Ombudsman wants fairness

Alberta Ombudsman Gord Button is insisting the province’s Out-of-Country Health Services Appeal Panel re-examine funding requests from two Red Deer families.

Alberta Ombudsman Gord Button is insisting the province’s Out-of-Country Health Services Appeal Panel re-examine funding requests from two Red Deer families.

Last week, the Ombudsman released his report Prescriptions for Fairness with 53 recommendations to improve the quality and fairness of decisions, and redress four applicants who were treated unfairly in the past.

One of the recommendations was that the appeal panel re-hear four cases, including a Red Deer mother who took her twin toddlers to Chicago for help with their severe sleeping disorder in 2005 and a Red Deer woman who had lung cancer surgery at the Mayo Clinic in Minnesota in 2003.

“Administrative errors were made by the appeal panel, and Albertans should not be the ones to suffer as a result. I expect the appeal panel to provide suitable redress in each of these cases,” Button said during the press conference held last week.

Emerald Raho, of Red Deer, took her twins, Nicole and Denise, to the United States when they faced a two-year wait just to undergo a sleep study in Canada, with no one to treat them afterwards.

Due to a genetic condition, the part of their brains that regulated sleep was not developed and caused the girls to use the rhythm of “head banging” to put themselves back to sleep. But the banging would also keep them awake so they weren’t getting the sleep they needed for their brains to develop and rectify the problem.

Within three weeks of seeing a specialist in Chicago in July 2005, her babies were sleeping.

Seven months later, Raho filed a $7,000 claim with the Out-of-Country Health Services Committee, to cover the cost of flights to Chicago and the sleep study. The committed denied the claim saying it was available in Canada, but would not tell Raho who was capable of treating her twins.

Lynn Clark, of Red Deer, was denied $100,000 in funding for lung cancer surgery performed at the Mayo Clinic in Minnesota in 2003.

After about 10 months of radiation and chemotherapy, her doctors in Red Deer and Edmonton recommended she go to the U.S. because there was nothing more that could be done in Canada.

Even though she succumbed to the disease a year later at age 64, she was able to remain active in the community and started a cancer support group that still runs today.

The committee denied her claim twice saying other treatment was available in Canada and that the surgery “wasn’t supported in general” by the Canadian Association of Thoracic Surgeons. Meanwhile, all three of her doctors, including the surgeon at the Mayo Clinic, were members of the thoracic association.

Like Raho, the committee would not say what treatment was available.

Her appeal was also denied.

Button’s report is based on an investigation announced in December after applicants were denied funding by the committee or panel without a clear explanation as to what evidence was considered and what criteria were used.

In many cases, the committee and panel determined services were available within Canada, but did not explain how they reached that conclusion, including what is considered a reasonable wait time for health services in question.

Button’s recommendations include giving applicants complete disclosure of the decision, and that physicians and dentists should complete and submit applications for funding on behalf of Albertans, with supporting documentation from specialists.

Button said physicians and dentists are best positioned to gather and present information on the availability of treatment and wait times.

The Ombudsman has asked that both Minister of Health Ron Liepert and the appeal panel respond to his recommendations by July 10.

Members of the Out-of-Country Health Services Committee and its appeal panel are appointed by Alberta Health and Wellness, but decisions are made independently of the minister of health.

szielinski@bprda.wpengine.com

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