1) Doctors, 2)The Immigration and Refugee Board – what is going on out there?

Clinic March 28th 2013

A refugee claimant with valid IFH sees us for a 2nd degree burn, He has a family doctor. He has IFH coverage for the burn. So why did he come to the volunteer clinic where we only treat the uninsured? His doctor will not use the IFH system. He demands $60 ( almost twice the OHIP rate) from his patient to just assess the burn. That doesn’t cover any treatment. The young refugee claimant leaves without treatment. He can’t afford it. He works at a low paying job under the table. He has been dressing the wound himself for 4 days. He needs help.

We wonder if his doctor is breaking the law? Can a doctor refuse a valid IFH patient by charging them before providing care for a burn? Apparently he can. We know the doctor is breaking ethical standards. Is he breaching professional standards? The CPSO and the OMA need to step in and provide guidance here. I even found myself wondering if some doctors bill patients, and then IFH? I don’t even want to go there.

A failed refugee claimant, a young woman sees us because she had a seizure, fell and hurt her shoulder. Her partner became angry at her and slammed onto the chair. That dislocated and fractured her shoulder. She sought care at a Toronto ER for the pain. She was told their was serious damage needing surgery. She did not have the money for the surgery. She was sent to a local shelter with a broken and dislocated shoulder, in pain, with a bill for over $1500. She can’t sleep on the shoulder. Her arm hangs limp at her side, withered by a prior gunshot injury. She is crying with pain. As she removed her shirt for us to examine her, the shoulder suddenly and completely dislocated. She wrenched in pain. She wrenched again when we reduced her dislocation. She asked us to do it because she cannot afford another ER visit.  Her interpreter told me it happens every day. The patient fixes the dislocations herself. She tried a friends pain killer in desperation. It made her drowsy and sick. Her shoulder was first damaged in her own country when she was 8. She was shot in the head and the shoulder in a violent attack on her home when she was a child. Her seizures stated after the bullet hit her brain. She came to Canada at age 28 to be with her uncles in Toronto and work towards status. After a few years her uncles were denied status and left. She stayed behind and made a claim for refugee status. She was afraid to go back to her country, and wanted to better her life. The Refugee Board judge denied her claim and her goals. She is trying to appeal. This is costly. She needs surgery on her shoulder. This is costlier.

She came for help with the pain tonight, so she could sleep, and stop the seizures. We will see what we can do.



Or maybe still…..

Many family docs are not registered with Blue Cross. About half, from what I can tell. Registering is very time consuming. Navigating the website once registered, is even more time consuming. Determining if your patient is covered for care, on what day – well.

Docs are at their computers while patients are turned down for an appointment. Let’s see how that might work?

“Sorry Mrs so and so, No, Dr XYZ can’t see you for your abdominal pain this afternoon. Why not? Because is he is too busy on the computer trying to check the IFH status of his IFH patients”.

Really? Not happening.

So, some docs ( including those at the CVC who volunteer their evenings) are seeing IFH patient and not charging the FEDS because they can’t manage this nonsense  They are giving the Feds, and Blue Cross a bunch of freebies. Why?

Blue Cross and the Feds have made a point of designing an obstacle course for an IFH  program.

We learned that Quebec has been covering some IFH patients at the point of care to prevent a delay and a tragedy in an urgent care situation. They simply pick up the tab, and  pay the tests, and doctor for the care provided. Again, another freebie for the FEDS, unless the FEDS or Blue Cross are reimbursing Quebec?

No one can tell us if they are. If anyone has information on this, please let us know.

If they are not, the FEDS are “mooching” again. At the CVC, we know what that feels like.

Or maybe……

Or maybe, just possibly, our patient with the disfiguring facial lesion was IFH covered when we called to affirm, but by the time we could get her facial deformity repaired, someone, somewhere had changed and downgraded her IFH coverage, but informed no one?

Maybe we will be pleasantly surprised when we learn it was a simple computer foul up, and we can get or funds back?

As for the here and now, we and our patients are out over 350 very valuable bucks, money gone to supporting the profits of Blue Cross.

