OHIP Changes to Out of Country Care

On Friday May 11th, 2011 The Globe and Mail reported on a case where an Ontario Tarlov Patient had won an appeal to be covered under OHIP's Out of Country Care (OOC) program.


The news story informed readers of the four day winning battle Rose had fought and also provided comments from a local, Ontario Neurosurgeon, Dr. Charles Tater who stated, "Rose could be treated in a timely fashion in Ontario. He had treated five patients over his career of nearly 50 years and he believed other neurosurgeons treated a similar number of cases."


Lawyer Perry Brodkin commented on the new changes saying, “This legislation makes patients guinea pigs because they’re not going to get the foremost expert in the world,” He also added that, “Under the new rules, that surgeon may have never performed the surgery or may have performed it only once.”


The news article and the suggestion of new rules caused a wave of concern to those diagnosed with symptomatic Tarlov Cysts. We were all worried about how those changes may prevent Tarlov Patients, like Rose, from receiving experienced treatment in future.


Neurosurgeon Frank Feigenbaum of the Research Medical Center in Kansas City, who operated on Rose’s Tarlov cysts, said in a letter entered as an exhibit before the appeal review board that the surgery is extremely intricate, complex and a “very scarce commodity.”


Dr. Feigenbaum also stated, “There are only a few surgeons in the world with experience and proven good outcomes with surgery for these rare giant cysts who would even attempt this surgery,” he wrote. “I am one of those surgeons.”


Rose's application for OOC had been refused on application, but after a four day appeal Rose's application was approved.


Reta Honey Hiers, president of the Tarlov Cyst Disease Foundation, testified during the appeal saying, "no Canadian physicians were on her list as having expertise to operate on such cysts; the one Ontario surgeon that was listed had asked to be removed." Which leaves many to wonder where these program changes may take future patients in need of experience to treat this rare diagnosis.


In an email received today from Perry Brodkin, he supplied a link which I've attached to this post that will bring you to the new list of amendments. 

(Click on the Post Caption in RED at the top of this post to be linked directly to the E-Laws site.)

However, according to Mr Brodkin one question remains, "At this time the major issue is whether the changes apply to a person who has appealed to the Health Services Appeal and Review Board, but has not yet had his or her hearing before the Board. The changes do apply to a person who has not had an Ontario physician complete and submit to OHIP a Prior Approval Application for Full Payment of Insured Out-of-Country Health Services before April 1, 2011."

In response to Mr. Brokins question the Ministry of Health and Long Term Care responded with the following.

"Any Health Services Appeal and Review Board (HSARB) appeals received prior to the regulations taking affect (April 1, 2011) will be adjudicated based on the old rules. Any application for Out-of-Country (OOC) health services approvals received prior to April 1, 2011 will be based on the old rules. Any application denied based on the old regulations and then appealed to HSARB will be adjudicated based on the old rules (in other words:  as long as the application was received prior to April 1, 2011 to the General Manager of OHIP or to an OHIP Office, any related HSARB appeal to that decision will be based on the old rules)". They also added, "All applications are date received stamped upon receipt; therefore, even if the application is reviewed after April 1, the review/appeal will be based on the old rules".

The battle for expert care is far from over and if you are in need of further information, guidance or legal support, please contact:

Perry Brodkin
Barrister & Solicitor
515 Rosewell Avenue, Suite 304
Toronto, Ontario M4R 2J3
Tel: (416) 482-3482
Fax: (416) 484-8290
E-mail: perry.brodkin@rogers.com

(all quotes in this posting were taken from the Globe and Mail article, and also from direct email contact with Mr. Brodkin. For that I am grateful. There are still a lot of professionals willing to help us fight for what we require as patients. I am grateful for their ongoing support.)

