'A gaping hole' in OHIP for dying Canadians seeking end-of-life-care

Laval Picard's last days were comfortable — because Wellington Hospice officials decided to take him under their care even without OHIP coverage.

The 66-year-old Quebec City man moved to Guelph, Ont. in late April to be closer to his family after receiving his advanced stage 4 cancer diagnosis. He had been recovering in hospital after bowel surgery at the time. On his way to Guelph, Picard had to get a blood transfusion in a Montreal hospital.

But when he finally got to Ontario, the Picards found out the province wouldn't pay the hospice bills until Laval had been in the province for 90 days — or three months. And at that time he was only given less than three months to live. 

"[Wellington Hospice] thankfully took him pro-bono," his son Jonathan Picard told CBC News last Thursday. "So right now unfortunately, they're having to rely on donations to care for my dad."

Laval Picard passed away that very evening, on May 17.

Finding a solution

On April 26, a week and a half before Wellington Hospice took him on, the ailing man had moved in with his son. 

Jonathan Picard and his wife cared for his father while his health continued to decline. The Picards hired a private nursing company to assess him every other day, and it was the hired nurse who communicated to the Local Health Integration Network about Picard's father's status.

"My dad had one pill left," he said.

It was a Local Health Integration Network nurse who ended up prescribing pain medication, after weeks of Picard searching for solutions, and who "lobbied the hospice really hard" to get them to take on Laval.

During that time, Picard said he wrote to the OHIP Eligibility Review Committee twice. Both times the committee said they wouldn't be able to do anything.

"The Ontario Health Insurance Act provides no discretion for the ministry to grant an earlier effective date of coverage for persons not exempt from the waiting period, either on compassionate grounds or to relieve financial hardship," an email from the committee said.

According to Regulation 552 under the Health Insurance Act, there are several categories of people who are exempt from the waiting period, including some children under 16 adopted overseas by Ontario residents and people who are admitted into long-term care homes immediately upon entry into Ontario from another province.

Even though his father ended up being in good hands, Jonathan Picard remained frustrated and wanted change from within the system.

Change took too long to come

Two years ago when Dan Duma moved from Alberta to Windsor to be with his family for his final days, he was met with the same challenges as Laval Picard.

At that time, Duma's situation prompted Windsor West MPP Lisa Gretzky to introduce a bill called "Dan's Law," which would remove the three-month waiting period for new Ontario residents to access OHIP-funded palliative or home care.

However, despite the bill being tabled twice with a lot of support from all parties, Gretzky said it was never passed.

Instead, in early May of this year, Ontario announced it was proposing a regulation change "to address gaps" in inter-provincial health coverage.

This proposal is currently open for public comment until June 18.

However, Gretzky thinks this is too little and too late.

"Any government at any time with the stroke of a pen could change the regulation," she told CBC News. "But if the bill passes and it becomes legislation, it is harder to undo that."

She said "a long, long list of medical professionals" who supported her bill is not happy that it "waited as long as it had" for these changes to be made.

A spokesperson for the Minister of Health and Long-Term Care said the changes are happening now because the province didn't get "enough traction" when they tried to "create a pan-Canadian deal to facilitate these services for everyone."

Petition for exemptions

Even if the regulation gets changed, Gretzky said it may not be put into effect until September.

"There are other people who are going to fall through the same cracks in our system," she said.

Back in Guelph, Picard had started a petition demanding the Eligibility Review Committee be granted authority to give exemptions for certain people — such as his dad.

Of over 4,600 signatures, Kirsten Stallman wrote "this red tape torture of Canadians is unacceptable."

CBC News asked the Ministry of Health and Long-Term Care on Thursday about the exact role of the committee — whether people can appeal the committee's decisions, as well as the person who can grant exceptions.

A spokesperson said a response will come on Tuesday.

Picard said he understands the need for there to be a general waiting period for people to get OHIP coverage. But for family members who "want to be at home with their family to die," there should be exemptions made.

"Aside from a little bit of support from the Local Health Integration Network, there really isn't much there," he said.

"It's a big gaping hole."