PART C -D e ci sion under Appea l The de c ision under appeal is the reconsid er a tion dec isio n of the Ministry of Social Deve lop m ent and Social Innovation (the ministry) dated 18 Augus t 2014 that denied the appellant's request for a non lo c al medical transportation su p plement for her child A to attend an appointm e n t with an or t h odontist in ano ther city. The m inistry he ld tha t the request did n o t meet all the requirements set out in section 2(1)(f) of Schedule C o f the Empl o yment and Assist ance for Persons with Disabilities Regulation. Specifica lly, the ministr y determ ined that an or th o d o n tist is not a "sp eci alist" as de f in ed in section 1 of Sc hedul e C, and t h e r e fo re a v isit to an orthodontis t does not meet the requirements of sect io n 2(1 ) (f)(ii) of Schedule C. Ac cordingly, the min istry does n ot have the a bility to assist w ith tran s po rt a t ion costs to see an orthod ontist. PA RT D -Re le van t Legisla tion Em ployme nt and A ssi s ta nc e for Persons with Di sabil ities Regulation (EAPWDR) , S ch edul e C, s ectio ns 1 an d 2(f ). I nterp reta tio n Act, se c t io n 29. EAAT003(10/06/01)
PART E -Summarv of Facts The ministry did not appear at the hearing. After confirming that the ministry was notified of the hearing, the hearing proceeded in accordance with section 86(b) of the Employment and Assistance Regulation. The evidence before the ministry at reconsideration included the following: 1. From the ministry's files: the appellant is a recipient of disability assistance, with 2 dependent children, A and B. 2 . A Health Insurance BC Request for Travel Assistance (TAP) form dated 20 May 2014 for A to travel to another city to visit Dr. X on 18 July 2014, with a confirmation number. 3 . A Request for Non-Local Medical Transportation Assistance, dated 20 May 2014, completed by the appellant, for travel to and from another city on 18 July 2014 to attend the office of an orthodontist (Dr. X) for appointments for A and B. At the end of the form, the appellant writes: "Need ferry fares also for B. A is covered." 4. A report dated 18 December 2012 regarding the appellant's child A, headed "Cleft Palate/Craniofacial Clinic," from the Children's & Women's health Center of British Columbia. The letter notes that A was referred to the team orthodontist, Dr. X, for management of her craniofacial and limb reduction syndrome. The letter goes on to summarize A's multiple medical conditions, reviewing the need for ongoing monitoring by a plastic surgeon, a specialist in otolaryngology, and the orthodontist. As part of the recommendation, the letter states: • "To see [Dr. X] for orthodontic evaluation and further planning which will probably involve orthodontic treatment and orthognatic surgery." • [A] has features of an oromandibular limb hypogenesis spectrum that has likely arisen from vascular induced embryopathy. She will require orthodontic and orthognatic interventions. ... " 5. A letter from Dr. X dated 15 June 2012, stating that he has recently seen A for an initial orthodontic examination. He goes on to write that given the child's extensive medical history and unusual craniofacial and dental findings, he has referred the child to the Cleft Pallet and Craniofacial Anomalies Team at a [Provincial Health Services Authority] hospital. He is a member of that team and thinks that she most likely has some sort of syndrome. Under his signature, credentials include D.D.S., F.R.C.D.(C), and Diploma, American Board of O r t h o d o n t i c s . 6. The appellant's Request for Reconsideration, dated 29 July 2014, regarding the denial of transportation assistance for A. The appellant writes that these trips were previously funded, the last one on 22 November 2013. The appellant writes that A has a medical diagnoses of craniofacial and limb reduction. . The child is having her oral care being managed by Dr. X in another city as there is no orthodontist where she resides. A has a Class Ill skeletal and dental malocclusion with narrow maxilla, bimaxillary and interior cross-bite, significant dental crowding. A is being monitored at six-month intervals, to keep watch to prepare for upcoming dental surgery. The appellant adds that these trips have been previously funded -the last approval was for 22 November 2013. EAAT 003(10/06/01)
