I APPEP PART C -Decision under Appeal Under appeal is the May 26, 2014 Ministry of Social Development and Social Innovation reconsideration decision that under the terms of the Employment and Assistance for Persons with Disabilities Regulation Schedule C section 2(1), the appellant does not qualify for a supplement for non-local medical transportation. The ministry found the out-of-town physician is not a specialist, the destination does not qualify under subsections (f)(i) through (f)(iv), and the treatment does not qualify under subsection (f)(v). PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Act (EAPWDA) section 5 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Schedule C section 2(1) EAAT003(10/06/01)
P A R T E S u m m a r v o f F a c t s T h e e v i d e n c e b e f o r e t h e m i n i s t r y a t r e c o n s i d e r a t i o n • t h e a p p e l l a n t i s d e s i g n a t e d a s a P e r s o n w i t h s u p p l e m e n t s u n d e r S c h e d u l e C , s e c t i o n 2 o f t h e E A ID a r e q u e s t f o r t r a v e l a s s i s t a n c e f o r m d a t e d M a a n d a n o u t o f t o w n p h y s i c i a n i n t h e r e f e r r a l s e c t i o n , a p p l i c a n t / p a t i e n t i n f o r m a t i o n s e c t i o n . e a " F i n d a P h y s i c i a n " l i s t i n g f r o m t h e C o l l e g e o w e b s i t e w i t h t h e n a m e a n d a d d r e s s o f t h e o u t o f t o w G e n e r a l / F a m i l y P r a c t i c e " . e a n a p p o i n t m e n t c a r d a n d a M a r c h 2 6 , 2 0 1 4 p w i t h t h e a p p e l l a n t ' s n a m e a n d a n o t e " M u s t c o m e t o u n t i l s t a b l e . " e a n u n d a t e d l e t t e r f r o m t h e a p p e l l a n t s a y i n g : b e c a u s e n o l o c a l d o c t o r w o u l d s e e h e r s i n c e a l o c a l n e e d s h e l p s w i t h d e b i l i t a t i n g p a i n ; s h e g e t s s p e c i a l a n d t h e p e r s o n e s c o r t i n g h e r c h a r g e s $ 8 8 f o r t h e r e f o r e a c h r e t u r n t r i p p l u s $ 2 0 f o r f o o d . 0 f i v e u n s i g n e d M a r c h a n d A p r i l 2 0 1 4 r e c e i p t s t • r e q u e s t f o r r e c o n s i d e r a t i o n f o r m i n w h i c h t h e l o c a l l y u n t i l t h e d o c t o r a s s a u l t e d h e r a n d b l a c k e n e d f i n a l l y o u t o f t o w n , t h a t s h e h a s t o p a y $ 5 0 e v e r y t w o s h e i s o n d i s a b i l i t y , h a s l i f e t h r e a t e n i n g i l l n e s s e s , i s o w a n t s b a c k t h e m o n e y s h e p a i d . W i t h t h e a p p e l l a n t ' s c o n s e n t , t w o m i n i s t r y o b s e r v e r s r e p r e s e n t a t i v e . A t t h e h e a r i n g t h e a p p e l l a n t g a v e e v i d e n c e t h a t s h e b l a c k e n e d h e r n a m e w i t h o t h e r d o c t o r s l o c a l l y a n d i n c a l l e d e v e r y d o c t o r a n d c l i n i c w h e r e m e t h a d o n e t r e a h e r d o c t o r , t h e y w o u l d n o t s e e h e r , a n d a f e w s a i d t h b a c k , b u t w a s t o l d t h e r e w a s s t i l l a w a i t l i s t a n d t h e y f i n d i s t h e d o c t o r s h e i s n