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Help Suzanne Aucoin
July 4, 2006 - The St. Catharines Standard
St. Catharines Standard (ON)
Front, Tuesday, July 4, 2006, p. A1
'I get why people go postal now"
Furious with OHIP
Peter Downs
Suzanne Aucoin is livid.
She's just learned from her lawyer that the province's health insurance
program - OHIP - is probably not going to reimburse her about $55,000 she
paid out of her own pocket for a colon cancer drug not available
commercially in Ontario.
She's been counting on the money to cover other treatments she'll need in
the future to fend off her terminal illness.
"I get why people go postal now. I truly get it," she says, during a recent
interview.
"People push you to the edge when you have so much other stress in your
life."
Aucoin, who lives in Port Dalhousie with her parents, was diagnosed with
colorectal cancer when she was 29.
Surgeons thought they had removed all of the cancerous cells.
But in November 2003, Aucoin learned the cancer had returned. This time, her
doctors told her it was terminal.
Aucoin, 35, has spent tens of thousands of dollars for cancer medications
not covered by the provincial government.
Two weeks ago, a month after her lawyer initially prepared her for a
letdown, Suzanne received the official word - OHIP rejected her application
for reimbursement.
Compounding her frustration, Suzanne feels as though the provincial
government put her in a Catch-22 position, leaving her no choice but to go
out on her own to buy the expensive drug Erbitux.
Patients with advanced colorectal cancer who have been told by their
physicians that Erbitux is a last resort to prolong their lives - such as
Aucoin - can apply to OHIP for out-of-country coverage to pay for the
intravenous drug.
Aucoin applied for the funding last October and was turned down by OHIP.
Shortly afterward, she began paying approximately $14,000 US a month to
receive Erbitux treatment at a private clinic in West Seneca, N.Y.
Then last December, Health Canada granted Aucoin special access to receive
the drug on this side of the border.
She became the first person to be treated with Erbitux at Hamilton's
Juravinski Cancer Centre.
She paid the centre approximately $6,400 a month for weekly infusion
treatments.
But in late March, Aucoin's Hamilton oncologist submitted a second
application to OHIP on her behalf for out-of-country coverage for Erbitux.
This time, OHIP approved.
She began receiving weekly treatments with Erbitux at Buffalo's Roswell Park
Cancer Institute in April on OHIP's tab - at a cost of approximately $24,000
US a month.
Once she was approved for out-of-country coverage, Aucoin tried to convince
OHIP to cover the thousands of dollars she spent previously on the drug.
She says her lawyer held out little hope of recovering the $25,000 she paid
for Erbitux through the Hamilton cancer centre because it doesn't meet
OHIP's out-of-country requirement.
Aucoin and her lawyer thought they had a better case for recovering the
$25,000 US she spent at the West Seneca clinic.
But two weeks ago, Aucoin says she was informed OHIP won't cover her
previous Erbitux bills in New York because she went to a private clinic and
not a public hospital.
"It makes me mental," says Suzanne, who is on a leave of absence from her
job as a chaplain at Denis Morris High School.
"My brothers and OHIP can get me from zero to boiling point in less than a
few seconds."
The Health Ministry's reciprocal agreements for out-of-country medical
coverage are with hospitals, not private clinics, says spokesman John
Letherby.
"The ministry will only approve if it's in a certain setting, i.e. a
hospital," he says.
Letherby also says the ministry begins paying a patient's medical treatment
costs only after approval for out-of-country coverage.
"When you have someone who goes ahead and gets treatment of their own
volition prior to out-of-country approval ... then any kind of costs
incurred prior to that are not reimbursable," he says
Aucoin says her decision to pay for Erbitux at the private clinic was
strictly economic. The clinic in West Seneca charged $10,000 US less a month
than Roswell Park.
"(OHIP) put me in that position in the first place. They denied my first
application for out-of-country coverage for no legitimate reason," she says.
Aucoin says health officials said her initial application was rejected
because they believed Erbitux was already available for use in Ontario.
But while Health Canada approved the drug for use last September, it was not
actually available commercially in any province.
The drug's manufacturer, Bristol Myers Squibb, never applied to market
Erbitux in Canada and recently announced it doesn't plan to do so because it
cannot charge the price it wants. The apparent bureaucratic misunderstanding
by decision-makers at OHIP infuriates Suzanne.
"That's what pisses me off. It's caused me eight months of unnecessary grief
now," she says.
"To me, if people would do their jobs properly, I wouldn't be in this
position."
Aucoin says she will appeal OHIP's decision.
And if the appeal is denied, she plans to take legal action against the
government to try to recoup the money she spent on Erbitux.
"The way that I'm going to get my justice, whether I get my money or not, is
through exposing them," she says.
