Problems for patients created by N.L. medical transportation system shift

Government documents describe a behind-the-scenes scramble after the province combined medical transportation services last summer, as staffing and IT issues resulted in patients having to change appointments, deal with long delays in getting their calls returned, and wait for payments.

The issues are outlined in Department of Health briefing materials obtained by CBC News through access-to-information.

Health Minister John Haggie acknowledges there were "a few challenges and some teething troubles" when work began last summer to amalgamate both programs under the umbrella of his department.

But he says a lot of work has gone into fixing those issues, and things are better now.

"I mean obviously it's unfortunate that had to happen at all, and I'm not here to defend the indefensible," Haggie said in an interview.

"But I think what I'm trying to say now is that that system is different than it used to be. We went through some challenges and we've come out the other side."

Decision was a 'Way Forward' commitment

The decision to combine the two programs was part of "The Way Forward" plan for the province launched by the Liberal government.

Previously, financial aid for medical transportation was provided through two different programs.

One was for MCP patients who footed the bill for out-of-pocket travel costs to get specialized insured medical services not available in their community.

The other was for people receiving income support, to help them get to medical appointments.

The decision was to combine delivery of the two plans under one umbrella, in the health department.

But the transition was not a smooth one.

The details of what happened are in draft health department information notes from late August 2018.

'Many challenges to staff and clients'

After the income support program was transferred to the health department in early June, officials there could not view any electronic files created before then.

"This has caused many challenges to staff and clients," an Aug. 22 information note advised. "The (client service officers) work with the clients addressing the current travel requirements with no documentation."

The call volume is extremely high with very few calls being answered.- August 2018 government briefing note

Other issues also became apparent from the start, according to those internal government documents:

• "The call volume is extremely high with very few calls being answered."
• A lack of clerical support meant a summer student was scanning mailed-in documents and adding them to the computer system. "With a shortage of staff, and waiting on Human Resources to hire the successful applicants, the (electronic document) queue continues to increase and clients are still not able to get their calls answered in a timely fashion."
• "Vendors and clients are not being reimbursed as efficiently as they are used to. Some clients had to change appointment dates."

According to the documents, more staff members were added in July and overtime was approved. Things started to get better by mid-August, when all employees were trained.

Analysis 'should have been a bit more detailed' 

Haggie acknowledges there were problems at the start.

"I think in retrospect the analysis of who did what in both departments should have been a bit more detailed beforehand," he said.

"That's with hindsight, and as everybody knows, that's 20/20."

He said officials figured out a way to work around the IT problems that had made it difficult to access confidential client information.

I think in retrospect the analysis of who did what in both departments should have been a bit more detailed beforehand. That's with hindsight, and as everybody knows, that's 20/20.- Health Minister John Haggie

As for the issue of calls not being returned, it was resolved by hiring an external call centre, Telelink, and having the company route inquiries to a client service officer.

"We had new phone protocols at the time and what we realized very rapidly was that the phone system wasn't up to it," Haggie explained.

Telelink initially provided after-hours answering service, but that was expanded to 24/7 coverage in December. 

The overall medical transportation move was supposed to be cost-neutral, although Haggie said the added expense of the Telelink contract may add to the tab in the near term. The price tag is about $12,000 a month.

Haggie said a lot of effort has gone into fixing the initial problems, and more work is underway, over the coming months, to further enhance what is being offered.

"The program now is different compared with what it was six months ago and it will be different again in another six to 12 months, in a way of providing a better service for the people who need the service," he said.

"We did have some challenges at first, but we're down to a place now where we are comfortable we've made significant improvements and got through those teething problems."

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