7. In the reconsideration decision, the ministry notes that a review of the appellant's files show that in November 2013 the ministry assisted with transportation to see an ophthalmologist. A request for additional travel assistance to see an orthodontist was denied at that time. The appellant's Notice of Appeal is dated 20 August 2014. In an attached letter, the appellant writes that her child A has some medical diagnoses for which she is being monitored by a [Provincial Health Services Authority] hospital Cleft Pallet and Craniofacial Anomalies team. Dr. Xis part of that team, working out of an orthodontics office in another city. He wants to see her every six months for follow-ups to monitor how her mouth is growing, and is planning on having A go through two phases of the orthodontic surgery as well is jaw surgery, and then she will have to have braces afterwards. At this time she has difficulties eating food normally and is a slow eater. She writes that A has been diagnosed with Class Ill skeletal and dental malocclusion with narrow maxilla, bimaxillary and anterior cross-bite, and significant dental crowding. She is congenitally missing some teeth. She also has some other teeth that have unusual morphology. The appellant refers to the letter of 12 December 2012, summarized in paragraph 4 above. The appellant writes that A has been seen and monitored by Dr. X on 15 June 2012, 22 March 2013 and 22 November 2013. The ministry covered the transportation costs for all of these dates. While the ministry claims it denied transportation costs for 22 November 2013, what it fails to see is that it refused to give her any extra funding for her other child, B, as they had already paid her for the travel expenses to cover her ophthalmology appointment for 7 November 2013, but that appointment was rescheduled for 22 March 2013. The appellant notes that there is no orthodontist in her hometown; this is why they have to travel to the other city for appointments. A is entitled to TAP because of her medical needs. The appellant goes on to describe how her application for transportation assistance for both A and B was denied by the ministry, and how she discovered that the combined application resulted in two denials, and two separate Requests for Reconsideration. Also attached to the Notice of Appeal is material summarized in paragraphs 2 to 6 above, as well as another Request for Reconsideration, dated 29 July 2014 regarding the denial of transportation assistance for B. A reconsideration decision relating to this request is also included. At the hearing, the appellant submitted the following documents: • An undated hand-written Pharmacare Special Authority Request for a prescription from the hospital team Medical Director, a paediatrician. • A hand written memo dated 26 Aug 2014 and signed by the paediatrician requesting assistance regarding the above. • A single page of photos of the appellant's child. • A two page typed letter dated 25 August 2014 from Dr. X addressed to the appellants' family doctor regarding A's many physical problems. • A six page typed letter dated 18 July 2014 letter from the paediatrician outlining A's many physical and emotional problems. EAA T003(10/06101)
I n h e r p r e s e n t a t i o n a n d i n a n s w e r t o q u e s t i o n s , t h e t h e 1 8 D e c e m b e r 2 0 1 2 r e p o r t i n d e s c r i b i n g A ' s m e d m a n a g e d , m o n i t o r e d a n d p l a n n e d b y t h e h o s p i t a l t e A h a s b e e n d e s c r i b e d t o h e r a s a " m e d i c a l m i r a c l e . r e q u i r e s e v e r a l m o r e , i n c l u d i n g t h o s e p l a n n e d b y D a n o m a l i e s , s h e h a s d i f f i c u l t y e a t i n g i t t a k e s h e r 1 5 w o u l d t a k e a f e w s e c o n d s a n d t h e m e d i c a l t e a m i d o n e u n t i l A g a i n s m o r e w e i g h t . T h e a p p e l l a n t s t a t e g e n e t i c t e s t i n g . T h e a p p e l l a n t s t a t e d t h a t D r . X h a s b e e n a u t h o r i z e d o f f i c e . W h i l e t h i s c o v e r s t h e f e r ry c o s t s , t h e r e a r e o t g r o c e r y b u d g e t . I t i s e m b a r r a s s i n g f o r h e r t o h a v e t o T h e b a l a n c e o f t h e a p p e l l a n t ' s p r e s e n t a t i o n w e n t t o g e t m e d i c a l c a r e a n d t r e a t m e n t s f o r c o n d i t i o n s t h a t D e c i s i o n , b e l o w ) . T h e p a n e l f i n d s t h a t t h e i n f o r m a t i o n p r o v i d e d i n t h e s u b m i t t e d a t t h e h e a r i n g a n d i n h e r t e s t i m o n y a t t h e r e c o r d s 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 , a s i i D e c e m b e r 2 0 1 2 r e p o r t . A c c o r d i n g l y , t h e p a n e l a d m E m p l o y m e n t a n d A s s i s t a n c e A c t . