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Help Suzanne Aucoin
Nov. 24, 2006 - The St. Catharines Standard
St. Catharines Standard (ON)
Front, Friday, November 24, 2006, p. A1
Suzanne's story
Review offers Aucoin hope
Ombudsman investigates why ministry rejected cancer patient for
out-of-country OHIP coverage
By PETER DOWNS
St. Catharines Standard
Part 13
The province's government watchdog has launched an investigation into
Suzanne Aucoin's fight against OHIP to recoup more than $52,000 she paid for
colon cancer drugs in Ontario and New York.
Ontario's ombudsman wants to find out why the Ministry of Health initially
rejected the St. Catharines woman for out-of-country OHIP coverage in
October 2005.
"We did serve a notice of intent to investigate on the Ministry of Health
and Long-Term Care today," Laura Pettigrew, senior legal counsel to the
ombudsman, told The Standard late Thursday afternoon. "We have commenced an
investigation."
Aucoin, 36, said she's grateful the ombudsman's office is probing the issue.
"It's nice to have some allies. It's nice to have some people who may have
some authority or power to do something about the situation to hold OHIP
accountable," she said.
Ontario's Health Services Appeal and Review Board rejected Aucoin's appeal
for reimbursement of her medical expenses last Thursday.
Investigators with the ombudsman's office contacted Aucoin through her
lawyer the following day. She met with them Monday in Toronto and filed a
formal complaint against the Health Ministry and OHIP.
"It gives me a feeling that something's being done and I don't have to be
front-lining it," said Aucoin, who is on leave from her position as a
chaplain at Denis Morris High School.
"I don't need this. This has been a whole year that never should have been."
Diagnosed with terminal colon cancer three years ago, Aucoin was told by her
Hamilton oncologist that her best chance at prolonging her life lay with an
intravenous drug called Erbitux, which is not available commercially in
Ontario.
Aucoin applied to OHIP to pay for her to receive the expensive medication at
a clinic in West Seneca, N.Y., through its out-of-country coverage program,
but was turned down.
Desperate to fend off the cancer that had already spread from her colon to
her liver and lungs, Aucoin decided to pay for Erbitux out of her own
pocket.
She spent $31,065 for the drug at the clinic in West Seneca from October to
December 2005. She paid a further $21,116 for Erbitux at Hamilton's cancer
centre through a federal special access agreement.
OHIP subsequently agreed to pay for Aucoin to get the treatment at Buffalo's
Roswell Park Cancer Institute beginning last March.
The ombudsman's office will focus its investigation on the circumstances
surrounding the ministry's rejection of Aucoin's initial application for
out-of-country OHIP coverage, Pettigrew said.
In the rejection letter, Aucoin's oncologist received in October 2005, a
health ministry official maintained the application couldn't be approved
because the drug was already available in Canada and was considered
experimental.
During her hearing before the Health Services Appeal and Review Board in
September, Aucoin's lawyer pointed out the health official was wrong. While
Erbitux was approved for use by Health Canada in September 2005, it has not
been made commercially available in any province or territory.
In the months after she was rejected for out-of-country medical coverage,
Aucoin learned anecdotally that OHIP had agreed to pay for other Ontario
cancer patients to receive Erbitux at Roswell Park 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 - approximately $11,000 more per month than she had
been paying at the West Seneca clinic.
While it was not mentioned in her rejection letter, Aucoin and her lawyer
learned several months later the ministry turned down the out-of-country
coverage request because officials had concerns about the licensing status
of the West Seneca clinic.
In its decision last week, the appeal and review board ruled it didn't have
jurisdiction to cover Aucoin's tab at the West Seneca clinic because it
doesn't meet its definition of a "licenced health facility."
Aucoin said she would have gone to any hospital or health centre for
treatment had the ministry only told her it had bearing on her initial
application's rejection.
"Because of that, there's been a domino effect of problems. It's a cascade
of issues that revolve around this original rejection letter," she said.
"I would have never had this problem. But because they said no, I had to go
out of pocket."
The ombudsman's office has been following Aucoin's case through reports in
The Standard and Toronto media outlets.
"We were aware of the circumstances," Pettigrew said. "This is an area that
we are certainly monitoring."
Pettigrew said she doesn't know how long the investigation will last.
Investigators must first begin collecting relevant documentation and
interviewing officials involved in the case.
"At this stage, it's a little premature to predict how long it's going to
take," Pettigrew said.
