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To All Family Physicians of Ontario: November 21, 2002

MEDICAL REVIEW COMMITTEE

By now, many of you will have seen, heard or read of the Coalition of Family Physicians of Ontario’s media release and media conference dealing with the inherent unfairness of the Medical Review Committee process here in Ontario that was held on November 19^th at Queen’s Park.

The Coalition has made it clear to the Ontario government and the Ontario Medical Association that the way the MRC process is currently being used to intimidate physicians and extort money from them is both appalling and intolerable, and must be changed immediately.

Please take a few minutes to read the following media release. Then why not reach for your chequebook and do what so many of your colleagues have done by becoming a member of the Coalition of Family Physicians of Ontario. If you haven’t already joined us, isn’t it about time that you were represented by somebody who actually cares about the fate of family physicians and is willing to stand up to government for you?

Remember, a strong voice for family physicians means a bright future for all of us!

Douglas Mark MD, President          Allan Studniberg MD CCFP, Interim Vice President

and the

Executive Committee of the Coalition of Family Physicians of Ontario

COALITION OF FAMILY PHYSICIANS OF ONTARIO SPEAKS OUT ON UNFAIR MRC PROCESS,

SAYS “GOVERNMENT-SPONSORED EXTORTION” MUST END

(November 19, 2002, Toronto, Ontario) – Dr. Douglas Mark, President of the Coalition of Family Physicians of Ontario, held a media conference today to discuss the inherent unfairness of the Ontario government’s Medical Review Committee process. In addition to examining why regulatory changes introduced in 1998 have led to hundreds of physicians being unfairly ordered to repay millions of dollars in legitimate billings, Dr. Mark also revealed how the severe financial and emotional distress caused by these MRC rulings have ultimately resulted in health-care rationing because physicians all across the province have been forced to change the way they practice medicine. Joining Dr. Mark at the media conference was health law advocate Tracey Tremayne-Lloyd of Tremayne-Lloyd Partners LLP, who has been working diligently – along with Dr. Mark and the Coalition – to bring these issues of fairness and due process to the attention of both the medical profession and the Ontario government.

     “Imagine your child is sick,” said Dr. Mark, a family physician practicing in Toronto. “All day long, she’s been running a fever – and now, for the past hour, she’s been throwing up almost non-stop. You call your doctor and, even though he’s already overbooked, he tells you to bring the child in immediately and he’ll squeeze you in. Being a conscientious physician, he examines the sick child thoroughly in order to determine whether it’s an ear infection, as he suspects – or food poisoning, meningitis, the flu or something else entirely. Eventually, the doctor is satisfied that it’s an ear infection we’re dealing with after all. He gives you the necessary instructions – as well as prescribing the appropriate medications – to make your child more comfortable, and sends you home. Given the fact the office is now completely overflowing with patients, the doctor writes a few lines in the chart – including the essential history, physical findings, diagnosis and medication prescribed – and then rushes off to see the next patient. The doctor bills OHIP for an intermediate assessment, and thankfully your child makes a full recovery.”

     Four years later, officials representing the government of Ontario send that doctor a letter informing him the child he saw four years ago should have been billed as a minor assessment – a medical service normally chosen by doctors when assessing extremely minor ailments or providing very brief advice to patients – and not an intermediate assessment. Even though no one from the government actually saw the patient, only the doctor’s handwritten chart, they have decided the doctor has been over-billing the system all this time, and now he is going to have most if not all of his intermediate assessments discounted, and be forced to pay back the difference to the government. One hundred thousand dollars. Two hundred thousand dollars. Three hundred thousand dollars. It does not matter. The Health Insurance Act or Schedule of Benefits will not do the doctor any good either – the government has rewritten the rules and made them retroactive.

     Dr. Mark presented another scenario. “Your parents are in their 80s, living on their own in an apartment building in a small town in rural Ontario. A ferocious winter storm hits, and they’re snowed in. Your father, who suffers from heart disease and high blood pressure, calls the doctor’s office to inform them that he is feeling anxious because your mother had a bad fall yesterday and is complaining of dizziness. The local doctor – again being a conscientious, caring physician – decides to brave the storm and pay your parents a visit. On the way, her car almost gets stuck in the snow. Once inside your parents’ apartment, she takes their histories, reviews their patient charts, examines them, makes any necessary adjustments to their medications, and generally ensures that they’re not in any immediate danger. She completes the paperwork back at her office, and bills OHIP for a house call.”

