Assistive Devices: Life and Breath
November 1, 2007
1 November, 2007
The Ministry of Health and Long-Term Care agreed to fund the home use of oxygen saturation monitors for children with life-threatening respiratory conditions, and to review the entire Assistive Devices Program.
The Ministry of Health and Long-Term Care agreed to fund the home use of oxygen saturation monitors for children with life-threatening respiratory conditions, and to review the entire Assistive Devices Program. No report was issued.
Case update - Annual report 2007-2008
In February 2007, SORT was assigned to investigate a complaint regarding the province’s refusal to fund oxygen saturation monitors for infants and children with chronic respiratory problems, for use outside of hospital. The devices, which measure a child’s heart rate, respiratory rate and blood oxygen saturation levels, are routinely used by hospitals and are acknowledged to be the standard of care for young patients who are transitioning from the hospital to the home. Long-term treatment for these children may include oxygen, mechanical ventilation, or a combination of both, meaning continuous monitoring of their oxygen levels is essential.
SORT investigators interviewed 27 families whose children had been or were still dependent on this technology, along with doctors, other health care professionals and Ministry of Health and Long-Term Care officials. Families were paying between $2,000 and $6,000 for the monitors, and many either had no private health insurance or were told it would not be covered by their insurer. SORT also found instances of hospitals not being able to discharge children who were otherwise well enough to go home, because their families could not afford the cost of a monitor. Instead, the health care system incurred the significantly higher cost of keeping them in a hospital bed.
The investigation also found evidence that senior staff from a children’s hospital had stressed to the Assistive Devices Program (ADP) that the technology was a necessity for this select patient population, but ADP officials had ignored their request. What’s more, the ADP had no process for tracking requests for funding, and had no sense of the number of requests for oxygen saturation monitors it had received.
The Deputy Minister of Health and Long-Term Care advised the Ombudsman in late March 2007 that he would review the matter along with the ADP. Four months later, he advised that oxygen saturation monitors would be added to the list of ADP-approved devices for children under 18 who experience unexpected drops in oxygen saturation due to life-threatening respiratory conditions. Funding for oxygen saturation monitors came into effect on November 1, 2007, and to date, 47 monitors have been provided to eligible children.
That left the question of all those families who had paid for the machines prior to November 2007. The Ombudsman asked the Ministry to consider reimbursing those families, retroactive to November 2002. Noting the ADP’s lack of data on requests for the devices, the Ombudsman suggested that a review of the entire program might be warranted.
In March 2008, ADP officials advised the Ombudsman that it would consider requests for retroactive reimbursement for oxygen saturation monitors on a case-by-case basis. Following on the Ombudsman’s suggestion, the Ministry also retained PricewaterhouseCoopers to conduct an operational review of the program, including an evaluation of the process ADP uses to decide which devices to list or delist. With the matter thus resolved, the Ombudsman opted not to issue a separate special report on the case.
Case update - Annual report 2006-2007
The Ombudsman received a complaint from a health care specialist at a children’s hospital regarding children with chronic respiratory problems who are dependent, for all or part of the day, on technology to assist them to breathe. Treatments for these children require an oxygen saturation monitor, which is provided at the hospital. The monitors can also be used at home under the supervision of a parent or other caregiver, however, the Ministry of Health’s Assistive Devices Program (ADP) does not pay for the devices once a child is discharged from hospital. Requests for funding for the monitors, which cost $2,000-6,000 apiece, have been repeatedly declined in recent years.
In February 2007, the Ombudsman notified the Deputy Minister of Health of his intention to investigate the circumstances surrounding the Ministry’s refusal to provide funding for oxygen saturation monitors. SORT investigators interviewed doctors, clinical practitioners, parents and Ministry officials.
In March 2007, the Director of the Assistive Devices Program met with the complainant and members of the hospital’s respiratory medicine division. On March 27, 2007, the Deputy Minister wrote to the Ombudsman to advise him that the Ministry was reviewing the matter and that ADP staff were establishing a working group to assist the Ministry in determining whether oxygen saturation monitors for children should be funded under the program, and to establish clinical guidelines for their use.