I APPEAL# PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (The Ministry)'s Reconsideration Decision, dated September 11, 2014 in which the Ministry denied the appellant a medical transportation supplement to pay for trips to attend appointments with a general practitioner in another community because the request does not meet the legislative criteria set out in the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Schedule C, Section 2 (1)(f), specifically because the appellant is not attending an appointment to the office of the nearest specialist in the field of medicine or surgery or to the nearest hospital to receive a benefit under the Medicare Protection Act or a service under the Hospital Insurance Act. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Act (EAPWDA) section 5 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) section 62, Schedule C sections 1 and 2(1)(f)(ii) and (vi) EAAT 003( 10/06/01)
P A R T E S u m m a r y o f F a c t s T h e a p p e l l a n t h a s b e e n d e s i g n a t e d a s a P e r s o n s w a s s i s t a n c e . T h e a p p e l l a n t r e q u e s t e d a h e a l t h t r a n s p t r a v e l f r o m h i s r e s i d e n c e i n C o m m u n i t y A t o a n a p p C o m m u n i t y B , a n d a n a d d i t i o n a l s u b s i d y t o a t t e n d t h 2 9 , 2 0 1 4 t h e m i n i s t r y d e n i e d t h e a p p e l l a n t ' s r e q u e s t r e c o n s i d e r a t i o n o f t h a t d e c i s i o n . T h e i n f o r m a t i o n b e f o r e t h e m i n i s t r y a t t h e t i m e o f r e c 1 ) A l e t t e r d a t e d J u l y 2 2 , 2 0 1 4 , t o " w h o m i t m a y c o n f i r m i n g t h e a p p e l l a n t ' s a p p o i n t m e n t o n A u o p i a t e a d d i c t i o n . T h e p h y s i c i a n n o t e s t h a t a l t m a i n t e n a n c e f o r a d d i c t i o n p u r p o s e s , h i s c h r o d r u g . T h e l e t t e r s t a t e s t h a t t h e c l i n i c d o e s n o t i s s u e s , a l t h o u g h o c c a s i o n a l l y s o m e p a t i e n t s m l e t t e r c o n c l u d e s w i t h a r e q u e s t f o r t h e a p p e l l a C o m m u n i t y B r e g u l a r l y . 2 ) A c o p y o f t h e n o t i c e o f d e c i s i o n t o t h e a p p e l l a m i n i s t ry ' s d e n i a l o f t h e a p p e l l a n t ' s r e q u e s t f o r f o r M i n i s t r y D e c i s i o n , i t s t a t e s : Y o u r e q u e s t e d c o n f i r m e d t h i s w i t h a w r i t t e n l e t t e r f r o m t h e D p e o p l e h e r e a t t h e c l i n i c f o r p a i n r e l i e f , b u t r a t p a t i e n t s w i l l e x p e r i e n c e o t h e r b e n e f i t s , i n c l u d m e d i c a l t r a n s p o r t a t i o n t o a t t e n d t h e [ C o m m u n A p p l i c a b l e L e g i s l a t i o n , h o w e v e r , n o b o x e s t o c h e c k e d o n e i t h e r p a g e . 3 ) C o p i e s o f t h e a p p e l l a n t ' s P a t i e n t D r u g S u m m p h a r m a c y i n C o m m u n i t y A T h e r e p o r t l i s t s t h m e t h a d o n e , w h i c h w e r e f i l l e d f o r t w o t i m e p e r 2 0 1 1 , a n d S e p t e m b e r 3 , 2 0 1 3 a n d J a n u a r y 2 F o r t h e p e r i o d o f S e p t e m b e r 3 , 2 0 1 3 t o J a n u a a p p e l l a n t h a s r e c e i v e d 3 9 p r e s c r i p t i o n s f o r m D r . A , b e t w e e n O c t o b e r 5 , 2 0 1 3 a n d J a n u a r y S e p t e m b e r 3 , 2 0 1 3 a n d O c t o b e r 4 , 2 0 1 3 . F o r t h e p e r i o d o f J u l y 3 , 2 0 1 1 t o S e p t e m b e r 7 m e t h a d o n e H y d r o c h l o r i d e 2 5 m g t a b l e t s o n t w C o m m u n i t y B . