Ethicists baffled by $20K medevac bill

Medical ethicists are baffled by the Yukon government's decision to bill a man $20,000 for a medevac he was told he would not have to pay. "If a server in a coffee shop offers you a muffin as a free sample, but charges you for it after you ate it, you have no obligation to pay...

Medical ethicists are baffled by the Yukon government’s decision to bill a man $20,000 for a medevac he was told he would not have to pay.

“If a server in a coffee shop offers you a muffin as a free sample, but charges you for it after you ate it, you have no obligation to pay,” said Dr. Dick Sobsey, director of the John Dossetor Health Ethics Centre at the University of Alberta, in an e-mail.

“This is really no different.”

Yukon’s ombudsman agrees. She found the Health Department committed “administrative negligence” when it proceeded to bill Sheldon Miller, 53, for a medical evacuation when he had been assured by doctors, nurses and administrators he would not have to pay.

But the territory won’t budge. Rules are rules, it insists, and uninsured patients are expected to pay the cost of medevacs.

The situation makes little sense to Sobsey.

“If someone representing health services told him it was free and he had no obvious reason to doubt it, they have no moral basis to collect and I doubt they have an enforceable legal one.

“If the employee who told him it was free should not have done so, health services might have a claim to charge the employee, but not the patient.

“The notion that the ‘rules’ say that he must pay only pays attention to one set of rules and not another.

“There are rules that say he must be given accurate information. There are rules that say that offering a service as free and then charging for it is fraud.

“In fact, some rules might be interpreted to say that taking someone on a trip with consent based on false information when they would refuse to go if given accurate information is abduction or kidnapping.”

Dr. Jeff Blackmer, director of medical ethics for the

Canadian Medical Association, agrees.

“There’s some fairness issues” in Miller’s case, he said. “You’d expect the policy, and the decisions based on that policy, to be fairly reasonable and humane and transparent.

“It seems awfully strange that anyone would expect a person in this type of situation, who needed life-saving care, who was given information … to be asked to pay it back.”

“It just, on the face of it, doesn’t seem very fair.”

Miller insists he would never have boarded the plane if he knew he’d be stuck with the bill, which is well beyond his means to pay.

He’s a highway cook. Work has been thin lately. His common-law wife works as a hostess at the Yukon Suspension Bridge.

They’re raising three young children, aged two, eight and nine.

Miller’s problems began in late June 2005, shortly after moving to the Yukon from the Northwest Territories. His chest felt tight. It hurt.

Doctors warned he may be about to have a heart attack. They advised him to see a specialist in Victoria.

Miller was not yet a Yukon resident. Nor did he have money to pay for the flight himself. He had recently declared bankruptcy and he explained this to health staff.

Don’t worry, he was told. The governments of the Yukon and NWT would sort it out.

They didn’t.

One ambulance attendant did warn Miller he would have to pay. But by then he was about to board the plane, and he had already received earlier assurances otherwise.

This warning was “too little, too late,” the ombudsman concluded.

Miller was relieved to be given a clean bill of health by a cardiologist in Victoria. But soon he had new reasons to be anxious.

He had been told to phone a number when he was ready to return to the Yukon. But when he got through, he was told he’d better speak with the NWT government.

In the end, a friend paid for his flight back to Whitehorse.

Then the bills began to arrive in the mail for his ambulance rides and medevac.

With growing interest, he now owes more than $20,000.

While the territory refuses to forgive Miller’s debt, it did change the way it deals with uninsured medevac patients, in accordance with the ombudsman’s recommendations. Clear rules are now in place to warn these patients they must pay.

This suggests the territory knows it mistreated Miller, the ombudsman noted in a letter to cabinet.

The Liberal and NDP oppositions have both urged the government to heed the ombudsman’s recommendations.

In response, Premier Dennis Fentie suggested the real victims are Yukon’s civil servants, under attack by the oppositions.

Yukon News has requested interviews with Premier Fentie and Minister Glenn Hart on the matter nine times. They’ve yet to reply.

Canadians are supposed to receive public health care, no matter where they live in the country. Miller’s treatment appears to fly in the face of this principle, said Blackmer.

“You’d expect that if you’re in a different province, and they can’t provide that kind of care in your locale, you’ll still be able to, in the public health system, get help to go somewhere else, particularly in an emergency-type situation.

“If you’re sick in Canada, you should have access to medical care … not differential access depending where you live.”

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