Visiting the ER or Emergency for Chronic Pain

Posted By: Sharon Jones Gillece

Visiting the ER or Emergency for Chronic Pain March 26, 2011 webmed article Visiting the ER for Chronic Pain How to reduce stress and suspicion when seeking chronic pain medications. By Katherine Kam WebMD Feature Reviewed by Brunilda Nazario, MD You’re a chronic pain patient who takes several prescription narcotics to control your symptoms. Then one weekend, excruciating pain lands you in the emergency room. There, a doctor grills you about your medications, in part to make sure that you’re a legitimate pain patient, not someone seeking drugs. What can you do to help the ER doctor to believe you?   It’s not always easy to tell chronic pain patients from drug-seeking patients, says Howard Blumstein, MD, FAAEM, president of the American Academy of Emergency Medicine and medical director of the North Carolina Baptist Hospital emergency room. Patients with chronic pain visit the ER for various complaints, he says. “Some of these patients have demonstrable disease, like sickle cell disease or chronic pancreatitis. I think that physicians are more likely to give them the benefit of the doubt when they come in and say they have pain.” “Other patients are prone to have problems that you can never objectively demonstrate, like chronic back pain and chronic headaches,” he says. “We just have to take their word for it. You can’t look into anything and tell whether or not they’re actually having pain.” Regardless of which group patients fall into, Blumstein says, “there are some patients who, because of their behavior or their frequent visits, still get labeled as being addicted to drugs or abusing drugs.” What type of behavior raises suspicions? “Patients will come in and be very demanding, get into fights with doctors and nurses because they don’t think they’re getting enough pain medicine, and that causes the health-care providers to become suspicious of the patient’s motives,” he says. Or the patient may ask for a specific narcotic like Demerol, or say they’re allergic to non-narcotic pain relievers. Understanding Suspicion in the Emergency Room “In most cases, it’s probably unfair to the patient,” Blumstein says. But emergency room doctors have strong motivations to carefully screen out drug seekers. They want to thwart drug abuse and any chance that narcotics will be diverted, for example, sold to strangers, or exchanged for illegal substances. “They have a high street value,” Blumstein says. ER doctors have one useful tool, though. Currently, 34 states have prescription drug monitoring programs that allow doctors to check a patient’s prescription history online. “I can look up a patient and see all the prescriptions that have been filled for controlled substances,” says Blumstein, who practices in North Carolina. Doctors can use the database to corroborate a patient’s story. Or they might see patterns that warn them to probe further for drug abuse, for example, prescriptions from numerous physicians that have been filled at multiple pharmacies. “It is an unbelievably great tool for physicians,” says Eduardo Fraifeld, MD, president of the American Academy of Pain Medicine. But ER doctors also rely on instincts, Blumstein says. “It’s all perception. It’s the whole gut impression that the health-care providers get about you.” So how can a patient with chronic pain convince the ER staff that his or her complaints are legitimate? Here are a few tips from the pain experts: 1. Make sure that you have a regular physician who treats your chronic pain. That’s a relationship that all chronic pain patients should establish before they ever set foot in an emergency room, Blumstein says. But many people don’t have a doctor, he says, “and it looks really bad from a doctor’s point of view when a patient comes in and says, ‘Oh, I have this terrible chronic pain,’ and the doctor says, ‘Who’s taking care of this terrible chronic pain?’ and the patient says, ‘Oh, I don’t have a doctor.’” “Before you get into a situation where there’s an exacerbation of your condition, make sure you have a regular doctor treating you,” he says. 2. Show that you’ve tried to contact your regular doctor before you go to the ER. If you’ve been in pain for five days and have not alerted your doctor, the ER staff will question how bad your pain really is, Blumstein says. Even if the pain struck just that day, make an effort to contact your regular doctor first, he suggests. ER staff will be more sympathetic to patients who have called their doctors and been told to go to the emergency room because the doctor was unable to see them, Blumstein says. “At least you’re showing you made an effort. You’re using the emergency room as your treatment of last resort, as opposed to the primary place you go for pain medication.” 3. Bring a letter from your doctor. “A letter from your physician, with a diagnosis and current treatment regimen, is a reasonable thing to carry with you,” Fraifeld says. “Particularly if you’re on chronic opioids in today’s atmosphere, I would highly recommend that to patients.” Make sure the letter has your doctor’s name and phone number, Blumstein says. That way, if ER doctors want to contact your physicians, they can. A letter is especially useful if you’re traveling or going to a hospital that you’ve never visited before. It’s fine to bring medical records, too, Fraifeld says. But don’t overdo it, Blumstein says. “I’ve had patients come in with tons of records -- I mean, you could measure the stack in inches. It just looks like you’re going overboard.” 4. Bring a list of medications. Bring a list of your medications, instead of relying on memory, Blumstein says. Fraifeld takes it one step further and suggests that patients bring the drugs. “Take all the pain prescriptions with you -- the actual bottles -- not just the list,” he says. “[Patients], I’m sad to say, highly contribute to their own problems by not even being able to tell physicians exactly what they’re getting and when they got it and whom they got it from.” 5. Work cooperatively with emergency room staff. “It might not be fair, but if a patient comes in screaming and shouting that they need pain medication right away, the staff isn’t going to like it. It calls negative attention to yourself,” Blumstein says. “And it is unfair, because you might be having agonizing pain, and why shouldn’t you speak up for yourself, right? But a lot of staffs don’t like it and they don’t respond well to it. So rather than demand things, try to work cooperatively with the staff.” COMMENT FROM SHARON My personal opinion on this is to have a copy of your regular monthly prescriptions and also bring the bottles. I usually bring my most recent prescription with me when I am travelling anywhere, for the airport staff and in case of emergencys. When I was admitted to Hospital 2 years ago with acute pain from Gallbladder after the Doctor had visited me at home and was sending me to Hospital in an Ambulance a family member remembered to bring my recent prescription, Its not the actual prescription its the copy and reciept, from the Chemist (Pharmacy). Make sure you always get a reciept when collecting your prescription. I don't know how it is done in the US and other countries, but here in Ireland, the reciept will be a copy of the original. Love to all Sharon