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I i t h D i s a b i l i t i e s a n d i s a s o l e r e c i p i e n t o f o rt a t i o n s u p p l e m e n t o n J u l y 2 8 , 2 0 1 4 i n o r d e r t o o i n t m e n t o n A u g u s t 2 1 , 2 0 1 4 w i t h a p h y s i c i a n i n i s p h y s i c i a n ' s o f f i c e o n a r e g u l a r b a s i s . O n J u l y a n d o n A u g u s t 2 9 , 2 0 1 4 h e r e q u e s t e d o n s i d e r a t i o n i n c l u d e d t h e f o l l o w i n g : c o n c e r n " , f r o m p h y s i c i a n A i n C o m m u n i t y B , g u s t 2 1 , 2 0 1 4 i n o r d e r t o r e c e i v e c a r e fo r h i s h o u g h t h e a p p e l l a n t i s t r e a t e d w i t h m e t h a d o n e n i c p a i n i s i n a d v e r t e n t l y t r e a t e d b y t h e l o n g a c t i n g t r e a t p e o p l e f o r p a i n , b u t r a t h e r f o r a d d i c t i o n a y e x p e r i e n c e b e n e f i t s s u c h a s p a i n r e l i e f . T h e n t t o r e c e i v e a s u b s i d y t o t r a v e l t o t h e c l i n i c i n n t , d a t e d J u l y 2 9 , 2 0 1 4 , p r o v i d i n g r e a s o n s f o r t h e m e d i c a l t r a n s p o r t a t i o n a s s i s t a n c e . A s R e a s o n s m e d i c a l t r a n s p o r t a t i o n t o [ C o m m u n i t y B J c l i n i c , r . A , h o w e v e r , t h e D r . w r i t e s , " W e d o n o t t r e a t h e r a d d i c t i o n i s s u e s . H o w e v e r o c c a s i o n a l l y i n g p a i n r e l i e f . T h e r e f o r e , y o u a r e n o t e l i g i b l e f o r i t y B J c l i n i c . T o t h i s d e c i s i o n i s a c h e c k l i s t o f i n d i c a t 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 h a v e b e e n a r y R e p o r t , d a t e d J u l y 1 5 , 2 0 1 4 f r o m a l o c a l e a p p e l l a n t ' s p r e s c r i p t i o n m e d i c i n e s , i n c l u d i n g i o d s , b e t w e e n J u l y 3 , 2 0 1 1 a n d S e p t e m b e r 7 , 8 , 2 0 1 4 . r y 2 8 , 2 0 1 4 , t h e s t a t e m e n t i n d i c a t e s t h a t t h e e t h a d o n e f o r p a i n m a n a g e m e n t , 2 7 p r e s c r i b e d b y 2 8 , 2 0 1 4 a n d 1 2 p r e s c r i b e d b y D r . B b e t w e e n , 2 0 1 1 t h e a p p e l l a n t w a s p r e s c r i b e d 2 4 0 o o c c a s i o n s , b y D r . C , a g e n e r a l p r a c t i t i o n e r i n
4) In Se c ti o n 3 of th e Reque s t for Recon si derati on, wrote t hat he is on di sab ility because of s e vere di f ferent pa in med ications over t he y e ar s an d has been takin g fo r a lo ng ti me. H e st ates that he has t add iction cli nic i n C ommuni t y B, be c a u se t he pre scrib ed i t fo r him , no longer ha s room f or th H e states th at p h ys ic ian B as k ed ph y si cia n A to conti nue taking met had o n e for pai n. In a n attac 2014, the appe l lant e xpla ins t hat he asked physic ind icat ing th at he is r ec eiving m etha done f or pain received this l etter. He sta te s tha t t he secret ar is o nly m and ate d t o pr e sc ribe metha done fo r addict physicians t hat can pre scri be metha do n e in t his b ecause his p re vious physi ci an n o longer prac i n h is n ew offi ce in Community C, th e app e ll a a ddi c ti ons clinics to r ec eive m etha done fo r pa As s et out in t he recons iderat ion d ecis ion , the mini stry refe rred to the ph y sicia n in C ommunity B, th i s physician Ph y si cians and Surg eons as a "s pe c ialist" a s d efined "gen era l prac tit io ner " , t heref o re he does not meet th e section 1 of S c hedu le C o f th e EAPW DR . The min istr appe ll ant is b ei ng treated f o r ad dic tion or pa in, h e does no not a ttending t he o ffice of t he neare s t s pecialis t. In hi s sig ned N otic e of Appeal the appel lant st ates t h sta tes, "The p r escri b i ng of methadone for pai n w as r H e ad ds t ha t no gen er a l p hysi cians in his t ow n hav e h e has to c ommute to receive the prescrip tion . The appell ant's evidence at the hearing included