So, who pays for medical travel?

So, who pays for medical travel? In the March 11 response from Patricia Living to the Yukon News' article on medevac services, she accused the paper of, "doing the public a serious disservice by linking supposed changes in medevac services to the ongoin

In the March 11 response from Patricia Living to the Yukon News’ article on medevac services, she accused the paper of, “doing the public a serious disservice by linking supposed changes in medevac services to the ongoing review of the Yukon medical travel program.”

The News article does confuse the two, but it was an honest mistake.

The public, the media and, apparently, even the paramedics aren’t too clear how these two services are, or are not, linked.

Living very clearly separates the role of Community Services’ medevac program and the Yukon medical travel program when she implies the medevac contract is solely for the purposes of sending patients out of territory for urgent medical care.

But is it really clear?

The roles of Health and Social’s Yukon medical travel program and Community Services’ emergency medical services are obfuscated by creative accounting practices and confused departmental priorities and processes. If there are any Ð Auditor General Sheila Fraser has concluded Health and Social fails to create and follow essential business practices, like establishing priorities, developing clear processes or establishing sound business plans for huge capital expenditures, like hospitals.

According to the Health and Social website, medical travel “refers to a medical emergency and to those nonemergency services, which are not available in the home community but are necessary for the well-being of the patient.”

According to the Community Services website, EMS is “responsible for the emergency transportation of the sick and injured from the scene to the nearest health-care facility able to provide the required level of care.”

If Health and Social’s medical travel program covers both emergency and nonemergency services, and EMS provides transportation for emergencies, how are these two programs separated Ð especially financially?

And who makes the call when EMS is to respond versus medical travel? And what’s the criteria determining the level of urgency?

Perhaps medical travel and EMS should delineate costs and calls based on emergency versus nonemergency care.

The term “medevac” is a truncated form of “medical evacuation.” Evacuation implies urgency. This urgency is rated on an internationally recognized scale by emergency responders of one to five.

One equals threats to life and limb. Five equals nonurgent.

One equals respiratory distress with risk of deteriorating to respiratory failure. Five equals sore throat.

One equals life or death. Five equals a medically necessary appointment in the next day or two.

Perhaps it would make sense if EMS were responsible for ratings one or two and Yukon Medical Travel responsible for three to five.

If only the program was that clear.

I do agree with Living that the News does the public a disservice in the article. It wrongly promotes the true cost of medical travel at a mere $10 million.

What should have been asked of ministers Glenn Hart and Archie Lang is: What is the true cost of medical travel in the Yukon?

And shouldn’t that be the purpose of the $300,000 federally mandated review?

Perhaps the News should have stated the Yukon’s Health and Social Services Department spends more than $10 million a year on medical travel.

The true costs to the territory on medical travel are not known because the medical transport services provided by Community Services and the medical travel program are inextricably linked and entirely confused.

Is that $10 million the money dedicated to funding individual citizens to travel to Vancouver or Edmonton on Air North or Air Canada in order to access medically necessary care that isn’t offered in the Yukon?

But what happens when the patient must be accompanied by a paramedic whose salary and overtime are paid by Community Services?

Or if the patient can’t wait for a scheduled flight because a bed is free in a hospital Outside, but will be taken up by someone else if not filled immediately?

Where’s the budget for the demand to move a patient to a southern hospital immediately to free up a bed in the Whitehorse General Hospital? Is that done under “medical travel” or “medevac?”

Or an in-territory flight that brings patients from the communities to Whitehorse for medically necessary treatment?

How are repatriation flights costed Ð when a patient returns to the Yukon Ð stable enough to fly, but still requires medical assessment on the return flight?

How does the territory justify the costs and risks of flying nonurgent medical flights within the territory on the medevac contract?

How are those wages and costs accounted for?

Whose budget line does all this fall under?

And when the federal Health Department is billed by the territorial government for First Nation patients, whose coffers get the payment?

The departments whose budgets are affected for providing that service?

Or into general revenue to be disbursed as the Finance minister deems fit?

Until medical travel stops using medevac as an internal on-demand taxi service to offset costs of nonurgent care, the Yukon and federal governments will never achieve clarity on the true cost of medical travel.

Perhaps the Yukon government should be more open with its departmental budgets. Perhaps the $300,000 audit should be a true audit of all medically necessary travel in and out of the Yukon.

Emily Smith