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The Ontario government has been ordered to reimburse a cancer patient for a procedure he had in the United States after the province refused to pay for his care abroad, sentencing him to a certain death within months.

Almost 1 1/2 years later, Stewart Anderson is alive, after he cashed in some of his retirement savings to pay for radiofrequency ablation, the medical equivalent of cooking a tumour to death.

“The whole point is if you waited on OHIP [the province's insurer] to do anything, you'd be dead,” said Mr. Anderson, a retired property assessor who lives in Whitby, east of Toronto.

“…I'm just one person. I'm lucky enough in the first place that I survived and I can talk about it.”

The decision of the Health Services Appeal and Review Board is being reported for the first time, just as the province reviews its process for sending patients out of the country. The process has been criticized for being inconsistent; the Ontario Ombudsman has described it as being “literally impossible for patients and physicians to understand.”

At issue is who qualifies for treatment obtained in the United States but funded by the province.

Doctors in Ontario performed 177 radiofrequency ablations on 163 patients from April of 2002 to April of 2007. Ontario also paid $198,415 to send five patients out of Canada to have the procedure done from April of 2003 to April of 2007, Health Ministry spokesman David Jensen said.

Mr. Anderson wasn't one of them. The province's insurer felt the treatment in his case appeared experimental.

Diagnosed with esophageal cancer in August of 2004, Mr. Anderson underwent chemotherapy and radiation treatment in Toronto. In March of 2005, the cancer had spread to his liver. Further chemotherapy was unsuccessful.

By late fall of 2005, Mr. Anderson had no options. He said he was told in December of 2005 that he had three to six months to live.

Surgeons had suggested an operation, but because of a previous heart attack, that was not an option. Radiofrequency ablation was considered, but when doctors learned the tumour was 5.6 centimetres, no one could or would do the procedure, according to the appeal board decision.

Surgical oncologist Sherif Hanna of Sunnybrook Health Sciences Centre filled out a form with the province's health insurer, dated Dec. 12, 2005, applying to have his patient travel to Alabama for the procedure within two weeks.

Failure to obtain treatment would result in irreversible tissue damage, Dr. Hanna stated in the form, entered as an exhibit at the appeal-board hearing. Asked whether a delay in obtaining treatment would cause the death of his patient, he ticked the box saying “yes.”

Dr. Hanna, a hepatobiliary and gastrointestinal surgical oncologist, declined comment, citing patient confidentiality.

Despite the urgency of the request, the reply came more than a month later in the form of a refusal on Jan. 16, 2006. The Health Ministry said it had “insufficient documentation” that the service and treatment are accepted in Ontario as appropriate for a person in his medical circumstances.

With no time to waste, Mr. Anderson, 59, headed to the American Cancer Ablation Center, located in Gulf Shores, Ala., where his liver tumour measured 9.5 cm. Had it been larger than 10 cm, the procedure would not have been possible. A small tumour on his lung was also ablated.

Jason Williams, the diagnostic and interventional radiologist who did the procedure on Mr. Anderson, said radiofrequency ablation is often done on inoperable cancers. The bigger the tumour, the less likely it can be fully killed.

A lot of doctors, he said, do not believe it is worthwhile to treat patients with a liver tumour larger than 4 cm.

“I disagree.” Dr. Williams said in a telephone interview from Clarksdale, in northern Mississippi, where he is director of radiology for the Northwest Regional Medical Centre.

“I don't think it's for everybody. You really have to be selective and there are a lot of factors to weigh in, but for people with larger tumours you may not be able to get rid of all of it but you can certainly increase their lifespan and improve their quality of life.”

Mr. Anderson is a case in point, he said, adding that the man has “lived way longer than anyone was expecting.”

Dr. Williams stressed that not all patients are candidates, depending on the size, location or type of tumour.

In Canada, radiofrequency ablation is widespread, and has been done for the past six or seven years on liver patients, according to Steven Gallinger, head of hepatobiliary pancreatic surgical oncology at University Health Network and Mount Sinai Hospital in Toronto. However, it is typically done on smaller tumours.

Ultimately, the appeal board agreed with Mr. Anderson. The March 26, 2007, decision said the treatment was “generally accepted in Ontario as appropriate but identical or equivalent treatment was not performed” in the province.

As for Mr. Anderson, who spent $27,618.50 on his treatment, he will get every cent of it back. “I feel great” he said. “I don't have any trouble with the cancer any more.”