. The Liberal and NDP Immigration critics had the following to say….

“At the end of the day, the minister of immigration, who failed on this whole issue and should listen to what all the stakeholders are saying and admit that he screwed up quite frankly, he didn’t do any consultation. And now he tries to pass on that he couldn’t do it because it was part of the budget? That is nothing but a cop-out. He had a moral responsibility to do some homework on this.”

NDP immigration critic Jinny Sims said she was told the policy change had nothing to do with the budget and suggested the late-day excuse is another example of “a government that is making it up as they go along.”

“There is too much power that is vested into this minister so that he avoids parliamentary oversight and parliamentary discussion and I would  say Canadian oversight over the decisions he makes,” she said.

“It’s become very clear they have not thought through the real impact of the changes they are making and then they end up having to make this kind of Monty Pythonish argument that they’re making right now.”

Why did the Conservatives do it this way? Why the secrecy? Two reasons. Because they could, and because they knew any other route would not pass the smell test, and would not produce their desired result.

The more painful question is – why are we letting them?

Read more: http://www.canada.com/Refugee+health+cuts+hidden+budget+bill+immune+from+scrutiny/7526456/story.html#ixzz2BpFC6rKX

“Your Money or Your Life” – as a taxpayer….

November 10th, 2012 ( updated November 14th)

We often hear the argument — “We can’t expect Canadian taxpayers to pay for healthcare for uninsured New Canadians”. Jason Kenney, on the I channel Documentary “Your Money or Your Life” repeated this argument. He went so far as to label New Canadians who expect differently, as “irresponsible”.

Who qualifies as a taxpayer?

Does arriving in Canada and buying a chocolate bar, where 15% of the purchase is a tax, qualify one as a taxpayer? No? How about purchasing a pair of winter boots to fend off the snow, and a winter coat and pair of gloves to fend off the cold winds of their new land?  Each item has a 15% tax applied to it — tax dollars that go to support a healthcare system “Canadian taxpayers” access, but that New Canadians are denied access to.

We find the “taxpayer” argument, and Mr Kenney’s comments, ringing hollow.

Still not convinced? If a New Canadian works in a Nursing Home after arriving, and is in the 3 month wait for healthcare, and takes a job cleaning the latrines of our parent’s room in a Nursing Home, cleaning up their faeces, and paying taxes from their minimum wage – would that be enough to convince the majority of Canadians they should receive healthcare when they get an infection from this work?

That was Theresa’s job when she arrived from Bangladesh – cleaning our, our parent’s and family member’s excrement from toilets. That was when her illness struck. She was forced to go off work, unable to afford healthcare. Theresa is now a Canadian Citizen. All this happened 13 years ago, when our clinic first started. Theresa still works in that same Nursing Home, still taking care of our family and loved ones.

The Ontario Government is responsible for the policy that places thousands just like Theresa in harm’s way. Mr. Kenney is the current Current Minister of Citizenship and Immigration in Canada. He stated that taxpayers should not have helped persons like Theresa get healthcare. He has defined Theresa, and others just like her, as “irresponsible”.




So, can anyone donate $6000 to help?

November 1st 2011.

Adya is 34 years old. She arrived in Canada, on a work permit, in 2008. She had a job offer, and was employed from the outset as a nanny in Toronto. She worked continuously, for several consecutive employers, until February 2012.

That comes to 4 years of working, paying taxes, in Canada, in Toronto, legally.

When her employer noticed, in February, that Adya was pregnant (she started to “show”), they suddenly no longer “needed her services”. They let her go. Out of work, in Toronto, meant that Ontario cut Adya off from her heath coverage ( OHIP).

So, out of work, and out of money for healthcare, for pregnancy care, Adya went from February 2012, to October 2012, until she was 35 weeks, without any pregnancy care. She couch surfed. She had inadequate funds for food. Her nutrition suffered.

So did that of her as yet unborn child, and Canadian citizen.

Adya will likely need a C- Section. As her doctors, we are being asked to pay for her operation and care. We are a volunteer frontline group of healthcare workers. We cannot afford to, nor should we be asked to.

When did these extreme views on compassion and healthcare enter Canadian “social justice”? When did Ontario falter and loose its way? Do a majority of reasonable, fair minded Canadians actually believe in these extreme policies? Do they believe what is happening to Adya, and her unborn is acceptable? Do we believe Ontario cannot correct this?

We are hoping for a positive pregnancy outcome for Adya, her baby, and Canada.


The Rant by Levant. We have a question? What should we do?

October 16th, 2012 — The Scarborough Volunteer Clinic

Last night we met Miklos in clinic. Yes, he is Hungarian. That immediately makes him the target of hateful rants from the likes of Ezra LeRant (aka Ezra Levant – Sun Media Sept 17th 2012), and the focus of negativity in Canada, with the release of CIC statistics on Hungary (Roma), and other refugee claimants.

