A Quebec man who fell and broke his jaw, cheekbone and a bone around his left eye while visiting British Columbia says his surgery was canceled after he was told his home province “won’t pay” for the procedure . Patrick Belanger, 23, said his experience is a warning to Quebecers and all Canadians who pride themselves on a universal health care system, because doctors in other provinces could deny treatment to Quebecers claiming they don’t they will be compensated. Belanger’s ordeal began when he and his girlfriend were walking along a trail in Sun Peaks, BC, on the evening of June 10. He tripped and stumbled backwards into the darkness, hitting his face on a boulder. He was taken by ambulance to Royal Inland Hospital in Kamloops shortly before midnight and was told he needed surgery for a “broken face.” But a surgeon wasn’t available Saturday, so he was discharged with a prescription for the opioid drug Percocet to manage his pain, Belanger said. The next morning, he and his girlfriend, Beth Cooper, returned to the hospital for surgery. But Belanger said that just as he was getting ready for surgery, the surgeon called off the procedure. “He said the hospital wouldn’t let him do the surgery because I was from Quebec,” Belanger said, adding that he had presented his provincial health card when he arrived in Royal Inland. “I was kind of in shock. The more I thought about it, the more I thought it didn’t make sense. Normally, you would do the surgery and calculate the charge afterwards, or at least I thought that would be the case,” he said. “I was quite scared. I was still out of it because I was in enough pain and on pain meds. And I was calling my parents trying to figure out what to do.” Belanger said he offered to pay for the surgery through his family’s private insurance, but the surgeon declined that option, saying he first needed to speak with a hospital administrator who was unavailable over the weekend. “When he told me the surgery couldn’t be done today, he suggested I go back to Quebec to go have the surgery,” Belanger said. He was given a 10-day window before the bones in his face began to fuse. “We thought it was completely absurd that I, with a broken face, was going to take a commercial airline to go and have surgery in my own country.” Belanger’s father and mother arrived in Kamloops later that week and tried unsuccessfully to speak with an administrator at the Internal Health Authority about the best options for their son, Richard Belanger said. “We were confused about his basic rights as a Canadian,” he said, calling his son’s experience a “nightmare.” Richard Belanger said he went to the surgeon’s private clinic to provide information about the family’s insurance plan as well as his credit card in case the surgery could be performed there. But staff told him the severe facial fractures his son suffered meant the operation needed to be done in hospital, he added. Four days of agony since the surgery was canceled left Belanger managing “severe pain” with prescription opioids and morphine before his case was switched to another surgeon, he said. “I would wake up in the middle of the night crying and screaming in pain.” The second doctor said he needed quick surgery, and the surgery was performed seven days after he fell, said Belanger, an economics student at Bishop’s University in Sherbrooke, Que. His family said they are still puzzled as to why the original surgeon did not perform the operation. “It’s gross incompetence on the part of the hospital and a failure on the part of the Canadian health care system,” said Belanger’s mother, Martha Ferris. Both Patrick and Richard Belanger say the end result was “discrimination” against a patient from Quebec, who pays hospital bills but does not participate in a reciprocal billing agreement for doctors’ fees that applies to all other provinces and territories . Doctors of BC, an association representing doctors, said an agreement allows its members to bill their own provincial medical plan for out-of-province patients and then the plan is reimbursed by the patients’ home jurisdiction. “Physicians are paid as if the patient were a BC resident,” it said in a written statement. “When a Quebec resident needs medical care in BC, doctors cannot charge the MSP for it and get paid,” the association said. However, doctors who provide services to Quebec residents can either bill that province or bill the patient, who would seek reimbursement from their government. The Ministry of Health in Quebec said doctors elsewhere are paid the same rates as if the patient had received the same treatment in his home province. Patients must pay any difference in costs and could apply for reimbursement through private insurance if they have it, the department said in a written response. The department recommended that Quebecers obtain private insurance before traveling outside the province. Richard Belanger said the family’s private insurance company refused to pay any costs after the first surgeon wrote in his son’s medical chart that he could return to Quebec and have the surgery there within 10 days. The insurer had also initially refused to pay expenses when an emergency room doctor noticed possible intoxication in his son’s chart, Belanger said. But that was later ruled out when the family asked why no tests were done to determine the presence of any substances, including alcohol, he added. Dr. Peter Stefanuto, the original surgeon, declined interview requests. In an email he said he could not speak to any specific case, but that “care is provided to all patients regardless of their province or country of origin on an urgent basis.” Issues surrounding reimbursement for services could best be handled through the BC and Quebec governments, Stefanuto added. Dr. Bob Rishiraj, who ended up performing the surgery, said he wasn’t concerned about any “politics” surrounding the billing, especially after learning the patient had been on opioids and methadone for days and that the longer wait for surgery involved the risk of infection. . “It became very concerning to me that he was using a lot of morphine and his pain was not well controlled. If we don’t, we have a problem of potentially having someone with potential drug abuse on the street,” he said. “I think a patient is a patient and it doesn’t matter if they’re from Quebec or Ontario or wherever. I think they should just be dealt with,” said Rishiraj. The risk of a billed patient not paying a doctor is low, and cost doesn’t appear to be an issue for Belanger’s family, he said. Interior Health did not respond to a request for an interview, but said in an email that the doctors are not employees of the health authority. Ferris said the family paid Rishiraj $2,563 and will apply for compensation from Quebec. The irony is that the family used their private health insurance while traveling out of the country, but didn’t expect to have to rely on it in Canada, she said. “It’s shocking to me, kind of shocking.” British Columbia’s Ministry of Health did not respond to questions about patients from Quebec who were refused surgery. Dr. Katharine Smart, president of the Canadian Medical Association, said Canada’s universal health care system is intended to provide care to all Canadian citizens and permanent residents. “We strongly encourage provincial and territorial governments to work together to ensure Canadians get the care they need, when and where they need it, and the federal government to enforce the principles of the Canada Health Act uniformly across the country,” he said in a written statement. Health Canada said the reciprocal billing agreements are administrative arrangements between provinces and territories to facilitate the portability criterion of the law while people are temporarily away in another part of the country and need care. “These agreements are voluntary and are not a requirement of the Canada Health Act,” it said in a written response. Belanger, who had trouble speaking because his jaw was wired shut for six weeks after the operation, said the emotional toll he took is “immeasurable,” in addition to the physical pain, which still includes migraines. Damien Kontandriopoulos, a professor of nursing and health policy researcher at the University of Victoria, said regardless of Quebec’s pricing scheme, the province pays, on average, higher doctors’ fees than other jurisdictions for the same care, which is reversed by practice her years ago. It is common for thousands of Quebec patients to receive care from family doctors in Ontario’s border towns and their province reimburses the cost, he said, adding that he is “shocked” that a patient would be denied services because of billing issues. But doctors in British Columbia, where relatively few Quebecers receive care, may be discouraged from seeking information on the prices that province pays because it runs to about 3,000 pages in some complex categories and in French, Kontandriopoulos said. , formerly a resident of Quebec. In Belanger’s case, the surgeon could have called his insurance company’s 24-7 hotline to get information from a representative, instead of saying that administrators were unavailable over the weekend, Kontandriopoulos said. He called Belanger’s week-long wait for surgery “crazy.” This Canadian Press report was first published on July 7…