the following information: • The appe llant stated that he suffers chronic back pain and stenosis, has been taking different pain medi cations for 20 years and has found tha given him any relief. • The appellant explained that physici a ns require a specia m e t hadone and there are only two in his area qu and physician B , t he specialist that used to practice in Community B and treat the appellant but has since moved to a full time practice in Community C and d appellant in his practice. • The appellant states that prior to seeinq physician B, he had been treated by a qeneral EAAT 003(1 0/06/01) APP E AL# ! dat ed Sep tembe r 24, 2014, the app ellant chron ic pain a nd he has b een pres cribed man y me th a done is the o ne he is curr e nt ly takin g an d o receive th e medicat ion fr om an last ph ysic ian (B), in C ommun i ty B, th at e a ppe llant i n h is new practi ce, i n Comm unity C. acce pt him as a pa tient so th at he co u ld hed handwritte n l e tt er, dated S ep tembe r 8 , ian B' s office t o correctly rewr ite a let ter, , not opiate add iction, however he has n o t y e t y at phys ici an A's cl inic to l d him that thei r office io n. H e co ncludes tha t there a r e onl y t w o ar ea which makes h is o ptio ns very limit e d and tices in Comm u nity B and has n o r oom available n t t h erefore has to at tend the C ommunity B in. st ates that a l thoug h the ap pellan t h as bee n is no t r eg i stere d wit h th e C olle ge of in t he Medicare Protectio n A c t, b u t as a c r i t eria for n o n -lo c al t ra nsp ortation und er y furt her sta tes t hat it does not m a tter if the t meet the legis la ted criteri a b e c aus e he is a t he is r eceiving m e t h a done fo r pai n. H e efe rr ed b y a sp e c ialist t o a ge n er al p hysi cian." t he special lic ens e to prescribe m et had on e, s o t met had o n e is th e on ly treatment th at has l lice nse in order to prescribe al ified t o do so, physician A in Community B, , o es not ha v e room fo r the
I APPEAL# practitioner, physician C in Community Bin 2011, received methadone prescriptions and travel to these appointments were covered by ministry supplements. • The appellant states that since being denied his travel subsidy, he has still been making the monthly 90km trip because has to, but covering the costs himself is putting him in financial hardship. • The appellant states that the secretary for physician A asked him to sign a form so that their office could receive a $500 supplement provided by the ministry. Once he had done so, he realized that his travel costs were no longer being covered, so he requested the physician's office send back the supplement they received, particularly because he learned it was to be used to cover the costs of the addictions counsellor at the clinic, which he did not use because he was only being treated for pain. • The appellant stated that he had requested a copy of the referral letter that physician B wrote to physician A so that he could show the ministry that he had been referred by a specialist to receive methadone treatment for pain by physician A. He was informed by physician B's office that if the ministry required that information, they would have to request it. When the appellant contacted the ministry office to ask if they would request the letter, he was told that the ministry won't gather information on his behalf and it was his responsibility. • The appellant concluded that he is receiving methadone treatment for pain, not addiction and has done so for several years. He only changed from seeing physician B, the specialist, to physician A because he had been referred to do so and there are no other options in his area. He added that traveling to a different specialist