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Health - case summaries
Patient involuntarily committed under mental health laws
Royal Columbian Hospital
2006 Annual Report
Although we do not have the authority to investigate the actions
of doctors, we can investigate administrative decisions by
officials in hospitals and other medical facilities. In one
situation a woman contacted us to complain that she had not been
fairly treated in hospital when she was involuntarily committed
under the Mental Health Act.
Ms. L expressed her concerns to
us about her treatment by doctors and hospital staff, as well as
the lack of action by the hospital in looking into her
complaints. We advised her that she could raise her complaints
about doctors with the College of Physicians and Surgeons and we
would investigate her complaints regarding the hospital
procedures in general.
Following her time at the
hospital under the Mental Health Act, Ms. L had a number of
complaints about how she had been treated. Ms. L also wanted to
know what her rights were in this situation and in light of her
experience wanted government to review its mental health
legislation. She initially directed her concerns to the hospital
officials but was not satisfied with the information she
received.
After contacting the hospital
officials we were told that Ms. L had been given the hospital’s
policies for dealing with people involuntarily committed under
the Mental Health Act, although in this case Ms. L had not
received a written copy of their statement of patients’ rights
in a timely fashion. We were then advised that the hospital’s
Manager of Mental Health was meeting with her to discuss the
hospital’s procedures.
The hospital officials indicated
they were always looking at how they could more effectively and
sensitively treat patients such as Ms. L and chart their
progress more thoroughly. A commitment was made by the Hospital
Manager to discuss these matters with staff to find ways to
achieve this goal. Ms. L was also advised that she could discuss
mental health legislation with her MLA. The hospital indicated
that it would continue to review this matter with Ms. L to
address her concerns and make any necessary changes to existing
hospital policies.
After discussing this matter
with Ms. L we concluded that her initial concerns were being
addressed and that further investigation was not necessary. We
did however encourage her to come back to our office if she was
not satisfied by the internal dispute resolution process.
Uninsured man charged high medical fees
Providence Health Care
2006 Annual Report
We received a complaint from a man who was shocked to find out
how much he had to pay to visit a doctor in an emergency room so
that he could get a prescription for urgently required
medication.
Mr. C knew that because he had
no medical insurance he would have to pay a fee to see an
emergency room doctor about the prescription, but he said he did
not know how much he would pay until he received a bill for $294
in the mail.
Mr. C told us that he felt the
fee should be reduced or cancelled because he was not informed
how much he would have to pay. He stated he would have found
another way of getting his medication if he knew he would have
to pay almost $300 to see a doctor to obtain a prescription.
After we discussed the matter
with Providence Health Care, which managed the hospital, an
offer was made to Mr. C to reduce his bill by 50 per cent. We
advised Mr. C that given the circumstances we believed the offer
of a 50 per cent reduction to be fair and reasonable.
Collector looking for unpaid
medical premiums
Medical Services Plan
2006 Annual Report
This office regularly receives
inquiries and complaints concerning medical coverage and Medical
Services Plan premium assistance for people with low incomes.
In this fairly common example,
Mr. R contacted us to complain that he was being pressured to
pay overdue medical premiums. Mr. R felt that he qualified for
premium assistance but he agreed to pay Revenue Services BC
(RSBC) the money it said was owed.
In a situation such as this, our
office can involve itself to first of all establish what the
facts are, and secondly to see if a simple solution can be found
to address the issue.
In Mr. R’s case we contacted the
Medical Services Plan to find out if he qualified for premium
assistance and if so, how the matter might be settled.
In response to our inquiries, we
were advised that Mr. R did qualify for premium assistance and
that he would be sent a refund cheque to cover the payment he
made to RSBC.
Problems with
medical plan
billing
Medical Services Plan
2006 Annual Report
In this example of never-ending
paper trails, Mr. A told us that Medical Services Plan (MSP) was
threatening to collect unpaid medical premiums covering a number
of years. He also told us he had been having difficulties
getting an application for premium assistance and that his
letters to MSP about this problem had gone unanswered.
