Tag: COVID-19

The Appalling Treatment of Dr. Elaine Ma Is Hurting Health Care in Ontario

I’ve written about the horrific treatment that Dr. Elaine Ma has been subjected to by the bureaucrats at Ontario Health before. The situation is so ridiculous that it could be a story presented at the Theatre of the Absurd.

What happened?

Dr. Ma is a family physician from the Kingston area. During the Covid pandemic she realizes the need to immunize as many people as possible to protect the community. She organizes a number of outdoor mass vaccination clinics, which resulted in Kingston being one of the most heavily vaccinated areas of the province. For her efforts, she wins the very well deserved the praise of many, and an award from the Ontario College of Family Physicians.

There are two billing codes for providing Covid vaccinations. One for physicians who work in a vaccination clinic that someone else set up (e.g. public health). Another for those who set up the clinics themselves, and paid for staff/heating for outdoors/tents/internet etc. Since she paid for all of that, Dr. Ma bills the second code.

Dr. Elaine Ma

Fast forward a couple of years and the callous and unthinking bureaucrats at OHIP decide that she has billed the wrong code and demand she pay back $600,000. I won’t restate all the steps she went through to fight this. I will state that the reasons for them wanting the money paid back varied between the clinic being outdoors instead of indoors, medical students being involved and so on. But eventually the case winds up at Divisional Court.

On Dec 16, the court handed down a ruling supporting Dr. Ma. What I had failed to realize before is that the Ontario Health bureaucrats main argument appears to be that there were no extenuating circumstances during the time of the Vaccine Clinics that Dr. Ma set up. Yes, you read that correctly. The whole country was in the midst of a (hopefully) once in a lifetime pandemic. Canada was effectively shut down for business. People were not allowed to visit loved ones in hospital or nursing homes. Travel had ground to a halt. But, in the minds of the soulless and spiteful bureaucrats, none of this constituted “extenuating circumstances”.

Thankfully, Divisional Court Justices Matheson, Varpio and O’Brien were having none of this nonsense. They clearly stated the decision by bureaucrats that there were no extenuating circumstances was “unreasonable.” (I would have, and will, call that decision much worse things). The Justices pointed out the obvious. There was clearly a public health crisis at the time, and that many leaders, including politicians were calling on physicians to get the vaccinations done.

More importantly they stated something the OMA’s legal team really needs to take a deep dive into:

…”that the wording of section 17.5 does not limit relief to unpaid claims; it only requires the presence of extenuating circumstances. Since OHIP typically pays claims first and reviews them later, a restriction on unpaid claims would effectively nullify the provision. The court called this interpretation unreasonable.”

Currently OHIP pays physicians whenever they bill. Later, OHIP decides if it was reasonable or not, and if OHIP feels the situation is unreasonable, they demand the money back. The justices seem to be saying this process is not fair. Which has implications far beyond this one case. Obviously, this would not apply to clear cut cases of fraud. It is a much much needed kick to the slow, incompetent, and spiteful OHIP review process. I can’t possibly understand the potential future implications for this – but I suspect there will be many.

Finally, the justices let their displeasure be known by ordering OHIP to pay Dr. Ma $10,000 in court costs. This strongly suggests to me that they were peeved at the OHIP bureaucrats for taking it this far, and really didn’t think it should have gone there.

How is this hurting health care now?

Ontario is currently seeing an unprecedented surge in flu cases. Flu season has come early. The current variant appears to be extremely strong. It is circulating at “sky high” levels among young people. Three children (at least) have died. Hospitals have declared outbreaks and wards are closed. Visitation has stopped.

Sign on the door to the Medical Ward of my Hospital

You know what would really help? If only some people would come up with some innovative ways of getting their communities vaccinated against the flu. Yes this year’s flu shot is a bit of mismatch for the current strain, but it still provides some protection and keeps you from getting really ill.

