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.




Clinic February 26, 2012

We need to arrange a CT scan for a patient who has valid IFH coverage. He has a serious medical condition.

Now that we have finally been able to obtain a working user name and password, we can ( usually) log into the Blue Cross IFH site to arrange treatment and care for refugee claimant patients with valid IFH.

When we tried to arrange the CT scan at the hospital for our patient, we were denied by Blue Cross.

Why? Even though we are the most responsible provider of healthcare for the patient, Blue Cross would not work with us. They told us their rules stipulate it must be the hospital where the CT scan will be done that must now call Blue Cross to arrange a CT scan for our patient.

Does it surprise you we are still waiting while the patient deteriorates? Our only option now is to send him to the hospital ER, take up space unnecessarily, consume resources, and occupy medical staff while they care for emergencies. When we do that the ER requires  $500 up front the patient doesn’t have, to be seen. So, no CT.

We will keep bugging our hospital to call. They are rather busy with the patients in front of them. We and our patient are not holding our breath.

Again. Stumbling blocks no other ill person with coverage faces. We can arrange CT scans for all OHIP patients without the hospital have to call OHIP first.

Again. Does this sound like the healthcare system access Canadians receive? Is this better healthcare than what insured Canadians receive?

Again. Wasted taxpayers money and healthcare resources in our hospitals – where you or your loved one is trying to get care.

Mr Kenny has told us “bogus refugee claimants” are coming to Canada and getting better care than Canadians. Really!?

Mr Kenny – please consider this the appropriate time for a truthful response.



Canada’s “Adjustment Bureau”. Lydia’s abdominal lump and pain.

Clinic: February 19th 2013

More refugee claimants with useless IFH papers. Useless because community family physicians still can’t determine, after hours, if the patient is covered. It is a useless system.

Lydia is a refugee claimant from a dangerous part of the plant. She arrived in clinic with abdominal pain and a lump. She is 21. She is young and scared, and alone. She has been here 3 months with no health coverage. She had tried to seek care for her pain and lump at a GTA walk in clinic. Lydia sought care after 430 pm, after Blue Cross shut their phone lines down for the day.

The clinic told Lydia they could not access the Blue Cross site to determine if her IFH paper meant she had IFH coverage. The document refugee claimants are given, you see, does not say what health coverage they have.

Why? Two reasons. First, that would make it too easy for the doctor to treat her and bill IFH/Blue Cross. Best to make the physician call and wait half an hour, or never find out if Lydia comes after hours ( she is working under the table all day). Secondly, the Government is always reclassifying refugee claimant’s eligibility status and telling no one. Having a paper confirming health coverage would block them from their behind the scenes ” Adjustment Bureau” antics.

So, on Feb 19th, Lydia came to us with this health problem, and showed us her IFH paper. The CVC went on line too. We tried to log into the the Blue Cross site. It was 8 pm. We ( 3 of us tried) were denied access. We used the user name, and the ID password Blue Cross sent us after we spent a morning with them, on the phone, setting these codes.

Tonight, again we tried to access the Blue Cross site. We were told we had tried too many times. We were denied access. We were told to reset our use name and password, again — and again, and again ,and again……..

We hear from community physicians all the time, facing the same problems.

Lydie has obviously not been paying attention. She and her illness are not playing by the new IFH rules. She is getting ill after 430. No matter how many times we tell our refugee patients not to do that, it just keeps happening. You think they’d learn.

Sleep well in Ottawa.



Cut the Crap Mr Kenny.

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?






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

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” 


This disturbing op ed (Toronto Star January 19, 2012), from frontline health professionals who volunteer with Doctors Without Borders paints a disgraceful and appalling picture of a home grown Canadian tragedy. Some of them are now volunteering here in Canada – treating refugees.
This shameful and outrageous situation is the direct result of stumbling blocks crafted by Federal and Provincial politicians. Immigrants and refugees new to Canada deserve a fighting chance. Canada’s refugees confront enough obstacles without being abandoned to fend for themselves with untreated illness and huge medical bills. All persons who need it, have a right to medical care – no conditions.

In Canada, we are all from somewhere else. Canada is defined by, built by its newness. Everything we enjoy — our democracy, our freedoms, our heritage, our culture, and our prosperity we owe in large part to those new to Canada. Every generation, since the first new Canadians arrived has been marked by its waves of new arrivals seeking opportunity and freedom. Our time, our generation is no different.

This remains the noble and defining ideal upon which our Nation has been built. We invite immigrants. We cannot grow without them. And yet, upon arrival we leave many of them medically uninsured and vulnerable. We open our hearts to refugees because we are a compassionate Nation. The ideals and values of freedom, fairness, compassion and dignity define us – or did? We are moved by the hardships and tyranny our refugees confront in far away lands. We admire their spirit to free themselves and bring their children and families to the safety and opportunity Canada affords.

And yet after surviving war, disease and famine in their native lands, thousands of New Canadian refugee claimants find themselves once again in harms way, in Canada. When they become ill or confront a medical emergency current Canadian and Provincial policies deny many of them access to public healthcare at the very moment they need it most.
It is hard to comprehend that Canada is now more dangerous to our refugees than the country and abuse from which they fled. How inhumane are we?
Paul Caulford, MD
Medical Director, The Volunteer Clinic for Medically Uninsured Immigrants and Refugees, Toronto 
The CVC  HumanKind     “Canada Means the World to Us”  (c)

Zero Health Coverage is what 8 years of work and paying taxes in Ontario gets you

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.


Mr. McGuinty, Ms Mathews: is this ‘the promise’ you had in mind?

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.


What next Mr Kenney? Your new “Interim Federal Health Program” is unusable!

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.



“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.