Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada.
Fighting for her life, the Windsor woman headed to the United States. In Pontiac, Mich., a surgeon excised the tumour - 35 centimetres at its longest - along with her ovaries, appendix, fallopian tubes, uterus and cervix. In addition, 13 litres of fluid were drained during that October, 2006, operation.
And there was little time to spare: Had she waited two weeks, she would have faced potential multiorgan failure, rendering her unstable for surgery, according to a letter from Michael L. Hicks, who performed the four-hour operation at St. Joseph Mercy Oakland.
"Based on my exam and experience as a gynecological oncologist, I felt it necessary to perform surgery within two weeks," said the letter written by Dr. Hicks, provided to Ms. de Vries's lawyer, Kate Sellar.
But a devastating cancer diagnosis was only the beginning of Ms. de Vries's troubles.
The Ontario Health Insurance Plan says it won't pay for the $60,000 cancer treatment because Ms. de Vries did not fill out the correct form seeking preapproval for out-of-country care.
As well, it says no medical documentation was submitted that indicated a delay in obtaining the service in Ontario would result in death or medically significant, irreversible tissue damage.
That administrative misstep has left Ms. de Vries, a 51-year-old corporate communications manager, with a staggering cancer bill. She has drained her savings, maxed out her credit cards, taken out a line of credit and relied on friends to hold a spaghetti-dinner fundraiser, which earned $11,125.
"I feel abandoned; I was fighting for my life," Ms. de Vries said. "... I definitely would like to get some money back but more importantly, I would like to see the situation rectified so [other patients] don't go through this."
Ms. de Vries's case raises questions about OHIP's out-of-country health coverage program, which was put under a review more than a year ago after cancer patient Suzanne Aucoin of St. Catharines, Ont., was denied funding for treatment she received in the United States.
Only after ombudsman André Marin intervened was Ms. Aucoin reimbursed $76,018.23 in January, 2007, to cover costs associated with the colorectal cancer drug Erbitux, among other expenses and legal fees. (She has since died.)
At the time, Mr. Marin described the out-of-country approval process as "literally impossible for patients and physicians to understand."
Just two months before Mr. Marin made those comments, Ms. de Vries was trying to get access to that same program.
To have an out-of-country treatment approved, the procedure must not be performed in Ontario, cannot be experimental and should be deemed medically appropriate. However, patients can have out-of-country treatment funded even if it is available in Ontario so long as there is a delay that would cause irreversible tissue damage or death. Part of the form must be filled out by the patient's physician.
Patients denied preapproved, out-of-country treatment can appeal their cases to the Health Services Appeal and Review Board. And that is what OHIP has suggested to Ms. de Vries.
But her lawyer, Ms. Sellar, said such an appeal would be futile: Since Ms. de Vries did not fill out the out-of-country form before receiving treatment in the U.S., she cannot win the appeal.
Health Minister George Smitherman has the discretion to reimburse Ms. de Vries for treatment, if he chooses to do so. Ms. de Vries said she contacted her MPP, Sandra Pupatello, about it. In the end, she was told she had to go through the appeal process.
