Saskatchewan Government Denies Patient Out-of-Country Coverage for Medically Necessary Surgery
What if a medical product that was supposed to help your condition ended up causing you harm? In 2010 Health Canada issued an advisory to hospitals and doctors warning about serious post-operative complications with transvaginal mesh. This information came too late for Stephanie Brad, a Saskatchewan woman who received a transvaginal mesh implant in 2006 to help with bladder leakage. Since then Stephanie has suffered through pain, infections, and additional surgeries to repair internal injuries caused by eroding mesh.
In 2012 Stephanie learned about a skillful surgeon in California whose technique for complete mesh removal has helped hundreds of women. Despite a referral from her specialist, the Saskatchewan government has refused to provide her with coverage for out-of-country medical services.
Last month Stephanie invited me along to an appointment with her Urologist to see how difficult it is to get approval for out-of-country care.
On the day of her appointment the waiting room is packed. An inner door opens and Stephanie’s name is called. We enter her Urologist’s office and both take a seat. I’m impressed by Stephanie’s composure throughout the conversation with her doctor. She’s done research, compiled facts and has a packet of information containing copies of letters and supporting documents. She is what I call an informed patient. Her doctor agrees that surgery for complete mesh removal is in Stephanie’s best interest. He is supportive of her leaving the country to access the surgeon of her choice. He talks about his phone calls to the Ministry of Health regarding her case. Then he tells her what I already know to be true – the final decision rests with the government. What about the decisions made by Stephanie and her doctor? Under a single-payer health care system the government decides the quality and quantity of medical services you receive.
Ten days after her doctor’s appointment the Saskatchewan government sent a final decision letter to Stephanie. The government has denied her out-of-country coverage for a surgery estimated to cost $30,000 US. The government claims there are doctors in Canada who can do mesh removal surgery. I’m sure surgery is cheaper in Canada due to price controls, but as a patient wanting the best chance for improved health and quality of life I don’t want the cheapest care I want the best care. Like Stephanie, I want the freedom to choose the surgeon who is right for me.
What is the next step available to Stephanie? Patients who are denied out-of-country coverage can appeal to the government’s Health Services Review Committee. Members of this committee review the government’s decision to make sure it followed legislation and its own policies and guidelines. If the Health Services Review Committee denies your application for appeal then you can lodge a complaint with the provincial ombudsman. The office of the Ombudsman teaches “The Fine Art of Fairness” to government employees to help them with their decision-making. It can review the “fairness” of the government’s decision and make recommendations.
Under a single-payer health care system it’s politicians and health care bureaucrats who decide what constitutes “need”, “medically necessary” services, “reasonable access”, and “fairness”. This is why there is little rhyme or reason as to which patients receive out-of-country coverage for medical services. What about the Saskatchewan government’s promise of putting patients first? What about its promise of patient-centered care? Those are political promises, not reality.
Just ask Stephanie Brad.