Photo: Patrick B? Langer
A Quebec man who fell and broke his jaw, cheekbones and a bone around his left eye while visiting British Columbia says his surgery was canceled after he was told his home province “will not pay” the procedure.
Patrick Bélanger, 23, said his experience is a warning to Quebec residents and all Canadians who are proud of a universal health care system because doctors in other provinces could deny treatment to people in Quebec. Quebecers maintaining that they will not be compensated.
Bélanger’s ordeal began when he and his girlfriend were walking down a trail in the tourist town of Sun Peaks on the night of June 10th. He stumbled and stumbled back into the darkness, hitting his face against a rock.
He was taken by ambulance to Kamloops Royal Inland Hospital shortly before midnight and told he needed surgery for a “broken face”. But on Saturday there was no surgeon available, so he was discharged with a prescription for the drug Percocet containing opioids to control his pain, Bélanger said.
The next morning, he and his girlfriend, Beth Cooper, returned to the hospital for surgery. But Bélanger said that just as he was preparing for the operating room, the surgeon canceled the procedure.
“He said the hospital wouldn’t let him do the surgery because I was from Quebec,” Bélanger said, adding that he had presented his provincial health card when he arrived in Royal Inland.
“I was a little in a state of shock. When I thought about it more, I thought that didn’t make sense. Normally, you would do the surgery and then calculate the bill, or at least I thought that would happen.” He said.
“I was pretty scared. I was still pretty out of it because I had a little pain and was taking pain medication. And I was calling my parents trying to figure out what to do.”
Bélanger said he offered to pay for the surgery through his family’s private insurance, but the surgeon turned down that option, saying he first had to talk to a hospital administrator who was not available. of the week.
“When he told me the surgery couldn’t be done today, he suggested I go back to Quebec to go do the surgery,” Bélanger said.
He was given a 10-day window before his facial bones began to fuse.
“We thought it was completely absurd for me, with a broken face, to go to a commercial airline to go and operate in my country.”
Bélanger’s father and mother arrived in Kamloops later that week and tried, unsuccessfully, to talk to an Internal Health Authority administrator about the best options for their son, Richard Bélanger said.
“We were baffled by his basic rights as a Canadian,” he said, calling his son’s experience a “nightmare”.
Richard Bélanger said he went to the surgeon’s private clinic to provide information about the family’s insurance plan, as well as his credit card in case the surgery could be done there. But staff told him the serious facial fractures his son suffered caused the surgery to have to be done in a hospital, he added.
Four days of anguish since the surgery was canceled caused Bélanger to manage “unbearable pain” with opioids and prescription morphine before his case was passed on to another surgeon, he said.
“I would wake up in the middle of the night crying and screaming in pain.”
The second doctor said he needed quick surgery and the surgery was done seven days after the fall, said Bélanger, an economics student at Bishop University in Sherbrooke, Que.
His family said they are still baffled why the original surgeon did not do the surgery.
“It’s a big incompetence on the part of the hospital and a failure on the part of the Canadian health care system,” Bélanger’s mother, Martha Ferris, said.
Both Patrick and Richard Bélanger say the end result was “discrimination” against a Quebec patient, who pays hospital costs but does not participate in a reciprocal billing agreement for physician fees involving all other provinces and territories.
Doctors of BC, an association representing doctors, said an agreement allows its members to bill their own Provincial Medical Services Plan for out-of-province patients and then the plan is reimbursed by the home jurisdiction. of patients.
“Doctors receive as if the patient were a BC resident,” he said in a written statement.
“When a Quebec resident needs medical care in BC, doctors cannot bill MSP and charge,” the association said.
However, doctors who provide services to Quebecers can bill in that province or bill the patient, who would ask for a refund from their government.
The Quebec Department of Health said doctors elsewhere receive rates as if the patient was receiving the same treatment in their home province. Patients have to pay any cost difference and could request a refund of the money through private insurance, if they have it, the department said in a written response.
The department recommended that Quebecers obtain private insurance before traveling outside the province.
Richard Bélanger said the family’s private insurance company refused to pay any costs after the first surgeon wrote in his son’s medical record that he could return to Quebec and undergo surgery there within 10 days. days.
The insurer had also initially refused to pay the costs when a doctor in the emergency room pointed to a possible poisoning in her son’s history, Bélanger said. But that was later ruled out when the family asked why a test was not done to determine the presence of any substances, including alcohol, he added.
Dr. Peter Stefanuto, the original surgeon, turned down requests for interviews.
He said in an email that he could not talk about any specific case but that “care is offered to all patients, regardless of their province or country of origin, in case of an emergency.”
Issues related to service compensation will be better addressed through the governments of British Columbia and Quebec, Stefanuto added.
Dr. Bob Rishiraj, who ended up doing the operation, said he was not worried about any “policy” around billing, especially after learning that the patient had been taking opioids and methadone for days, and that a longer wait for in surgery it carried the risk of infection. .
“It was very worrying for me that he was using a lot of morphine and his pain was not well controlled. If we don’t, we have the problem of having someone with the potential for narcotics abuse along the way,” he said. .
“I think a patient is a patient and it doesn’t matter if they’re from Quebec or Ontario or wherever. I think they should just be treated,” Rishiraj said.
The risk of a patient charging for not paying a doctor is low, and cost did not appear to be an issue for Bélanger’s family, he said.
Interior Health did not respond to a request for an interview, but said in an email that the doctors are not employees of the health authority.
Ferris said the family paid Rishiraj $ 2,563 and will ask for a refund in Quebec.
The irony is that the family has used their private health insurance while traveling abroad, but did not expect them to have to rely on Canada, he said.
“It’s mind-boggling for me, a little shocking.”
The British Columbia Ministry of Health did not answer questions about Quebec patients who were denied surgery.
Dr. Katharine Smart, president of the Canadian Medical Association, said Canada’s universal health care system is designed to provide care to all Canadian citizens and permanent residents.
“We strongly encourage provincial and territorial governments to work together to ensure that Canadians receive the care they need, when and where they need it, and the federal government to enforce the principles of the Canada Health Act in a consistent manner. the country, “he said in a written statement.
Health Canada said reciprocal billing agreements are administrative agreements between provinces and territories to help facilitate the portability criterion of the act while people are temporarily out of another part of the country and need care.
“These agreements are voluntary and are not a requirement of the Health Act of Canada,” he said in a written response.
Bélanger, who had trouble speaking because his jaw was closed for six weeks after surgery, said the emotional weight he has suffered is “incalculable,” in addition to the physical pain, which still includes migraines.
Damien Contandriopoulos, a professor of nursing at the University of Victoria and a health policy researcher, said that regardless of Quebec’s billing regime, the province pays, on average, higher physician fees than other jurisdictions for the same care. , an investment in its practice years ago.
It is common for thousands of Quebec patients to receive care from GPs in Ontario’s border cities and their province to reimburse the cost, he said, adding that he is “surprised” that services will be denied to a patient for billing issues.
However, doctors in British Columbia, where relatively few Quebeckers receive care, can be dissuaded from looking for information on fees paid for that province because they are listed in about 3,000 pages in some complicated categories and in French, said Conandriopoulos, a former resident . of Quebec.
In Bélanger’s case, the surgeon could have contacted his insurance company’s hotline 24 hours a day, 7 days a week to get information from a representative, instead of saying that the administrators they were not available on the weekend, Conandriopoulos said.
He called Bélanger’s one-week wait for surgery “insane.”