Paying taxes gets you no healthcare – Incredulity

    For more than 10 years J has waited to know his fate in Canada. His “case”, and its twisted turns have dumfound even us. J can’t pay up front. It may spell the end of his bid for safety. We have J’s permission to share his story with you.
    This is a case that eloquently underscores the inhumanity and cruelness, the inconsistencies and failures, the incredulities of immigration policies in Canada.
    We first met J  and his wife about 4 months ago. They came to the CVC for his medical care. He came for treatment of untreated high blood pressure.
    J fled Liberia. Charles Taylor’s brutality and murder of family and friends took its toll. Taylor is a man now disgraced before the World Court in the Hague, convicted of war crimes and brutality typical of Nazi thugs. In Canada, J filed a refugee claim for safety. He was denied. The Immigration and Refugee Board deemed he was not in danger in Liberia. Really?
    Somehow J was given a work permit to work in Canada once his application avenue changed, while he appealed his claim after the denial at IRB.
    J landed a job as a security guard in Toronto,  6 years ago. J still holds that job. J still pays  his Federal and Provincial and Municipal taxes, and his EI every year, in full, and on time.
    And yet, during all these years of employment and paying taxes, J was denied OHIP, denied refugee status, denied IFH, denied healthcare when he needed it most.
    J came to the Volunteer clinic one evening feeling unwell a few months ago. The volunteer physician on duty diagnosed severe and malignant hypertension. This a condition where the blood pressure has gone so high a stroke or brain hemorrhage is imminent.
    J was referred to the area ER that evening. As uninsured as he was, his life was now on the line. J was admitted. He was treated. His life was saved. After 4 days he was discharged. He was handed a bill for $10,000.
    J and his wife do not have the funds to cover this in one payment. They told the hospital they want to pay their bill, but can only do so over time, with a payment schadule.
    Denied, Turned down. Pay in full or we refer to a collections agency.
    They came to the CVC in despair a few weeks after the hospital stay, with the bill. The mere suggestion of “collections” had them both frightened, in tears. A collection’s claim would severely threaten J’s journey to becoming a permanent resident in Canada. It raised the fear of failure and deportation at the very moment they were making progress in Canada, after years of paying in to the system.
    In a cruel twist of fate, J was notified that he would receive OHIP shortly after his hospital stay. His number arrived a month after his hospital stay, and 6 years after he began working and paying taxes in Ontario. It would not be retroactive. The bill remained.
    The CVC wrote the Hospital, offering to help manage the matter, and discuss and contribute to a payment plan. We received no reply. This is devastating to J and his wife. It posed enormous risk, and possible failed claims to stay in Canada
    J watched friends and family murdered in Liberia, and decided to make the escape for his life. He paid into OHIP for years, but was denied access to it when he needed it most. He now faces a failed bid to stay in Canada, because he became ill.
    We all think J should have received care without cost. If not, his taxes should be returned, for all the good it did him to pay them. He could use the refund to pay his hospital bill?

Ontario’s 3 month wait for OHIP – A Prayer for 2 weeks.

Clinic, May 7th, 2013

” I was hoping… Please, let it wait 2 more weeks” These words were uttered tonight by a 70 year old gentleman, a landed immigrant with 2 weeks left before his 3 month agonizing wait for OHIP was over. We compare that 3 month wait to a type of “medical hazing”, a ritual immigrants must endure before they are allowed into our fraternity.

M.C. had waited some time before asking for help at the CVC. He noticed trouble passing urine for the past few weeks. In the past few days he could barely force it out. It burned, and it woke him up 6 times each night to pee.

Finally in desperation, and unable to handle an ER visit and Hospital cost, he came to the CVC. He was near total urinary obstruction from an enlarged, and a likely now infected prostate. He is now on antibiotics and other meds, and we have our fingers crossed he will avoid the ER and hospital, until his OHIP kicks in.

He might not make that deadline.

Who thinks this up. This poor man will wait 2 more weeks if he can, then enter hospital 2 weeks later when his OHIP arrives, with near total urinary obstruction and probable kidney failure. He may well spend a week or more in hospital, possibly end up on dialyses, and require surgical intervention. The total bill would be $25,000.

And it all would be prevented by a $30 visit to a doctor or NP, and a $45 antibiotic prescription.

Again – please, who really thinks this stuff up?




PART 2 – It Costs us all more to deny healthcare – who will the politicians be voting for??

May 7th, 2013

Today, in the Toronto Star, an edited version of the following submission appeared in support of healthcare access for all – for Toronto and Canada’s landed immigrants, refugee claimants, sponsored persons, and all other medically uninsured newcomers to Canada…..