o w s e e i n g i n a n o t h e r t o w n . s h e w a s i n a b a d b u s a c c i d e n t , a n d c a n n o l o n g e r t r a f r o m t h e b u s a c c i d e n t . S h e m a d e a r r a n g e m e n t s t o b t ( i p , f o r a t o t a l o f $ 2 5 0 . H e r a p p o i n t m e n t s a r e n o w o s h e w o u l d e n d u p i n h o s p i t a l . T h e t r e a t m e n t s h e r e c f o r b y M S P . T h e a p p e l l a n t p r o v i d e d t h e R e q u e s t f o r r e q u i r e d b y t h e m i n i s t r y . S h e s a i d s h e q u a l i f i e s f o r t h d i s a b i l i t i e s , h a s a l i f e t h r e a t e n i n g i l l n e s s , a n d m u l t i p l e S h e n o w h a s a d r i v e r w h o w i l l t a k e h e r f o r $ 2 0 , a o a v E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E ii w a s D i s a b i l i t i e s , e l i g i b l e t o r e c e i v e g e n e r a l h e a l t h P W D R . r c h 2 9 , 2 0 1 3 w i t h t h e n a m e o f a l o c a l p h y s i c i a n a n d t h e a p p e l l a n t ' s n a m e a n d s i g n a t u r e i n t h e f P h y s i c i a n s a n d S u r g e o n s o f B r i t i s h C o l u m b i a n p h y s i c i a n , d e s c r i b i n g h e r r e g i s t r a t i o n a s " F U L L r e s c r i p t i o n f o r m f r o m t h e o u t o f t o w n p h y s i c i a n m y o ff i c e o n c e w e e k l y f o r t h e n e x t f e w w e e k s s h e n e e d e d t o a t t e n d t h e o u t o f t o w n d o c t o r d o c t o r b l a c k e n e d h e r n a m e ; t h e m e d i c a t i o n s h e t r a n s p o r t a t i o n b e c a u s e s h e c a n ' t c o p e w i t h a b u s ; t u r n t r i p , t h e c o s t o f a b u s t i c k e t ; s h e r e q u e s t s $ 8 8 o t h e a p p e l l a n t f o r $ 5 0 e a c h a p p e l l a n t w r i t e s s h e w a s g e t t i n g m e t h a d o n e h e r n a m e , t h a t s h e t r i e d e v e r y w h e r e l o c a l l y a n d w e e k s t h a t c o m e s o u t o f h e r f o o d m o n e y , t h a t u t o f f o o d i n t h e m i d d l e o f t h e m o n t h , a n d j u s t a t t e n d e d t h e h e a r i n g w i t h t h e m i n i s t r y h a d b e e n a s s a u l t e d b y h e r d o c t o r , w h o t h e n n e a r b y c o m m u n i t i e s . T h e a p p e l l a n t s a i d s h e t m e n t s a r e a v a i l a b l e l o c a l l y , b u t w h e n t h e y c a l l e d e y h a d a 3 -6 m o n t h w a i t l i s t . S h e h a s c h e c k e d w o u l d n o t t a k e h e r n a m e . T h e c l o s e s t s h e c o u l d T h e a p p e l l a n t e x p l a i n e d t h a t t h r e e y e a r s a g o v e l b y b u s . T h e m e t h a d o n e t r e a t m e n t s r e s u l t e d r i v e n t o t h e d o c t o r ' s o ff i c e f o r $ 5 0 p e r r e t u r n n l y e v e r y t h r e e w e e k s , b u t w i t h o u t t h e t r e a t m e n t s e i v e s b y t h i s d o c t o r a n d t h e m e t h a d o n e i s p a i d T r a v e l A s s i s t a n c e f o r m a n d t h e d o c t o r ' s n o t e e s u p p l e m e n t b e c a u s e s h e i s a p e r s o n w i t h b a r r i e r s . S h e i s a s k i n g f o r t h e m o n e y s h e p a i d . m e n t s h e c a n m a n a !=J e .