Or how about an innovative idea for where to safely look after patients like was done during the Covid crisis. My friend Dr. Bryan Recoskie set up a unique 18 bed ward in our local Legion, to look after non-covid patients while the hospital wards were shut with covid positive patients.

Dr. Bryan Recoskie

And yet, I don’t see any of that happening right now. Don’t get me wrong, doctors continue to go to work. We continue to care for the sick and continue to comfort those in need. We continue to do our best in these trying circumstances.

But I can’t find any evidence (please correct me if I’m wrong) – of where people are doing unique out of the box things to try and mitigate the currently unfolding nightmare. Given the potential exists that IF you try something unique, you may wind up undergoing two years of pure hell by bitter, ruthless and depraved bureaucrats – can you blame people for not trying?

To quote a good friend of mine, “The damage has been done. Nobody is going to stick their necks out now.”

What should happen (but won’t):

First, under no circumstances should OHIP appeal the decision from Divisional Court. The mercilessly inhumane bureaucrats need back down. Second, Health Minister Sylvia Jones needs to do what she should have done a year ago – and direct the bureaucrats not to seek any recovery at all from Dr. Ma. It’s just the right and decent thing to do.

Finally, it would really help if Minister Jones issued a formal apology to Dr. Ma for how she has been treated by the bureaucrats. It’s not just the OHIP bureaucrats. Jones’ own communications director, Hannah Jensen claimed Dr. Ma had “pocketed the funds“, a statement that clearly suggested malfeasance.

Do that, and maybe, just maybe, physicians would once again feel comfortable coming up with out of the box solutions for crises that are occurring.

Maybe.

Dr. Elaine Ma Case is Proof Ontario is Unfriendly to Physicians

Last week, the Ontario Health Sector Appeal and Review Board (HSARB) denied the appeal by Dr. Elaine Ma in her fight against the Ontario Health Insurance Plan (OHIP). At the risk of upsetting Dr. Ma and many (? all) of my colleagues, that decision actually was legally appropriate. HSARB can’t actually look at whether a case is reasonable or not, their job is to go by what’s written in bulletins/updates. The real affront to physicians is that it should never ever have gotten here in the first place.

The Background

For non-physicians reading this, here is a condensed summary of what happened. It’s 2020. The Covid pandemic is raging. Ontario Premier Doug Ford appoints General Rick Hillier to oversee the Covid Vaccination program. He’s tasked with, as Ford calls it, “the largest vaccine rollout in a generation, a massive logistical undertaking, the likes of which this province has never seen.” Hillier’s stated goal? To get shots in everyone’s arms by August 2021.

Dr. Elaine Ma from Kingston realizes the need to act quickly to help her community. She organizes outdoor mass vaccination clinics. Over 35,000 shots were given and Kingston became the most vaccinated area of the province. Dr. Ma was given an Award of Excellence by the Ontario College of Family Physicians for her efforts.

Picture of an outdoor vaccination clinic found elsewhere on the web

The Dispute with OHIP

So what happened? For the Covid vaccine clinics, there were two sets of billing codes assigned. The first was a standard hourly rate. This was meant for physicians who attend a vaccine clinic and perform immunizations there. There were numerous such clinics set up by hospitals/public health/pharmacies and so on. Those agencies paid for the setup costs of those clinics. The physician just showed up and vaccinated.

The second set of codes is used by physicians who give vaccinations in clinics they set up. These codes pay somewhat more, but they’re meant to compensate physicians for the fact that they have to cover all the overhead in those clinics.

Dr. Ma would have had to make sure that things like electricians were hired to ensure that there was power and Internet access outdoors. She may have needed to arrange for commercial grade outdoor tents. Propane heaters to heat the tents and the propane might have been needed. Some staff were paid (others volunteered). All of this organizational work, and figuring out payments, needed to be done in advance. She did it.

She therefore billed OHIP the second code. This is entirely reasonable given the circumstances and the work she did.

So what happened?

