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Help Suzanne Aucoin
Sept. 22, 2006 - The St. Catharines Standard
St. Catharines Standard (ON)
Front, Friday, September 22, 2006, p. A1
Suzanne's story
Another bureaucratic battle takes its toll
By PETER DOWNS
Standard Staff
Part 10
Her one possible mistake may have been to try to save herself thousands of
dollars on expensive cancer treatments.
Suzanne Aucoin's attempt to stretch her limited budget as far as possible
could end up costing her more than $30,000.
Rejected last October by OHIP for out-of-country coverage for a colon cancer
drug not available in Ontario, Aucoin searched for the lowest price for the
medication she could find in the U.S.
The St. Catharines resident arranged to receive treatment with the
intravenous drug - Erbitux - at a private clinic in West Seneca, N.Y., for
approximately $14,000 US per month.
That price was $10,000 less than OHIP was paying for other Ontario patients
to get Erbitux at Buffalo's Roswell Park Cancer Institute.
But as good as the deal looked to Aucoin, OHIP didn't like it.
Last June, the province's health insurance program rejected her application
to be reimbursed the $31,065.62 she paid for Erbitux at the West Seneca
clinic from October to December.
Aucoin, 36, is now fighting to reverse that decision.
She and lawyer Brian Cohen appeared before Ontario's Health Services Appeal
and Review Board for a one-day hearing Monday in Toronto.
They are also seeking reimbursement for an additional $21,116.70 Aucoin paid
to get Erbitux at Hamilton's cancer centre through a federal special access
agreement.
"Fourteen thousand dollars is still an exorbitant amount to pay, but it's
less than $24,000," Aucoin told the three-member tribunal.
"I have to go where I'm going to get the drug and the treatment to save my
life."
And that's precisely the point on which Aucoin's case will turn - where she
received the drug in the U.S.
To qualify for out-of-country coverage by OHIP, Ontario patients must
receive approved treatments or services at "a hospital or licensed health
facility," testified Dr. Hugh Langley, medical consultant to OHIP's general
manager.
And OHIP has ruled that the West Seneca clinic where Aucoin was treated with
Erbitux doesn't fit that definition.
"I have not seen any evidence that it is a licensed health facility,"
Langley said under questioning by Aucoin's lawyer.
Instead, the lawyer representing OHIP - John Johnston - contended the place
where Suzanne received the cancer drug was merely a doctor's office and not
a licensed cancer treatment facility.
Aucoin testified that she and her Hamilton oncologist were never informed by
OHIP about its concerns over the licensing status of the clinic where she
received Erbitux treatment.
When her initial application for out-of-country coverage for the drug was
rejected last October, a Health Ministry official said the request was
rejected in part because the drug was already available in Canada.
Aucoin's lawyer noted the health official was wrong. While Erbitux was
approved for use by Health Canada last September, it has not been made
commercially available in any province or territory.
Aucoin testified she learned anecdotally that OHIP had agreed to pay for
other Ontario cancer patients to receive Erbitux at the Roswell Park Cancer
Institute in Buffalo.
Her oncologist, Dr. Pierre Major, submitted a second application for
out-of-country coverage at Roswell last winter. OHIP approved Aucoin's
application in March and began paying Roswell approximately $25,000 US per
month for her treatment.
Aucoin testified she felt OHIP's initial rejection and the severity of her
disease left her no choice but to go out on her own to buy the expensive
drug Erbitux.
"I don't have a lot of choices and I don't have a lot of time. Living with a
life-threatening disease is very scary," she said.
"I'm not asking for botox, I'm asking for life-saving treatment."
Aucoin, diagnosed with terminal colon cancer three years ago, said she would
have gone to any clinic or hospital for Erbitux treatment had OHIP only told
her where it was willing to cover the bills.
Without that direction and without OHIP's paying the bill, she said she went
where she could get the drug at the lowest price.
Cohen argued his client should not be forced to bear the financial cost of
OHIP providing her inaccurate and incomplete information.
"It was a stopgap measure to keep herself alive until she got approval for
out-of-country coverage," he argued.
"The outcome is to penalize Suzanne for having spent her health-care dollars
so wisely."
But Johnston maintained OHIP doesn't have discretion to "step outside the
box."
He said Cohen was given the opportunity to prove the West Seneca clinic
where Aucoin was treated with Erbitux meets OHIP's definition of a licensed
medical facility, but didn't do so.
Johnston also argued OHIP doesn't have jurisdiction to use its
out-of-country fund to reimburse Aucoin the money she spent for Erbitux at
Hamilton's cancer centre because the facility isn't outside the country.
The outcome of Aucoin's appeal isn't expected to be decided by the tribunal
for several weeks, possibly months.
After the hearing, Aucoin said the experience reinforced a lesson she's
learned repeatedly during her battle with cancer - navigating Ontario's
health system is far too complicated.
A legal proceeding is not the way a person with a terminal disease should
have to go about getting life-saving treatment.
Not with a lawyer at her side.
Not as an appellant.
And not facing off against the bureaucracy of a provincial health insurance
program that was supposedly created to take care of people when they're ill.
"It's just another drain on a life that's already draining," said Aucoin.