Th e ministry representative r eferred to the r econsideratio f or medical transporta tion, stating the legislation re fers p erson 's cir cums ta nces, and in this case the criteria were not m le gi s lation addresse s immediate life-threate ning situations, m thre atening n eed and that legislation does not a pply here. doc umentati o n of the local refusals of treatm en t , and no ev decision. EAAT003(10/06/0I) I APP EA n decision a n d outlin e d the eligibility cr it e ria to ava ilability of medical treatments, not to the e t. She sa id while another par t o f th e e th a d one tr e a tm ent is not a life She commen t ed there was no idence on which to make a di ffer ent
I A PPE Ai PART F -Reasons for Panel Decision The i s sue is the reasonableness of the mi nistr y's decision denying t h e ap pellant fundin g for n on-local medical tr anspo rtation. R el evant L egi s l ation EMPLOYMEN T AND A SSIST ANCE FOR PERSONS WITH DISABI L I T IES ACT ( excerpt) Disability assistance and supplements 5 Subj ect to the regulati ons, the minister may provide di sab ility as sistance or a supplement to or for a family unit t hat is eligible for ii. EMPLOYMENT A N D ASSIS TANCE FOR PERSONS WITH DISABILITIES REGULA T ION (excerpt) Hea lt h su pplement for p e rso n s facin g d i rect and imm inent l ife thr eateni ng healt h need 69 T he min is ter may provi de t o a fa mily unit an y heal th supplement set ou t i n sec t ions 2 ( 1) (a) an d (f) [general health s u pp leme n t s ] an d 3 [me dical equipme n t and devices] o f Sc he dule C, if the health suppleme nt is prov id ed t o or f or a p ers on in the famil y unit who is othe rwise not eligi ble for the healt h sup plement un d er thi s reg ulation , and if th e mini ster is s at is f ied tha t (a) the pers on fa ces a di rect and imminent life threatening need a n d th ere are n o resources available to t he person 's fami l y u n it with whi ch to mee t that nee d, (b ) th e he alth supplement is n e c e s sary to meet t hat nee d , (c) the person 's fa mily uni t is rec eiving p remiu m assistance u n der the Medicar e Protecti o n Act, and (d ) the requ irem ents sp ecifie d in the follo wing prov isions of Sche d u le C, as applicabl e , are me t: ( i ) p ara gra p h (a) or (f) o f se ction ( 2) (1 ); ( ii ) sec tions 3 t o 3.12, ot h e r tha n para graph ( a ) of s ect i on 3 ( 1). [en. B.C. Reg . 61/ 201 0, s. 4; am. B.C. Reg. 197/201 2, Sch . 2 , s. 8.] SCHEDULE C (excerpts) "specialist" means a me d ical practitioner recognized as a specialist in a field of medicine or surgery in acco rdance with the byla w s mad e by the board fo r the College of Physici ans and Surgeons of British Columbia under s ecti on 19 ( 1 ) ( k.3) and ( k .4) o f /he Health Profes sions Act. General health supplements 2 (1) The following are the health supplements that may be paid for by the minister if p rovide d t o a family u n i t tha t is eligible under section 62 (gen eral health sup pleme nts] of th is regulation: (f) the least expensive appropriate mode of transportation to or from (i) a n office, in the local area, of a medi c al pr actitioner or nurse practition er, (ii) the office of the nearest available specialist in a field of medicine or surgery if the person has been referred to a specialist in that field by a local medical practitioner or nurse practitione r, iii the nearest suitable EAAT003(10/06/01)