Even when Mr. A was eventually
approved for premium assistance, the coverage did not extend to
all of the years in question so MSP still wanted substantial
payments from him.
We contacted MSP and learned
that prior to 1998 Mr. A’s medical premiums had been fully
covered because he was receiving income assistance. When his
income assistance ended he was notified that he was responsible
for paying his own premiums. He was also provided with an
application for premium assistance at that time, which they had
no record of being returned.
When he did apply for premium
assistance in 2005 there was a backlog of applications due to
the transfer of billing from MSP to Health Insurance British
Columbia (HIBC). Mr. A’s application was finally processed in
January 2006 and backdated to January 1, 2004. Although Mr. A
would likely have qualified for premium assistance back to 1998,
at that time the legislation limited how far an application
could be backdated. As a result, Mr. A still owed the provincial
government for his medical coverage premiums between 1998 and
the end of 2003.
Happily, the province made
changes that meant that his premium assistance application for
the earlier years could now be processed. We were able to advise
him that as his application for premium assistance had now been
approved we were closing this file.
Father intervenes in son’s
medical billing dilemma
Health Insurance British
Columbia
2006 Annual Report
A man contacted us to complain
that Health Insurance British Columbia (HIBC) was not managing
his son’s medical coverage properly and that he had to intervene
on his son’s behalf because HIBC was not treating his son
respectfully.
Mr. G told us that when his son
applied for medical coverage following his graduation from
university, he was told by HIBC that he would automatically
qualify for premium assistance for at least a year based on his
previous year’s income.
Although his son completed an
application for premium assistance, there was a delay in
processing and his son received monthly bills from HIBC. HIBC
itself advised his son to ignore these bills. After receiving a
bill for the fifth month in a row his son was threatened with
legal action if he did not pay, Mr. G contacted us to complain
on behalf of his son. He also told us that although he and his
wife were treated reasonably by HIBC staff, he did not feel his
son was being treated with the same respect.
After we investigated these
complaints, HIBC wrote to the family to apologize for the delay
in processing the application. HIBC acknowledged that a number
of administrative errors had been made that resulted in Mr. G’s
son continuing to be billed and that bill being sent to a
collections agency, all for a debt he did not owe.
No medical coverage without
application for permanent residency
Health Insurance British
Columbia
2006 Annual Report
We investigated a complaint by a
woman that Health Insurance British Columbia (HIBC) refused to
approve medical coverage for her because she was not a legal
resident of Canada. She said that due to a recent diagnosis of
cancer she was in need of medical coverage.
We were told by Ms. E that she
was unable to get approval for medical coverage until
Immigration Canada had confirmed for HIBC that they were in
receipt of and processing Ms. E’s application for permanent
residency. Ms. E said that in the meantime, she was spending a
lot of money for cancer treatment as a non-resident.
We looked into this matter by
contacting a Supervisor at HIBC to see what could be done to
assess Ms. E’s application for medical coverage more quickly.
The supervisor indicated that she could check Immigration
Canada’s electronic system to determine if Ms. E’s application
for permanent residency had been received.
HIBC confirmed that they had
received electronic verification that Ms. E’s application for
permanent resident status was being processed. They said that
they had approved Medical Services Plan coverage for Ms. E
retroactive to the earliest date possible. We were able to let
Ms. E know that she was now covered for medical treatment and
that she may be entitled to be reimbursed for her previous
medical expenses.
Ambulance billing freezes income
tax refund
Ministry of Health
2006 Annual Report
A man came to us with a
complaint that he had been unfairly billed by the Ministry of
Health for ambulance transportation and that his income tax
refund had been seized by the Ministry in order to force him to
pay the bill.
He explained that he should have
been exempt from paying for ambulance services because he was on
income assistance and premium assistance, and that the
government’s decision to seize his income tax refund had added
to his financial difficulties.
