Wait 14 weeks or pay $5,000

I think not
Long wait forces Ontario cancer patient to buy operation in land he fled

From Wednesday's Globe and Mail

An Ontario cab driver was faced with this choice: Wait more than 14 weeks for cancer surgery, or travel outside of Canada and purchase the lifesaving operation he could not receive here quickly enough.

In the end, Branislav Djukic returned to the place he fled in 1995, the former Yugoslavia, seeking a better life in Canada. In Belgrade, he underwent surgery to remove a portion of his left kidney at a cost of $5,000.

It was an operation the Ontario government was ordered to reimburse after the Health Services Appeal and Review Board ruled last year that the wait Mr. Djukic faced was too long — a decision reported on for the first time now.

“I felt very bad,” Mr. Djukic, 51, said in an interview from his home in London, Ont. “I couldn't believe that in a rich country, you had to wait so long.”

His daughter, Maja Djukic, who launched his appeal, said she was stunned when Canada left him to languish in a lengthy queue.

“Canada prides itself in being one of the best countries in the world to live in and this is one of the reasons we came here,” Ms. Djukic said.

“However, in a time of need for somebody in my dad's situation, Yugoslavia offered better and faster treatment. They could not understand that they would make you wait that long to treat a disease of such seriousness in a country such as Canada and neither could we.”
In Mr. Djukic's case, he asked the Ontario government to fund a more timely cancer surgery out of the country after he was given a date in an Ontario hospital of Jan. 17, 2005 — a wait of 14 weeks and three days.

But in a letter dated January, 2005, the Ontario government denied his request for out-of-country surgery, saying it was unlikely the wait would adversely influence his prognosis.

Now the process for handling out-of-country care has come under the spotlight, and Ontario Health Minister George Smitherman announced yesterday that he will review it.

Ontario's move comes after colorectal cancer patient Suzanne Aucoin was denied funding for the drug Erbitux in the United States. After an investigation by the province's ombudsman, the Ontario government agreed to reimburse Ms. Aucoin for her costs.

In an interview last night from her home in St. Catharines, Ont., Ms. Aucoin said the government is reimbursing her $76,018.23, which includes the cost of the drug, among other expenses and legal fees.

“It's been a long, difficult journey and I feel a sense of relief,” the 37-year-old said. She described the province's out-of-country coverage as being “consistently inconsistent,” with some patients approved for some drug treatments, such as Erbitux, but not others.

Figures obtained by The Globe and Mail under freedom-of-information laws show Ontario has spent more than $31.5-million over the past five years funding out-of-country cancer treatment — either because it was ordered by the Health Services Appeal and Review Board to reimburse patients such as Mr. Djukic or because it voluntarily sent patients to other countries for care.

The same figures show Ontario paid for at least 18 different types of out-of-country cancer treatment — including chemotherapy, bone-marrow transplants, doctor consultations, surgery and proton-beam treatment — according to the figures from 2001-2002 to April 20, 2006, the most recent available.
Other provinces have also sent patients out of Canada for care, mostly to the United States.
Specifically, British Columbia sent 22 people, including one patient who went twice, to the United States for care from 2001 to 2006, spending $1.79-million, according to that province's Health Ministry.

Alberta approved $850,286 in spending for five patients who left the country for cancer care in 2005-2006. And Saskatchewan funded 14 out-of-country cases, including nine stem-cell transplants at a total cost of $2.2-million, during the same time period.

John Denstedt, senior medical director of surgery services for the London Health Sciences Centre, said all surgical cases are assessed by physicians on a case-by-case basis, where they are scheduled according to clinical urgency.

While the money from the Ontario government helps, Dr. Denstedt said a lack of resources, including the shortage of anesthetists, limits the hospital's ability to increase the number of operations.
Terrence Sullivan, president and CEO of Cancer Care Ontario, said that in the 1990s and early 2000 waiting times for cancer surgery were growing. Today, the waiting times have stabilized and are falling for most cancers.

As for Mr. Djukic, the road to surgery was a long one. His first symptom, back pain, sent him to the emergency room in November, 2003. An ultrasound revealed no abnormalities. Two more times in the next couple of months, Mr. Djukic returned to the hospital with pain; doctors suspected a back spasm and urinary-tract infection, according to the 10-page decision.

When Mr. Djukic noticed blood in his urine in April, 2004, he was referred to the urology clinic at London Health Sciences Centre. A renal ultrasound on June 28, 2004, found a lesion that was suspected as being cancerous.

He was seen by doctors again on Aug. 20, 2004, where another CT scan was ordered to further define the lesion. That Sept. 29, 2004 scan revealed a renal cell cancer and, on Oct. 8, he was given a surgery date of Jan. 17, 2005.

All told, the wait from the first time Mr. Djukic had blood in his urine to the scheduled surgery was about nine months.

“We were very confused, we didn't know what to do,” Mr. Djukic said of the wait. “I was lost.”
But he cut that wait short when he had surgery in Belgrade in 2004.

According to the Feb. 14, 2006 decision, the Health Services Appeal and Review Board said it was “necessary for him [Mr. Djukic] to travel out of Canada to avoid a delay in obtaining treatment that would result in medically significant, irreversible tissue damage.”

Though the operation to remove the cancer only cost $5,000, he says he paid another $5,000 in travel and accommodation costs that the government was not ordered to reimburse him for.

Even with the wait times, I am happy with have universal health care unlike our American neighbours to the south.

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