Ontario to Pay $76,000 Drug Bill Toronto Star, January 31, 2007

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Ontario to pay $76,000 drug bill Toronto Star, January 31, 2007

AARON LYNETT FOR THE TORONTO STAR Suzanne Aucoin in the home of her parents in St. Catharines, Ont., will be reimbursed for treatment for colon cancer she received in Buffalo, N.Y. Aucoin said she's delighted the victory will have an impact beyond her own case.

Bittersweet victory over bureaucracy: `I should never have had to deal with this' Jan 31, 2007 04:30 AM ROB FERGUSON QUEEN'S PARK BUREAU

Also ran in: National Post, The Globe and Mail, St. Catharines Standard, Peterborough Examiner, North Bay Nugget, The Kitchener Record, Timmins Daily Press, Hamilton Spectator, Cornwall Standard-Freeholder, Broadcast News, CBC News.ca

She's fighting colon cancer but Suzanne Aucoin is elated after a rare personal apology from Ontario's health ministry, which admitted it was wrong in refusing to pay for her chemotherapy in Buffalo and is reimbursing her every penny.

A cheque for $76,018.23 was expected to arrive at her St. Catharines home today following an investigation by Ontario Ombudsman André Marin, who said the rules for seeking out-of-country treatment are so complex "it's like handing patients a Rubik's cube." Marin persuaded bureaucrats to change their minds about Aucoin's case – and their policy for others in her situation, with clearer guidelines to be issued along with better explanations when requests for any form of out-of- country treatment are denied.

Aucoin said she's glad the victory will have an impact beyond her own case but it remains bittersweet after more than a year of appeals to bureaucrats and Ontario Health Insurance Plan review boards.

"I should never have had to deal with this, it takes all my energy to fight cancer," the 36-year-old teacher on medical leave told the Toronto Star last night before heading out for a celebratory dinner.

"It rights a wrong on some levels but you cannot put a price tag on my mental strain and stress."

The money will cover her $57,000 bill for drugs with the remainder going to her legal fees for Toronto lawyer Brian Cohen, who called the decision "marvellous" proof that patients can fight the system.

Aucoin's colon cancer has spread to the liver, lungs and lymph nodes and she remains under treatment with the drug Erbitux, which she had to obtain first in Buffalo and later in Hamilton at her own expense after OHIP rejected her application for funding two years ago.

Bureaucrats first ruled the Erbitux and other drugs for which she applied were experimental and not eligible, although her own doctor recommended them as the best course of treatment and other Canadians were being sent to Buffalo for Erbitux at the time. So she arranged to get them at a private clinic in a Buffalo suburb at about half the cost of the better-known Roswell Park Cancer Institute where the province sends patients.

A subsequent appeal for coverage was rejected last November because the private clinic – run by a licensed cancer specialist also on staff at Buffalo's Mercy Hospital – was itself not licensed, as required by provincial guidelines to protect taxpayers from funding treatment at dubious clinics.

This was despite the fact that the appeal board found "no indication" the private clinic was not reputable and testimony that New York state or local law does not require such facilities to be licensed. Marin's office had been following Aucoin's case but could not get involved until the official appeals were exhausted two months ago.

"We were shaking our heads from Day 1," Marin said. "They were fighting her every step of the way. It's an absolute calamity what happened to her."

Health Minister George Smitherman said in a statement last night that Marin's investigation prompted officials to review the out-of-country health coverage program to make it "work better for Ontario patients," including immediate steps to provide doctors with more information.

There is a need for "greater information about funding for particular treatments, to ensure that decisions about funding for out-of-country treatment are consistent and based on evidence, and to improve the quality of reasons provided when requests are denied," the statement continued.

Out-of-country treatments can be authorized when the care is not experimental, is not available in Ontario, and when delay "would result in death or medically significant irreversible tissue damage."

In Aucoin's case, the major problems included "unintelligible" form letters she received rejecting her applications, said Marin.

"They need to stop doing form letters, they need to be more in tune with the public they serve," he added.

The apology to Aucoin came in the form of a phone call to her home yesterday afternoon by deputy health minister Ron Sapsford. "He just sort of said ... `I realize you've had a difficult time,'" Aucoin recalled. "I accepted it, I thanked him for it."