Island methadone medics set to close two of three clinics within 30 days

Minister of Health assures Expositor of continuity of care for patients

MANITOULIN—Opiate addiction doctors on Manitoulin (Dr. Dressler, providing service to the M’Chigeeng Health Centre and Northeastern Manitoulin Family Health Team, and Dr. Sankey, providing service through the Sunrise Clinic in Wikwemikong) have notified patients that they will be withdrawing services on the Island and have referred patients to their offices in Sudbury. This change has left Island health organizations scrambling to come up with solutions for patients, but the Minister of Health and Long Term Care Dr. Eric Hoskins has ensured a continuity of care for Manitoulin methadone patients.

“Our first priority is to ensure the 150 individuals (opiate addiction patients) are supported and their continuity of care,” Minister Hoskins told The Expositor during a Monday afternoon phone interview. “We are working with the communities and we are confident we are going to be able to provide support and make the transition as convenient as possible.”

“Wikwemikong has a new doctor (Dr. Koka) already working at their clinic in the community and M’Chigeeng is also in conversations with the same doctor and is hoping that he can provide the same service in their community,” continued Minister Hoskins. “Dr. Dressler has agreed to continue providing service in the community until November 20, as they work to find a replacement doctor.”

Effective November 5, the 26 patients of the Northeastern Manitoulin Family Health Team (FHT) will be accessing the services of Dr. Dressler at his Espanola clinic at the Espanola Family Health Team.

Espanola FHT Manager Jon Brunette confirmed that Dr. Dressler’s Northeastern Manitoulin FHT patients would be transferring to Dr. Dressler’s care at the Espanola FHT.

“He will be moving his clinics to Friday, which is a less busy day here, in order to mediate interference with our other patients,” said Mr. Brunette.

When asked if funding will be provided to assist individuals having to travel to Espanola or to the First Nation communities to provide a replacement doctor, the minister responded that he has asked his ministry to look into both.

“On October 1, 2015, changes were made to the Ontario Health Insurance Plan (OHIP) billing schedule,” states a press release from the FHT.  “This change affects physicians who are working in methadone clinics. Physicians saw their billable services revenue cut by roughly 30 percent. The consequence of this change is that smaller programs, with fewer than 50 patients, are no longer financially viable for stand-alone physicians, those not associated with a company.”

Manitoulin Health Centre Chief of Staff, Dr. Stephen Cooper, who is also the acting chair of the Rural Expert Panel of the Ontario Medical Association, further explained this change to The Expositor.

“The government has cut physician fees three times since 2012 alone,” explained Dr. Cooper. “This fall the government made the decision to make further cuts and chose specific areas, one of which was the fee for urine testing.”

He shared that with the classic doctor fee for service structure, doctors can bill OHIP for appointments with patients as well as urine tests.

Methadone patients are required to do urine screening from once a week to two times a week depending on the patient’s treatment and how long the patient has avoided illegal drugs.

Dr. Cooper said with the government cutting the costs of urine testing, clinics with low volumes such as in Little Current, where the doctor isn’t physically seeing patients as often (the doctor most typically meets with patients through teleconference), the urine testing was a main component in covering the rental space, staff and other operational costs of running the clinic.

“With their large clinics in Sudbury, doctors have other sources of income to make the clinic work,” said Dr. Cooper. “My argument is that the government is urban-based, and while maybe the cuts made sense in urban clinics, the MOHLTC didn’t think the idea through and its effect on rural practices and, in turn, patients.  The MOHLTC hasn’t been focused on rural medicine for the last 10 years. This is evident by the fact that they made a mistake and didn’t even realize they were making it in this case.”

Minister Hoskins argued that the urine testing fee change was an evidence-based change and that there are a number of other billable services that make practices viable.

“With private practice fee per service there are a number of services that physicians can bill for (through OHIP),” said Minister Hoskins. “When they meet with patients or assessments it can be anywhere from $30 up to $144. They also receive a monthly maintenance fee for each patient enrolled in their roster which is upwards of $30. They can also bill for counselling from $60 up to $100. We reviewed the fees for urine testing and found that it was too high and recommended a reasonable change from $29 to $15.”

“The change was never intended to drive the financial aspect (of methadone practices),” added Minister Hoskins. “Frontline physicians, including physicians in the North and rural areas throughout the province, through a combination of fee structures, are adequately compensated. As evidence by Dr. Koka taking over services in Wikwemikong, the model is still viable.”

“Dr. Koka started seeing patients on Tuesday, October 27,” said Wikwemikong Chief Duke Peltier. “He is transitioning patient care to his practice at the clinic in Wikwemikong. Addiction services are still be provided in the same building, the only change is the physician.”

“Dr. Sankey provided notice on October 5 verbally and in writing on October 8 to patients that he would suspending operations in Wikwemikong on October 30 due to cutbacks from the ministry of health effective October 1,” continued Chief Peltier. “We were forced to seek out alternative care for our clients. We were lucky to find an alternative physician in time. We are happy that we are able to keep our families together and our members in the community.”

Representatives from the FHT, M’Chigeeng Health Services and Wikwemikong Health Services met last Friday to discuss the gap in methadone services now on Manitoulin and look at options.

“Our capacity to deliver care is already strained on Manitoulin Island; this will further negatively impact this reality,” stated the FHT press release. “Limiting patient access goes against the stated priority of the LHIN as well as that of the Ministry of Health and Long Term Care. This most certainly applies to the Island-wide philosophy held by our collective team of health providers. Patients will be forced to endure limited or no access to needed methadone treatment and, for lack of a realistic option, they will abandon their treatment resulting in withdrawal and unnecessary psychosocial stress. Regretfully, due to unilateral and unduly hasty revisions undertaken by the Ministry of Health, in the absence of any community consultation, particularly rurally, we are currently unable to give methadone clients any viable treatment options.”

Though solutions have now been reached for Wikwemikong patients and temporarily for FHT patients now forced to travel to Espanola and hopefully for M’Chigeeng patients, all parties agree that a long-term plan needs to created.

“This is an opportunity to look at how effective care can be delivered,” said Minister Hoskins. “We can look at how we can work together to develop a better approach. The ministry’s primary health team and the Local Health Integration Network (LHIN) is committed to finding a solution through consultation.”

Grand Council Chief of the Anishinabek Nation Patrick Madahbee told The Expositor he spoke with Minister Hoskins on behalf of all (methadone) patients on Manitoulin and that it was a positive conversation.

“He has assured myself and Chief Isadore Day (Ontario Regional Chief) continuum of care for patients for the next three months or longer and will be giving the issue top priority,” said Chief Madahbee. “We have called up frontline workers on Manitoulin and will be creating a working group with the Union of Ontario Indians Health Team to brainstorm a long-term solution. We have also been on the phone with Health Canada looking at funding to help with transportation costs. We will also be working with the federal and provincial governments on this matter, as well as looking into the matter across Ontario, seeing if any other areas in the province have been affected.”

Northeastern Manitoulin FHT Director Judy Miller said that she learned of nine other family health teams dealing with methadone program closures due to the fee cut change after sending a request out to her colleagues. Minister Hoskins said he was not aware of any other similar methadone clinic closures.

The Expositor will continue to follow this transition and negotiations to develop a long-term solution for opiate addiction patients on Manitoulin.