"Why do I need to go there?"
pdowns@stcatharinesstandard.ca
St. Catharines Standard (ON)
Front, Friday, September 22, 2006, p. A1
Suzanne's story
Another bureaucratic battle takes its toll
By PETER DOWNS
Standard Staff
Part 10
Her one possible mistake may have been to try to save herself thousands of
dollars on expensive cancer treatments.
Suzanne Aucoin's attempt to stretch her limited budget as far as possible
could end up costing her more than $30,000.
Rejected last October by OHIP for out-of-country coverage for a colon cancer
drug not available in Ontario, Aucoin searched for the lowest price for the
medication she could find in the U.S.
The St. Catharines resident arranged to receive treatment with the
intravenous drug - Erbitux - at a private clinic in West Seneca, N.Y., for
approximately $14,000 US per month.
That price was $10,000 less than OHIP was paying for other Ontario patients
to get Erbitux at Buffalo's Roswell Park Cancer Institute.
But as good as the deal looked to Aucoin, OHIP didn't like it.
Last June, the province's health insurance program rejected her application
to be reimbursed the $31,065.62 she paid for Erbitux at the West Seneca
clinic from October to December.
Aucoin, 36, is now fighting to reverse that decision.
She and lawyer Brian Cohen appeared before Ontario's Health Services Appeal
and Review Board for a one-day hearing Monday in Toronto.
They are also seeking reimbursement for an additional $21,116.70 Aucoin paid
to get Erbitux at Hamilton's cancer centre through a federal special access
agreement.
"Fourteen thousand dollars is still an exorbitant amount to pay, but it's
less than $24,000," Aucoin told the three-member tribunal.
"I have to go where I'm going to get the drug and the treatment to save my
life."
And that's precisely the point on which Aucoin's case will turn - where she
received the drug in the U.S.
To qualify for out-of-country coverage by OHIP, Ontario patients must
receive approved treatments or services at "a hospital or licensed health
facility," testified Dr. Hugh Langley, medical consultant to OHIP's general
manager.
And OHIP has ruled that the West Seneca clinic where Aucoin was treated with
Erbitux doesn't fit that definition.
"I have not seen any evidence that it is a licensed health facility,"
Langley said under questioning by Aucoin's lawyer.
Instead, the lawyer representing OHIP - John Johnston - contended the place
where Suzanne received the cancer drug was merely a doctor's office and not
a licensed cancer treatment facility.
Aucoin testified that she and her Hamilton oncologist were never informed by
OHIP about its concerns over the licensing status of the clinic where she
received Erbitux treatment.
When her initial application for out-of-country coverage for the drug was
rejected last October, a Health Ministry official said the request was
rejected in part because the drug was already available in Canada.
Aucoin's lawyer noted the health official was wrong. While Erbitux was
approved for use by Health Canada last September, it has not been made
commercially available in any province or territory.
Aucoin testified she learned anecdotally that OHIP had agreed to pay for
other Ontario cancer patients to receive Erbitux at the Roswell Park Cancer
Institute in Buffalo.
Her oncologist, Dr. Pierre Major, submitted a second application for
out-of-country coverage at Roswell last winter. OHIP approved Aucoin's
application in March and began paying Roswell approximately $25,000 US per
month for her treatment.
Aucoin testified she felt OHIP's initial rejection and the severity of her
disease left her no choice but to go out on her own to buy the expensive
drug Erbitux.
"I don't have a lot of choices and I don't have a lot of time. Living with a
life-threatening disease is very scary," she said.
"I'm not asking for botox, I'm asking for life-saving treatment."
Aucoin, diagnosed with terminal colon cancer three years ago, said she would
have gone to any clinic or hospital for Erbitux treatment had OHIP only told
her where it was willing to cover the bills.
Without that direction and without OHIP's paying the bill, she said she went
where she could get the drug at the lowest price.
Cohen argued his client should not be forced to bear the financial cost of
OHIP providing her inaccurate and incomplete information.
"It was a stopgap measure to keep herself alive until she got approval for
out-of-country coverage," he argued.
"The outcome is to penalize Suzanne for having spent her health-care dollars
so wisely."
But Johnston maintained OHIP doesn't have discretion to "step outside the
box."
He said Cohen was given the opportunity to prove the West Seneca clinic
where Aucoin was treated with Erbitux meets OHIP's definition of a licensed
medical facility, but didn't do so.
Johnston also argued OHIP doesn't have jurisdiction to use its
out-of-country fund to reimburse Aucoin the money she spent for Erbitux at
Hamilton's cancer centre because the facility isn't outside the country.
The outcome of Aucoin's appeal isn't expected to be decided by the tribunal
for several weeks, possibly months.
After the hearing, Aucoin said the experience reinforced a lesson she's
learned repeatedly during her battle with cancer - navigating Ontario's
health system is far too complicated.
A legal proceeding is not the way a person with a terminal disease should
have to go about getting life-saving treatment.
Not with a lawyer at her side.
Not as an appellant.
And not facing off against the bureaucracy of a provincial health insurance
program that was supposedly created to take care of people when they're ill.
"It's just another drain on a life that's already draining," said Aucoin.
"Why do I need to go there?"
pdowns@stcatharinesstandard.ca