"I want to let the public know things aren't right and things have to
change."
pdowns@stcatharinesstandard.ca
St. Catharines Standard (ON)
Front, Tuesday, July 4, 2006, p. A1
'I get why people go postal now"
Furious with OHIP
Peter Downs
Suzanne Aucoin is livid.
She's just learned from her lawyer that the province's health insurance
program - OHIP - is probably not going to reimburse her about $55,000 she
paid out of her own pocket for a colon cancer drug not available
commercially in Ontario.
She's been counting on the money to cover other treatments she'll need in
the future to fend off her terminal illness.
"I get why people go postal now. I truly get it," she says, during a recent
interview.
"People push you to the edge when you have so much other stress in your
life."
Aucoin, who lives in Port Dalhousie with her parents, was diagnosed with
colorectal cancer when she was 29.
Surgeons thought they had removed all of the cancerous cells.
But in November 2003, Aucoin learned the cancer had returned. This time, her
doctors told her it was terminal.
Aucoin, 35, has spent tens of thousands of dollars for cancer medications
not covered by the provincial government.
Two weeks ago, a month after her lawyer initially prepared her for a
letdown, Suzanne received the official word - OHIP rejected her application
for reimbursement.
Compounding her frustration, Suzanne feels as though the provincial
government put her in a Catch-22 position, leaving her no choice but to go
out on her own to buy the expensive drug Erbitux.
Patients with advanced colorectal cancer who have been told by their
physicians that Erbitux is a last resort to prolong their lives - such as
Aucoin - can apply to OHIP for out-of-country coverage to pay for the
intravenous drug.
Aucoin applied for the funding last October and was turned down by OHIP.
Shortly afterward, she began paying approximately $14,000 US a month to
receive Erbitux treatment at a private clinic in West Seneca, N.Y.
Then last December, Health Canada granted Aucoin special access to receive
the drug on this side of the border.
She became the first person to be treated with Erbitux at Hamilton's
Juravinski Cancer Centre.
She paid the centre approximately $6,400 a month for weekly infusion
treatments.
But in late March, Aucoin's Hamilton oncologist submitted a second
application to OHIP on her behalf for out-of-country coverage for Erbitux.
This time, OHIP approved.
She began receiving weekly treatments with Erbitux at Buffalo's Roswell Park
Cancer Institute in April on OHIP's tab - at a cost of approximately $24,000
US a month.
Once she was approved for out-of-country coverage, Aucoin tried to convince
OHIP to cover the thousands of dollars she spent previously on the drug.
She says her lawyer held out little hope of recovering the $25,000 she paid
for Erbitux through the Hamilton cancer centre because it doesn't meet
OHIP's out-of-country requirement.
Aucoin and her lawyer thought they had a better case for recovering the
$25,000 US she spent at the West Seneca clinic.
But two weeks ago, Aucoin says she was informed OHIP won't cover her
previous Erbitux bills in New York because she went to a private clinic and
not a public hospital.
"It makes me mental," says Suzanne, who is on a leave of absence from her
job as a chaplain at Denis Morris High School.
"My brothers and OHIP can get me from zero to boiling point in less than a
few seconds."
The Health Ministry's reciprocal agreements for out-of-country medical
coverage are with hospitals, not private clinics, says spokesman John
Letherby.
"The ministry will only approve if it's in a certain setting, i.e. a
hospital," he says.
Letherby also says the ministry begins paying a patient's medical treatment
costs only after approval for out-of-country coverage.
"When you have someone who goes ahead and gets treatment of their own
volition prior to out-of-country approval ... then any kind of costs
incurred prior to that are not reimbursable," he says
Aucoin says her decision to pay for Erbitux at the private clinic was
strictly economic. The clinic in West Seneca charged $10,000 US less a month
than Roswell Park.
"(OHIP) put me in that position in the first place. They denied my first
application for out-of-country coverage for no legitimate reason," she says.
Aucoin says health officials said her initial application was rejected
because they believed Erbitux was already available for use in Ontario.
But while Health Canada approved the drug for use last September, it was not
actually available commercially in any province.
The drug's manufacturer, Bristol Myers Squibb, never applied to market
Erbitux in Canada and recently announced it doesn't plan to do so because it
cannot charge the price it wants. The apparent bureaucratic misunderstanding
by decision-makers at OHIP infuriates Suzanne.
"That's what pisses me off. It's caused me eight months of unnecessary grief
now," she says.
"To me, if people would do their jobs properly, I wouldn't be in this
position."
Aucoin says she will appeal OHIP's decision.
And if the appeal is denied, she plans to take legal action against the
government to try to recoup the money she spent on Erbitux.
"The way that I'm going to get my justice, whether I get my money or not, is
through exposing them," she says.
"I want to let the public know things aren't right and things have to
change."
pdowns@stcatharinesstandard.ca