We discussed this with the
Ministry, which confirmed that the man had been on income
assistance during the time in question and that under the
circumstances he should not have been charged for the ambulance
service.
To resolve the issue, the
Ministry agreed to release the income tax refund that had been
seized and to erase the man’s debt from its records.
Man wants list of doctors
prescribing medication
College of Physicians and
Surgeons of BC
2006 Annual Report
Although we may not always be
able to provide a complainant with the result they are looking
for, we can provide a valuable service in those situations by
helping to explain the reasons behind decisions or actions they
may not agree with.
For example, Mr. U came to us
with a complaint that the College of Physicians and Surgeons of
BC refused to provide him with a list of doctors in the Lower
Mainland that could prescribe him methadone for medical
purposes.
After investigating the matter,
we advised Mr. U that in our view it was reasonable for the
College not to provide the public with the names of doctors
authorized to prescribe methadone because these doctors had
specifically asked the College to not provide their names
publicly.
We explained to Mr. U why he
could not get the list of doctors from the College, that
information however was available regarding methadone clinics,
and that he also had the option of visiting his own doctor for a
referral.
Although he did not get the list
he wanted, Mr. U did benefit from an independent and impartial
review of his complaint as well as a full explanation of why he
could not obtain what he had requested and options about what he
could do to deal with his situation.
Lack of adequate reasons for
decision
College of Dental Surgeons
2006 Annual Report
Mr. C. complained to the College
of Dental Surgeons that a dental student acting under the
supervision of a dentist had performed a root canal on Mr. C
without his knowledge or consent. Mr. C believed that the dental
treatment he received was substandard and he made other related
complaints to the College.
The College wrote a very brief
response to Mr. C in which it stated that Mr. C’s allegation
could not be supported and a decision had been made to take no
action. The letter stated that the Dentists Act and the Rules
made under the Act prevented the College from providing details
of its investigation.
Mr. C complained to the
Ombudsman’s Office that the College failed to address all of his
concerns and failed to provide reasons for its decision not to
proceed further.
Following our review of the
College’s records, it appeared that the College investigated and
deliberated in respect of each of the concerns raised by Mr. C.
However, in the absence of any meaningful analysis or reasons
for the decision in the College’s letter to Mr. C, we could
understand why Mr. C might be left with the impression that not
all of his concerns were addressed.
The provision of reasons for a
decision is fundamental to ensuring a fair and transparent
decision-making process. Reasons enable parties to understand
the factors considered by the decision-maker and the rationale
on which conclusions were reached. Reasons reduce the appearance
of arbitrariness and help to promote public confidence in the
fairness of administrative proceedings. Reasons also enable
parties to determine whether there may be grounds on which to
dispute a decision.
The College was not persuaded
that under the existing legislative scheme it was obligated to
provide reasons in cases such as the one involving Mr. C.
However, the College agreed to write a supplementary letter to
Mr. C with reasons in order to resolve his complaint. The
supplementary response proposed by the College contained
adequate detail and reasons to address our concerns in this
case.
We remained concerned by the
College’s general unwillingness to provide reasons for its
decisions not to take action in regard to a complaint; however,
it appeared our concern would soon be resolved.
We were informed by the Ministry
of Health that the Dentists Act would likely be repealed in the
2006 session of the Legislature
and that the College of Dental Surgeons would then be governed
by the Health Professions Act. Once that occurred, we understood
that the College would be required in circumstances similar to
Mr. C’s to provide reasons for its decisions. In view of this
and the College’s provisions to Mr. C of reasons for its
decision, we discontinued our investigation. At the time of
printing this report, the Dentists Act has not yet been
repealed.
A man contacted us to complain that the Forensic Psychiatric
Services Commission (FPSC) had told him to change the way he
dresses. Mr. J said he was told by FPSC staff not to wear his
black clothing, skull bandana, iron cross necklace and black Goth
makeup.
