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Help Suzanne Aucoin
Nov. 17, 2006 - The Toronto Star
OHIP REJECTS CANCER DRUG CLAIM - PROVINCE WON'T COVER WOMAN'S CHEMOTHERAPY
IN BUFFALO
Friday, Nov. 17, 2006
ROB FERGUSON, Queen's Park Bureau, The Toronto Star
A St. Catharines woman with terminal colon cancer has lost an appeal of
OHIP's rejection of her claim for $52,000 in chemotherapy, mostly in
Buffalo, on a technicality that suggests the government is spending millions
extra on other patients, her lawyer says.
Ontario's Health Services and Appeal Board ruled yesterday that the
intravenous treatments of the drug Erbitux for Suzanne Aucoin at a private
clinic in a Buffalo suburb are not eligible for reimbursement because the
clinic is not licensed.
The 16-page ruling came despite the fact the licensed cancer specialist who
runs it, and is also on staff at Buffalo's Mercy Hospital, said a separate
clinic licence is not required under local law.
Aucoin's lawyer said the decision defies common sense for that reason and
one other: the Erbitux treatments she got at the private clinic cost just
over half the amount charged at the better known Roswell Park Cancer
Institute in Buffalo, where the provincial government sends patients
approved for out-of-country treatment.
"That's not pocket change," said Brian Cohen.
He obtained statistics under the Freedom of Information Act, showing that
OHIP approved 146 applications for out-of-country Erbitux treatments for
Ontario residents with colon cancer from January 2005 to the end of
September this year at a cost of $10 million.
"If OHIP had spent that money more wisely in the way Suzanne did ... it
could have treated another 100 or so patients with colon cancer," Cohen
argues.
When Aucoin applied to OHIP for Erbitux treatment last fall, after her
Hamilton oncologist advised her it was the only medicine that could slow her
tumour growth, it was considered experimental in Canada. It later became
available here under a special access program and she received treatment in
Hamilton.
In its ruling, the board said it "has no discretion to authorize payment for
medical services rendered at a facility which is not licensed."
That guideline is intended to protect the taxpayers of Ontario from paying
for treatment at "fly-by-night" operations, noted the board, which also
found "there is no indication whatsoever that ... clinic is a disreputable
operation."
Aucoin, a 36-year-old teacher on medical leave, said the appeal board was
powerless in the face of an "asinine" regulation that does not take
situations like hers into account.
The government should more clearly define what facilities are suitable, she
added.
Health Minister George Smitherman said it was difficult for him to comment
on the board's decision because he is not familiar with the "twists and
turns" of the case.
But if it's true that OHIP is paying more for treatments than it needs to,
"this is something that we can, of course, take a look at," he said.
The board also rejected a bid for reimbursement of Erbitux later given to
Aucoin at a Hamilton cancer clinic, saying OHIP is not a drug-payment plan.
Aucoin, who was first diagnosed with the cancer in 1999 and saw it take a
turn for the worse three years ago, said she will not challenge the board's
decision in court just now.
"I need all the strength I can get to be well," said Aucoin, whose cancer
has spread to her lungs and liver. So far, her fundraising efforts have
covered about half the $52,000 in question.
OHIP REJECTS CANCER DRUG CLAIM - PROVINCE WON'T COVER WOMAN'S CHEMOTHERAPY
IN BUFFALO
Friday, Nov. 17, 2006
ROB FERGUSON, Queen's Park Bureau, The Toronto Star
A St. Catharines woman with terminal colon cancer has lost an appeal of
OHIP's rejection of her claim for $52,000 in chemotherapy, mostly in
Buffalo, on a technicality that suggests the government is spending millions
extra on other patients, her lawyer says.
Ontario's Health Services and Appeal Board ruled yesterday that the
intravenous treatments of the drug Erbitux for Suzanne Aucoin at a private
clinic in a Buffalo suburb are not eligible for reimbursement because the
clinic is not licensed.
The 16-page ruling came despite the fact the licensed cancer specialist who
runs it, and is also on staff at Buffalo's Mercy Hospital, said a separate
clinic licence is not required under local law.
Aucoin's lawyer said the decision defies common sense for that reason and
one other: the Erbitux treatments she got at the private clinic cost just
over half the amount charged at the better known Roswell Park Cancer
Institute in Buffalo, where the provincial government sends patients
approved for out-of-country treatment.
"That's not pocket change," said Brian Cohen.
He obtained statistics under the Freedom of Information Act, showing that
OHIP approved 146 applications for out-of-country Erbitux treatments for
Ontario residents with colon cancer from January 2005 to the end of
September this year at a cost of $10 million.
"If OHIP had spent that money more wisely in the way Suzanne did ... it
could have treated another 100 or so patients with colon cancer," Cohen
argues.
When Aucoin applied to OHIP for Erbitux treatment last fall, after her
Hamilton oncologist advised her it was the only medicine that could slow her
tumour growth, it was considered experimental in Canada. It later became
available here under a special access program and she received treatment in
Hamilton.
In its ruling, the board said it "has no discretion to authorize payment for
medical services rendered at a facility which is not licensed."
That guideline is intended to protect the taxpayers of Ontario from paying
for treatment at "fly-by-night" operations, noted the board, which also
found "there is no indication whatsoever that ... clinic is a disreputable
operation."
Aucoin, a 36-year-old teacher on medical leave, said the appeal board was
powerless in the face of an "asinine" regulation that does not take
situations like hers into account.
The government should more clearly define what facilities are suitable, she
added.
Health Minister George Smitherman said it was difficult for him to comment
on the board's decision because he is not familiar with the "twists and
turns" of the case.
But if it's true that OHIP is paying more for treatments than it needs to,
"this is something that we can, of course, take a look at," he said.
The board also rejected a bid for reimbursement of Erbitux later given to
Aucoin at a Hamilton cancer clinic, saying OHIP is not a drug-payment plan.
Aucoin, who was first diagnosed with the cancer in 1999 and saw it take a
turn for the worse three years ago, said she will not challenge the board's
decision in court just now.
"I need all the strength I can get to be well," said Aucoin, whose cancer
has spread to her lungs and liver. So far, her fundraising efforts have
covered about half the $52,000 in question.