t h e H o s p i t a l I n s u r a n c e A c t R e g u l a t i o n s , o r ( i v ) t h e n e a r e s t s u i t a b l e h o s p i t a l a s d e f i n e d i n p a r a g r a p h ( H o s p i t a l I n s u r a n c e A c t , p ro v i d e d t h a t ( v ) t h e t r a n s p o rt a t i o n i s t o e n a b l e t h e p e r s o n t o r e c e i v e a b h o s p i t a l s e r v i c e u n d e r t h e H o s p i t a l I n s u r a n c e A c t , a n d ( v i ) t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e p e r s o n ' s f a m i l y A p p e l l a n t ' s P o s i t i o n T h e a p p e l l a n t r e p o r t e d t h a t s h e w a s a s s a u l t e d b y h e n a m e , a n d s h e h a s t r i e d e v e r y w h e r e l o c a l l y f o r t h e m d e b i l i t a t i n g p a i n . S h e w a s o n l y a b l e t o l o c a t e a n o u t n o t c o p e w i t h t a k i n g a b u s , a n d p a i d $ 2 5 0 f o r t r a n s p o t o u s e h e r f o o d m o n e y t o p a y h e r t r a n s p o r t a t i o n c o s t l i f e t h r e a t e n i n g i l l n e s s , m u l t i p l e b a r r i e r s , a n d t h e n e e s h e s h o u l d b e r e i m b u r s e d h e r t r a n s p o r t a t i o n e x p e n s M i n i s t r y ' s P o s i t i o n T h e m i n i s t r y a r g u e s t h e a p p e l l a n t w a s n o t r e f e r r e d t o f o r s p e c i a l t y t r e a t m e n t , a s p r o v i d e d i n s e c t i o n 2 ( 1 ) ( f ) t o w n p h y s i c i a n i s n o t a s p e c i a l i s t , d e f i n e d i n S c h e d u l t r e a t m e n t i s a b e n e f i t u n d e r t h e M e d i c a r e P r o t e c t i o n a n y o f t h e o t h e r e l i g i b l e c a t e g o r i e s f o r m e d i c a l t r a n s p m i n i s t r y f u r t h e r s a y s t h e a p p e l l a n t ' s s i t u a t i o n i s n o t a o f t h e l e g i s l a t i o n . P a n e l ' s D e c i s i o n T h e a p p e l l a n t g a v e e v i d e n c e t h a t s h e s u f f e r s w i t h a s m e t h a d o n e , b u t a s a r e s u l t o f a d i s p u t e h a s b e e n u n a t r a v e l b y b u s a n d i n c u r r e d e x p e n s e s t o b e d r i v e n t o a S c h e d u l e C o f t h e E A P W D R l i s t s t h e c r i t e r i a f o r w h i c h o f t r a n s p o r t a t i o n . S e c t i o n 2 ( 1 ) ( f ) ( i ) r e f e r s t o l o c a l t r a n a p p e l l a n t ' s p h y s i c i a n i s n o t l o c a l , a n d t h e r e f o r e t h e a p T h e m i n i s t r y ' s f i n d i n g o n t h i s i s s u e w a s r e a s o n a b l e . S e c t i o n 2 ( 1 ) ( f ) ( i i ) r e f e r s t o t h e n e a r e s t a v a i l a b l e s p e c i m e d i c a l p ra c t i t i o n e r r e c o g n i z e d a s a s p e c i a l i s t i n a f i e b v l a w s m a d e b v t h e b o a r d f o r t h e C o l l e g e o f P h v s i c i a E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L e ) o f t h e d e f i n i t i o n o f " h o s p i t a l " i n s e c t i o n 1 o f t h e e n e f i t u n d e r t h e M e d i c a r e P r o t e c t i o n A c t o r a g e n e r a l u n i t t o c o v e r t h e c o s t . r d o c t o r , w h o t h e n b l a c k e n e d t h e a p p e l l a n t ' s e t h a d o n e t r e a t m e n t s n e c e s s a r y f o r h e r o f t o w n d o c t o r w h o w o u l d t r e a t h e r , s h e c o u l d r t a t i o n t o h e r a p p o i n t m e n t s . S h e s a y s s h e h a d s . S h e a r g u e s a s a p e r s o n w i t h d i s a b i l i t i e s , a d o f m e t h a d o n e t o a v o i d e n d i n g u p i n h o s p i t a l , e s . t h e o u t o f t o w n p h y s i c i a n b y a n o t h e r p h y s i c i a n o f S c h e d u l e C o f t h e E A P W D R , a n d t h e o u t o f e C . T h e m i n i s t r y a c k n o w l e d g e d t h a t m e t h a d o n e A c t . T h e m i n i s t r y s a y s t h e r e q u e s t d o e s n o t f i t o r t a t i o n a v a i l a b l e u n d e r t h e l e g i s l a t i o n . T h e l i f e t h r