Paying For Health Care In Canada
lukin2006
Posts: 9,087
He had six months to live. He was rejected for a transplant in Ontario. Then he went overseas and beat the odds. But his fight had just begun, Isabel Teotonio reports
January 27, 2007
Isabel Teotonio
staff reporter
After receiving the grim diagnosis that he had six months to live, Adolfo Flora did exactly what the doctors instructed – he got his affairs in order.
He updated his will and made financial arrangements so his wife and 13-year-old son would be cared for after he was gone.
It was Christmas 1999 and the 50-year-old Toronto high school teacher had been diagnosed with liver cancer – the result of a tainted blood transfusion that gave him Hepatitis C.
"The biggest blow was them saying you have six months, go home and get your papers in order," said Flora, the retired chemistry teacher, in an interview this week. "Even now, seven years later, the impact is indescribable."
Specialists told him a transplant was useless because the cancer was spreading. It was, he said, "the final nail in the coffin."
But a month and a half later, that nail loosened when Flora sought a second opinion and was told the outlook wasn't so bleak. Suddenly, the spectre of death was replaced with a will to live. "We now had hope where before there was none," recalled Flora, who eventually went to England for a liver transplant after being denied in Ontario.
That turning point sparked a long fight with the health-care system, one that ended last week when the Ontario Divisional Court rejected his appeal of an earlier decision and ruled he would have to pay the $450,000 cost of his life-saving treatment.
Back in 1999, transplant specialists in Ontario said he was unsuitable for a transplant because the tumours in his liver had grown too large. Even with a new organ, his chances of survival were slim.
It was a prognosis his friends, family and even his physician refused to accept. They scoured the Internet, rifled through medical texts and contacted international experts. His brother, an ophthalmologist, drafted a list of about 40 experimental treatments being done overseas. Even Flora's 82-year-old mother offered up her own liver.
In England, doctors recommended chemoembolization – a treatment that Ontario considered then to be experimental.
British doctors told Flora his only shot at beating the cancer would be a liver transplant from a living donor – his brother, Dr. Peter Flora, who agreed, without hesitation.
"There was no choice, nothing to think about, no decision other than `When is it going to be done?'" recalled the 59-year-old eye specialist. "Livers regrow. And so what if you have a scar that looks like a Mercedes symbol on your gut?"
To pay for the $450,000 treatment, Flora drained his savings, borrowed money from a close friend and used the proceeds from the sale of his mother's home.
Although the operation was a great success, with Flora beating the odds and the cancer, his fight wasn't over.
The Ontario Health Insurance Plan refused to pay for the overseas treatment because the experimental chemo was not part of the insured services and Ontario specialists had rejected him as a transplant candidate. The Health Services Appeal and Review Board later upheld the decision.
In last week's court ruling, the judges said the government does not have to do everything possible to save the lives of its citizens in every circumstance.That ruling was the final blow for a man who, for the past seven years, has been on what he describes as a "debilitating" emotional roller coaster. He had hoped that the one indisputable piece of evidence in his case – being free of cancer and Hep C – would have tipped the balance in his favour.
"People have to know there are limitations with their health-care system, and those limitations may impact their lives," said Flora. "People tend to get lulled into a sense of complacency. I did." Flora's story begins with a routine surgery in 1973 to remove a benign tumour from his esophagus that was causing his stomach to contract.
But during the procedure, a vein was accidentally nicked, which caused heavy bleeding and he consequently required a blood transfusion.
A routine check three years later revealed he had contracted Hepatitis C, a viral disease that can result in cirrhosis of the liver and liver cancer.
He says he could have launched a lawsuit but didn't. Having doctors in his family, he knew that doctors can also make mistakes.
From 1979 to 1999, liver specialists monitored Flora's condition. But a couple of years passed without doctors running a full battery of tests on him. By November 1999, Flora was already in the advanced stages of liver cancer and not a suitable candidate for a transplant.
The death sentence came when specialists said the cancer had invaded the portal vein, which carries blood to the liver.
"I was at fault. I wasn't an aware consumer," recalled the soft-spoken Flora, as tears welled up in his eyes. "A simple test would've picked up the cancer at an earlier stage..." The weeks following that bleak prognosis were the most difficult of his life. He and wife Marijana tried to remain optimistic for their son, Christopher, but each time Flora sat down to deal with his estate, the grief was overwhelming.
The couple, who taught at the same school, stayed on until Christmas when he took early retirement. Marijana also did not return in the new term because she planned to spend those final months with her husband.
