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User fee declared illegal
November 1, 2003


By Ann Lukits

Saturday, November 01, 2003 - 07:00

Local News - In a swift and decisive act that could have wide-ranging implications, Ontario’s Health Ministry has warned a Kingston institution that a planned user fee for outpatient assessements would be illegal.

A senior official issued a stern directive last night to all public hospitals in Ontario, warning that charging user fees for outpatient rehabilitation assessments contravenes provincial health laws.

The one-page memo, signed by assistant deputy minister Hugh MacLeod, also ordered hospitals that charge fees to stop immediately and to refund patients who have been charged.

Citing the 1990 Health Insurance Act, MacLeod noted that occupational therapy and physiotherapy are included in a list of outpatient services “to which an insured person is entitled without charge.”

“Given this entitlement,” MacLeod wrote, “hospitals are not permitted to charge fees to insured persons for such outpatient services. Therefore, any hospital currently charging such fees should discontinue the practice immediately and provide a refund to patients who have been charged such a fee.”

The memo puts a stop to a controversial plan by Providence Continuing Care Centre to introduce a $50 user fee Monday at St. Mary’s of the Lake Hospital in Kingston and St. Vincent de Paul Hospital in Brockville.

By charging patients $50 for rehabilitation assessments, Providence hoped to generate additional revenue to help offset operating deficits at the two sites.

Barbara Theman, the centre’s director of communications, told The Whig last night that “we’ll definitely not be proceeding with the proposed fee and fortunately, from our perspective, the ministry has clarified this issue before we implemented a fee.”

The fee was put on hold earlier this week after the ministry advised Providence administrators that it wanted to review the hospital’s plan.

The plan drew criticism and review by the ministry after it was revealed in a Whig-Standard story on Wednesday.

Theman said the reaction at Providence to the ministry’s response was chiefly one of relief. The decision to impose the fee was difficult “and then to learn that it was not clear cut was [also] difficult,” she said.

“We’re relieved that this clarification came before we took the step of initiating a fee. That’s our overwhelming feeling right now – relief that this came in time for us to avoid violating a regulation. And secondly, there’s a kind of morning-after feeling that we’re still faced with these challenging deficits.”

St. Mary’s of the Lake is projecting a $395,000 shortfall for the current fiscal year. The $50 assessment fee was expected to reduce the deficit by $50,000 between Nov. 4 and March 31.

St. Vincent de Paul expects to end the 2003-04 year with a $303,000 deficit and the assessment fee would have reduced it by $31,000.

Under the Providence plan, only new referrals for physiotherapy, occupational therapy and speech and language pathology would have been charged the $50 assessment fee. All subsequent treatment sessions were to be paid by the Ontario Health Insurance Plan.

An exception was made for Providence staff, who were not required to pay the $50 as part of a commitment by their employer to wellness and a quick return to work.

Once it became public, the fee came under heavy fire. The Ontario Physiotherapy Association, the Kingston Health Coalition and local health policy expert Dr. Sam Shortt raised concerns about the deterrent effect of fees on patients with limited incomes and the growing trend by hospitals to impose new charges to offset deficits.

The Peterborough Regional Health Centre has been charging $45 for outpatient rehabilitation assessments since 1995. The fee was introduced after the newly elected Conservative government slashed hospital operating budgets throughout the province.

It was unclear last night if the Peterborough institution will be responsible for refunding all of the fees charged in the last eight years.

Djamel Lounis, a former senior policy adviser with the Health Ministry and an expert on physiotherapy regulations, contacted The Whig-Standard earlier this week after learning of the Providence plan.

Lounis said Providence would contravene both federal and provincial health legislation, including the Canada Health Act, if it went ahead with the plan.

Last night, Lounis congratulated the ministry for taking a decisive stand against such fees.

“I think it’s absolutely great,” he said. “I expected this to happen because I thought it was absolutely appropriate for the ministry to react the way they did.”

Lounis added that he believes many hospitals are charging patients for other services that are covered under the OHIP and he hopes the government will continue to investigate such practices.