THE CROSS-BORDER SHUFFLE FOR DRUG-ABUSE TREATMENT

Not All Troubled Teenagers Who Need Funding To Travel To U.S. Clinics
Actually Receive It

What do you do if your teenager regularly runs away from home, selling
drugs (or themselves to pay for drugs), and has been in and out of
hospital for suicide attempts and overdoses since Grade 9?

What do you do when that same teenager agrees to go for treatment for
the first time in three years, but the waiting list for a bed in an
Ontario treatment centre is four months long? Can you risk the wait?

It's a bit of a well-kept secret, but when medical treatment isn't
available here in Ontario or where the wait times here put patients'
lives at risk, OHIP has an "out-of-country" program that can cover the
cost of treatment in the United States.

This program pays for a variety of medically necessary U.S.-based
medical treatments, from cancer treatments to hip surgeries.

The program only funds treatment out-of-country, not out-of-province.
For better or worse, Ontario sends patients for treatment on the
public's dime to places like Utah and Pennsylvania, but not New Brunswick.

For Ontario teenagers dependent on drugs and experiencing serious
mental health issues, the out-of-country program has provided funding
to access badly needed in-patient care. But not all teenagers who need
access to the funding actually receive it.

The application has to be made by an Ontario-based doctor, and not all
doctors are familiar with the ins and outs of the program. Ontario
teenagers with drug and mental health issues do not always have a
family doctor or child psychiatrist to turn to.

Often these teenagers have not provided their doctors with the kind of
information a doctor relies on to certify a genuine need for the
treatment (teens are not always so open about their use of illicit
drugs with their doctors - who knew!).

Other doctors are rightfully wary of the extensive research and time
that goes into applying for funding for which they receive no
compensation.

The program often denies funding because physicians haven't provided
medical evidence to show that there is a risk that their patients
could die or face "irreversible tissue damage" if they are forced to
wait for the treatment in Ontario.

When you're seeking a hip surgery, your doctor provides an X-ray that
shows the damage to the joint. What kind of "medical evidence" can you
provide to show that there's a real risk a teenager will OD on the
street?

When an adult cancer survivor's experience with the out-of-country
program was made public this spring, the province's ombudsman got
involved. Andre Marin likened the program to a "cruel game" that
frustrates rather than facilitates efforts to access medically
necessary treatment.

For teenagers who are turned down for the funding, there are few
options left. Politically, there appears to be limited support for
fighting a disease with the stigma of drug addiction. While the
province's crisis in children's mental health service has been well
documented, it remains largely unaddressed.

Health care seems to have taken a back seat to education in the
provincial election this time around. It remains to be seen where our
leaders stand on the state of Ontario's mental health and drug
dependency programs.

On the federal front, Prime Minister Stephen Harper has announced a
$35 million commitment to drug treatment. It isn't yet clear whether
this funding will have any real effect on the state of Ontario's
provincial drug treatment resources.

Lawyers like me assist families and their doctors with the
ever-increasing demands of the application process for out-of-country
funding. And when the applications are denied, we regularly launch
appeals for our clients to the Health Services Appeal and Review Board.

As a lawyer, I like to have a hand in ensuring that those who need and
deserve treatment receive it. But make no mistake: Patients should not
have to hire a lawyer to make the program requirements understandable
and to secure the funding. And if the larger issue of access to
treatment for teenagers with mental health and substance abuse
problems was remedied in this province, believe it or not, I'd be just
as happy to be out of a job.

Kate Sellar is a Toronto-based lawyer practising in human rights,
employment and health law at Bakerlaw.