A flicker of hope appeared after a new physician, Dr. Florence Wong, sent him for a second ultrasound. It turned out the portal vein was not invaded.
Wong explored treatment options with various Ontario specialists, but because his cancer was advanced, they said he wasn't a suitable candidate for a transplant from a dead donor, given the scarcity of organs. And a living-related liver transplant from adult to adult, in which a portion of a living donor's liver is transplanted, had never been done in Canada.
"We were running into closed doors in Ontario so we decided to go to Europe," said Flora. At London's Cromwell Hospital, chemoembolization treatments shrunk the tumours substantially but doctors warned the only way to get rid of the cancer was with a transplant. But the wait for an organ from a dead donor was eight months – time Flora didn't have.
His only alternative was a living-related transplant, which had been done at that British hospital numerous times. And his brother was the only potential donor.
There was "zero choice," explained Peter Flora, a father of two daughters. "You either help someone you love or you ignore someone you love. ... I think everybody would make the same choice."
Before the brothers and their wives set out for England, Wong completed a form seeking reimbursement from OHIP for the cost of his treatment in England. The claim was denied, but it did not dissuade them from pushing ahead with the 10-hour operation in March 2000.
A week after the procedure, the first living-related liver transplant on adults in Canada was performed in London, Ont.
Flora believed the worst was behind him, but he was forced to relive much of it when he appeared before the review board to fight OHIP's refusal to pay his treatment bills. "It brought back everything in vivid technicolour," recalled Flora, adding the lengthy legal battle also opened fresh wounds.
On one occasion, a lawyer for OHIP said his treatment should not be funded because it was still uncertain if Flora would even survive.
"She said that in front of me to the review board," he recalled. "I felt like screaming at her and saying I was going to be here longer than she was."
Flora appealed the board's decision to the Ontario Superior Court of Justice and believed the mere fact that he was alive had proven his case.
But not so.
Now Flora says the "apparent callousness" of last week's decision has left him questioning the government's responsibility in providing health care.
While he understands there's a fear in opening the floodgates to claims for alternative treatments in other countries, he points out he did not go to some backwater country for an experimental procedure. "I'd like to see those limitations on the (health-care system), if not erased, then modified in such a way to accompany the needs of every individual," he said.
"Because Ontario is not necessarily at the forefront of every medical innovation, Ontario's people cannot take advantage of everything that is available internationally."
His comments were echoed by his brother Peter Flora.
"What have I learned from all of this? Number one: Don't trust our health-care system for anything.
"And Number two: You have to be your own advocate. ... You have to work at finding appropriate information for the problem you've got, but you then have to find a way of sorting through the information to ensure you're looking at the right thing to do, and that's the hard part."
January 27, 2007
Isabel Teotonio
staff reporter
After receiving the grim diagnosis that he had six months to live, Adolfo Flora did exactly what the doctors instructed – he got his affairs in order.
He updated his will and made financial arrangements so his wife and 13-year-old son would be cared for after he was gone.
It was Christmas 1999 and the 50-year-old Toronto high school teacher had been diagnosed with liver cancer – the result of a tainted blood transfusion that gave him Hepatitis C.
"The biggest blow was them saying you have six months, go home and get your papers in order," said Flora, the retired chemistry teacher, in an interview this week. "Even now, seven years later, the impact is indescribable."
Specialists told him a transplant was useless because the cancer was spreading. It was, he said, "the final nail in the coffin."
But a month and a half later, that nail loosened when Flora sought a second opinion and was told the outlook wasn't so bleak. Suddenly, the spectre of death was replaced with a will to live. "We now had hope where before there was none," recalled Flora, who eventually went to England for a liver transplant after being denied in Ontario.
That turning point sparked a long fight with the health-care system, one that ended last week when the Ontario Divisional Court rejected his appeal of an earlier decision and ruled he would have to pay the $450,000 cost of his life-saving treatment.
Back in 1999, transplant specialists in Ontario said he was unsuitable for a transplant because the tumours in his liver had grown too large. Even with a new organ, his chances of survival were slim.
It was a prognosis his friends, family and even his physician refused to accept. They scoured the Internet, rifled through medical texts and contacted international experts. His brother, an ophthalmologist, drafted a list of about 40 experimental treatments being done overseas. Even Flora's 82-year-old mother offered up her own liver.
In England, doctors recommended chemoembolization – a treatment that Ontario considered then to be experimental.
British doctors told Flora his only shot at beating the cancer would be a liver transplant from a living donor – his brother, Dr. Peter Flora, who agreed, without hesitation.
