Out-of-country cancer care: The Out-of-Country Conundrum

Out-of-country cancer care: The Out-of-Country Conundrum

July 20, 2006

20 July, 2006

The Ministry of Health overhauled its out-of-country care program and paid $75,000 to a chemotherapy patient who was wrongly denied coverage.

The Ministry of Health overhauled its out-of-country care program and paid $75,000 to a chemotherapy patient who was wrongly denied coverage. No report was issued.

 

Case update - 2007-2008

The Out-of-Country Conundrum When Suzanne Aucoin came to the Ombudsman’s Office in 2007, she was fighting two battles: She was refusing to give in to stage four colon cancer and she was demanding that the Ontario Health Insurance Program (OHIP) pay for the treatment she had undergone in Buffalo, New York, through the Ministry of Health and Long-Term Care’s out-of-country funding program.

SORT’s investigation of Ms. Aucoin’s situation and the workings of the out-of-country program found that OHIP’s forms and procedures were all but impossible for even physicians to understand, there was little explanation given for its decisions and it was failing to communicate basic information to patients and their doctors. The Ombudsman likened it to handing patients a “Rubik’s Cube” and leaving them to figure it out for themselves.

In Ms. Aucoin’s case, the Ombudsman recommended that she be reimbursed $76,000 for her medical and legal fees. He also recommended an overhaul of the entire program. The Ministry agreed and, with the matter thus resolved, no formal report was issued.

The Ministry hired two external consultants and their review of the program was completed in the summer of 2007. A copy of their report was provided to the Ombudsman. Among the changes now in place are a redesigned website that makes more information about the out-of-country program available to patients and their physicians, and in more accessible language. The Ministry has revised the letter it sends to doctors who apply to the program on their patients’ behalf, giving clearer reasons and fuller explanations to those whose applications are denied. Updated information about the program was also sent to physicians, hospitals, clinics and laboratories in an OHIP bulletin.

Sadly, Ms. Aucoin lost her battle with cancer in November 2007. “Her challenges to the system led to changes that ended up being far wider and deeper than I think she ever imagined,” the Ombudsman said in a tribute in her hometown newspaper, the St. Catharines Standard. “She had a real sense that she had turned the system on its head and had accomplished something … I think she’s saved a lot of people from going down that same agonizing bureaucratic maze.”

 

Case update - 2006-2007

On Nov. 23, 2006, the Ombudsman notified the Ministry of Health and Long-Term Care of his intention to investigate the case of Suzanne Aucoin, who had been denied funding for cancer treatment under OHIP’s out-of-country program. Ms. Aucoin was first diagnosed with Stage 1 colorectal cancer in June 1999, at the age of 28. She underwent surgery and was assured she had been cured, but in October 2003 she learned it had returned and worsened to Stage 4, considered ncurable. She was told she could expect to live 22 months with chemotherapy, but only a year without it. In November 2004, she began treatment with the anti-cancer agent Avastin, which she obtained and paid for through a cancer specialist in Buffalo, New York. The drug manufacturer refunded two-thirds of this cost to her on compassionate grounds, but she was still out of pocket approximately $20,000 U.S.