Yukon’s Health Department acted unfairly when it billed a man nearly $20,000 for a medevac to Victoria, after he had been assured he wouldn’t have to pay, the territory’s ombudsman has found.
“Patients who are told ‘not to worry’ or that it will be ‘worked out’ and who then make a decision based on those reassurances, are entitled to rely on that information,” wrote Tracy-Anne McPhee in her final report, tabled in the legislature last week.
But, despite McPhee’s objections, the government won’t drop the fees.
The man was just two days short of becoming a Yukon resident when, in late June of 2005, he began to suffer from chest pain and other symptoms consistent with a lead-up to a heart attack.
Whitehorse didn’t have the equipment for a complete heart diagnosis, so a doctor recommended the man be flown Outside.
Had he secured Yukon residency, the man’s subsequent flight to Royal Jubilee Hospital would have been fully paid for by the territory.
But the man, who had recently moved from the Northwest Territories, had not yet lived in the Yukon for the required two months to become a resident.
When told he needed to be sent Outside, the man asked how much it would cost. He explained he had no money.
He had recently filed for bankruptcy and was not yet discharged. Not long before, he depended on social assistance.
He had worked as a cook at Ogilvie Camp on the Dempster Highway for six weeks before his health problems began.
Health staff told the man not to worry about medevac costs. The two territorial governments would sort that out, a doctor, two nurses, an administrator and flight staff all told him.
One ambulance attendant warned the man he would have to pay for the trip. But “this is too little, too late,” McPhee concluded.
By then, the man had already agreed to be evacuated. Others had told him he wouldn’t have to pay. And he was never told the magnitude of how much the medevac would cost.
He was also assured the government would fly him back to Whitehorse. It didn’t.
During the evacuation, the man was given the telephone number of Yukon Insured Health Services. He was told to call when he was ready to return to Whitehorse.
But when he called from Victoria, the man was told he’d better call the NWT’s health department or social assistance.
In the end, a friend bought the man a return airline ticket to Whitehorse.
He later received a bill for $18,176 for the medevac and ambulance rides.
The man’s treatment amounts to “administrative negligence,” states McPhee. The hospital and medical staff failed “to meet the standard of care owed to the public.”
“It seems clear to me that the question of costs and the issue of who pays should be part of the discussion with a patient about treatment options,” states McPhee.
The man’s treatment also likely flies in the face of the Medical Council of Canada’s guidelines on obtaining consent from patients.
It requires physicians to disclose to patients “what a reasonable person would want to know in a given circumstance,” states McPhee. This surely includes disclosing a bill of nearly $20,000 to a bankrupt man, she states.
The hospital and health department have since adopted McPhee’s recommendations that they create clear rules about how to deal with noninsured medevac patients. Such guidelines did not exist when the man was treated.
But the territory refuses to write off the man’s debt incurred from his medevac.
“Government billings, in accordance with policy, will continue,” Premier Dennis Fentie told the legislature last Thursday, when Liberal Leader Arthur Mitchell asked if the man’s debt would be dropped.
Fentie then tried to flip roles. He accused Mitchell of being callous and hard-hearted for criticizing government workers, who he said are “hardworking Yukoners who do everything they can to address the quality of life for all Yukon citizens.”
The ombudsman’s powers stop at being able to make recommendations to cabinet and having her reports tabled in the legislature. These avenues are now exhausted.
The government insists it’s only following the rules, which say the man must pay.
But there’s a difference between following the letter of the law and behaving fairly, states McPhee.
“The fact that a policy exists and is being consistently applied does not necessarily mean that the application is fair in all situations,” she wrote.
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