Dr. Elaine Ma (left) and Dr. Piotr Oglaza, Medical Officer of Well being for KFL&A Public Well being, on the St. Lawrence School mass vaccination clinic on Saturday, Dec. 18, 2021. Photograph by Cris Vilela/Kingstonist.
Not solely is OHIP demanding an area physician pay again what she was reimbursed for working quite a few vaccination clinics on the peak of the COVID-19 pandemic, however the provincial authorities appears to have recognized about it for months but has achieved nothing to proper the obvious fallacious.
When COVID vaccinations had been developed in early 2021, Normal Rick Hillier was appointed to guide the province’s vaccination job pressure and sounded a “call to arms” to combat the virus.
Premier Doug Ford himself saluted Hillier, saying the duty pressure, generally known as Operation Distant Immunity, “was launched to protect the most vulnerable populations in the province.” Ford lauded Hillier as a “master tactician” who was crucial in getting the infrastructure in place to make sure the success of Ontario’s vaccination program and “developing our vaccine distribution plan” with “mass vaccination sites, mobile and hospital clinics.”
Dr. Elaine Ma. Photograph through OCFP.
In the meantime, in Kingston, one of many individuals with boots on the bottom in Hillier’s operation, Dr. Elaine Ma, was instrumental in serving to to launch the biggest vaccination roll-out in lots of generations, organizing a number of drive-through mass vaccination clinics. Like Hillier, she was hailed for her heroic efforts and obtained the Ontario School of Household Physicians Award of Excellence for 2021.
Within the eyes of the Ontario Well being Insurance coverage Plan (OHIP), nonetheless, that apparently means little. OHIP now appears to be punishing Ma for a similar actions she was lauded for on the peak of the vaccine rollout.
When Kingstonist reached out to Ma to debate her medical clinic’s cancellation of a deliberate drive-through vaccination clinic this month, Ma revealed that she was now going through an OHIP Well being Companies Attraction and Evaluate Board (HSARB), and the provincial-run insurance coverage plan was asking her to pay again $600,000 for the clinics she ran on the peak of the pandemic.
Native MPP sought authorities response months in the past
Ted Hsu, Member of Provincial Parliament (MPP) for Kingston and the Islands, introduced the scenario out into the open throughout query interval within the Ontario Legislative Meeting on Could 15, 2024, and .
The Could 15, 2024, Hansard of the forty third Parliament, 1st Session particulars Hsu’s try and intervene on Ma’s behalf when he rose to talk on OHIP protection of COVID-19 immunization.
He informed his fellow parliamentarians, “In late 2021, COVID-19 cases skyrocketed in the Kingston area with the Omicron variant. An enterprising local doctor, Elaine Ma, ran a drive-through mass vaccination clinic. Community members, like my own daughter, volunteered to help. Thousands were quickly inoculated during a critical couple of days. That’s why I was shocked when I learned that OHIP asked Dr. Ma to pay back its $600,000 reimbursement. Why? OHIP said because shots were given in the St. Lawrence College parking lot, not in her office.”
Hsu additionally reminded the Meeting that this was not the primary time this matter had been delivered to the federal government’s consideration: “This is a follow-up to a letter to the minister [of health]’s office that I sent several months ago: Does our government have the backs of doctors who think out of the box and take the initiative to protect us during health emergencies? Would the minister intervene and override OHIP’s action and offer a fair solution?”
Speaker Ted Arnott acknowledged then-Home Chief and Minister of Lengthy-Time period Care Paul Calandra, who answered shortly, “Of course, we’ll look into that. I know, in my own riding, we had a drive-thru vaccination clinic, which worked very well.” He then shifted to criticism of the previous Liberal authorities’s well being report and of the New Democratic Get together (NDP) for supporting the Liberals.
After a lot shouting within the legislature, Hsu once more made his level, saying, “Mr. Speaker, this is not really a partisan question. OHIP asked Dr. Ma to repay about $600,000 in reimbursement for costs incurred. And $600,000 is about the cost for one COVID patient to stay a couple of months in the ICU. So that drive-thru clinic was a really cheap way to vaccinate thousands and prevent many additional COVID-19 patients going to the ICU. Dr. Ma followed the rules, the steps to qualify her mass clinic under the prescribed… billing codes and [Ontario Medical Association] billing practices for mass clinics. She is being punished for no good reason.”
Hsu reminded the federal government, “The minister of health [Sylvia Jones] has the power to conduct post-payment review. Will she intervene today? Will she set a healthy precedent so that in our next public health emergency, doctors who take the initiative to protect us in good faith can count on support from the system?”
After many interjections by parliamentarians on all sides and makes an attempt by Arnott to regain order, Calandra once more mentioned the federal government would look into the difficulty, earlier than launching one other assault on the previous Liberal authorities.
But months later, Ma finds herself going through the Well being Companies Attraction and Evaluate Board listening to in Toronto with no intervention by the federal government.
“I think our community greatly appreciated the innovative drive-through clinic held at the St. Lawrence College parking lot during the pandemic… Many of us have been disappointed that the government hasn’t accommodated a reimbursement for that local health initiative, nor for the flu vaccination clinic this past weekend,” Hsu mentioned in electronic mail correspondence with Kingstonist on Monday, Oct. 28, 2024,
“We have been working with Dr. Ma behind the scenes for over a year now… The Health Minister has the power to make an accommodation, but so far has not intervened. Because the case is before the Health Services Appeal and Review Board with the hearing continuing this coming week, I will hold back some comments until after a decision is made.”