350 bucks – not that much? Some one donated it. That same person earned it. They paid taxes on it. And it can pay for 6 pregnancy ultrasounds.

It is impossible to describe the outrage we are feeling right now.


Is this stuff legal?? Or is it “bogus”

Clinic,  March 22nd, 2012

A few months ago, a refugee claimant with a disfiguring facial abnormality sought care at the clinic. It happened after she arrived here.

When we called Blue Cross in February 2013, we were told she was covered for IFH, but we needed to tell them the diagnoses. The disfiguring lesion on the Right side of her face had grown large enough rapidly that it reached a size where it was obscuring her vision, disfiguring her face.

Blue Cross did not accept our diagnoses. They wanted more. We provided more.

Finally, In the end, we could not wait any more. A plastic surgeon removed the cyst, restored her full field of vision, and her appearance, and the CVC used some funds we raised to help her.

Now, there is a bill. We hoped Blue Cross would come through after the fact, honour their IFH.

When we called Blue Cross, they told us this patient was no longer identifiable in their system.

Let me see if I have this right? We call. Our patient has coverage. We send her for the out patient surgery. We call for the payment to submit the fee. Blue Cross can’t find her in their “system” any more.

Hmmm. Funny that.

I remember that once I called my car insurance company to inquire what would happen to my issuance rates if I claimed a fender bender. I decided that because my rates would go up, I would take care of the repair costs myself. A year later my insurance rates rose anyways – because I called.

Funny that. But then again, who among us really likes or trusts Insurance companies?

Come to think of it, why is healthcare in Canada now being placed in the hands of a private insurer? Is that legal? Does it not contravene the Canada Health Act? Why should we be surprised by obstruction and claim problems.

That’s what private insurers do. That is why Canadians don’t want their healthcare payments and system in the hands of for profit private insurers.

Mr Kenney constantly repeats his message that bogus refugee claimants are taking Canadians for suckers. That is what politicians do, until we all believe that their message is true, or we turf them.

Maybe the Blue Cross system he designed is bogus?

Maybe Blue Cross really did have another computer foul up? Goodness knows we have had enough in our case. For us, it’s just “one glitch after another” with Blue Cross. We don’t trust a bloody soul at CIC or Blue Cross anymore – not a bloody soul.

We covered the bill on behalf of the patient – not the Conservatives.




A man’s coat on a small boy.

CVC – pre 2012

Shahameer was 5 when one evening, his mother brought him to the CVC. I remember how sweet and cute he was. His face was gorgeous, nothing but smiles, mopped in shining black hair. They had arrived without status, refugee claimants, Shahameer and his mother. When they came to the CVC, Shahameer had no health coverage, no IFH, nothing.

Then I noticed he was wearing a mans trench coat, far too big for his small 5 year old frame. Our clinic nurse Jennifer explained it was to mask his “deformity”.

As it turned out this little boy from Pakistan had been burned. He was playing, as 5 year olds do, with his friends, in the slums of Karachi. He and his friends had the misfortune to choose a play area where 2 religious groups decided to stage a fight – with real weapons, real firebombs. One of these was thrown at Shahameer because he was known to be from a family of the “wrong “religion. The Molotov cocktail exploded beside him. The young boy suffered 3rd degree burns.

Because he had no care available in Pakistan, his wounds fostered and fused. His chest adhered to his hip because he lay in a bed, bent over by the burns. When the wounds “healed”, Shahameer’s chest was bound to his hip, and Shahameer was bet over and deformed, as a result.

His mother brought him to Canada, first to protect him form more of man’s inhumanity to fell child, and secondly, to see if there might be treatment to help her son stand straight again.

Canada’s “response” to this 5 year old refugee from hell was to make him wait further for any kind of healthcare or assistance.

That is when, in a man’s trench coat designed to hide his deformity, Shahameer came to our clinic, to our attention.

The happy ending here, is that plastic surgeons at Toronto’s Hospital for Sick Children accepted our referral – pro bono. They operated and helped Shahameer stand tall, again.

