I A PPEAl PART C -Decisi o n un d er Appeal The Ministr y of Socia l Development and Social Inn ov ation (the ministry) rec onsid er ation decision d a ted 25 June 2014 determined t h at t h e appella nt was not eligible for assis t ance with the medical tr ans portation hea lth supplement b ecau se the medical practitioner she wa s refe rred to was not in her local area and because he was not a specialist under s. 2 of Sc he du le C of th e Employment and Assistance for Persons with Di sa bilitie s Regulation. PAR T D -Rel evant Legisla tio n Em ployment and Assistan ce for P ersons w ith Disa bilit ies Reg ula t ion (EAPWD R), section 62. EAPWDR Sc hed ule C , se ction 2 (1) ( f) . EAAT003(10/06/01)
I APPEA PART E -Summary of Facts The following evidence was before the ministry at the time of reconsideration: o The appellant is designated as a Person with Disabilities (PWD) and provided assistance as a sole recipient. • On 22 August 2013, she was diagnosed with cancer and subsequently had surgery. • A series of 8 "Request for non-local medical transportation assistance" forms in March, April, May and June 2014 for weekly travel to a neighbouring community for appointments with a pain specialist, by car, taxi and/or bus transportation. • A series of 8 appointment cards showing the appellant's appointments in April, May and June 2014 at the medical clinic in the neighbouring community to either receive her prolotherapy treatment and/or for appointments with a family doctor. • A Referral Letter dated 18 November 2013 by the physician that is administering the appellant's treatment stating that she had an injection of her hip and spine and was advised to rest following this procedure. • Another Referral Letter by the same physician dated 25 February 2014 stating he would resume treatments in early April 2014. • A letter to the ministry dated 4 April 2014 by a physician who treated the appellant for cancer advising them that the appellant had to travel out of her local area to a neighbouring town for scheduled appointment with a doctor on 8 April 2014 and that she might be required to travel with an attendant. It stated in capital letters that this was the closest location available for such treatment. • A letter dated 13 June 2014 by a local physician stating that the appellant needed to see a doctor in a neighbouring community and needed help/support with transportation. It stated that "she is seen by a pain specialist there and this service is not available in [her local area]. It will be on an ongoing basis for 6-12 months." • A 2-page undated document titled 'What is Prolotherapy?" explained the treatment administered by the appellant's doctor. • A 1-page letter by the appellant, undated but written shortly after 9 June 2014 and faxed to the ministry on the 12th, stated that her family doctor moved out of her community and that after her surgery for cancer she had problems and the doctor who treated her for prolotherapy referred her to a family doctor in the same town as him. She stated that she needed a doctor but that there were none available in her community and consequently she requested transportation assistance to that neighbouring community. She stated that it was the closest place where she could find a doctor and that both doctors were specialists. • In her request for reconsideration dated 19 June 2014, the appellant stated that the doctor treating her with prolotherapy was a specialist and was the closest to where she lives. She was getting better, could walk without a cane but she still needed treatment because she still had pain as a result of her cancer. She had already paid for transportation for 7 appointments but owed that money and still had more appointments in the future. • A printout dated 25 June 2014 from the internet, College of Physicians and Surgeons of British Columbia website, titled "Find a Physician" indicates that the doctor providing the prolotherapy treatment to the appellant has a class of registration as "FULL General/Family Practice" and CCFP -Family Medicine. In her Notice of Aooeal dated 2 July 2014, the appellant indicated that the doctor treatin!=I her with EMT 003(10/06/01)
