Local woman undeterred after OHIP compensation case denied

Posted Apr 26, 2012 By Stacey Roy

EMC News - An April 19, 2012 denial of her claim for OHIP compensation will mean Smiths Falls-area resident Judy Butcher's health care journey is not yet over.

"I'm really disappointed," Butcher said of the outcome.

She is planning her next step in the process despite not having formally receiving word of her denial by the Ontario Health Services Appeal and Review Board (HSARB).

News of her denial for a requested $7,000 in compensation - the cost of chronic cerebrospinal venous insufficiency (CCSVI) treatment she underwent in Egypt in March 2011 - came to her by way of a fellow MS patient who was surfing the internet and happened upon it. By deadline this week Butcher had not received formal notification from the board itself. In this decision report, the board denied Butcher's request because her treatment is considered experimental and not insured by the OHIP program under section 24(1)17 of Regulation 552. This regulation aims to disqualify treatments that are too early to determine whether it will help. On this point Butcher's and the board's opinions differ.

Following her treatment in Egypt last March, Butcher has been able to regain some of her mobility and her ability to drive.

"It's not gone but it's definitely improved," she said of her spasticity last year during an interview with The Record News at the time of her return.

Her ultimate denial by the board came as no surprise to Perry Brodkin, a Toronto lawyer who specializes in health care law, specifically government reimbursement. In speaking with The Record News this week, Brodkin points out that Butcher was up against a seasoned lawyer and an expert medical doctor hired by OHIP for the Feb. 7 hearing. The gravity of these hearings is akin, according to Brodkin, to a medical malpractice suit in the Supreme Court of Canada. It is for this reason that he would like to see the Minister of Health restrain OHIP's representation in these matters.

"OHIP should be prohibited from being represented by a lawyer where an appellant is not represented by a lawyer," Brodkin said. "That's a good first step in creating a more level playing field."

Brodkin spent at least 18 years of his life working as OHIP's lawyer and knows the provincial program has at least 20 medical advisers who are experts in the appeal process. This level of expertise is too much for individual patients like Butcher who don't have the means for such representation. He encouraged Butcher to file a complaint to the Ontario Ombudsman's office outlining this unfair representation and requesting a new hearing, which she plans to do. The only other alternative for the Easton's Corners woman is to take the case to the divisional court of the Superior Court of Justice, which is extremely expensive. Butcher is in a unique position as her case was filed before April 1, 2011 when the laws changed to require patients to have a specialist fill out a form for out-of-country OHIP coverage. Butcher's was signed by a family doctor after six others refused. She came home from Egypt to find the OHIP refusal for payment dated March 3, 2011, which started the ball rolling toward an appeal process. At the Feb. 7, 2012 hearing in Ottawa the review board was made up of Marla Burstyn (designated vice chair), Deborah Coyne and Marc D'Amours (board members). However, it is noted that Coyne did not participate in the final decision. Butcher has written Leeds-Grenville MPP Steve Clark asking for his help in finding out why Coyne was not part of the decision process.

"At my hearing Ms. Coyne seemed very shocked to learn that this procedure was done here every day, just not for CCSVI, even though CCSVI has been designated by the International Union of Phlebologists as a 'truncular, venous malformation preceding MS plaque,'" Butcher writes in her letter to Clark dated April 23, 2012.

An email request from The Record News to the Health Services Appeal and Review Board asking for Coyne's contact information for further comment was returned with this statement: "Ms. Deborah Coyne is no longer a Board Member with the HSARB. As such, I am sorry I can be of no further assistance," wrote Chris Popovich, executive assistant and researcher, Health Boards Secretariat, Health Professions and Health Services Appeal and Review Boards. Butcher plans to move forward with the appeal to the Ontario Ombudsman's office.