Posted on 03/12/2008 1:34:22 PM PDT by socialismisinsidious
Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada.
Fighting for her life, the Windsor woman headed to the United States. In Pontiac, Mich., a surgeon excised the tumour - 35 centimetres at its longest - along with her ovaries, appendix, fallopian tubes, uterus and cervix. In addition, 13 litres of fluid were drained during that October, 2006, operation.
And there was little time to spare: Had she waited two weeks, she would have faced potential multiorgan failure, rendering her unstable for surgery, according to a letter from Michael L. Hicks, who performed the four-hour operation at St. Joseph Mercy Oakland.
"Based on my exam and experience as a gynecological oncologist, I felt it necessary to perform surgery within two weeks," said the letter written by Dr. Hicks, provided to Ms. de Vries's lawyer, Kate Sellar.
But a devastating cancer diagnosis was only the beginning of Ms. de Vries's troubles.
The Ontario Health Insurance Plan says it won't pay for the $60,000 cancer treatment because Ms. de Vries did not fill out the correct form seeking preapproval for out-of-country care.
As well, it says no medical documentation was submitted that indicated a delay in obtaining the service in Ontario would result in death or medically significant, irreversible tissue damage.
That administrative misstep has left Ms. de Vries, a 51-year-old corporate communications manager, with a staggering cancer bill. She has drained her savings, maxed out her credit cards, taken out a line of credit and relied on friends to hold a spaghetti-dinner fundraiser, which earned $11,125.
"I feel abandoned; I was fighting for my life," Ms. de Vries said. "... I definitely would like to get some money back but more importantly, I would like to see the situation rectified so [other patients] don't go through this."
Ms. de Vries's case raises questions about OHIP's out-of-country health coverage program, which was put under a review more than a year ago after cancer patient Suzanne Aucoin of St. Catharines, Ont., was denied funding for treatment she received in the United States.
Only after ombudsman André Marin intervened was Ms. Aucoin reimbursed $76,018.23 in January, 2007, to cover costs associated with the colorectal cancer drug Erbitux, among other expenses and legal fees. (She has since died.)
At the time, Mr. Marin described the out-of-country approval process as "literally impossible for patients and physicians to understand."
Just two months before Mr. Marin made those comments, Ms. de Vries was trying to get access to that same program.
To have an out-of-country treatment approved, the procedure must not be performed in Ontario, cannot be experimental and should be deemed medically appropriate. However, patients can have out-of-country treatment funded even if it is available in Ontario so long as there is a delay that would cause irreversible tissue damage or death. Part of the form must be filled out by the patient's physician.
Patients denied preapproved, out-of-country treatment can appeal their cases to the Health Services Appeal and Review Board. And that is what OHIP has suggested to Ms. de Vries.
But her lawyer, Ms. Sellar, said such an appeal would be futile: Since Ms. de Vries did not fill out the out-of-country form before receiving treatment in the U.S., she cannot win the appeal.
Health Minister George Smitherman has the discretion to reimburse Ms. de Vries for treatment, if he chooses to do so. Ms. de Vries said she contacted her MPP, Sandra Pupatello, about it. In the end, she was told she had to go through the appeal process.
Bill Hryniuk, a past chairman of the board for the Cancer Advocacy Coalition of Canada, said cases like Ms. de Vries are "happening quite a bit." The problem, Dr. Hryniuk said, is that "no one is in charge. No one is in charge of the case and the patient bounces around. ... It really is a bad system. Really, it's no system."
Even after Ms. de Vries obtained a CT scan in the U.S. that suggested she had ovarian cancer, she still couldn't get treatment in Ontario. She was referred to a gynecologist who would not take her as a patient because she had dismissed his practice partner some years earlier. Another gynecologist said he did not believe she had ovarian cancer. And a general surgeon said she needed a gynecological oncologist.
At that point, in October, 2006, her condition was worsening - so she tapped her savings and went to the U.S.
After the surgery, she tried to get into the cancer system in Windsor, this time for chemotherapy. In November, she was told there was a six-week wait for chemotherapy, and she ended up getting chemo in the U.S. as well.
Ron Foster, vice-president of public affairs and communications for Windsor Regional Hospital, which includes the Windsor Regional Cancer Centre, said such a wait even back in 2006 would have been unusual - that it may have been as long as three weeks. Today, chemotherapy begins within one week of being referred by a doctor, he said.
Several improvements have also been made to the out-of-country process. A bulletin describing the program was mailed to the province's physicians, hospitals and associations in October, 2007. The next month, a special website was created. Those who receive denial letters are now provided a special telephone number to call for clarification on why the request was rejected, said Health Ministry spokeswoman Joanne Woodward Fraser.
But all that was too late for Ms. de Vries.
"I feel disappointed that when you're going through something like I did, you had to think about financial issues. It put a tremendous amount of strain on us," she said.
Her husband, Adriaan de Vries, an IT systems engineer, said they had no choice but to go to the U.S. "Nobody was in charge," he said, "and nobody really cared."
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My suggestion would be fly to the Philippines or India for decent, inexpensive medical care, if Hillobama will let you...
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Saint Lukes is the choice for US Embassy personnel in PI..
AND they have an “International Patient Care” program...
http://www.stluke.com.ph/
http://www.stluke.com.ph/index.php?page=parent&pageID=74&parentID=74
Looks like a fine hospital. Do you know if Cebu has anything similar?
Looks like a fine hospital. Do you know if Cebu has anything similar?
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I never spent time in Cebu,, however as there are large numbers of medical schools there ,, and being that it is the most metropolitan area other than Manila I would feel good about visiting a hospital there.. If you’re planning on living in Cebu ,, you can be in Manila in under 90 minutes on PAL or one of the other airlines..
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