(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.
Sincerely,

 

By the way…

April 30th

… did we ever tell the story of one foreign worker we treated? She worked as a domestic, brought in through the very program now making the news.

She was employed as a domestic, until she became pregnant, and started throwing up a lot. Her employer did 2 things. First, they paid her below minimum wage, something they could not do with a Canadian citizen. Secondly, they fired her when her vomiting revealed she was pregnant.

She tried to get another job. Same problems. Unemployed, she lost her health insurance.

She had no money to pay for her rent, food, or the healthcare she would now have to pay for her pregnancy and delivery care.

She is now in debt, with child.

The foreign worker program is rubbish. It has no teeth to protect workers, or Canadians. It abuses them, and it was set up to be abused.

 

The Foreign worker Program from CIC is Rubbish

2013 / April 30th

Hmmmm? The foreign worker program reeks, eh. Stinks to high heaven of political manipulation of immigrants, by the CIC boss, yet again. This time the purpose may be to bestow financial incentives on businesses, or maybe to use immigrants and immigration policy to drive down fair wages for Canadians while suppressing wages for immigrants

Gotta admire that – let’s blame immigrants again. Better still, let’s abuse them!

You can’t make this stuff up. How can nonsense like this be how our immigration policy is determined? Whatever the motive, the program is blatantly incompetent and corrupt. For that alone Mr Kenny must resign. The program is Rubbish, a sham. It’s impact has meant hardship for thousands of newcomers to Canada – denied a fair wage, fired at the drop of a hat, minimal if any workplace protection.

Please, I will not be organizing any support events for Mr Kenny. I don’t like the man’s politics. I don’t like how he arrogantly messes up the healthcare of refugee claimants when ill, who have endured more hardships in a year than this fancy lad ever has.  I don’t like how he arrogantly dismisses those who disagree with him.

I don’t like how he manipulates Canada’s immigration policies to reflect his personal outlooks and beliefs.

That being said I still think he should resign for the mismanagement and abuse within the foreign worker policies he oversees. He would demand nothing less from any of us who screwed up this badly. He would demand it because he would say the country deserves better.

He would be right.

 

Hotel Rwanda. Ruth dropped by to say hello.

Clinic, April 17th, 2013

Ruth dropped by to the clinic yesterday. She has her OHIP now, and her Canadian status. But it wasn’t always that way. She also has her new husband, and her newborn child. Ruth dropped in to say hello. We were so happy to reconnect.

We first met Ruth about 8 years ago. She arrived in Canada as a refugee claimant. Rwanda, her native home land, had betrayed Ruth. The racial, religious, tribal, and brutal conflicts took everything from her. They took her children, and family, and hacked them to death in front of her.

Ruth left. She came to Canada. She filed a refugee claim. We ( Canada) didn’t make that easy. No slam dunk here. God only knows why? The IRB ( Immigration and Refugee Board) is a national disgrace. Has been for a long time. Laced with pork barrel political appointees over the years, it understands little of what it adjudicates in many cases. It is rife for political persuasion. It is, a joke.

Healthcare dried up for this brave but mentally broken soul. As others do, Ruth drifted into the shadows. Her seizures, worsened by the horrific traumas escalated out of control. Her moods plummeted into a depression and PTSD abyss.

And yet, through it all, Ruth’s spirit prevailed. Some Canadians cared. Her social worker at  the Centre for Victim’s of Torture arranged pro bono mental healthcare. God Bless them. The CVC lent a hand with her epilepsy care. Her neurologist waived her fees. How could we not?

A few years ago we learned that Ruth found a new mate in Toronto. A gentle man sent by a different reality. Together, they delivered a baby – a beautiful baby girl. Last night, Ruth brought her Canadian baby, her child, all limbs attached, to see us, to be introduced, to touch and hold. Ruth’s tearful smile was all that was needed.

Ruth lives in Toronto with her child and husband. She smiles more. She is legally in Canada now. She can vote.

The CIC had the power then to deny Ruth, 8 years ago. Why do they need more power now? That power apparently is no match for the power of the human spirit to survive, and thrive. Mr Kenney and the Conservatives don’t stand a chance against it, never will, thank God. All they can do is try to weaken a nation. And it seems they cannot succeed at that, fortunately.

Maybe it is true? What doesn’t kill you makes you stronger. Regardless, Canada is stronger because Ruth is here. We are stronger because she reminds us what courage is all about, and what the human spirit is capable of.

I feel ashamed when I get overwhelmed by the clinic, and some nights wish I could be at home resting.

“A Revenue Stream” ??

In a recent post we outlined the ongoing tragic situation of an uninsured denied refugee claimant who has a bill for over $1500 for 2 visits to GTA  ERs.

$1500 is a lot of money – for most of us. It is an insurmountable sum of money for a refugee women in a shelter.

While recently reviewing some health data on the Canadian Institute for Health Research (CIHR), I was surprised to learn that in 2010 ( the most recent statistic year) the average cost for an ER visit in Ontario was $148.

Perhaps visits to GTA hospitals are higher? We have long wondered why uninsured refugee claimants and immigrants are asked for $500 up front to get ER treatment? We wonder why we have never heard of any of these patients having any of that money returned. Many have been asked to pay more during their visit.

How can it be that every uninsured new Canadian entering the ER has an illness worth the same $500 price tag? How can every ER in the GTA have the same operating costs?

When I worked in hospital administration, a senior VP once remarked that we could not lower the cost for uninsured care, or make it reflect the correct cost as hospital’s with deficits considered uninsured refugees and immigrants “a revenue stream, in the same category of high parking fees.”

I wonder what becomes of any of us who feel we have any right to make money off the backs of the poor and vulnerable when they are ill – off the back of a 30 year old refugee women in a shelter with a severe injury from domestic abuse.

An injury she left the ER with twice – untreated.

 

 

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?