Nov 28, 2009 - 04:30 AM

By Melinda Dalton, Joe Fantauzzi, Parvaneh Pessian and Matthew Strader

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Third in a Three Part Series

Record numbers of Ontarians are being sent to the U.S. by their government for routine health care that should be available at home. A Metroland Special Report shows thousands of others are funding their own medical treatments south of the border, at high personal cost. The numbers have been rising for the last 10 years. Government approvals for out-of-country health care funding are up 450 per cent. Should Ontarians have to use a passport to get health care?

BOWMANVILLE -- To most people, it's just a patch of cement at the foot of a garage door but what Tammy Wallace-Smith sees is the sight of her unconscious body curled up in the fetal position, being swallowed by a sea of flames.

At least it's what she imagines she looked like back in May when her husband and neighbours burst into the garage where she was trapped on the night her Bowmanville home was struck by lightning.

"Even though I don't remember, there's maybe a part of me that unconsciously does so every time I look at it, I just break," said Ms. Wallace-Smith, who sustained second- and third-degree burns to 65 per cent of her body.

She spent six weeks south of the border at Buffalo's Erie County Medical centre undergoing skin grafts and other treatment. Her experience would teach her the best care available wasn't necessarily in Canada. There aren't enough beds for burn victims and, from her experience, staff in the U.S. appeared better trained in dealing with her injuries.

Ms. Wallace-Smith is far from alone in her experience. Many Ontarians know the personal health-care stories of Shona Holmes, Lindsay McCreith and Belinda Stronach, the former federal cabinet minister and Magna International auto heiress. The three are among the public faces in the emerging debate over growing numbers from Ontario going to the U.S. for medical care.

Many, such as Ms. Stronach, who went to California for some of her 2007 breast cancer treatment, pay U.S. medical bills entirely on their own.

Others, such as Ms. Holmes, of Hamilton, and Mr. McCreith, from Newmarket, elect to go south for what they believe is their only option, then battle with the Ontario government to be paid back.

Figures published in Metroland's Special Report on Cross-Border Care show Ontario patients are travelling to America for health care in record numbers. Ontario expects to spend an estimated $164 million next year on cross-border care, triple the $56.3 million spent in 2005.

There's been a 450-per cent increase in OHIP approvals for out-of-country care since the beginning of this decade, a time of explosive growth in new technologies and therapies not covered or available here. Ontario funded 2,110 out-of-country procedures in 2001, and 11,775 last year.

"Those astounding figures ... don't include the people who don't actually get OHIP pre-approval," says NDP leader Andrea Horwath. "They just skip that whole process because they have deep pockets and they can pay to get the procedures in a private system down in the States. And that further erodes the public system here."

Long waits for MRIs and other diagnostics, poor access to doctors and unacceptable delays for some surgeries are worrisome, says the 2009 report of the Ontario Health Quality Council, set up by the Province to monitor the state of health care.

There's been some progress, the council says, but the Ontario health system is not meeting all needs.

"People should be able to get the right care at the right time in the right setting from the right provider," the report says.

Christine Elliott, Whitby-Oshawa MPP and health critic for the Ontario Progressive Conservative Party, says that in some cases, while OHIP may bear the cost of an Ontarian's treatment outside of the province, there are other impediments to consider.

"There's also things like meals and accommodation that aren't necessarily covered so it means if you don't have your own independent resources, there are many situations in which even if OHIP is paying for the procedure, you still can't go because you can't pay for the rest of the costs," she says, adding that Ontarians shouldn't have to simply accept the drawbacks of medical care outside the province.

"From a financial perspective, it's very difficult for people but also from a recovery aspect, to have to go far away from friends and family for procedure and sometimes people have to stay in that other location for a long period of time, certainly isn't conducive to best outcomes in terms of their recovery,"

Mr. McCreith and Ms. Holmes believe their rights to care were breached.

Last month, Mr. McCreith lost his appeal to have OHIP repay the $27,600 US he spent in Buffalo in 2006 on brain cancer surgery. Mr. McCreith says he would have had to wait four months for an MRI and three months more to see a specialist if he had not gone south.

Ms. Holmes -- who spent $95,000 on brain surgery at the Mayo Clinic in Arizona -- became a darling of the U.S. conservative movement when she agreed to be the face of American TV ads against President Barack Obama's health-care plan last spring.

Ms. Holmes's comments that Canadian-style health care failed her set off a firestorm north of the border.

That's partly because crossing the border to get U.S. health care has for decades been regarded as taboo. But as waiting lists swelled, and access began to lag, out-of-country travel for medical care became more common, Ontario figures show.

Natalie Mehra, a director of the Ontario Health Coalition, a public interest health care group, says she hopes the government's response will be to rebuild access to hospital services in the public system here.

If the growth in out-of-country care continues, "I fear it will simply serve as fodder for the American media and the privateers in Canada," Ms. Mehra says.

She was referring to the ongoing debate in the U.S. over how to provide health care, in which Ms. Holmes figured, and companies pushing for the right to offer Ontarians health care in a pay-for-service, private parallel system.

"That (private health care) would be not a solution at all, but in fact the dismantling of our public health care system."

Nationwide opinion polls consistently show high levels of overall satisfaction with Canada's universal health care. Still, researchers are also finding disquiet over some of the system's vulnerable areas.

More than 50 per cent of respondents cited concerns about wait times for treatment, a shortage of medical professionals or lack of government resources, according to a Nanos Research poll released this month.

Critics say Ontario should fix the system here, and use the out-of-country approvals system exclusively for the reason it was set up -- to be a "safety net, allowing access to new, proven procedures, and help fill gaps in provincial medical services," says a 2007 review of OHIP's out-of-country procedures.

Ms. Elliott also insists the best way to resolve the cross-border treatment problem is to take a multi-faceted approach that addresses all the underlying deficiencies in the system without neglecting one area to improve another. "Simply talking about reducing wait times in one particular area isn't going to be enough to reduce the wait times for all issues and to relieve some of the other congestion we're seeing in other areas of our health care system," she says.

"I think we really need to do a lot more work on making sure that we can take care of Ontarians within Ontario."