Healthy City? City Council can make that a reality on May 7th.
On May 7th, Tuesday Toronto City Council has the opportunity to right a long standing and unhealthy social injustice that plagues and harms tens of thousands Torontonians. Canada’s disgraceful denial of healthcare equity and eligibility to our landed immigrants and some Canadian citizens caught in Ontario’s 3 month with for OHIP, to refugee claimants waiting for or denied Interim Federal Health, and sponsored members in the family class, many in the foreign worker and student visa program, children and youth new to Canada, or those on our streets and homeless who have no documents. 
On May 7th City Council will debate and vote on recommendations affirming the uninsured receive healthcare access. This motion passed unanimously at the Toronto Board of Health on April 29th, chaired by councillor Mihevc.
Who will they be voting for? Mike for one. He came to Canada 26 years ago. He came in the foreign worker program. Mike picked our tobacco and tomatoes – for 22 straight years. He had OHIP – until he suffered disabling back pain. He missed his first day at work in 20 years. When Mike couldn’t work, his OHIP was cancelled, leaving him unable to get medical treatment for the kidney stones causing his pain and damaging his kidney. When he appealed to Immigration Canada, they told Mike “to go home”. Mike told them “Canada is my home now”. 
Tiny Maria and her brave mother Gladys for another. Maria is just 4 weeks old. Gladys came here from Africa to prevent her yet unborn baby girl from certain Female Genital Mutilation (circumcision). Gladys made her refugee claim. She was still waiting for healthcare when Maria was born. Maria was denied OHIP papers because her mother did not have refugee claim approval yet. This contravenes the rules, but it happens. Maria became ill at 4 weeks, as newborns can do. Mom has a $5000 plus hospital bill she is paying off, $10 at a time, for 20 years.  
A host of evidence based studies in the scientific literature clearly confirm it is much more expensive to a health system to deny care than to provide it up front. Tuesday’s vote is a no brainer. The current situation is unhealthy for everyone.       
Toronto is a robust, bustling city built by and lived in by newcomers. It is Canada’s “Port of Call”. Toronto and the GTA receives more new Canadians by both percentage and overall numbers than any other city. These countless medically uninsured neighbours work (often under the table) supporting a robust economy, supporting a healthcare system we enjoy but deny them access to. What sense does that make? What sense does it make to leave thousands without care for pneumonia, broken limbs, influenza, tuberculoses, appendicitis or cancer? If a fire breaks in their motel strip room on Kingston Road, would we not send the fire trucks until they paid up front? Or would we send them a bill after? How are life threatening illnesses any different?
The United Nations has referred to Toronto as North America’s most ethno-racially diverse city. On May 7th City Councillors have the chance to make it North America’s most healthy city – for all of us!

(PART 1) It Costs us all more to deny healthcare

May 7th, 2012

The following letter has been sent to all Toronto City Councillors in advance of Today’s vote to affirm ( or not ) what the Toronto Board of Health meeting historically accomplished on April 29th 2013 for the uninsured. One of the fully endorsed recommendations was the provision of healthcare for Canada’s uninsured living in Toronto.

Well done Mr Mihevc and Dr McKeown!

Board of Health – Meeting 21
HL21.5 Medically Uninsured Residents in Toronto  (Ward All)
Dear City Council members
On May 7th 2013 you are scheduled to consider
Board of Health – Meeting 21
HL21.5 Medically Uninsured Residents in Toronto  (Ward All)
One consideration you will contemplate are the financial implications of providing access to care for medically uninsured refugee claimants immigrants in the Toronto. The prevailing “myth” is that providing this care is more expensive than withholding it.
The available evidence has proven that the exact opposite is the case. The provision of frontline healthcare to this medically uninsured population saves money – and a lot of it. The same evidence from research studies clearly underscores the benefits and savings to the system in terms of system throughput, ER wait times and staffing, bed availability, overcrowding, and lengths of stay on expensive hospitals.
The facts are as follows
1) One study in a city with high numbers of uninsured immigrants describes the NET after costs outcomes when 13,000 uninsured were provided with free access to comprehensive 24/7 Primary Care health services.
– $ 2,000,000 annually in savings at the local hospital by prevented admissions and ER visits
– more bed availability and shorter stays for all patients admitted to hospital
– $700,000 in improved revenue for the hospital because of more bed availability for insured patients who were denied admission pre project.
reference: Academic Medicine 2000, 75 (4): 323 – 330., Managed care for Uninsured Patients at an Academic Health Centre., Arthur Kauffman, et al.
2)  20 % of the patients we treat at the Community Volunteer Clinic for medically uninsured newcomers to Canada are pregnant. The majority ( a total of 250) have received no, or inadequate pregnancy care. Having no care results in a 7 times increase in maternal band newborn morbidity and mortality. The cost of providing basic antenatal pregnancy care ( not including delivery) to one expectant immigrant mother is ( based on fee for service. In a midwife clinic it is considerable less)
3)  the cost to provide the social, educational and healthcare costs to one damaged newborn ( asphyxia at birth, advanced prematurity, neonatal and infant sepsis) is $500,000-1,000,000 dollars. This is based on an educational study conducted in New York State.
It is not  health wise or economically sound fiscal policy to put a mother and Canadian pregnancy at risk, as often happens in unattended pregnancies. At our Community Volunteer Clinic in Scarborough we routinely see pregnant women denied access to pregnancy, and delivery care. Their only option is to go the ER in labour – a most cost ineffective step. They end up in labour and delivery, without a full medical history and end up with an urgent C- Section – again an dangerous and high cost delivery.
The time has come for someone in the political landscape to come to their senses and take what is ethically, morally, and economically — the right step.