Aucoin said she's hopeful the investigation will ultimately push the
government to improve how it deals with applications for out-of-country
medical coverage. "I'm hoping they say ... 'You get your money back and
guess what - we're also going to tell them that they need to simplify the
out-of-country process,' " she said.
pdowns@stcatharinesstandard.ca
St. Catharines Standard (ON)
Front, Friday, November 24, 2006, p. A1
Suzanne's story
Review offers Aucoin hope
Ombudsman investigates why ministry rejected cancer patient for
out-of-country OHIP coverage
By PETER DOWNS
St. Catharines Standard
Part 13
The province's government watchdog has launched an investigation into
Suzanne Aucoin's fight against OHIP to recoup more than $52,000 she paid for
colon cancer drugs in Ontario and New York.
Ontario's ombudsman wants to find out why the Ministry of Health initially
rejected the St. Catharines woman for out-of-country OHIP coverage in
October 2005.
"We did serve a notice of intent to investigate on the Ministry of Health
and Long-Term Care today," Laura Pettigrew, senior legal counsel to the
ombudsman, told The Standard late Thursday afternoon. "We have commenced an
investigation."
Aucoin, 36, said she's grateful the ombudsman's office is probing the issue.
"It's nice to have some allies. It's nice to have some people who may have
some authority or power to do something about the situation to hold OHIP
accountable," she said.
Ontario's Health Services Appeal and Review Board rejected Aucoin's appeal
for reimbursement of her medical expenses last Thursday.
Investigators with the ombudsman's office contacted Aucoin through her
lawyer the following day. She met with them Monday in Toronto and filed a
formal complaint against the Health Ministry and OHIP.
"It gives me a feeling that something's being done and I don't have to be
front-lining it," said Aucoin, who is on leave from her position as a
chaplain at Denis Morris High School.
"I don't need this. This has been a whole year that never should have been."
Diagnosed with terminal colon cancer three years ago, Aucoin was told by her
Hamilton oncologist that her best chance at prolonging her life lay with an
intravenous drug called Erbitux, which is not available commercially in
Ontario.
Aucoin applied to OHIP to pay for her to receive the expensive medication at
a clinic in West Seneca, N.Y., through its out-of-country coverage program,
but was turned down.
Desperate to fend off the cancer that had already spread from her colon to
her liver and lungs, Aucoin decided to pay for Erbitux out of her own
pocket.
She spent $31,065 for the drug at the clinic in West Seneca from October to
December 2005. She paid a further $21,116 for Erbitux at Hamilton's cancer
centre through a federal special access agreement.
OHIP subsequently agreed to pay for Aucoin to get the treatment at Buffalo's
Roswell Park Cancer Institute beginning last March.
The ombudsman's office will focus its investigation on the circumstances
surrounding the ministry's rejection of Aucoin's initial application for
out-of-country OHIP coverage, Pettigrew said.
In the rejection letter, Aucoin's oncologist received in October 2005, a
health ministry official maintained the application couldn't be approved
because the drug was already available in Canada and was considered
experimental.
During her hearing before the Health Services Appeal and Review Board in
September, Aucoin's lawyer pointed out the health official was wrong. While
Erbitux was approved for use by Health Canada in September 2005, it has not
been made commercially available in any province or territory.
In the months after she was rejected for out-of-country medical coverage,
Aucoin learned anecdotally that OHIP had agreed to pay for other Ontario
cancer patients to receive Erbitux at Roswell Park 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 - approximately $11,000 more per month than she had
been paying at the West Seneca clinic.
While it was not mentioned in her rejection letter, Aucoin and her lawyer
learned several months later the ministry turned down the out-of-country
coverage request because officials had concerns about the licensing status
of the West Seneca clinic.
In its decision last week, the appeal and review board ruled it didn't have
jurisdiction to cover Aucoin's tab at the West Seneca clinic because it
doesn't meet its definition of a "licenced health facility."
Aucoin said she would have gone to any hospital or health centre for
treatment had the ministry only told her it had bearing on her initial
application's rejection.
"Because of that, there's been a domino effect of problems. It's a cascade
of issues that revolve around this original rejection letter," she said.
"I would have never had this problem. But because they said no, I had to go
out of pocket."
The ombudsman's office has been following Aucoin's case through reports in
The Standard and Toronto media outlets.
"We were aware of the circumstances," Pettigrew said. "This is an area that
we are certainly monitoring."
Pettigrew said she doesn't know how long the investigation will last.
Investigators must first begin collecting relevant documentation and
interviewing officials involved in the case.
"At this stage, it's a little premature to predict how long it's going to
take," Pettigrew said.
Aucoin said she's hopeful the investigation will ultimately push the
government to improve how it deals with applications for out-of-country
medical coverage. "I'm hoping they say ... 'You get your money back and
guess what - we're also going to tell them that they need to simplify the
out-of-country process,' " she said.
pdowns@stcatharinesstandard.ca