A Quebec man who fell and broke his jaw, cheekbone and a bone around his left eye while visiting British Columbia says his surgery was canceled after he was told his home province “won’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 because doctors from other provinces might deny treatment to Quebecers by claiming they don’t they will be compensated.
Bélanger’s ordeal began when he and his girlfriend were walking along a trail in the resort town of Sun Peaks, BC, on the night of June 10. He stumbled and staggered backwards into the darkness, hitting his face on a rock.
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He was taken by ambulance to the Royal Inland Hospital in Kamloops shortly before midnight and told he needed surgery for a “broken face”. But a surgeon was unavailable Saturday, so he was released with a prescription for the opioid-containing drug Percocet to control his pain, Bélanger said.
The next morning, he and his girlfriend, Beth Cooper, went back to the hospital for surgery. But Bélanger said that just as he was getting ready for surgery, 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 at Royal Inland.
“I was a bit in shock. As she thought about it more, I thought it didn’t make sense. Normally, you would do the surgery and calculate the billing afterwards, or at least I thought that was what was going to happen,” she said.
“I was pretty scared. He was still pretty out of his mind because he was in a lot of pain and was taking painkillers.
“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 declined that option, saying he first needed to speak with a hospital administrator who was unavailable over the weekend.
“When he told me the surgery couldn’t be done today, he suggested I fly back to Quebec City to have the surgery,” Bélanger said.
He was given a 10-day window before his facial bones began to fuse.
“We thought it was completely absurd that I, with a broken face, would take a commercial airline to operate in my own country.”
Bélanger’s father and mother arrived in Kamloops later that week and tried unsuccessfully to speak with an administrator from the Inland Health authority about the best options for their son, Richard Bélanger said.
“We were puzzled about 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 practice to provide information about the family’s insurance plan and his credit card in case the surgery could be performed there. But staff told him the serious facial fractures his son suffered meant the surgery had to be done at a hospital, he added.
Four days of anguish since the surgery was canceled had Bélanger managing “excruciating pain” with prescription opioids and 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 a quick intervention, and the surgery was performed seven days after the fall, said Bélanger, an economics student at Bishop’s University in Sherbrooke, Quebec.
His family said they are still puzzled as to why the original surgeon did not perform the surgery.
“This is gross incompetence on the part of the hospital and a failure on the part of the Canadian health 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 costs but does not participate in a reciprocal medical billing agreement involving all other provinces and territories.
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Doctors of BC, an association that represents doctors, said an agreement allows its members to bill their own provincial Medical Services Plan for patients from outside the province and then the plan is reimbursed by the patients’ home jurisdiction.
“Physicians are paid as if the patient were a resident of BC,” he said in a written statement.
“When a Quebec resident needs medical care in BC, doctors cannot bill MSP for it and get paid,” the association said.
However, doctors who provide services to Quebecers can either bill that province or bill the patient, who would then seek reimbursement from their government.
The Quebec Department of Health said doctors elsewhere are paid at rates as if the patient received the same treatment in their home province. Patients must pay any difference in cost and may request to be reimbursed 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 the costs after the first surgeon wrote in his son’s medical record that he could return to Quebec and have the surgery there within 10 days.
The insurer had also initially refused to pay costs when an emergency room doctor noted a possible poisoning in her son’s chart, Bélanger said. But that was later ruled out when the family asked why a test for the presence of any substance, including alcohol, was not done, she added.
Dr. Peter Stefanuto, the original surgeon, declined interview requests.
He said in an email that he could not speak to any specific case but that “care is provided to all patients regardless of their province or country of origin on an emergency basis.”
Issues related to compensation for services would be best addressed through the BC and Quebec governments, Stefanuto added.
Dr. Bob Rishiraj, who ended up performing the operation, said he wasn’t concerned about any billing “politics,” especially after learning the patient had been taking opioids and methadone for days, and a longer wait for surgery carried the risk of infection. .
“It became very worrying to me that he was using a lot of morphine and that his pain was not well controlled. If we don’t, we have the problem of possibly having someone with narcotic abuse potential in the future,” she said.
“I think a patient is a patient and it doesn’t matter if they’re from Quebec, Ontario or wherever,” Rishiraj said.
“I think they should just be treated.”
The risk of a billed patient not paying a doctor is low, and cost did not appear to be an issue for Bélanger’s family, he said.
Salud Interior did not respond to an interview request, 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 request a refund from Quebec.
The irony is that the family used their private health insurance while traveling out of the country, but did not expect to have to rely on it in Canada, he said.
“It’s mind-boggling to me, a bit shocking.”
The British Columbia Ministry of Health did not respond to questions about Quebec patients who were denied surgery.
Emotional toll ‘incalculable’
Dr. Katharine Smart, president of the Canadian Medical Association, said Canada’s universal health care system aims 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 uniformly throughout the country,” he said in a statement. written statement.
Health Canada said the mutual billing agreements are administrative arrangements between provinces and territories to help facilitate the act’s portability criteria 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,” he said in a written response.
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Bélanger, who had trouble speaking because his jaw was wired shut for six weeks after the surgery, said the emotional toll 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 scheme, the province pays, on average, higher medical fees than other jurisdictions for the same care, the opposite. of his practice years ago.
It is common for thousands of Quebec patients to receive care from family doctors in Ontario border towns and for their province to reimburse the cost, he said, adding that he is “surprised” that a patient would be denied services due to billing issues. .
However, doctors in British Columbia, where relatively few Quebecers receive care, may be deterred from seeking information on fees paid by that province because they appear on some 3,000 pages in some complicated categories and in French, said Contandriopoulos, a former resident. of Quebec.
In Bélanger’s case, the surgeon could have contacted his insurance company’s 24-7 phone line to get information from a representative, instead of saying administrators weren’t available over the weekend, Contandriopoulos said.
He called Bélanger’s week-long wait for the “crazy” surgery.
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