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Ontario pledges palliative care teams for patients wishing to die at home

A spokesman for Health Minister Eric Hoskins confirmed that the ministry informed 26 community palliative care teams on Friday that they had been formally accepted to the program for patients wishing to die in their own homes and that funding would begin to flow.

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For nearly two years, Darren Cargill, a palliative medicine specialist in Windsor, Ont., has been waiting for the money that he and his team of doctors and nurses were promised to provide round-the-clock support to gravely ill patients who want to die in their own homes.

On Monday, he finally received an e-mail from the provincial government saying the funding – $172,000 per year for the whole team – would begin to flow within 60 days, retroactive to April 1, 2013.

The e-mail arrived in Dr. Cargill's inbox after The Globe and Mail began asking questions about the pay delay late last week and after The Windsor Star highlighted the issue in a column accusing the province of incompetently managing an experiment in community palliative care that the Auditor-General had praised in her most recent report.

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"The ministry came to us in April of 2013 and said we could go forth and start providing this care and we could sort out the details afterward," said Dr. Cargill, a palliative physician at the Hospice of Windsor and Essex County. "That's where the story starts."

The story actually begins even earlier than that, with Dr. Cargill and his fellow palliative care specialists trying to solve a thorny problem: How can the health-care system help more people to die comfortably at home?

Dr. Cargill worked with the Ontario Medical Association, which represents the province's 28,000 doctors, and the Ministry of Health and Long-Term Care, to develop a solution that was essentially an extension of the traditional hospital on-call program.

Hospital physicians are paid a basic fee to be on-call; if they are summoned to the hospital, they bill the Ontario Health Insurance Plan for whatever services they provide.

Dr. Cargill's idea was to assemble teams of palliative care experts to provide that same level of 24/7 support to patients who want to die at home, something he and his colleagues were already doing for patients in the border city of Windsor.

The province and the OMA together agreed in the spring of 2013 to set aside $5-million per year from the pot of money Queen's Park pays to doctors to cover the on-call fees for as many as 30 palliative care teams in what came to be known as the Community Palliative Care On-Call Program.

But then red tape choked the plan. None of the new on-call money was distributed as the ministry and the OMA worked together to hammer out details, such as which teams would qualify for the funding.

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In the meantime, Dr. Cargill and other community palliative care teams elsewhere in Ontario carried on, doing their on-call duty free.

If they made house calls during an on-call shift, they could bill OHIP, but if not, they were not compensated for providing over-the-phone support such as taking calls for medical advice and re-filling prescriptions by phone in the middle of the night.

Dr. Cargill's community palliative care team fielded more than 38,000 phone calls in 2014. "A large number of those occur outside of business hours … If our program didn't exist, what would have happened with those phone calls and more important, what would have happened to those patients?"

OMA president Ved Tandan said his organization shares some of the blame for the delay in setting up a complicated new program, but he fully expected the money to begin flowing after a formal deal was inked last fall, just a few months before contract negotiations between doctors and the province collapsed.

"There was no action until there was media interest in this," Dr. Tandan said.

A spokesman for Health Minister Eric Hoskins confirmed that the ministry informed 26 community palliative care teams on Friday that they had been formally accepted to the program and that funding would begin to flow.

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"Our government is dedicated to ensuring Ontarians can access quality care throughout their lives, and that includes palliative and end-of-life care," Dr. Hoskins said in an e-mailed statement. "Last year, physician groups were invited to apply for funding to the [Community Palliative Care On-Call Coverage] program. Since that time, the ministry has been working jointly with the OMA to review applications, construct accountability mechanisms and finalize program details."

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Health reporter

Kelly Grant is a health reporter with The Globe and Mail. More

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