Our investigation of this matter included discussions with a
Director at FPSC and a review of any relevant files. We learned
that although the files showed Mr. J was asked to make changes to
his clothing style, there was no record that he had been told to
stop wearing black clothes and makeup. We were told by the
Director that other patients had said that they were negatively
affected by certain symbols, such as skulls, and for this reason
Mr. J was asked to change the way he dressed. We concluded that
the FPSC had acted in a fair manner.
Health Authority Resolves
Concern about Inadequate Homesupport Services
Health Authority
2003 Annual Report
An elderly woman, Ms C, complained that her
local health authority failed to provide her with adequate
home-support services. She said that her husband was recently
placed in a care facility, but she remained at home with a
number of different medical problems that made it increasingly
difficult for her to cope on her own.
Ms. C noted that most recently, problems
with her knees made it impossible for her to transfer herself
into her wheelchair to get to the washroom. This led to concerns
about personal hygiene. Both her home-support case manager and
her physician seemed unsympathetic, telling her she was not
trying hard enough to cope on her own. She wanted an immediate
increase in her home-support hours, but her goal was to obtain a
bed in a care facility, for she felt that even with adequate
support she could no longer cope at home.
Ms. C had limited interpersonal skills,
and it seemed possible that her somewhat confrontational manner
might have obscured her real need for additional help. We
advised the health authority of the complaint and were pleased
with the immediate and helpful response. Ms. C’s home-support
needs were re-assessed immediately and her hours were doubled. A
further assessment was conducted some days later and her hours
were again increased. In the meantime, the health authority
placed her on the waitlist for the first available long-term
care bed in her community and a place was found for her only a
few days later.
Residency
requirements waived for long-term care patient
Vancouver Island Health Authority
2004 Annual Report
Mr K complained about the residency
requirements of the Vancouver Island Health Authority (VIHA) for
obtaining subsidized placement of his 93-year-old mother in a
long-term care facility. He explained that he and his wife had
moved to British Columbia from Ontario several months
previously. Since his mother had no other family
members or friends left in Ontario, there was no choice but to
move her too. He described his mother as requiring a secure
long-term care home because of her dementia. Her only income, he
said, was CPP and Old Age
Security. VIHA told him that his mother would not qualify for
any subsidies or be placed on a waiting list until she had
resided in BC for a year. The complainant believed the residency
requirement was unfair because
as a pensioner himself, it was difficult for him to help pay the
cost of a private facility.
After we contacted VIHA about this matter,
the Director of Risk Management told us that according to the
records, there had been only an informal enquiry from the
complainant about the requirements of the program in this
province. He said that staff did not interpret this as a formal
request for waiving the residency requirement. The Director
arranged to have someone contact the complainant for more
information about the mother’s
situation and to make arrangements for an assessment of her
condition. Subsequently, a facility liaison person from VIHA
assessed the complainant’s mother as requiring care, approved
the application for waiver of the
residency requirement, and placed the mother on a waiting list
for a facility.
Mr A filed a web-based complaint about the
Medical Services Plan (MSP) after he received a demand for
payment of premiums for medical coverage even though MSP had
said his application for coverage had not been
received.
New MSP
customer’s cards sent twice to wrong address
Medical Services Plan
2004 Annual Report
In August 2003, he had submitted an
application to MSP after moving to BC and was told he would be
enrolled after a three-month waiting period. When he had not
received his cards by Christmas, he
contacted MSP and was advised his application had not been
received. Mr A submitted a new application immediately and was
told he would have to wait a further three-month period. At the
end of the second
waiting period, Mr A had not received the cards. Mr A contacted
MSP and was informed that the cards had indeed been sent out
after each application was made, but were on both occasions sent
to the wrong address,
even though the correct address had been included on both
application forms.
After receiving the notice from the
collections department demanding payment for the period of time
he had been waiting for his cards, Mr A paid the premiums and
contacted the Ombudsman. We contacted MSP and credit was quickly
provided for the period of time in question.
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