Friday, June 19, 2009


Incompetence, Games Or Just Stupidity

It was with great fanfare that the Ontario Health Ministry said at the start of this year that men would be as good as women when it came to cancer tests.
One major cancer test for men is Prostate Specific Antigen (PSA) and men have always had to pay for it out of their own pockets, even though it is useful in detecting and monitoring the cancer that is a major killer.
So finally the Gliberals at Queen's Park lived up to all the campaign promises and said that OHIP would cover the test no matter where you had it. But then they threw a curve in secret. It's free only if it is used for monitoring cancer patients and ordered by a doctor.
That rules out a man having the test just because he's been told to do so as he grows older.
Since my PSA is being monitored by a urologist because it is up a tad, I'm covered. Or so you would think. But life is never that simple.
The last time I had one was six months ago. It had been ordered by the specialist but when I showed up at the first-floor blood letting room of Princess Margaret Hospital, they said they had no record. Since his office is upstairs, I went there and by luck, or so the nurse said, I found someone to authorize it. Took an hour.
Now I needed another test, which has to be done a week before you see the specialist. So I phoned the hospital and left three messages, asking for someone to book the appointment (and tell me) to avoid another runaround. No luck.
I found a government requisition form signed last year by my specialist and armed with it went to the local LifeLabs office (used to be called MDS Diagnostic Services.) I'm a regular visitor there, damn it. I said that I also needed my monthly INR test. (Measures the slipperiness of the blood of patients taking warfarin, you know, rat poison.)
Since my veins are deep or missing or something, drawing blood from me is not that easy, so I figured they could stick one needle in and get enough blood for both the INR and PSA tests.
The lab person demanded $50 first. I said the PSA test has been free for six months. I waved the appropriate form. She wouldn't budge.
So instead of a simple walk from the clinic on Bloor near Prince Edward, I phoned my doctor's office, the able Bernie Gosevitz, went downtown by subway, waited, then got the blood drawn on the second attempt. The nurse said the test would cost. I explained it was now free when authorized by a doctor for monitoring. All this took several hours and two transit fares, and in the running around, I temporarily misplaced my OHIP card, which caused endless problems.
Several days later an invoice arrived from Gamma-Dynacare Labs for $30. Phoned and demanded an explanation. OHIP only covers cancer patients, she said, and all my specialist had indicated was a PSA test was needed. And he has to state that it's a test required to monitor cancer. Wotinhell you think it's for, I said, when a prostate specialist from a cancer hospital orders a PSA test. You think he's wondering about changing my hair colour. She said they would check further.
It's nice that the Gliberals finally made the PSA test free for some men after all the years of Tory and NDP governments refusing to treat men the same as women, who have always got their cancer tests for free. But it took years of lobbying by urologists. Now there is controversy about the value of the test, but enough urologists think it useful that it should be done. And they told the health ministers so. Only George Smitherman was honest enough, apparently, to tell the urologists that he only had so much money and would like to be shown the Gliberals would win enough votes to justify the diversion of funds.
So what's going on now? The health ministry wants to let on that the PSA test is free but it's really only covered if it isn't the routine one that men are supposed to get as they age. You don't get into this hassle if you go to the hospital clinic, providing you live in or near Toronto, but that isn't convenient for many, and as my experience shows, there can be glitches. (Not a slam at Princess Margaret because I've found the staff can be quite accommodating. Now if they only had more reading in the Prostate Clinic than Chatelaine and Flaire, which is silly considering it's a male clinic.)
Life is complicated enough without carrying a book of regs about when the health minister will pay and when he stiffs us. But then I'm cynical enough to wonder if this confusion is deliberate to make money for labs and save enough for OHIP so they can waste it on bureaucrat's salaries and golden handshakes.
Post Script:
Gamma Dynacare billed me again even after one staffer talked to my specialist. I wrote this blog. Then I got another bill. I emailed the lab with all the details and nothing happened. Finally, at the end of August, I wrote the lab including a copy of my blog and the email that had been ignored. And I got a letter in September from the director of corporate communications cancelling the charge and including a copy of the new laboratory requisition form where the doctor must specify whether the PSA test "meets OHIP eligibility criteria' or is just for "screening purposes."
Gamma Dynacare is a giant lab, not some hole-in-the-wall outfit. If this is my experience with it, and as a journalist I'm used to red tape and hassles, what about the men who just want to get through life with as few arguments as possible. Just imagine all the extra money that rolls in when they pay those invoices.
Just imagine the savings for OHIP too. And the question remains. Since women aren't charged for their tests and examinations to detect cancer, why do men have to pay for a basic cancer screening? Is not the provincial health ministry a clutch of hypocrites when they stop giving out contracts to their buddies long enough to boast how they now pay for PSA tests.

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