I APPEAL# prolotherapy is a specialist and that this treatment is working as she no longer uses a cane and hopes to be able to eventually work, even part time. This doctor is the only one in this area that specializes in this treatment. With her written submission for this appeal, the appellant provided the following additional documents: • A 1-page document by a physician that treated the appellant for cancer explaining her condition as of 3 June 2013. • A letter by the appellant stating that she had been to at least 10 doctors in her local area and that none of them can deliver the prolotherapy treatment. She does not own a computer and phoning a doctor at a provincial number is not an option since she already knows what is wrong with her health and they would not be able to treat her over the phone, as this is a hands-on treatment. The prolotherapy doctor is not a general practitioner but specializes in that treatment and is doing other tests that are required. • A doctor's note dated 22 June 2014 on a prescription form signed by physician A confirms that the appellant needs "polotherapy'' for her back and that it is not available in her local area, only in the neighbouring town. • A doctor's note dated 11 July 2014 on a prescription form signed by physician B confirms that the appellant requires prolotherapy treatment in the neighbouring community, which is not available in her local area and that she will be treated "2 weekly for the next year''. The panel determined the additional documentary evidence was admissible under s. 22(4) of the Employment and Assistance Act as it was in support of the records before the minister at reconsideration, particularly that it confirms what the appellant had been stating to the ministry and provides some corroboration of her statements. EMT 003(10/06/01)
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e u n d e r a p p e a l i s w h e t h e r t h e m i n i s t r y ' s d e a s s i s t a n c e w i t h t h e m e d i c a l t r a n s p o r t a t i o n h e a l t h s w a s r e f e r r e d t o w a s n o t i n h e r l o c a l a r e a a n d b e c a u C o f t h e E A P W D R w a s a r e a s o n a b l e a p p l i c a t i o n o f e v i d e n c e . T h e a p p l i c a b l e l e g i s l a t i o n c a n b e f o u n d a t S c h e d u l e a s a s p e c i a l i s t : 1 I n t h i s S c h e d u l e : . . . " s p e c i a l i s t " m e a n s a m e d i c a l p r a c t i t i o n e r r e c o g n i z i n a c c o r d a n c e w i t h t h e b y l a w s m a d e b y t h e b o a r d f B r i t i s h C o l u m b i a u n d e r s e c t i o n 1 9 ( 1 ) ( k . 3 ) a n d ( k . 4 A n d s e c t i o n 2 ( G e n e r a l H e a l t h S u p p l e m e n t s ) i n d i c a t r a n s p o r t a t i o n a s s i s t a n c e : 2 ( 1 ) T h e f o l l o w i n g a r e t h e h e a l t h s u p p l e m e n t s t h a t f a m i l y u n i t t h a t i s e l i g i b l e u n d e r s e c t i o n 6 2 { g e n e r a l ( f ) t h e l e a s t e x p e n s i v e a p p r o p r i a t e m o d e o f t r a n s p o ( i ) a n o f f i c e , i n t h e l o c a l a r e a , o f a m e d i c a l p r ( i i ) t h e o f f i c e o f t h e n e a r e s t a v a i l a b l e s p e c i a l i h a s b e e n r e f e r r e d t o a s p e c i a l i s t i n t h a t f i e l d p r a c t i t i o n e r , ( i i i ) t h e n e a r e s t s u i t a b l e g e n e r a l h o s p i t a l o r r e d e f i n e d i n s e c t i o n 1 . 1 o f t h e H o s p i t a l I n s u r a n ( 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 s e c t i o n 1 o f t h e H o s p i t a l I n s u r a n c e A c t , p r o v i d e d t h a t ( v ) t h e t r a n s p o r t a t i o n i s t o e n a b l e t h e p e r s o n P r o t e c t i o n A c t o r a g e n e r a l h o s p i t a l s e r v i c e u ( 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 T h e m i n i s t r y a r g u e d t h a t t h e a p p e l l a n t w a s n o t e l i g i b b e c a u s e : • T r a n s p o rt a t i o n w a s n o t r e q u i r e d t o a t t e n d a g e n e l o c a l i t y t h a t i s c l o s e , 1 0 k m , t o a s m a l l t o w n t h a t 1 0 0 k m f r o m t h e n e i g h b o u r i n g t o w n w h e r e t h e d o • W h i l e t h e d o c t o r s h e h a s b e e n r e f e r r e d t o i s a s p p r a c t i t i o n e r , h e i s n o t r e g i s t e r e d a s a s p e c i a l i s t i n P h y s i c i a n s a n d S u r g e o n s b u t i s r e g i s t e r e d a s a g • T h e o t h e r d o c t o r t h a t s h e h a s b e e n r e f e r r e d t o a a d m i n i s t e r s t h e p r o l o t h e r a p y i s a l s o a G P a n d n o m i n i s t r y a r g u e s t h a t w h i l e t h e a p p e l l a n t s t a t e d t h a p p e l l a n t c a n h a v e a c c e s s t o d o c t o r s o n l i n e , b y p • T r a v e l w a s n o t r e q u i r e d t o a t t e n d a n a p p o i n t m e n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A , c i s i o n t h a t t h e a p p e l l a n t w a s n o t e l i g i b l e f o r u p p l e m e n t b e c a u s e t h e m e d i c a l p r a c t i t i o n e r s h e s e h e w a s n o t a s p e c i a l i s t u n d e r s . 