February, 2013

Last evenings clinic was super busy with uninsured refugees, refugee claimants, sponsored persons, landed immigrants in the 3 month wait, and several new categories of uninsured we don’t understand. (In case it matters to Mr Kenny, not one of our 21 patients last night was Roma)

Mr Kenney has claimed that he does not want refugee claimants “taking us for suckers” and getting “better care benefits” than Canadians. I know he said it because I watched him stand up in our Parliament and say it. He claims Refugees got better care than Canadians before he beat his chest and introduced his IFH “reforms” He did what he did to ensure it wasn’t so, and look like Captain Canada and protect us all. Hogwash and hyperbole (thanks for that word).

The fact is is, IFH was never like that, never better than what Canadians receive. We know, because we work in the system on the front lines, daily. Another fact – no one ( not even the CVC team) wants or expects new Canadians to get “better care” than others. No one is asking for that. Mr Kenney is stooping to scapegoating, story telling and silly spin. Plain and simple – the facts don’t support Mr Kenny.

You judge.

* some refugees with valid IFH have had it reclassified and cut, without explanation or their knowing. We checked at Blue Cross. Sorry, it’s true.

*  a refugee claimant fleeing Mr Charles McArthur Ghankay Taylor’s Liberian brutality (he witnessed his brother’s beheading by Taylor’s thugs outside their house) is stripped of IFH after his Canadian failed hearing. He “was not in danger”. He is allowed to work in Canada while appealing. he takes a job, he pays taxes for 5 years, taxes that pay for our healthcare, but he is denied any healthcare coverage when he is ill. He has a hospital bill for over $10,000 for his medical emergency.

* another refugee claimant fleeing Mexico’s drug cartel violence, where his teenage female children who were kidnapped for ransom, is turned down for IFH when our refugee board decides they are not in danger in Mexico. Their claims, while true, are “not severe enough”. They live in a shelter in Toronto now, in one room, trying get the $3000 for the appeal. The girls go to school in Toronto. The man wants to work. He is told by Canada that if he works, he will be deported before his appeals are heard. He works under the table as a mover – no protection. He became ill on the job. He came to clinic.

*  doctors who treat an IFH refugee face a Blue Cross and CIC tangled web of appalling bureaucratic obstacles that take an hour to navigate. They turn down the patient unless the patient can provide $50 for an appointment.

* IFH, when given, is for much shorter periods of time. Expiry dates come quickly. Reapplication takes months, is tangled and costly, often requiring a lawyer, and leaves the refugee uninsured and impoverished. Is this incompetence, or planned?

* refugee claimants at the point of Canadian entry describe being told by border officials not to apply for IFH. In the past when they apply at the Border at entry, which is Canadian law that they do so, they receive IFH there. They are now being mislead. They are told not to apply for refugee status at their Canadian entry point. Rather they are told to go to an immigration office and apply once in Canada . They then find out this means they will have to wait at least 6 weeks for their IFH to be approved, rather than get it at the time of entry. This happened to a Nigerian refugee claimant, 39 weeks pregnant, who had to flee to protect her 12 year daughter from Female Genital Mutilation ( Circumcision). Her first child bled to death after the same abusive “surgery”. The delay in her IFH resulted in a $4000 bill for the delivery, and over a month of uninsured status for the newborn – a Canadian now!

* when a refugee claimant with an IFH paper presented to clinic recently with uncontrolled diabetes, Blue Cross was closed. She became ill after 430 pm when Blue Cross closes for the day. When we went on line to check her IFH status  she needed the ER), the Blue Cross Web site failed to function, and failed to let us check her health coverage. She had tried 7 clinics, all of whom turned her down for care. Did I mention she was pregnant??

* One time we called Blue Cross and even though the refugee claimant had IFH coverage, we were unable to give care because, according to Blue Cross we didn’t know the valid diagnostic code for her condition ( Blue Cross knew). It took us 2 weeks before we could refer her for care for a facial deforming lesion.

* Once we called Blue Cross for an IFH patient and were told she was covered – today. We were informed that every time she presented for care we would have to call back, present diagnostic codes, and see if she was still covered on that that day. The time consumption, the added staff needed is prohibitive to most family doctors and nurse practitioners. These stumbling blocks severely impair our efficiency to see patients, maintain system through put.

Does this sound like the healthcare system and level of care you receive? Do these patients sound like they are taking us for suckers?

