The Newfoundland and Labrador Medical Association (NLMA) says it deserves more than a phone call the day before changes are made if the provincial government is looking to tinker with the health-care system.
That’s exactly what happened on Feb. 28, when the Department of Health and Community Services contacted the NLMA by phone and said laser treatment for vascular skin lesions will no longer be covered by MCP as of the following day, March 1.
“This decision was made without consultation with the NLMA and with less than 24 hours notice to the province’s dermatologists and their patients,” said Dr. Sandra Luscombe, past-president of the NLMA.
Dr. Ian Landells, a dermatologist, was bluntly critical of the government’s decision.
“The only issue we have is that this is being done without consulting any of the medical experts (or) any of the physicians who are involved in these procedures,” said Landells, who operates a laser treatment clinic based in St. John’s.
“They are consulting people within their own ranks who really have very little understanding of what they’re doing, and the patients, the people of Newfoundland, are paying the price.”
Vascular skin lesions, described as highly visible blood vessels, are known to be associated with rosacea, lupus, Rendu-Osler-Weber syndrome, and CRST syndrome. Landells said this province has some of the highest rates for rosacea in North America.
“I do also think that they are taking away a service that is important for many, many people, and that we could have perhaps discussed this with them and looked at ways to decrease the use of laser and to look at specific cases where it would be indicated,” said Landells, who added thousands of patients will be affected by the change.
Port-wine stains — also known as nevus flammeus — will remain covered by MCP, though laser treatment will require prior approval.
This news comes not long after the Newfoundland and Labrador Dental Association raised concerns about changes to the province’s adult dental program. It said the province did not consult with the association on changes made by the Department of Health and Community Services to cap levels for the program.
Luscombe said the NLMA shares those concerns, noting patients without access to adequate dental care may end up in emergency rooms at hospitals.
While those who can afford laser treatment for vascular skin lesions will be able to successfully seek it, Luscombe said the move by the government to eliminate MCP coverage for the procedure will prove detrimental to patients without the means to pay for the procedure.
“These decisions may save the province some money, but these savings have a negative impact on a very vulnerable population already facing barriers to accessing medical care.”
The NLMA had initially scheduled a news conference for Wednesday to discusss the matter, but chose to postpone it after an official with the Department of Health contacted the organization and said Health Minister Susan Sullivan was willing to meet with the group.
That discussion took place Thursday morning. According to Luscombe, that was the minister’s first meeting with the NLMA since June 2012. The NLMA had previously requested a meeting with the minister in January to discuss sustainability in the health-care system. That meeting did not happen.
At Thursday’s meeting, Luscombe said the health minister was receptive to the NLMA’s concerns and committed to consulting with the association on future MCP changes the government may be considering.
From speaking with the minister, Luscombe got the impression the government was dealing with time constraints in making this decision.
Landells said the government acknowledged during the meeting that the change was not handled properly.
“I doubt very much if they’re going to bring this fee code back as a result of this,” he said. “However, they did acknowledge that it was handled improperly, because not only were we not consulted, we were given no notification. We had to scramble to notify our patients that those coming the next day or three days later may potentially not be covered for their services. They may have travelled a long distance across the province to attend that appointment, solely for that purpose, and they would not be covered.”
Any patient who received one-to-three treatments since the beginning of last September will be eligible to get MCP coverage for up to three more treatments between now and the end of May, depending on how many they have already undergone.
Speaking with reporters at the House of Assembly after question period, Sullivan noted that laser treatment for vascular skin lesions is not covered by any other provincial health-care plan in the country. She said if the treatment is deemed to be medically necessary, MCP will cover it.
Sullivan said she values the input of professional associations, but added there are times when the government needs to take charge in matters.
“However, there are times when government has the latitude to make a decision, and government has to govern. And in this time of fiscal restraint, there are times when we make decisions based on the best information that we have and based on the time limitations that we have as well."
Focusing on the upcoming provincial budget, Sullivan said the province needs to make sure the cost of health care does not exceed 40 per cent of the full budget amount. The province currently spends almost $3 billion annually on health care.
While the NLMA has no problem working with the province to find ways to make health care sustainable, Luscombe cautioned that solutions must never come at the expense of patient care.
Asked whether she expects other services currently covered by MCP will be de-listed in the near future, Luscombe said there will be lots of cuts in many areas.
“I would think that the government would want to look at some other services, but the government is always looking at services with us. We’re more than willing to look at those services in the best interest of the patient.”