Photo: Patrick B?langer
A Quebec man who fell and broke his jaw, cheekbone and a bone around his left eye during a visit to British Columbia says his surgery was canceled after being told his home province “wouldn’t pay” for the procedure.
Patrick Bélanger, 23, said his experience is a warning to Quebec residents and all Canadians who pride themselves on a universal health care system, as doctors in other provinces could deny treatment to Quebecers by claiming they won’t be reimbursed.
Bélanger’s ordeal began when he and his girlfriend walked a path in the seaside town of Sun Peaks on the evening of June 10. He stumbled and stumbled backwards in the dark, slamming his face against a boulder.
He was taken by ambulance to the Royal Inland Hospital in Kamloops just before midnight and was told to undergo surgery for a ‘broken face’. But no surgeon was available on Saturday, so he was discharged with a prescription for the opioid-containing drug Percocet to manage 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 being prepared for the operating room, the surgeon canceled the procedure.
“He said the hospital wouldn’t allow him to operate because I was from Quebec,” Bélanger said, adding that he had shown his provincial health card when he arrived at Royal Inland.
“I was a bit in shock. When I thought more about it, I thought there was no point. Normally you would do the surgery and figure out the billing afterwards, or at least I thought that would happen,” he said.
“I was pretty scared. I was still pretty out of it because I was in quite a bit of pain and on painkillers. And I called my parents to find out what to do.”
Bélanger said he offered to pay for the surgery through his family’s private insurance, but the surgeon declined that option, saying he would first need to speak to a hospital administrator who was unavailable on weekends.
“When he told me the surgery couldn’t be done today, he suggested I fly back to Quebec City to have the surgery done,” Bélanger said.
He was given a 10-day window before his facial bones would begin to fuse.
“We just thought it was completely absurd that, with a broken face, I would take a commercial airline to have surgery performed in my own country.”
Bélanger’s mother and father arrived in Kamloops later that week and tried unsuccessfully to talk to a Home 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 and his credit card in case the surgery could take place there. But staff told him that the serious facial fractures his son suffered meant the surgery had to be performed in a hospital, he added.
Four days of anxiety since the surgery was canceled, Bélanger had managed “excruciating pain” with prescription opioids and morphine before his case was passed on to another surgeon, he said.
“I woke up in the middle of the night crying and screaming in pain.”
The second doctor said he needed to intervene quickly and the surgery was performed seven days after he fell, said Bélanger, an economics student at Bishop’s University in Sherbrooke, Que.
His family said they are still puzzled as to why the original surgeon did not perform the surgery.
“It’s gross incompetence on the part of the hospital and a failure of Canada’s health care system,” said Bélanger’s mother, Martha Ferris.
Both Patrick and Richard Bélanger say the end result was “discrimination” against a patient from Quebec, who pays hospital fees but does not participate in a reciprocal billing agreement for physician fees involving all other provinces and territories.
Doctors of BC, an association that represents doctors, said an agreement allows its members to bill their own provincial plan for medical services for patients from outside the province and the plan will then be reimbursed by the patient’s jurisdiction.
“The doctors are paid as if the patient were a resident of BC,” a written statement said.
“If a Quebec resident needs medical care in BC, MSP doctors cannot account for it and get paid,” the association said.
However, physicians providing services to Quebecers can either bill that province or bill the patient, who would demand reimbursement from their government.
The health department in Quebec said doctors elsewhere are paid at rates as if the patient were getting the same treatment in their home province. Patients must pay any difference in costs and can apply for reimbursement through private insurance, if they have one, the department said in a written response.
The department recommended that Quebecers purchase private insurance before traveling outside the province.
Richard Bélanger said the family’s private insurance company refused to pay the costs after the first surgeon wrote in his son’s medical card that he could return to Quebec and have surgery there within 10 days.
The insurer had also initially refused to pay the costs when an emergency room doctor found possible intoxication on his son’s card, Bélanger said. But that was later ruled out when the family asked why no test had been done to determine the presence of substances, including alcohol, he added.
dr. Peter Stefanuto, the original surgeon, turned down requests for an interview.
He said in an email that he could not talk about a specific case, but that “emergency care is provided to all patients, regardless of their province or country of origin.”
Issues related to compensation for services are best addressed through the BC and Quebec governments, Stefanuto added.
dr. Bob Rishiraj, who eventually performed the surgery, said he wasn’t worried about the “politics” surrounding the billing, especially after learning that the patient had been taking opioids and methadone for days, and a longer wait for the surgery increased the risk. brought on infection.
“It became very concerning to me that he was on a lot of morphine and that his pain was not well controlled. If we don’t do it, we have a problem that someone might be abused with narcotics,” 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 just need to be treated,” Rishiraj said.
The risk that a patient who gets a bill won’t pay a doctor is low, and costs didn’t seem 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 doctors are not employees of the health authority.
Ferris said the Rishiraj family has paid $2,563 and will seek reimbursement from Quebec.
The irony is that the family used their private health insurance while traveling outside the country but didn’t expect to rely on it in Canada, she said.
“It’s baffling to me, a little shocking.”
British Columbia’s Department of Health did not respond to 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 Canadians receive the care they need, when and where they need it, and the federal government to uniformly apply the principles of the Canada Health Act. nationwide,” she said in a statement. written statement.
Health Canada said the reciprocal billing agreements are administrative arrangements between provinces and territories to facilitate the law’s portability criterion while people are temporarily in another part of the country and need care.
“These agreements are voluntary and not a requirement of the Canada Health Act,” it said in a written response.
Bélanger, who had difficulty speaking because his jaw was closed for six weeks after surgery, said the emotional toll he has suffered is “incalculable”, on top of 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 schedule, the province pays higher physician rates on average than other jurisdictions for the same care, a reversal from the practice of years ago. .
It is common for thousands of Quebec patients to receive care from primary care physicians in Ontario’s border towns and have their province reimburse the costs, he said, adding that he is “appalled” that services would be denied to a patient on the basis of billing issues.
However, doctors in British Columbia, where relatively few Quebec residents are cared for, may be deterred from seeking information about fees paid by that province, as they are listed on about 3,000 pages in a number of complicated categories, and in French , said Contandriopoulos, a former Québec resident.
In Bélanger’s case, the surgeon could have contacted his insurance company’s 24-7 phone line to get information from a representative, rather than saying administrators were unavailable on weekends, Contandriopoulos said.
He called Bélanger’s weeks-long wait for surgery “insane.”