2 o f S c h e d u l e t h e l e g i s l a t i o n o r r e a s o n a b l y s u p p o r t e d b y t h e C o f t h e E A P W D R t h a t f i r s t d e f i n e w h o q u a l i f i e s e d a s a s p e c i a l i s t i n a f i e l d o f m e d i c i n e o r s u r g e r y o r t h e C o l l e g e o f P h y s i c i a n s a n d S u r g e o n s o f ) o f t h e H e a l t h P r o f e s s i o n s A c t . t e s a t p a r a g r a p h 1 ( f ) w h o i s e l i g i b l e f o r m e d i c a l m a y b e p a i d f o r b y t h e m i n i s t e r i f p r o v i d e d t o a h e a l t h s u p p l e m e n t s ] o f t h i s r e g u l a t i o n : . . . rt a t i o n t o o r f r o m a c t i t i o n e r o r n u r s e p r a c t i t i o n e r , s t i n a f i e l d o f m e d i c i n e o r s u r g e r y i f t h e p e r s o n b y a l o c a l m e d i c a l p r a c t i t i o n e r o r n u r s e h a b i l i t a t i o n h o s p i t a l , a s t h o s e f a c i l i t i e s a r e c e A c t R e g u l a t i o n s , o r p a r a g r a p h ( 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 t o r e c e i v e a b e n e f i t u n d e r t h e M e d i c a r e 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 r s o n ' s f a m i l y u n i t t o c o v e r t h e c o s t . l e f o r m e d i c a l t r a n s p o r t a t i o n s u p p l e m e n t r a l p r a c t i t i o n e r i n h e r l o c a l a r e a a s s h e l i v e s i n a i s c o n s i d e r e d a s h e r l o c a l a r e a w h i l e s h e i s o v e r c t o r s a r e . e c i a l i s t i n p a i n m a n a g e m e n t a c c o r d i n g t o a l o c a l a f i e l d o f m e d i c i n e o r s u r g e r y b y t h e C o l l e g e o f e n e r a l p r a c t i t i o n e r ( G P ) . n d t h a t i s i n t h e s a m e b u i l d i n g a s t h e d o c t o r w h o t a s p e c i a l i s t a n d i s n o t i n h e r l o c a l a r e a . T h e e r e w a s n o a v a i l a b l e G P i n h e r l o c a l a r e a , t h e h o n e a n d a t h e r l o c a l h o s p i t a l . t a t 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 o r r e h a b
h o s p i t a l . e T h e m i n i s t r y i s s a t i s f i e d t h e a p p e l l a n t m a y n o t h n e i g h b o u r i n g c o m m u n i t y t w i c e a m o n t h f o r 6 -1 2 T h e a p p e l l a n t a r g u e d t h a t s h e h a s b e e n r e f e r r e d t o n e i g h b o u r i n g t o w n b e c a u s e n o o n e i s a v a i l a b l e i n h t h i s t r e a t m e n t h a s b e e n r e a l l y h e l p f u l f o r h e r . S h e h t o l d h e r t h e y c o u l d n o t p r o v i d e t h i s t r e a t m e n t . S h e s h e w a s o n l y t r y i n g t o k e e p h e r h e a l t h u p s o t h a t s t o f e e l a l i t t l e b e t t e r w i t h t h i s t r e a t m e n t a n d s t i l l n e e b e a b l e t o g o t o h e r a p p o i n t m e n t s w i t h a s l i t t l e s t r e d o e s n o t w o r k f o r h e r a s s h e h a s n o c o m p u t e r a n d e i t h e r s i n c e s h e k n o w s w h a t s h e h a s a n d t h e t r e a t m r e i t e r a t e d t h a t t h e d o c t o r w h o p r o v i d e s t h e p r o l o t h e p a i n m a n a g e m e n t . T h e p a n e l c o n s i d e r e d f i r s t w h e t h e r t h e l o c a t i o n w h i s o u t s i d e o f h e r " l o c a l a r e a " a n d a s t h e m i n i s t r y s t a t o w n i n q u e s t i o n i s o v e r 1 0 0 k m f r o m t h e a p p e l l a n t a n d t h u s , t h e p a n e l f i n d s t h e m i n i s t r y r e a s o n a b l y d t h e p r o l o t h e r a p y t r e a t m e n t i s n o t p a r t o f t h e a p p e l l a H e n c e , t h e q u e s t i o n a s t o w h e t h e r t h e d o c t o r a d m i a s i f h e w e r e , t h e m i n i s t r y w o u l d b e a b l e t o p r o v i d e 2 ( 1 ) ( f ) ( i i ) o f S c h e d u l e C o f t h e E A P W D R . T h e e v i d e a p p e l l a n t ' s c o m m u n i t y c o n s i d e r t h a t d o c t o r a s b e i n t h e a p p e l l a n t t o h i m . H o w e v e r , s . 