would likely be many hours away over mountain passes, which would lead to much larger travel expenses and be extremely difficult and dangerous in the winter months. The ministry relied on the information within the reconsideration decision and otherwise submitted no new information. The ministry confirmed that in order to receive a supplement for transportation for medical treatment outside the appellant's local community, the treatment must be provided by a specialist as defined by the Medicare Protection Act and physician A is a general practitioner and therefore does not meet the legislated criteria. The ministry also stated that there may be some discretion for general practitioners who have received specialized training in pain management, however physician A has only provided a letter stating that he is treating the appellant for an addiction with methadone that inadvertently treats his pain. EAAT 003(1 0/06/01 )
P ART F -Reasons for Panel Dec i sion Th e issue on the appea l is whethe r the Ministry's dec appellant a medical t ransportation s upplem ent t o p ay p ractitioner in another community was reasonab l e , on leg isla tive criteria set ou t in the Employment and Assis ( EAPWDR) Sch e dule C , S e ction 2 (1 ) (f), because th the offic e of the neares t speciali st in the field of medicin receive a benef it un d er th e Medica r e Pr ote c t i on Act o The rele vant section of the EAPWDA is as follows: D i s ab ility ass i s ta nc e a n d su p plements Sec t i on 5 Subje ct to the regu l at ions, assis t ance or a suppleme nt to o r for a fa The relev an t sect i o ns o f the EA PW D R ar e as f o llo ws: General heal t h s u p ple ments 2 (1 ) T he fo ll owi ng are the health supp leme provid ed t o a fam il y u nit that is eli gibl su ppleme n ts] of this re gulati o n: (f ) the lea st expen sive ( i ) an office, i n the pr ac t it i o ne r ( ii ) the o ffice o f th m ed i cine or s ur gery if the per specialist in tha t fiel p ractitioner, (iii) t h e nearest suitable general hospital or rehabilitation hospital, as those facilities ar Hospital Insurance Act Regulations, or (iv) the nearest suitable hospital as defined in paragraph (e the definition of "hospital" in section 1 of the Hospital Insurance Act, provided that (v) th e tr ansportation benefit under the Medicare Protection Act or a general hospital service under the Hospital Insurance Act, and (vi) there are no resources available to the person's family unit to cover the cost. EAAT 003(10/06/01) I AP PEAL# i sion of September 11, 2014, to deny the for t r ips to atte nd app ointments with a gene r a l the basis that his requ es t did not m eet t he t an ce for Persons with Disabilities Reg ul at ion e appellant i s not attending an appoin t ment to e or surgery or to the nearest hospital to f a se rvice under the Hospital Insu ra n c e Act. the minist e r m a y pr o v ide d isabil ity mily u ni t that is e l igible f or it . n ts tha t m ay be pai d for by the mi nister if e under s e cti on 62 [ g enera l heal t h appropr i a te mo de o f tra n sportation to o r from local area , of a m edical pra ctitio ner or nurse e ne are st availa bl e sp eci alist in a field of s on has be en referred to a d by a local medical pr act itioner or nurse e defined in section 1.1 of the ) of is to enable the person to receive a
APPEAL# I Schedule C Health Supplements Definitions: S. 1 "specialist" means a medical practitioner recognized as a specialist in a field of medicine or surgery in accordance with the bylaws made by the board for the College of Physicians and Surgeons of British Columbia under section 19 (1) (k.3) and (k.4) of the Health Professions Act. EAAT 003( 10/06/01)