We never saw this young man again. We took that as a good sign. We have often wondered what he must look like, now. We wonder what became of him, after Sick Kids stepped in.

Not all our cases, all our stories have this reassuring outcome. Endings, or beginnings like this are too often, too rare.

I bet Shah is a proud Canadian about now? He must be just about finishing High School, or entering University. I wonder what he will do next?







A bill for kindness. Imagine that!

The CVC (pre June 2012)

Mr S was handsome young man from Sri Lanka. He was 20, tall, lean, well groomed and patient as he waited in clinic. It struck me that he waited standing up, for over an hour. There were open chairs in our waiting area. It was then I noticed his right pant leg hung at his side, empty.

He was denied IFH as a refugee claimant, and denied OHIP. He was now being sponsored. He had no health coverage when he suddenly experienced a grand mal seizure the week before. He never had seizures before. He was treated in the ER, then handed a bill for over $1000.

He didn’t come to us for help with the bill. He came because he needed an MRI to determine why he had the seizure. The MRI would cost $2000. The ER offered it then, but he couldn’t afford it. The ER sent him to us.

The CVC arranged for the MRI. It showed a brain access from a deadly infection. He died within 2 months.

During our efforts to treat him, we learned how his pant leg came to be empty. He was, you see, a rescue worker during the Sri Lankan civil war. He was a volunteer with an aid organization that rescued children from heavily land mined areas. Imagine that!

Mr S volunteered, with others, to carry children, in his arms, across land mine laden fields, to safety. First, they swept the fields. Then they carefully ferried the children across to safety. One time, on one particular trip, he lost his leg.

It shamed us that his refugee claim was denied in Canada – that he experienced rejection from people who will never do what he did, by someone paid well, to reject him.

It shamed us that when he had a seizure, Canada handed him a bill.

It shamed us that no one found it within them to get him an MRI.

It saddened us deeply when he died.


“Undesirables” ?

Mr Kenney is adored, and “undesirables” need not show up, ( Toronto Star Feb 2013)

In 2000, a young couple arrived in Canada. Shortly after, they came to the CVC. We still know them, well.

Some years before they met, just outside Afghanistan. She, was from Siberia. He was from Afghanistan. The Russian invasion of his country had brought them together.

When they arrived in Canada, she was pregnant. She was 22. He was 23. They are married now. If I remember, they were married then? I remember they were in love, pregnant and young. They remain in love.

In 2000, on arrival in Canada, Victoria was in her mothers womb. All I could decipher, was Victoria’s  heartbeat with the Doppler- thump, thump, thump thump – and her small head buried deep in her mother’s pelvis, far too eager to get out, ready to emerge. Victoria is 13 now. I saw her last week, for her school immunization. She is is perfect. She loves soccer.

I first laid eyes on Victoria when her dark hair emerged, as she exited her mother and landed in Canada – conceived so very far away, in so much hope.

2 weeks ago I read the Toronto Star article, describing crowds of the economic new Canadians adoring Mr Kenney. I read that  Shahram Saremi Chair of the IC Youth Organization stated — ” I think what he (Kenney) is trying to do politically is to make sure the genuine people who are looking at settlement in a peaceful country would get the benefit, rather than the undesirables“.

Really Shahram? I worry about anyone under 30 who holds such views.

Victoria,  and her parents, and hundreds of thousands over the years just like them, were, the “undesirables” you speak of.
Both her parents are now proud Canadian citizens. So are their 3 children. While I was immunizing Victoria, she spoke of becoming a doctor. She has my bet, my prayer, this Afghan new Canadian woman. The family owns a house now. Their father, well, he started a trucking business. He was in a few months ago. He has 4 trucks, and employs 15 Canadians. He has a business that he owns. He works 13 hour days. He works weekends. He works for VictorIa
When he arrived he claimed refugee status. He, and his wife, and their yet unborn Victoria, were denied – deemed not to be in danger. They were your typical “undesirables”.
 Frankly, I really like this family. My money is on them.

This story is true. It is a story Mr Fiorito wrote about so well, in 2000.

Look it up.