"There was no choice, nothing to think about, no decision other than `When is it going to be done?'" recalled the 59-year-old eye specialist. "Livers regrow. And so what if you have a scar that looks like a Mercedes symbol on your gut?"
To pay for the $450,000 treatment, Flora drained his savings, borrowed money from a close friend and used the proceeds from the sale of his mother's home.
Although the operation was a great success, with Flora beating the odds and the cancer, his fight wasn't over.
The Ontario Health Insurance Plan refused to pay for the overseas treatment because the experimental chemo was not part of the insured services and Ontario specialists had rejected him as a transplant candidate. The Health Services Appeal and Review Board later upheld the decision.
In last week's court ruling, the judges said the government does not have to do everything possible to save the lives of its citizens in every circumstance.That ruling was the final blow for a man who, for the past seven years, has been on what he describes as a "debilitating" emotional roller coaster. He had hoped that the one indisputable piece of evidence in his case – being free of cancer and Hep C – would have tipped the balance in his favour.
"People have to know there are limitations with their health-care system, and those limitations may impact their lives," said Flora. "People tend to get lulled into a sense of complacency. I did." Flora's story begins with a routine surgery in 1973 to remove a benign tumour from his esophagus that was causing his stomach to contract.
But during the procedure, a vein was accidentally nicked, which caused heavy bleeding and he consequently required a blood transfusion.
A routine check three years later revealed he had contracted Hepatitis C, a viral disease that can result in cirrhosis of the liver and liver cancer.
He says he could have launched a lawsuit but didn't. Having doctors in his family, he knew that doctors can also make mistakes.
From 1979 to 1999, liver specialists monitored Flora's condition. But a couple of years passed without doctors running a full battery of tests on him. By November 1999, Flora was already in the advanced stages of liver cancer and not a suitable candidate for a transplant.
The death sentence came when specialists said the cancer had invaded the portal vein, which carries blood to the liver.
"I was at fault. I wasn't an aware consumer," recalled the soft-spoken Flora, as tears welled up in his eyes. "A simple test would've picked up the cancer at an earlier stage..." The weeks following that bleak prognosis were the most difficult of his life. He and wife Marijana tried to remain optimistic for their son, Christopher, but each time Flora sat down to deal with his estate, the grief was overwhelming.
The couple, who taught at the same school, stayed on until Christmas when he took early retirement. Marijana also did not return in the new term because she planned to spend those final months with her husband.
A flicker of hope appeared after a new physician, Dr. Florence Wong, sent him for a second ultrasound. It turned out the portal vein was not invaded.
Wong explored treatment options with various Ontario specialists, but because his cancer was advanced, they said he wasn't a suitable candidate for a transplant from a dead donor, given the scarcity of organs. And a living-related liver transplant from adult to adult, in which a portion of a living donor's liver is transplanted, had never been done in Canada.
"We were running into closed doors in Ontario so we decided to go to Europe," said Flora. At London's Cromwell Hospital, chemoembolization treatments shrunk the tumours substantially but doctors warned the only way to get rid of the cancer was with a transplant. But the wait for an organ from a dead donor was eight months – time Flora didn't have.
His only alternative was a living-related transplant, which had been done at that British hospital numerous times. And his brother was the only potential donor.
There was "zero choice," explained Peter Flora, a father of two daughters. "You either help someone you love or you ignore someone you love. ... I think everybody would make the same choice."
Before the brothers and their wives set out for England, Wong completed a form seeking reimbursement from OHIP for the cost of his treatment in England. The claim was denied, but it did not dissuade them from pushing ahead with the 10-hour operation in March 2000.
A week after the procedure, the first living-related liver transplant on adults in Canada was performed in London, Ont.
Flora believed the worst was behind him, but he was forced to relive much of it when he appeared before the review board to fight OHIP's refusal to pay his treatment bills. "It brought back everything in vivid technicolour," recalled Flora, adding the lengthy legal battle also opened fresh wounds.
On one occasion, a lawyer for OHIP said his treatment should not be funded because it was still uncertain if Flora would even survive.
"She said that in front of me to the review board," he recalled. "I felt like screaming at her and saying I was going to be here longer than she was."
Flora appealed the board's decision to the Ontario Superior Court of Justice and believed the mere fact that he was alive had proven his case.
But not so.
Now Flora says the "apparent callousness" of last week's decision has left him questioning the government's responsibility in providing health care.