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )a p p e l l a n t r e f e r r e d t o t h e a b o v e d o c u m e n t s a n d i c a l / d e n t a l c o n d i t i o n s a n d h o w A ' s c a r e i s b e i n g a m , o f w h i c h D r . X i s a m e m b e r . S h e s t a t e d t h a t " A h a s h a d 1 4 s u r g e r i e s s i n c e b i r t h a n d w i l l r . X . B e c a u s e o f t h e c h i l d ' s d e n t a l / c r a n i a l f a c i a l m i n u t e s t o c h e w s o m e t h i n g t h a t a n o t h e r c h i l d s r e l u c t a n t t o h a v e t h e o r t h o d o n t i c s p r o c e d u r e s d t h a t t h e m e d i c a l t e a m i s a l s o w a i t i n g t o d o t o i s s u e T A P f o r m s t o c o v e r A ' s v i s i t s t o h i s h e r e x p e n s e s a n d t h e s e a r e a d r a i n o n h e r g o t o t h e m i n i s t r y t o r e q u e s t e m e r g e n c y f u n d i n g . a r g u m e n t a s t o h o w c h i l d r e n d e s e r v e i t h e r i g h t t o a f f e c t t h e i r h e a l t h ( s e e P a r t F , R e a s o n s F o r P a n e l a p p e l l a n t ' s N o t i c e o f A p p e a l , i n t h e d o c u m e n t s h e a r i n g i s i n s u p p o r t o f t h e i n f o r m a t i o n a n d s u b s t a n t i a t e s t h e i n f o r m a t i o n p r o v i d e d i n t h e 1 8 i t s t h i s e v i d e n c e u n d e r s e c t i o n 2 2 ( 4 ) o f t h e
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 i n t h i s 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 w a s a n o n l o c a l m e d i c a l t r a n s p o rt a t i o n s u p p l e m e n t u n d e h e r c h i l d A t o a t t e n d a n a p p o i n t m e n t w i t h a n o r t h o d i s w h e t h e r t h e m i n i s t r y d e t e r m i n a t i o n , f i n d i n g t h a t a s e c t i o n 1 o f S c h e d u l e C , a n d t h e r e f o r e a v i s i t t o a n s e c t i o n 2 ( 1 ) ( / ) ( i i ) o f S c h e d u l e C a n d a s a r e s u l t t h e t r a n s p o rt a t i o n c o s t s t o s e e a n o r t h o d o n t i s t , i s r e a s o r e a s o n a b l e a p p l i c a t i o n o f t h e l e g i s l a t i o n i n t h e c i r c u T h e r e l e v a n t l e g i s l a t i o n i s f r o m S c h e d u l e C o f t h e E D e f i n i t i o n s 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 e 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 o r t u n d e r s e c t i o n 1 9 ( 1 ) ( k . 3 ) a n d ( k . 4 ) o f t h e H e a l t h P r o G e n e r a l h e a l t h s u p p l e m e n t s 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 m a 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 h e a l t h s u p p 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 ( i ) a n o f f i c e , i n t h e l o c a ( i i ) t h e o f f i c e o f t h e n e a t h e p e r s o n h a s b e e n r e f p r a c t i t i o n e r o r n u r s e p r a ( i i i ) t h e n e a r e s t s u i t a b l e f a c i l i t i e s a r e d e f i n e d i n s ( 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 " i n s e c t i o n 1 o f 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 M e d i c a r e P r o t e c t i o n A c A c t , a n d ( v i ) t h e r e a r e n o r e s o u r A n d f r o m t h e I n t e r p r e t a t i o n A c t E x p r e s s i o n s d e f i n e d 2 9 I n a n e n a c t m e n t : " m e d i c a l p r a c t i t i o n e r " m e a n s a r e g i s t r a n t C o l u m b i a e n t i t l e d u n d e r t h e H e a l t h P r o f e s s p r a c t i t i o n e r " ; T h e p o s i t i o n o f t h e m i n i s t r y , a s s e t o u t i n t h e r e c o n s r e c o g n i z e d a s s p e c i a l i s t s i n t h e f i e l d o f m e d i c i n e o r S u m e o n s o f B C . O rt h o d o n t i s t s a r e r e c o a n i z e d a s d e E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )r e a s o n a b l e i n d e n y i n g t h e a p p e l l a n t ' s r e q u e s t f o r r s e c t i o n 2 ( 1 ) 1 ) o f S c h e d u l e C o f t h e E A P W D R f o r o n t i s t i n a n o t h e r c i t y . M o r e s p e c i f i c a l l y , t h e i s s u e n o r t h o d o n t i s t i s n o t a " s p e c i a l i s t " a s d e f i n e d i n o rt h o d o n t i s t d o e s n o t m e e t t h e r e q u i r e m e n t s o f m i n i s t r y d o e s n o t h a v e t h e a b i l i t y t o a s s i s t w i t h n a b l y s u p p o r t e d b y t h e e v i d e n c e o r i s a m s t a n c e s o f t h e a p p e l l a n t . A P W D R : 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 i n 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 B r i t i s h C o l u m b i a f e s s i o n s A c t . 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 f a m i l y u n i t t h a t e m e n t s ] o f t h i s r e g u l a t i o n : t e m o d e o f t r a n s p o r t a t i o n t o o r f r o m l a r e a , o f a 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 p r a c t i t i o n e r , r e s t a v a i l a b l e 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 i 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 b y a l o c a l m e d i c a l c t i t i o n e r , g e n e r a l h o s p i t a l o r r 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 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 c e A c t R e g u l a t i o n s , o r 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 ( e ) o f t h e d e f i n i t i o n 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 , 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 e n e f i t u n d e r t h e 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 n d e r t h e H o s p i t a l I n s u r a n c e 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 u n i t t o c o v e r t h e c o s t . o f 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 B r i t i s h i o n s A c t t o p r a c t i s e m e d i c i n e a n d t o u s e t h e t i t l e " m e d i c a l i d e r a t i o n d e c i s i o n , i s t h a t o rt h o d o n t i s t s a r e n o t s u r g e r y b y 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 n t a l s o e c i a l i s t s a n d r e ri i s t e r e d w i t h t h e R o v a l