The sudden increase in billings did not go unnoticed by OHIP and was flagged. This is absolutely appropriate. As taxpayers, we need to be sure that there is a mechanism to catch outlying bills. The anomaly was sent for review by the various bureaucrats at OHIP. Also appropriate.

So what went wrong?

Basically everything after that. The OHIP bureaucrats reviewed the situation. As pointed out by Perry Brodkin (OHIPs former lawyer, who was quoted extensively in the Kingstonist) – the information was sent “up the hierarchy” and would have reached the deputy health minister and minister.

Former Deputy Minister of Health Dr. Catherine Zahn
Ontario Health Minister Sylvia Jones

The bureaucrats and health minister decided she didn’t qualify for the codes. The reasons given (see the Kingstonist articles for more details) change at a whim. First it was that the clinic was outdoors not inside (you mean at a time when we are all social distancing – we should have crammed unrelated people into a clinic to immunize them??). Then it was that medical students were used (despite the strong endorsement of using medical students by the then Dean of Queen’s University Medical School, Dr. Jane Philpott). Then it was that she paid people to work there.

Dr. Jane Philpott – former Dean of Queen’s University Medical School – and a strong supporter of the vaccination clinics set up by Dr. Ma

Then things got ugly

And finally, after repeated questioning by the Kingsonist, things got really ugly when Hannah Jensen, the communications director for the Minister of Health issues a statement alleging that Dr. Ma “pocketed” the funds. This basically amounted to an allegation of theft by Dr. Ma and was widely viewed as a disgusting, immoral and reprehensible comment in the medical community. Even the Kingstonist was alarmed by this and called the statement “rife with allegations.”

Hannah Jensen, Communications Director for Minister of Health Sylvia Jones (photo from LinkedIn Profile page)

Why this offends doctors so much.

Let’s be clear about this. There is zero tolerance in the broader medical community for misappropriation of funds/intentional fraudulent OHIP billing. Zilch. Nada. But there is a recognition that the imperfect OHIP billing schedule needs to be interpreted with reason, especially when times are unreasonable (and what could possibly be a more unreasonable time than a once in a lifetime pandemic?).

Dr. Ma did all the work to meet the billing criteria (even the OHIP bureaucrats were forced to admit that yes, over 35,000 shots were given and yes she had planned and organized the whole thing). The fact that she did it outside and had medical students help when some 20 year old pre pandemic memos said not to is an unwarranted use of a technicality.

For many physicians, this brings back memories of when another set of bureaucrats persecuted physicians. They even told one paediatric respirologist that in order to bill a code, he had to perform rectal and pelvic exams on children!

What does this mean for Ontario Health care?

First, as Dr. Ma herself pointed out, it is now illegal for physicians to bill any procedures that they delegated to medical students. This means that medical teaching will effectively grind to a halt. Why would any doctor teach a medical student to say, suture a wound, when that doctor would now be financially penalized?

Second, this story has made the national press. It has also been reported in Canadian Journals that cater to physicians and other health care workers. The message to them is clear. Do NOT think of relocating/starting up a practice in Ontario. You will be treated grossly unfairly by the bureaucrats and health minister and there will be no reasonable interpretation of the rules.

What can be done?

According to Brodkin, Health Minister Sylvia Jones and Premier Doug Ford can direct OHIP to disregard the HSARB ruling. They need to do so immediately. However, because politicians only think of re-election, and not what is right, Dr. Ramsey Hijazi, the founder of the Ontario Union of Family Physicians wants to up the pressure on them.

Dr. Ramsey Hijazi, founder of the Ontario Union of Family Physicians – pictured inset.

His group has set up a petition that clearly demands that justice be done in this case. It demands that the Minister and Premier disregard the HSARB ruling. We need to support our health care heroes not penalize them on technicalities in outdated bulletins.

I urge all of my followers to sign the petition. If this case is allowed to go on, trust me on this, there will be negative consequences for health care in Ontario, and we don’t need any more of those.

Click here to sign the petition.