Miklos arrived in Canada with his wife Ilona, seeking refugee status. Miklos’ wife received inadequate prenatal care in the EU. They lived in poverty, without adequate healthcare access. They lost their children in childbirth.

Miklos is not his real name. Same for Ilona. Our aim is to prevent any backlash against them as their refugee claim is heard. We realize Mr Kenney, thru his CIC spokesperson has attacked us and others for this policy, suggesting we ( health providers) are making this stuff up – but so be it. We have good reason to protect refugee claimants.

As we have pointed out unattended pregnancies result in maternal and infant death 7 times more frequently than those with proper healthcare. After the deaths of their newborn, Miklos was attacked and beaten up by Neo Nazi Arian thugs while living in the EU. He suffered severe concussions and brian injuries.  He developed epileptic seizures. He and his wife had enough. They sought safety and asylum in Canada. Miklos and Ilona were living a “safe country”, a DCO at the time of the beatings. Mr Kenney is about to lead Canada on a DCO journey of his own ( CIC WEBSITE)

Miklos works underground supporting an economy we all enjoy. He works at dangerous jobs, for less than minimum wage –  construction, moving jobs, anything to support the family. He works despite his seizures.

A month ago Miklos developed chest pains. He sought medical care. When they arrived in Canada 2 years ago Miklos and Ilona were granted legal status here, with Interim Federal Health Care for medically necessary problems while awaiting their hearing. Last time we looked, chest pain was a medically necessary condition?

Miklos and Ilona attended the clinic where they had been receiving care. But this time, they were told their IFH was no longer valid. They would have to pay to be assessed and treated. Somewhere, someone at a desk had reclassified them without so much as a word.

At our clinic we determined Miklos’ symptoms signalled a potential life threatening problem. He needed access to healthcare as soon as possible. He could not afford this.

Ilona and Miklos are in Canada legally, waiting a long time for their refugee hearing. Whose fault is that? As Canada drags its heels, they drag refugee claimants like Miklos and Ilona and others through life threatening circumstances, and cut their access to life saving healthcare.

What would Canada like its health providers to do here? How should we respond? Should we follow the CIC’s lead? Should we allow Miklos to go untreated, let him have his heart attack on the streets of Canada while the Government cuts his access to healthcare? And what would Canadian’s think of their own doctor or nurse, if they could do that?

Miklos was beaten with steel pipes by the same Neo Nazi Arian type thugs who in the recent past sent countless Jews and others to their innocent deaths, as they begged the world and us for help and safety. Mr Levant of all people, of all peoples, should know better. He should know the perils of promoting hatred by one race against another, by one group against another. The Canadian Government should be very careful if they are to focus their nation’s attention on racial and cultural groups seeking our help and suggest they are “bogus”. This can go nowhere good.  It has been tried before. Turns out to be quite a bad idea. The new policies of Citizenship and Immigration Canada, that put the most vulnerable of asylum seekers in harm’s way to fend for themselves, have no place in Canada, or any compassionate nation. Ditto for the Rant by LeVant.

Thank you Mr Farber for eloquently pointing this out.

Again, Miklos and Ilona are in Canada legally. When they are ill, with life threatening conditions, awaiting their fair hearing, Canada has a responsibility to respond humanely and effectively. How hard can that be?

Instead, Miklos faces the possibility of an avoidable heart attack, in Canada, a country he asked for help.



“She is covered – Today”.

That was the reply from Blue Cross when we called last week to see if we could arrange medically necessary pregnancy care investigations for Anna. She is a refugee claimant dating before Mr Kenney’s Orders in Council. She still carried, and showed us what she thought were still “valid” IFH papers. Anna is delivering a baby soon. The word “Today” caught our nurse’s attention. It is the first time we have heard it used when we call to find out who is covered for what under new IFH classifications. This was a first, and all very new to us.

None of us had the heart to tell Anna her papers, with Canada stamped proudly across them, were no longer worth the paper they were written on. Any day now, she was going to be “re-classified”, just like so many others refugee claimants we treat.

Our nurse asked what “Today” meant? It meant we must call again, tomorrow, to check if her eligibility to IFH has been reduced, cut, if she has been “reclassified”. And it means call again in 2 days when Anna’s tests are scheduled. It means we must call Blue Cross daily to see if her IFH coverage status has been cut. The reason, according to Blue Cross is because Citizenship and Immigration Canada is reclassifying the IFH status of many refugee claimants who are waiting their refugee hearings. CIC is moving through a long list, and Anna’s number could be up at anytime. We have no idea who is being reclassified, why, or on what criteria? Neither the patient nor their doctor are privy to what information is being obtained and how it used to reclassify?

If our government can do this, behind closed doors to refugee claimants such as Anna – what can they do to any one of use, whenever they choose?

It would now seem when Canada makes a promise, it isn’t worth the paper its written on.