“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.

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