'You pay or you die:' Manitoba residents left with huge medical bills after receiving emergency care in the U.S.
SPRAGUE, Man.—Andrew Thiessen had to sell a parcel of his land to pay off a hospital bill costing close to $40,000.
Verna and Harold Kittleson had to re-mortgage their home to cover her hospital bill of more than $60,000.
Then there is Jon Rozsa, who owes more than $100,000, which he says he can never repay.
Thiessen, Verna Kittleson and Rozsa are thankful to still be alive, but they will literally be paying the price for several years to come.
They are three of several residents of this small community—located approximately 175 kilometres from Winnipeg in the far southeast corner of Manitoba—who say they have fallen through the cracks of a unique arrangement allowing them to receive medical care at clinics in both Roseau and Warroad, Minn., just across the U.S. border, that's covered by Manitoba Health.
Thiessen, for example, was diagnosed with severe kidney failure at a clinic in Roseau on Sept. 14, 2015. The 64-year-old cancer survivor was told his condition was serious enough that he would not be allowed to leave the clinic, unless taken by ambulance to a Winnipeg hospital for emergency dialysis.
However, calls to both the Health Sciences Centre and St. Boniface Hospital confirmed no treatment was immediately available.
So Thiessen was taken by ambulance to a hospital in Grand Forks, where treatment was successful. A few months later, Thiessen received a bill for US$28,939.46 from the American hospital.
Kittleson, meanwhile, had been diagnosed with a pericardial disorder (inflammation of the membrane around the heart) in July 2015. The 62-year-old's condition worsened to the point where she opted a month later to travel to Grand Forks for surgery to reduce the inflammation.
Kittleson said her condition continued to deteriorate that fall, but doctors in Winnipeg wanted to wait until swelling reduced to operate. However, following another trip to Roseau, she was referred by a cardiologist to seek treatment in Grand Forks. She was hospitalized on Dec. 9, 2015.
It was during that stay Manitoba Health advised Kittleson the province would not pay for her hospital bill. She left on Dec. 21.
Over the next few months, Kittleson had her lungs drained nine times while awaiting surgery in Winnipeg, which occurred last March. Her heart ailment is history, but not the bill from Grand Forks, which originally totalled US$69,000 but was later reduced to US$47,000.
Kittleson appealed to the Manitoba Health Appeal Board, but was denied on the basis that she should have waited to be treated in Winnipeg. She had argued that not only did she fear for her life, but that she was referred to Grand Forks by a cardiologist at a Roseau clinic.
Kittleson and her husband decided to borrow against their home to pay off the bill. "I told them (the Grand Forks hospital) I would be more honorable to them than my government was to me."
In the case of Thiessen, the appeal board concluded he acted "reasonably" and had "no option" but to be treated in the U.S.
The ruling read, in part: "There is also no dispute that this represents a hardship and in all these circumstances a significant unfairness to the Appellant. The application of the regulation in this instance is unfair and unreasonable and the result is detrimental financially and emotionally for the Appellant."
However, the ruling then acknowledged that despite no wrongdoing, the board had no jurisdiction under current legislation to aid Thiessen's attempts to recover costs.
"As frustrating as it may be, the Board has no power to correct injustice or unfairness except to the extent permitted by legislation," the decision read.
Of a hospital bill of US$28,939.46, Thiessen was reimbursed $1,850 by the province. Thiessen was forced to sell some family-owned land to cover the cost, noting he would otherwise not be allowed to use care facilities in Roseau in the future.
Then there is Rozsa's case. Rozsa, 49, was rushed to the Roseau hospital at dawn on March 13, 2016. Doctors diagnosed a heart attack and attempted to contact medical staff at St. Boniface Hospital to see if they could treat Rozsa immediately.
With no immediate response and the clock ticking, doctors in Roseau decided to rush Rozsa by ambulance to Grand Forks, where doctors installed two stents. Rozsa was later told one artery had a 98 per cent blockage and another 100 per cent.
"They basically saved my life," the Sprague resident said.
But now Rozsa is facing almost US$80,000 in medical bills after Manitoba Health declared his surgery was not considered to be life threatening. Rozsa can't understand, since doctors in Roseau insisted on emergency surgery in Grand Forks.
Either way, Rosza said "there's no possible way" he can pay off that debt. He works as a seasonal labourer in the bush near Sprague and he's recently divorced.
"I'm renting a room from my mother," he said. "What can I do?"
Since the surgery in Grand Forks, Rozsa has had another stent installed at St. Boniface and is awaiting an operation for a fourth stent.
"This isn't doing any good for my heart, worrying about a US$80,000 debt," he said. "Every morning I wake up worrying about it. I told one of my doctors (in Roseau) that I wished I would have died."
When asked to provide details of the cross-border agreement, a spokesperson for the department Manitoba Health, Seniors and Acting Living said health insurance for Manitobans outside the country is limited to coverage at Manitoba rates for emergency care unless the service is unavailable elsewhere in Canada and prior department approval has been obtained on the basis of a referral from a Manitoba specialist.
In southeastern Manitoba, however, the province has made arrangements to pay in full for emergency services and primary care at two clinics in Roseau, Minn. and Warroad, Minn., the provincial spokeswoman said. The agreement with Altru Health System facilities in Roseau and Warroad does not address costs associated with transportation.
"Although there is a provision in the agreement that requires the American physicians to repatriate patients to a Canadian facility for specialist care, Altru physicians may choose to transfer patients onto another US facility rather than to repatriate the patient to a Canadian facility," a statement from the province said. "As charges for medical services outside of Canada are frequently significantly higher than rates in Manitoba, all Manitobans are strongly encouraged to obtain sufficient private insurance to cover any health care needs that may arise when they are outside the country."
Thiessen's son-in-law, Cam Brown, said the appeal board's admission that Thiessen was treated "unfairly" — with no means to deliver justice — is proof that the system is flawed.
"This is everything to me," Brown said, referring to a more equitable compensation system. "If you find a solution to this all the other problems go away. The formula is absurd. They (Manitoba Health) are knowingly offsetting the costs on to the customer.
"They need to address the cracks in the system."
Keith Okeson, CEO of LifeCare Medical Centre, said doctors in Roseau understand the parameters of the agreement with Manitoba Health. Therefore, instances of residents in southeastern Manitoba communities being stuck with major medical bills are rare and usually involve cases where patients "self-refer" to specialists.
"The only time we would send someone to Grand Forks is if we cannot find a physician to accept the patient (in Winnipeg) or if there's going to be a real lengthy delay in transportation, whether it's a ground or air ambulance," Okeson said.
One complicating factor, Okeson added, was the presence of "visiting specialists" at Roseau medical clinics who may offer referrals to Manitoba patients without a detailed knowledge of the agreement.
Meanwhile, Kittleson said there should be a direct line of communication dedicated to decision-making during emergencies, so residents don't feel they have to make decisions under medical duress.
"Either you die or you pay," she said. "Something should be done for our emergency care. It's not right."
When asked what they would do if they experienced similar emergency health problems in the future, Harold Kittleson replied: "We'll have to go straight to St. Boniface hospital."
"And hopefully you'll live until you get there," Verna Kettleson added.
This report is used by permission from the Winnipeg Free Press.