Well being/insurance coverage legislation knowledgeable provides perception
Within the meantime, Kingstonist reached out to Erik Knutsen, a professor at Queen’s College of Regulation, in hopes of higher understanding Ma’s scenario. Well being and insurance coverage legislation are amongst Knutsen’s areas of educational curiosity, and he’s a co-author of Stempel and Knutsen on Insurance coverage Protection, one of many main American insurance coverage legislation treatises.
Whereas Knutsen admitted he couldn’t be an neutral observer of Ma’s case as a result of he’s a buddy of the physician and has recognized in regards to the case because it started, he was useful in explaining the method Ma is now going through.
“OHIP is the provincial organization that pays for our medical services. We tend to forget that, you know. Sure, It’s public money, and everybody thinks health care is free, but there’s a cost to it. The doctors and nurses are paid; they’re paid per service,” he mentioned.
The related legislation is the Well being Insurance coverage Act and the rules thereunder, together with the Ministry of Well being Schedule of Advantages for Doctor Companies, Knutsen defined: “That sets out the rules of the game for what the province, through OHIP, will pay for and what it won’t pay for. It’s a long, complicated schedule… arrived at by agreement between the province and the Ontario Medical Association.”
He continued, “OHIP, as an organization with the money, follows this schedule of benefits, but as with lots of laws, sometimes what you’re supposed to do in certain situations can be murky” — and the pandemic was murky.
“Everybody was told, and we had General Rick Hillier saying, ‘Get shots into arms, we’ll sort it out after the fact. We’ve got to save people because they’re going to drop like flies,’” Knutsen recalled.
It was for that purpose that Ma started organizing mass vaccination clinics. Knutsen identified that she organized, supervised, and ran the enormous clinics, inoculating 1000’s, even on holidays reminiscent of Boxing Day and New 12 months’s Day, and that her crew of health-care professionals and medical college students, together with the Medical Officer of Well being, took time away from their very own households and houses throughout the holidays to look after the broader group.
He speculated that, two and a half years later, OHIP reviewed the paperwork, noticed the large variety of individuals being handled in such a brief time frame, and determined that it didn’t match the foundations. So, based on Knutsen, OHIP most likely determined, “‘Let’s claw back all those thousands of shots that we paid Dr. Ma to do so effectively. She will earn $0 per shot because it didn’t fit with the rules.’”
Knutsen identified that Ma had the complete help of and permission from Kingston, Frontenac, Lennox and Addington (KFL&A) Public Well being to run the clinics. He additionally famous “that if anything happened in one of those clinics,” reminiscent of a vaccination harm, “it was Dr. Ma who had taken on all of the liability.” So to demand the cash again as if the clinics didn’t even occur, “when she was saddled with that responsibility for those tens of thousands of shots, is kind of an odd thing.”
And for OHIP to ask for the cash again as a result of the clinics didn’t occur in a physician’s workplace is absurd, Knutsen mentioned. “Nobody could be in closed spaces then; that was the point,” he mentioned in an exasperated tone.
Not solely that, however Ma has “compensated the teams of family doctors to come and help at her clinics as well as medical students,” Knutsen added. “The money isn’t the issue; it’s that the work was done.” If OHIP didn’t suppose Ma needs to be doing what she was doing, they may have informed her instantly, he mentioned.
Former OHIP lawyer is aware of the method
Perry Brodkin, a well being lawyer in personal observe, acknowledged, “The law is the only thing that matters to OHIP.” And he ought to know; he was the only lawyer for OHIP from 1973 to 1991.
Primarily based on his expertise, he defined the method that possible occurred with this case and the way he expects it’ll proceed.
First, Brodkin mentioned, OHIP bureaucrats would discover this $600,000 invoice as an aberration — that such a large cost could be unprecedented within the historical past of OHIP.
“So they would come to me with this aberration, and I would say, ‘What law applies?’ And then I would look for the law in 2020, 2021, beginning of 2022,” he mentioned, noting that he could be working with physicians.
“We would go one meeting after another, and we would come to a conclusion [about which] are the relevant pages of the schedule… Based on that, we would decide yes, we are going to recover the $600,000, or no, we are not going to recover the $600,000.”
“And then,” he mentioned — and that is the vital half Ted Hsu and the individuals of Ontario must know — “We’d run it up the hierarchy because you want the assistant deputy minister, the deputy minister, and the minister [of health] to know.” At first, Brodkin mentioned he wasn’t positive it could go all the way in which as much as the premier — however on this case, Ma had informed Kingstonist she had spoken on to Premier Ford, and he mentioned he felt she was being mistreated.
“Of course,” Brodkin mentioned, “the litigation may not be concluded until 2029,” at which era the present premier and well being minister is probably not round.
He expects the listening to possible concluded yesterday (October 29), and we gained’t know the choice till subsequent yr. After that, he mentioned, it is going to be appealed regardless of who comes out on high.
Kingstonist contacted native MPPs, OHIP, Minister of Well being Sylvia Jones, and Premier Doug Ford on Friday, Oct. 25, 2024, for feedback. Presently, solely MPP Hsu has responded.
Kingstonist will present extra on the listening to and its final result, in addition to additional developments, as data turns into out there.