Colle g e of Dentist s of Canada. The m inistry has no abil o rt hod ontist. The appe llant's posit ion is that ch il dren deserve the rig essent i al fo r their h ealth. D r. X is pro viding a specialty he meet h er child's spe cial need s. Dr. X is a member o th e management, monitoring and pla nning o f her c hild' th at D r. Xis p la nni ng is an ess e n tia l el emen t o f the ch circumstances , the a ppellant su b mits that i t is unr e asonable for the ministry to d assistance for A to visit t he orthodontist as mo nitoring and tr P anel dec is i on The eviden c e is compelling th at the appell an t's child, A, has severe and complex dental/craniofacial a noma lies req uiring extensive tr ea tm en t. T he c h ild 's plann ed b y a team head ed by a pedia tr icia n an d in c sec t ion 1 of Sched u l e C o f the EAPWDR , and cente h os p ita l in a di f ferent cit y . Dr. X , whose o ffi c e is in anoth te a m 's orthodo n t i st . Th e le gi sl ati o n pr o vides th a t t he m ini st ry may pay a med n o n -l oca l t ravel only u nder spec ified cir c um st ances: p r act i tioner locally, to the nearest su it ab l e hospi tal in BC o "s pecialist. " The legi sl ation doe s n ot co ver any o ther tra medica l r easons , even i f recomme nd e d by a p h ysician, th Med icare Protectio n Act or is p a id for by th e ministry E APWDR. For ins tan c e, the ministr y is not authorized to pr a c omm ercial x ray l a borato ry or blo od-work cl i nic , t a physica l o r massage th e rapist o r to a hosp i t a l or a A "speci a list'' is defined in Section 1 of Schedule C o recognized as a specialist in a field of medicine or surgery in accordance with t the board for the College of Physicians and Surgeons of BC (CPSBC). A medical pra d efined in t he In terpretation Act a s a registrant of the CPS requires graduation from a recog ni z ed medical school, wit or equivalent). Dr. X, the orthodontist , does not have a medical degree, but the degree of Docto Dental Surgery or D.D.S., and therefore is not eligible to qualify as a medical practitioner as defined in legislation. The pa n el therefo re finds that, even though Dr. X is a dental reasonable in determining that a visit to his office would not be a visit to a "specialist" as defined in the legislation and that therefore the ministry has no ability to assist with transportation office. The panel has reviewed the legis l ati o n and finds that the minister has no discretionary authority to make exceptions in this regard under unus those relating to the appellant's child's medical conditions and treatment. Based on the foregoing, the panel finds that the ministry was reasonable in denying the appellant's re quest for medical transportation assistance for her child to see an orthodontist was a reasonable aoolication of the leaislation in the circum stances of the ann EM T003(10/06/01) ity to assist w ith t r a n s po rt ation cost s to see an ht t o ge t m ed ical care a nd treatments i f it is al th se r vic e that is medically essential to f the te a m o f me d i cal special ists t hat has taken on s compl ex medical ca r e. The orth o d ontic s work i ld's treatme nt program. Und e r the se e ny tran sp ortation e a tment prog r e s se s . he at h c are is b e ing m a nage d , monitored and luding other me dical "spe cialists" as d e fined in red at a Pro vincial Health Serv ices Au th o r ity er ci ty, i s al so a member o f th e tea m , as the ical tran sp or t a t i on supp leme nt for loc al and to th e o f fice of a med ical practitioner or nu rse r to t he office of a n ear es t avai l a bl e nsp or t a t i on cost s t h at m ay be required f o r e servic e p r ovide d is a b e nef i t u nde r th e und e r provisi o n s elsewher e in Sc h edule C of the ovide tr ansportation ass ist a nc e f o r visit s to o an o ptomet r is t for a n e ye-glass pres criptio n , to specialist in a not her province or country. f th e EAPW D R as a medi cal pra ctitioner h e bylaw s made by c ti t i on er is B C. Reg i st r at io n as a medical p r a ct itioner h a deg r e e as a Doc t or of M e dic ine (M.D. r of specialist, the ministry was costs to his ual o r exce pt i on al circumstances, such as ellant. The p a nel t her ef o re confir m s the
ministry's decision. EM T003(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.