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‘Yes, Minister’

Dear sir:

When bureaucrats wish to do something stupid, they first make, and then quote, a stupid regulation to justify it.

I enclose a letter from a Mrs. Mahoud replying on behalf of Mr. Wilson, the minister of health, to letters of mine concerning Northern Health Travel Grants. Patients’ names have been blacked out; the letter is otherwise unaltered.

Your readers must first understand that travel grants are paid to the nearest facility providing a given service in Northwestern Ontario or Manitoba. That distance limits the amount paid. If I choose to send my patients to Toronto for a service available in Winnipeg, then the patient will receive expenses to Winnipeg. Since facilities for renal transplants exist in Winnipeg, patients’ expenses, according to the ministry’s regulations, will be covered to Winnipeg.

They must also understand that the ministry’s own regulations specifically allow travel grants for referral to a specialized university clinic. The third thing to understand is that the legal responsibility to determine who is and is not a specialist is given to the College of Physicians and Surgeons of each province, not to the ministry of health.

It is unfortunate the ministry of health in Ontario is trying to assume a power which does not belong to them when they insist that they will only recognize as specialists those physicians possessing certification by the Royal College of Physicians and Surgeons of Canada. The licensing bodies in each province have the power to ignore this requirement in certain cases where a physician’s qualifications are extraordinary and where that physician works for a university.

Now that the ministry finally has admitted that they have been ignoring their own regulations in refusing travel grants to patients attending university clinics, Mrs. Mahoud has graciously stated, in essence, that they are responsible for payment of these grants but that they will not pay them if Dr. Bolli signs them. Dr. Bolli was the head of the department, a specialist in the Manitoba register appointed by the University of Winnipeg.

The absolute and total stupidity of this ruling has been pointed up by the fact that Dr. Bolli, who is a distinguished and internationally-known specialist in his field, has now been recruited by the University of Western Ontario as the specialist heading up a new department of Nephrology in Ontario, and is practicing as a specialist in Ontario at this time.

The reason for writing this letter is that the stupidity of the ministry’s arrangements for patients from Northwestern Ontario does not stop there. As detailed, we are expected to send patients to the nearest facility in Ontario or Manitoba providing specific services. The second patient referred to in Mrs. Mahoud’s letter was in renal failure and becoming very anaemic. There is a treatment for this called Eprex, a drug which costs $300 a week. Since the drug is only used in very special circumstances, it would be provided free to a Manitoba resident when ordered by their nephrology clinic. It is not paid for by the Manitoba government for an Ontario resident.

It would be paid for by the Ontario government if the patient were being seen by an Ontario dialysis unit. Catch 22 is that I am bound to send potential renal transplant patients to the nearest facility, which is in Manitoba.

My patient is now being seen by an Ontario dialysis unit in Thunder Bay, and is receiving Eprex as well as dialysis. The financial strain of $300 weekly on top of the hundreds of dollars already spent in travel to Winnipeg may well have been a factor in their decision to forgo any possibility of renal transplant. It is hoped the folks at the ministry are pleased and proud of their handling of this case.

Normally the excesses of bureaucrats are checked by politicians. If Mr. Wilson endorses his ministry’s officials when they override the legally-appointed bodies qualified to decide who is a specialist, he comes off as a wimp. If he is unaware of their actions, he comes off as mildly incompetent.

Someone from the local Conservative party should inform him of the facts. The mayor or the town council should be taking up the cudgels when we are treated as second-class citizens. At the moment, my only impression of this ministry and its minister is that they would make a wonderful model should someone decide to make a sequel to the TV series, “Yes Minister.”

Sincerely,

Dr. B.T. Johnstone

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