     Four years later, this doctor also gets a letter. Government officials inform her that she had no business making a house call to check on your parents, as they should have visited the doctor at her office – even though there was no way they could have possibly done so because of the snow storm. The government has decided – again, based on looking at a few of the doctor’s patient charts – that she too must have been over-billing the system for years. “What’s the likelihood this doctor will ever make another house call after going through this experience?” asked Dr. Mark.

     Continuing, Dr. Mark explained, “Should either of these doctors wish to challenge the appropriateness of these judgments or charges, they’ll be told that if they do so, it’ll expose them to tens of thousands of dollars in investigation costs, and will further expose them to the potential of the publication of their identities, thereby damaging their professional and personal reputations. In addition to all this, all monies owed, including interest, must be paid within one year of the decision – otherwise, assets such as RRSPs, cars, homes or other life savings could be seized.” As if that was not bad enough, the regulations demand that interest be calculated – often over several years – on a retroactive basis to the alleged overpayment. The result being that even if a physician paid the alleged amount within hours of the MRC making its decision, there is no way he or she could avoid years and years of interest being added to the total by the government’s draconian retroactive interest regulation. However, if the doctors make an offer to settle – which often happens because they cannot afford to pay the costs of an appeal on top of the penalty and retroactive interest – the government may let them off with paying only about 90 per cent of what the government says the doctors owe them. “Sounds hard to believe,” Dr. Mark added. “And yet, every year in Ontario, roughly 100 doctors find themselves dealing with just this kind of government-sponsored extortion.”

     Dr. Mark went on to say that, since 1998, when the Ontario government began to make subtle regulatory changes, both the number of doctors being audited by the Medical Review Committee and the amounts being collected have increased dramatically. “Between 1998 and 2002, the MRC, working closely with the General Manager of OHIP, has ordered doctors to repay close to $25 million,” Dr. Mark added. “That’s $25 million in legitimate billings that roughly 400 physicians have had to pay back to the government of Ontario – all because the government thinks it has the right to extort this money from doctors through intimidation and scare tactics. You have to wonder where’s the fairness in a process that turns the most basic precepts of our justice system on its head, where a person is deemed guilty, sentenced without trial, the sentence then carried out by high-jacking the accused’s bank account, before advising them that if they wish to prove their innocence, they must go through a process that’ll cost them tens of thousands of dollars and take years to achieve – all while dealing with the reality of financial ruin. You also have to wonder how happy our patients would be to know that Ministry of Health and Long-Term Care bureaucrats are using regulatory changes – changes approved by Cabinet, incidentally, without ever reaching the floor of the legislature for debate – to ration health care on the backs of hard-working, conscientious physicians by determining what is medically necessary and what is not.”

     Ms. Tremayne-Lloyd then proceeded to take everyone through an analysis of this very complicated and complex issue, explaining how the government had suddenly decided in 1998 to begin enforcing Section 27.2(2) of the Health Insurance Act, which forces physicians to repay the amount owing before the reconsideration or appeal is heard. Ms. Tremayne-Lloyd concluded her remarks by saying, “This government doesn’t feel that our doctors deserve the rights of an accused bank robber, extortionist or con artist, all of whom are free from sentencing or the seizure of their assets until they have been tried and convicted in a court of competent jurisdiction.”

     On the issue of how all this is affecting physicians, Dr. Mark said, “We refer to colleagues who’ve gone through the MRC process as ‘the Living Dead’ because that’s exactly how they’ve told us they feel. They’re suffering from anxiety, humiliation and depression. They also live with the knowledge that it’s very likely the government will target them again in another year or two for another audit, in hopes of extorting more money to pay for a ‘crime’ in which the only victim is the very doctor who’s been accused. Most have altered their practices in ways that aren’t at all beneficial for their patients. Some have quit medicine altogether. All because a government that claims it wants to do something about our severe doctor shortage is Hell bent on rationing health care and putting doctors out of business.”

     In order to address this serious situation, Dr. Mark will be putting forth a motion at the OMA’s Council Meeting this weekend in Toronto. The motion calls on the OMA to “request the Minister of Health and Long-Term Care to immediately direct the General Manager of OHIP to cease the demand for immediate repayment and collection, under the provisions in Section 27.2(2) of the Health Insurance Act, until the Medical Review Committee and all appeal processes have been completed.”

     Dr. Mark concluded by urging the premier and the health minister to undertake a complete review of the entire MRC process and stop rationing health care on the backs of hard-working, conscientious physicians. “This way, family physicians will be able to practice medicine in a stable environment instead of having their lives turned upside down in a system where the rules are unclear and unfair, and can easily be manipulated by nameless, faceless bureaucrats who obviously think it’s better to use a retroactivescope than a stethoscope.”