Government told officials not to enforce laws against health user fees
Documents obtained by nurses under FOI reveal government policy
has been to ask offending doctors and clinics to refund patients,
but to take no action if they refuse
View video of news conference.
Internal Health Ministry documents reveal the BC government deliberately and consciously decided not to enforce laws that protect patients from user fees charged by doctors or private for-profit clinics for services covered by public health insurance.
The documents — released under the Freedom of Information Act - confirm exactly what the BC Nurses' Union has been alleging in ongoing legal action the union first launched in 2005. The government had no intention of defending patients when they were forced to pay illegal fees for medically-necessary procedures.
BCNU has asked under FOI for any subsequent version of the policy to indicate whether it has been changed or is still in effect, but no new policy has been produced.
The documents show explicitly that the government would not act to enforce its own laws because of political considerations.
BCNU president Debra McPherson says reading the documents was chilling. "Here are internal memos in which Health Ministry bureaucrats discuss how to respond to letters received from legal counsel representing BCNU in this matter. They say the government's policy was to write offending physicians and clinics asking them to refund these illegal fees to their patients, but to take no further action if they ignore the request or otherwise refuse to comply.
"This confirms that this government has no commitment to the values and principles of Canada's public healthcare system, which is based on the principle that healthcare should be available to everybody who needs it, regardless of the size of their wallet.
"They also show the government wrote to patients who complain and suggest they seek a refund of the illegal fees themselves. What an insult to patients, what an abdication of governmental responsibility," McPherson says.
One document is an email from Assistant Deputy Minister Craig Knight to then Deputy Minister Penny Ballem December 9, 2004. Another is a December 10, 2004 update apparently prepared for Knight for a meeting with Health Canada. It reads:
"In March/April 2004 the Ministry adopted revised procedures for dealing with reports of extra-billing, In essence these procedures require staff to follow up on complaints but stop short of any enforcement action. (emphasis ours)
"(After asking the patient for documentation and reviewing it) if it appears to be a case of extra-billing, MSP then writes to the doctor (normally the surgeon to remind him/her of the provisions of the (Medicare Protection Act) and to request a refund. However, MSP does not attempt any remedial action in the event the physician does not voluntarily rectify the situation."
The document acknowledges that before March 2004, MSP procedures included requesting repayment of any inappropriate charges and, if necessary, taking remedial action against physicians under the Medicare Protection Act with possible penalties of mandatory de-enrollment from MSP.
But that all changed after the government refused to bring into force the whole of Bill 92, which would have given the government the authority to take action against private clinics, as well as individual physicians. The government appeared to accelerate its support for the growth of patient-pay for-profit healthcare by deliberately looking the other way from illegal extra billing for medicare insured services.
Another document is a November 16, 2004 briefing note prepared for Stephen Brown, Assistant Deputy Minister, Medical and Pharmaceutical Services Division. It refers to possible action against a physician "either for violation of the billing rules in Part 4 of the Act or for failure to respond in good faith to a communication from the commission. Such action could include de-enrolment for a specified period.
However, such action would carry significant political implications...." (emphasis ours)
"MSP's current approach, amended in March 2004, is to follow up on patient complaints of extra-billing as follows:
Write to the doctors involved to request refunds but do not attempt any remedial action in the event they do not voluntarily rectify the situation.
Write to the patients suggesting they seek refunds" (emphasis ours)
Says McPherson: "These documents show the government knew these fees violated their own laws, but the government consciously refused to act. The fundamental principle of medicare is that everybody pays for healthcare through our taxation system and nobody pays for services that are medically-necessary. The conscious betrayal of these principles by the BC government as revealed in these documents is quite frankly breathtaking.
In its legal case, BCNU has been seeking a BC Supreme Court order directing the government to enforce the laws of medicare, what the documents show the government has consciously and deliberately declined to do.
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