Monday, November 5, 2007

How long will we have to wait? Until he's paralyzed before they make a decision?

OHIP lets family down

So there is now a new bank loan on her house, strains in her marriage and worries as to how she and her retired husband will repay more than $65,000. While OHIP drags its feet. But her son Billy had the neck surgery he needed a few days ago. It meant taking him to a Detroit hospital that could fit him in right away, rather than the year it would have probably taken here at home.

In 2003, though, he slipped on stairs and injured his neck. It took almost 12 months before he finally underwent surgery at St. Michael's Hospital. After the operation, though, he was back walking and on the job.

Then last June, Hopkins fell again. He lost his balance on the stairs at home and when he went to grab the handrail, it came away from the wall, sending him reeling backwards and crashing to the floor. When he went to the emergency department in Oshawa, they told him the X-ray only showed his old injury and released him with Tylenol.

As the months went by, he felt increasing numbness in his hands and feet and walking became increasingly difficult. Finally, it got so bad that he could no longer work.

Their family doctor was having trouble getting him in to see a neurologist. On Sept. 5, Hopkins was in so much pain that he went to the emergency at St. Mikes and after nine hours of waiting, was told he needed an MRI and they would call him.

The call didn't come.

Meanwhile, his mother was helplessly watching her son's mobility deteriorate before her eyes. Pat Hopkins, 54, was confiding her anguish to her girlfriend in Michigan when her friend said she'd see what she could do.

A short time later, Hopkins had an appointment with a neurologist at Henry Ford Hospital in Detroit. A $6,000 MRI showed Hopkins had suffered significant new damage to his neck from the fall in June. He needed an operation that would cost at least $40,000.

They tried to follow the proper procedure. On Sept. 27, Hopkins' family doctor applied to OHIP for pre-approval of the out-of-country surgery. According to its regulations, OHIP will pay for operations outside the country if the "delay in getting the same treatment in Ontario would lead to death or medically significant tissue damage."

To everyone involved, it was obvious that any further delays would mean Billy would soon not be walking at all. The odds of OHIP approving the operation also seemed to be in their favour -- last year OHIP allowed 5,799 out-of-country cases and denied 707 applications.
Since the family were told it takes about two weeks for a decision, the young man scheduled his operation in Detroit for Nov. 1, giving the bureaucrats five weeks to reply. But the date for the surgery arrived a few days ago and there was still no word from OHIP.
A spokesman at the ministry said they try to make their decisions as quickly as possible -- but they cannot comment on specific cases.

Without approval in time, Hopkins' mom had to write the hospital a $30,000 cheque as a deposit for the operation last week while his dad went to get a loan from the bank.

So she is calling to lament the poor state of our health-care system, of how months had passed without a proper diagnosis and months more would have elapsed before her son would have received the surgery he so badly needed.

And now she is left with a growing American hospital bill they can ill afford.

You ask, ever so gently, whether they should have postponed the surgery until they received approval from OHIP?

His mom is defiant -- as surely as any mother would be in a similar situation. "How long will we have to wait?" she asks in exasperation. "Until he's paralyzed before they make a decision?"

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