e a t e n i n g o n e a s a d d r e s s e d i n s e c t i o n 6 9 e r i o u s c o n d i t i o n f o r w h i c h s h e i s p r e s c r i b e d b l e t o o b t a i n t h e t r e a t m e n t l o c a l l y . S h e c a n n o t n o t h e r t o w n f o r h e r t r e a t m e n t s . t h e m i n i s t r y m a y p a y a s u p p l e m e n t f o r t h e c o s t s p o r t a t i o n . I t i s u n d i s p u t e d t h a t t h e o f f i c e o f t h e p e l l a n t d o e s n o t q u a l i f y u n d e r t h i s s u b s e c t i o n . a l i s t . S p e c i a l i s t i s d e f i n e d i n t h e l e g i s l a t i o n a s a l d o f m e d i c i n e o r s u r g e ry i n a c c o r d a n c e w i t h t h e n s a n d S u r g e o n s o f B r i t i s h C o l u m b i a u n d e r
section 19 (1) (k.3) and (k.4 ) of t he Health Professi ons of Physician's and Surgeons shows, the appellan t's physicia College. T h e panel finds the physic ian is no t a specialist as defined in th t he appe llant does not qualify unde r this subsection. transportation to a hospital and a r e not applicabl e in this cas a hosp ital. Th e pa nel find s that t he ap pellant do e s no ministry's findings on the s e criteria were reason abl e . The recons i dera tio n decision indicates that the appellant would n t he service requ es ted was not transportat i on to e nable Medica r e Protect i on Act. A s acknowledged by the ministry a appellant in her evi denc e, her trea tm ent and the methadone fin ds tha t t he transportat ion supplemen t re qu e sted w Protection Act. The m inistry' s finding on this issue was requires t he appellant' s request to also fal l with in sec of t he a ppellant do es not fall within the l e g i s lated c ri t er transport a tion in t hese c ircums ta nces. A t t he he aring , i n re s ponse to t he app e l la n t' s assert i on she has s tat e d t hat t he l egi s l a ti on al lows for the pro v i sio n of supplemen certain circu m stances. The pa n el notes tha t s e c ti on per so ns facing direct an d imm in en t life-thre a te nin g he medical transp orta tio n su ppleme nt , st at e s that the requir b e met. In this case, for th e reasons a bove, th e p a nel d et ermined that the criteri a of se ction 2 ( 1 )(/ ) wer e no t me th e r e co n s ider at i on d eci s i on. The pa n el fin ds the m in ist ry ' s de termination that th e appellan tr a n s portati on e xpens e s w as a re as o nabl e a pplication of the circums t a n c e s of the a p pell a nt, an d confi rms the decisi EAAT003(10/06/01) APPEAi I Act. As the phys i cian ' s listing from th e Colle ge n is not recognized as a speci a li s t by the e legisla tion and th erefore Sect i ons 2(1 ) (/)(iii) an d (iv ) refer to e as th e app e llant is not being refer red to t qualif y under section 2(/)(i ) to (iv) and t he ot qualify under sectio n 2(1)( v ) as th e app ellant to receive a benefit un der the t the he ar i ng, and as stated by the is paid f or by MSP. As such, th e pa nel as to r ec eive a bene fit under the M edicare unreasonable. However, the legislation tion 2(/)(i) to (iv) of Schedule C. As th e r e quest ia, s h e canno t q u a l ify for the co st of a li f e-t hreat ening il ln ess, th e min istry t s to a meet a life-threate ning need in 69 of the E AP W DR (H e alth supp le ment f o r alth ne ed), as it relates t o the provision of a e men ts o f s ection 2(1 ) (/) of Schedule C m u st has fo un d that th e mini s try r ea s onably t . Se c tio n 69 was not a basis f or de nial in t d oes no t qu al i fy for paymen t o f medical ap pl i c able enactment in t he on .
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.