T h e a p p e l l a n t a r g u e s t h a t h e w a s r e f e r r e d t o p h y s i c i s p e c i a l i s t , p h y s i c i a n B w h o l e f t C o m m u n i t y B t o p r a c s p a c e f o r h i m i n h i s p r a c t i c e . H e a l s o s t a t e s t h a t t h e g e n e r a l p r a c t i t i o n e r ( p h y s i c i a n C ) i n t h e s a m e o f f i c e c i r c u m s t a n c e s h o u l d n o t b e h a n d l e d a n y d i f f e r e n t l y . t h a t h e w a s b e i n g t r e a t e d f o r a d d i c t i o n b e c a u s e t h e i f o r n o n a d d i c t i o n p u r p o s e s , e v e n t h o u g h h e o n l y r e c T h e m i n i s t r y ' s p o s i t i o n i s t h a t t h e a p p e l l a n t i s a t t e n d p r a c t i t i o n e r , w h o d e s p i t e b e i n g l i c e n s e d t o p r e s c r i b e M e d i c a r e P r o t e c t i o n A c t . P h y s i c i a n A i s l o c a t e d 9 0 k m s e c t i o n 2 ( 1 ) , t r a n s p o r t a t i o n t o a n o f f i c e o f a m e d i c a l o n l y f o r a n o f f i c e i n t h e l o c a l a r e a . T h e p a n e l f i n d s t h a t a l t h o u g h t h e a p p e l l a n t h a s e x p l a w a s r e f e r r e d t h e r e b y h i s p r e v i o u s s p e c i a l i s t a n d i t i s c o m m u n i t i e s t h a t c a n p r e s c r i b e m e t h a d o n e a n d h a s t h a t p h y s i c i a n A i s a g e n e r a l p r a c t i t i o n e r a n d n o t a s A c t . T h e r e f o r e , t h e p a n e l f i n d s t h a t t h e m i n i s t r y r e a s e l i g i b l e t o r e c e i v e a s u p p l e m e n t f o r t r a n s p o r t a t i o n t o a p p e l l a n t ' s r e q u e s t d i d n o t m e e t t h e c r i t e r i a o f E A P W C o n c l u s i o n I n c o n c l u s i o n , t h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s d e c i t r a v e l t o m e d i c a l a p p o i n t m e n t s b e c a u s e t h e p h y s i c i a s e c t i o n 2 o f t h e E A P W D R w a s r e a s o n a b l y s u p p o r t e d t h e l e g i s l a t i o n i n t h e c i r c u m s t a n c e s o f t h e a p p e l l a n t . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I a n A f o r m e t h a d o n e t r e a t m e n t b y h i s p r e v i o u s t i c e i n a d i f f e r e n t c o m m u n i t y a n d n o l o n g e r h a d m i n i s t r y c o v e r e d h i s t r a v e l c o s t s t o a t t e n d a i n 2 0 1 1 f o r t h e s a m e t r e a t m e n t , s o t h i s H e a r g u e s t h a t p h y s i c i a n A i n a c c u r a t e l y s t a t e d r o f f i c e i s n o t p e r m i t t e d t o p r e s c r i b e m e t h a d o n e e i v e s m e t h a d o n e t o m a n a g e h i s c h r o n i c p a i n . i n g a p p o i n t m e n t s w i t h p h y s i c i a n A , a g e n e r a l m e t h a d o n e , 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 b y t h e a w a y a n d a s s t a t e d i n E A P W D R S c h e d u l e C , 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 m a y b e p a i d i n e d t h a t h e i s a t t e n d i n g p h y s i c i a n A b e c a u s e h e t h e o n l y o f f i c e i n a n y o f t h e n e i g h b o u r i n g t h e s p a c e t o a c c e p t h i m a s a p a t i e n t , i t r e m a i n s p e c i a l i s t a s d e f i n e d b y t h e M e d i c a r e P r o t e c t i o n o n a b l y d e t e r m i n e d t h a t t h e a p p e l l a n t i s n o t t h e a p p o i n t m e n t s w i t h p h y s i c i a n A b e c a u s e t h e D R S c h e d u l e C s e c t i o n 2 . s i o n t o d e n y t h e a p p e l l a n t a t r a v e l s u p p l e m e n t t o n d i d n o t m e e t t h e c r i t e r i a u n d e r S c h e d u l e C b y t h e e v i d e n c e a n d a 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 p a n e l t h u s c o n f i r m s t h e m i n i s t r y ' s d e c i s i o n .
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.