January 25th 2013

The voices grow louder. They grow in numbers and strength. The efforts of CIC ( Kenney, Pavlich) to marginalize and vilify Canadian doctors and nurses speaking up, are as predicted, failing. The truth is a wonderful value. Besides never having to remember what you said, it has a reassuring way of always coming out.

“Refugees in Canada have poorer access to health care than in refugee camps” 

http://www.thestar.com/opinion/editorialopinion/article/1317272–refugees-in-canada-have-poorer-access-to-health-care-than-in-refugee-camps

January 2013

FJ arrived in Canada 8 years ago from a nation with a brutal war crime President. All he asked for was refugee status and a chance to work and call Canada home. He was denied refugee status, got a chance to work, and still, after 8 years has no eligibility to Provincial or Federal Health coverage in Canada. He pays for a system he can’t use.

FJ came to the Volunteer Clinic this past week. He had a common condition, quite treatable, that had reached a life threatening level, that was otherwise totally preventable. For 8 years he has worked steadily, with a work permit. For 8 years he has faithfully paid his taxes and dues. For 8 years he has been denied OHIP or IFH.

We had no choice. He was sent to the hospital for care. Now, he will have a very large bill. His journey to freedom and safety as a refugee will be delayed and obstructed, again.

It is impossible to have any faith in our immigration and healthcare system for refugees at either the Federal or Provincial levels. Totally impossible. What a mess. A mess that can and will kill.

January 2013

S.Y. came to Ontario as a sponsored person, to be with her husband and children in Ontario. She arrived in 2011. A year later she discovered a breast lump. You guessed it. It is breast cancer.

As you read further, keep in mind that since 2004 her husband has been working and paying taxes in Ontario, Canada.

This sad story begins 8 years earlier. S.Y.’s husband was granted Landed Immigrant status in Canada in 2004. Shortly after arriving in Canada he landed a job cleaning in a hospital in Ontario. A year later, in 2005, he was permitted to bring his 2 children here as Landed Immigrants. This did not include his wife, their mother S.Y. The reasons are unknown.

In 2011 S.Y. was allowed to come to Canada. She was denied Landed Immigrant status. We do not know why?  Instead, the mother of their children, 48 year old S.Y. was allowed to enter Canada ONLY if her husband, on his Hospital Cleaning salary, agreed to sign documents promising he would pay any and all costs for her life in Canada. This is called a “sponsorship class” by Citizenship and Immigration Canada. His promise included paying “all” medical / hospital bills.

One of their children is in grade school. The other attends University here. His father helps pay his tuition, using his income as a cleaner at a healthcare location that treats our aging parents.

The father was true to his promise, until his money ran out. When his wife S.Y. found her breast lump, he paid over $3000 in health care bills to have the lump removed and biopsied. It was cancer. Unfortunately there is now a second surgery required. This one will cost $5000. The cancer was not totally removed during the first surgery

If S.Y. is to have any hope of seeing her son graduate from University, she will need chemo-therapy and radiation after surgery. The costs may approach $60,000, maybe more. The family has spent all their money on healthcare, already.

Mr McGuinty, Ms Mathews – you didn’t really mean her husband had to go bankrupt, sell his small house, and return to his homeland to keep his promise, and save his wife’s life? Did you?

I bet you are better than that.

January 2013

Again tonight, more refugee claimants with valid IFH arrived seeking healthcare. Again, tonight, at Clinic, our volunteer doctors and nurses treated frightened, confused, refugee claimants with valid IFH documents, denied care at GTA doctor’s offices. Why?

This happens every clinic. In our last entry we called on GTA doctors to “sign up” for their patient’s sakes. We must respond professionally. Please sign on to be an IFH provider with Blue Cross, before Mr Kenney is allowed to maim someone, or end a life.

Mr Kenney, and the Federal Conservatives are clearly the problem. The real stumbling blocks have been calculatingly imposed by Mr Kenney (minus the democratic process). It is a “new” but unusable and failed IFH Program for Refugee Claimants. Implementing an IFH healthcare system that impedes and harasses healthcare providers in  doing their work, and injects fear and confusion into the souls of our New Arrivals, is not stupidity. It is planned. Our entry yesterday is long. It is long because it takes that much space to recount the stumbling blocks placed by Mr Kenney. There is a famous quote …..

  “Woe to that man through whom the stumbling block comes”.

Is designing a healthcare system that deceives, and denies refugee children and their parents urgent healthcare, a system that impedes doctors and nurses from providing care to Canadian refugee children, a “stumbling block”? We think it is.

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.