Questions raised around who can access Alberta’s out-of-country health care funding

Tamara Polo lived a full and busy life, balancing a successful career with raising three young children. But that all came to halt when she was hit as a pedestrian in a parking lot in September of 2023, seriously injuring her entire spine.

“As soon as I get upright and my spine is loaded with the weather of my head, I’m instantly ill and have to lay back down,” describes Polo. “I’m sitting on the sidelines of my three beautiful children’s and a husband’s life waiting for access to care.”

Polo’s search for medical care has been long and extensive. After exhausting her options in Canada and being told there was nothing that could be done to improve her quality of life, she expanded her search to include international options, going for consultations with neurosurgeons in Spain and the United States.

“I saw three doctors,” says Polo. “All three doctors conclusively said that every vertebra in my neck was damaged.”

Upright imaging available internationally allowed doctors to see the full extent of the damage to Polo’s spine while it was under pressure of her head and gravity and was diagnosed with cervical instability, a condition where there is significant movement between the vertebrae in the neck compromising spinal stability.

A diagnosis is not available in Canada because the vertical imaging technology is not offered north of the border.

Initially, Polo underwent an occipitocervical fusion (C0-C2) to stabilize the skull and the first cervical vertebrae, crowdsourcing to cover the out of country costs. But she says it became clear shortly after that surgery that her injuries were far more extensive than originally thought. She learned she would need a complete reconstruction with rods and screws from her skull to upper back to stabilize her spine.

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“For me to have a chance at being healthy for my children, to me, that is a medical necessity,” says Polo.

Polo applied for funding to cover the operation through the Out of Country Health Services Committee (OOCHSC), a program set up to evaluate applications eligible for insured coverage under the Alberta Health Care Insurance Plan.

Polo’s application, and appeal, were both denied.

“The reason for denial is because I don’t meet the criteria,” explains Polo. “The criteria requires an in-country diagnosis, but the system itself is unable to produce the diagnosis.”

Polo isn’t the only Albertan struggling to access funding through the program.

Samantha Lieskovsky is in the process of appealing an OOCHSC decision denying funding for treatment for her two-year-old daughter Myla’s rare vascular condition. Since sharing her story with Global News, Lieskovsky says she’s been overwhelmed with the number of Canadians reaching out with their own, similar stories.

“They are all around the same themes,” says Lieskovsky. “Barriers, delays, and policies that are not working to help families get care.”

Lieskovsky calls the eligibility criteria for OOCHSC funding restrictive and too limited in its scope, forcing families to take on added responsibilities at an already stressful time.

“(Families) are being forced to become advocates, and fundraisers, and voicing all of this when we should be able to just focus on the medical side of it.”

But experts say the committee is operating within its guidelines, and any changes have to come from the government.

“The members of the committee have the right to consult with specialists, but they are going to stay right in the middle of that lane and swim exactly where they have been told they are going to swim,” says Myles Leslie with the University of Calgary’s School of Public Policy. “Which means you want to start talking to the people who set up the lanes.”

Leslie says conversations about what is and is not covered through the OOCHSC have to take into account Canada’s universal health care, and the confines of that system. However, Leslie adds it’s important for regulations to be able to adapt, especially when dealing with topics like health care that are rapidly evolving.

“When we start to have the political discussion about expanding the basket of services, the basket of things available to everybody, we’re going to have to make some choices about things that are not available to everybody,” explains Leslie.

The Ministry of Primary and Preventative Health Services says it “recognizes how difficult these situations are for patients and families, especially when they are facing extremely rare and complex conditions,” adding it takes “these concerns seriously and understands the importance of ensuring Albertans can access the care they need.”

The province says regulation of the out-of-country health services process was established nearly two decades ago.

A statement to Global News reads, in part, “since then, patient needs have grown more complex and medical treatments and technologies have advanced significantly. That is why we have launched a review of the program and are actively assessing whether changes are needed to better meet the needs of Albertans and reflect advancements in care.”

But until those changes come, Polo is confined to her bed, missing milestones as her children grow up.

Her only option is to turn to friends and family for help, launching a GoFundMe to raise the money needed to travel to the United States for the life-changing surgery.

“When the criteria is so narrow and so restrictive that it leaves a mother in their bed with three children, it is definitely time for use to have a look at the criteria,” says Polo.

“Canadians do not own my health care, the government owns my health care.”

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