While he understands there's a fear in opening the floodgates to claims for alternative treatments in other countries, he points out he did not go to some backwater country for an experimental procedure. "I'd like to see those limitations on the (health-care system), if not erased, then modified in such a way to accompany the needs of every individual," he said.
"Because Ontario is not necessarily at the forefront of every medical innovation, Ontario's people cannot take advantage of everything that is available internationally."
His comments were echoed by his brother Peter Flora.
"What have I learned from all of this? Number one: Don't trust our health-care system for anything.
"And Number two: You have to be your own advocate. ... You have to work at finding appropriate information for the problem you've got, but you then have to find a way of sorting through the information to ensure you're looking at the right thing to do, and that's the hard part."
I have certain rules I live by ... My First Rule ... I don't believe anything the government tells me ... George Carlin
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
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Comments
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
So what do you propose? What is wrong? Are you saying that the people in charge of health care should just act like there is a never-ending supply of money and pay a half a million dollars to try and save everyone who gets a terminal diagnosis? I'm not following you.
Thats exactly what I'm saying, if the treatment is available in the UK or in the USA or other civilized nations then its worth exploring and treating people, it's not like he got treatment in some back ally, he was treated in a respectable country. Your saying draw a line, well dude we don't have a monopoly on which treatments work and don't work and since our government has jacked our taxes up tp pay for this so called health care system, then it their obligation to pay for people to get treatment for illness's out of country if we do not provide them.
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
Health Canada approves new treatments all the time. If this guy died while receiving this experimental treatment and dropped a half a million dollars, not only would he be dead but his family would have been in the poor house. People have to be careful about which doctors they trust. Anyway, new treatments need research before being approved. Would you complain if Health Canada decided against researching treatments, paid for all of these experimental treatments no questions asked and a bunch of coliccy babies died because whoever came up with the experimental treatment didn't know that you can't treat colic with fire?
...and you trust health Canada? also factor in that Doctors made mistakes from the get go that caused him his problems, and continued to make mistakes after he was diagnosed terminally, so therefore they are obligated to treat him. I also thought like him, doctors make mistakes, the moral of the story, sue...and sue everyone involved for as much money as possible...never know when you'll need to seek treatment elsewhere.
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
"Life Is What Happens To You When Your Busy Making Other Plans" John Lennon
this tells me that you don't know what the fuck you are talking about. I live near the border and i know three people that have that have kept their Canadian citizenship in case they ever get hit with a serious illness. is the hospital here (the closest to the Canadian Border) flooded with Canadians? hell no, it's flooded with uninsured Americans people that have let their illnesses go so far that they end up with no choice but to go to the ER.
this guy would've been denied having his transplant covered in the US as well even if he had insurance, because insurance companies will NOT cover what the insurance company considers experimental treatments/surgeries. not only that but this guy would've had to sell everything he owned and been bent over in debt unless he was independently wealthy. so he would've faired absolutely no better had he been an American with health insurance. had he had no insurance in the US after his initial diagnosis he would've been sent home with some pain killers to die
angels share laughter
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that's just three people that i consider friends (actually i have another that's kept her Finnish citizenship) that have kept their citizenship, so the real numbers i'm sure are many, many more. I don't claim to be an authority on the citizenship of people but I know what people working at that hospital tell me. I'll look and see if i can find any numbers for the last 5 years but i doubt that I can with hipa laws in place, but i'll try.
also there's that my son had to go to Canada to get the medical care that he needed, that two doctors here refused to do.
so when I saw that you were talking out of your ass, i thought that I'd mention it.
angels share laughter
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Wow. Just what colour is the sky in your world?
The only thing that border-town Canadians "flood" to US hospitals for is quicker access to MRIs. It's hardly for the opportunity to pay 10000 to get a knee operation.
I have dwelled into this topic many times and have listened to many of those from both side...the best pro-pay for your healthcare arguement even said the American system was pooer than our current social system....he suggested a system like those of Scandanavia counrtries (which annually rank the highest) as a good system to head towards.....
My dad recently died from pancreatic cancer and spent 10 days dying in an over crowded emergency room because there are no other beds available. Meanwhile there were other people in emergency who were just laying in stretchers in the aisles for up to 15 hours waiting for an emergency room bed.
With the population aging as it is there is no way the Canadian system can hold. It was implimented when Canada's demographics were a small, youthful population. Things have changed and sadly, the healthcare system must as well.
Wow, that's rough. My condolences to you about your father. And I further empathise with the many emotions I would imagine you have felt given the less than optimal circumstances surrounding his passing.
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