1 , S c h e d u l e C o f p r a 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 c c o r d C o l l e g e o 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 C a n d t h e C o l l e g e c o n f i r m e d t h a t t h i s d o c t o r w a s n o t r e g i s t e r e o r s u r g e r y . N o t o n l y i s t h e r e e v i d e n c e t h a t h e w a s n r e c o g n i z e d b y t h e C o l l e g e b y l a w s a s a s p e c i a l i s t a n r e a s o n a b l y d e t e r m i n e d h e w a s n o t a s p e c i a l i s t a s d T h e p a n e l n o t e s h o w e v e r t h a t t h e m i n i s t r y m a d e t h r e l y o n a n o n l i n e d o c t o r o r b y t e l e p h o n e o r h e r l o c a t h a t n e e d s f o l l o w u p ; t h e p a n e l f i n d s t h i s c o m m e n t c o m m u n i t y a n d n o t t o t h e p r o l o t h e r a p y t r e a t m e n t a n s o m e p a r t s o f t h e p r o v i n c e . T h e r e i s n o i s s u e a s t o s e e i n g i s n o t a s p e c i a l i s t b u t a G P a n d t h e a p p e l l a n T h e p a n e l n o t e s t h e r e i s n o e v i d e n c e t h a t t h e c o n d i f i n d s t h e m i n i s t r y r e a s o n a b l y c o n c l u d e d t h e a p p e l l a s u p p l e m e n t u n d e r t h o s e d i s p o s i t i o n s . I n c o n c l u s i o n , t h e o a n e l f i n d s t h e m i n i s t r v r e a s o n a b E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L a v e t h e r e s o u r c e s t o p a y f o r t r a v e l t o t h e m o n t h s . a s p e c i a l i s t c l o s e s t t o h e r c o m m u n i t y i n a e r o w n l o c a l a r e a t o p e r f o r m p r o l o t h e r a p y a n d t h a t a s s e e n m a n y d o c t o r s i n h e r a r e a t h a t h a v e a l l a r g u e d t h a t t h i s w a s c a u s i n g h e r l o t s o f s t r e s s a n d h e w i l l n o t e n d u p i n h o s p i t a l . S h e w a s j u s t s t a r t i n g d e d m o r e t e s t s t o b e d o n e a n d s h e w o u l d l i k e t o s s a s p o s s i b l e . S h e a r g u e d t h a t o n l i n e m e d i c i n e c o n t a c t i n g a d o c t o r b y p h o n e w o u l d n o t w o r k e n t c a n n o t b e p r o v i d e d o v e r t h e p h o n e . S h e r a p y t r e a t m e n t i s n o t h e r G P b u t a s p e c i a l i s t i n e r e t h e t r e a t m e n t i s a d m i n i s t e r e d t o t h e a p p e l l a n t t e d i n i t s a r g u m e n t s , t h e e v i d e n c e s h o w s t h a t t h e ' s c o m m u n i t y a n d t h a t a n o t h e r t o w n i s a b o u t 1 0 k m e t e r m i n e d t h e t o w n w h e r e t h e d o c t o r a d m i n i s t e r i n g n t ' s l o c a l a r e a . n i s t e r i n g t h e t r e a t m e n t i s a s p e c i a l i s t i s i m p o r t a n t m e d i c a l t r a n s p o r t a t i o n s u p p l e m e n t u n d e r s . n c e s h o w s t h a t m a n y o t h e r d o c t o r s i n t h e g a p a i n m a n a g e m e n t s p e c i a l i s t a n d h a v e r e f e r r e d t h e E A P W D R d e f i n e s s p e c i a l i s t a s a m e d i c a l a n c e w i t h t h e b y l a w s m a d e b y t h e b o a r d o f t h e m i n i s t r y p r o v i d e d e v i d e n c e t o t h e e f f e c t t h a t t h e d w i t h t h e m a s a s p e c i a l i s t i n t h e f i e l d o f m e d i c i n e o t " r e g i s t e r e d " b u t t h e r e i s n o e v i d e n c e h e i s d t h e r e f o r e t h e p a n e l f i n d s t h e m i n i s t r y e f i n e d b y t h e l e g i s l a t i o n . e u n f o r t u n a t e s t a t e m e n t t h a t t h e a p p e l l a n t c o u l d l h o s p i t a l w h i l e s h e h a s a k n o w n m e d i c a l c o n d i t i o n r e f e r r e d s p e c i f i c a l l y t o t h e l o s s o f h e r G P i n h e r d s a d l y r e f l e c t s t h e s h o r t a g e o f f a m i l y d o c t o r s i n w h e t h e r t h e o t h e r d o c t o r t h a t t h e a p p e l l a n t i s t d i d n o t p r o v i d e a n y e v i d e n c e t o t h e c o n t r a r y . t i o n s s e t i n s . 2 ( 1 ) ( ! ) ( i i i ) a n d ( i v ) e x i s t e d a n d t h u s n t w a s n o t e l i g i b l e f o r m e d i c a l t r a n s p o r t a t i o n l v d e t e r m i n e d t h e d o c t o r d e l i v e r i n a t h e
I APPEAL prolotherapy treatment as well as the other family doctor were not specialists according to the legislation but GPs, and as such, reasonably determined their offices were not in the appellant's local area. Consequently, the ministry reasonably determined the appellant did not meet the conditions set at s. 2(1) (f) of Schedule C of the EAPWDR for a medical transportation supplement. Therefore, the panel finds the ministry's decision was reasonably supported by the evidence and confirms the decision. EMT 003(10/06/01)
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.