‘LOW’ FEES FOR ASSISTED DYING UPSET DOCTORS

Doctors’ dilemma: New setup barely covers costs, and patients could struggle to gain right for help

A Vancouver Island doctor has stopped carrying out medically assisted deaths, citing a new provincial fee structure that’s so low that doctors are barely covering their costs.

The association overseeing physicians who provide assisted death fears more doctors could withdraw services if the fees are not changed, leaving seriously ill patients struggling to get access to a right affirmed by the Supreme Court of Canada.

For providing a medically assisted death, B.C. set a flat rate of $200 plus $113 for a home visit. There is no cap on the assessment time in Manitoba and Alberta.

Dr. Jesse Pewarchuk, a Victoria internal medicine specialist, has written a letter to colleagues stating: “Recent changes to the MSP physician fee schedule have made MAID [medical assistance in dying] economically untenable and I unfortunately can no longer justify including it in my practice.”

Pewarchuk, an early supporter of medically assisted dying, told the Times Colonist “it was an agonizing decision” to withdraw his services.

He said the inadequate Medical Services Plan fees “demonstrates a total lack of knowledge of what goes into this service, a lack of respect for those who are providing it and a blatant disregard for patients.”

Dr. Stephanie Green, president of the Canadian Association of MAID Assessors and Providers, said two more doctors have indicated they might stop taking patients for medically assisted dying if the compensation does not improve.

Green said she and two other doctors have restricted where they would go to perform an assisted death in order to avoid travel costs that the province does not cover.

“It’s just taking too much time for the lack of compensation,” she said.

Island Health said two physicians have asked to be removed from the MAID providers list in the last three months; one cited fees as the reason and one cited time constraints.

However, the number of doctors willing to provide medically-assisted dying continues to grow, with Island Health listing 21 physicians at the end of last month, up from 14 in March, said Island Health spokeswoman Meribeth Burton.

Vancouver Island has one of the highest rates of assisted dying in Canada, with 77 people choosing this way to die in 2016.

Fees for doctors are determined by the Ministry of Health and Doctors of B.C. The Medical Services Commission accepted a recommendation from a tariff committee, which includes representatives from Doctors of B.C.

Physicians in B.C. are paid $40 for every 15 minutes for a legally required assessment to determine if a patient meets the criteria for a medically assisted death. However, the first assessment is capped at 90 minutes and the second assessment is capped at 75 minutes, which Green said is a fraction of the time it takes to conduct a thorough assessment.

Green said it takes closer to three hours to have a face-to-face talk with the patient, to gather the patient’s medical records and to talk to family, psychiatrists and other doctors.

“It’s a matter of getting to know the patient, who they are, how they’ve lived their life, how they’ve come to this decision. It’s an in-depth, very intense, very intimate counselling session with the patient,” Green said. “This is not something you want to rush.”

Pewarchuk said the flat fee of $200 is inadequate to cover the time it takes to pick up the drugs from a pharmacy, answer questions from the patient and their family, confirm consent, prepare an IV, administer the drugs, provide aftercare for family and friends, and fill out paperwork to send to the coroner. Alberta pays physicians $205 per hour and covers their travel costs.

Dr. Trina Larson Soles, president of Doctors of B.C. acknowledged the challenges of coming up with a fee for an entirely new service, especially one as sensitive as assisted dying.

“I know this is a new procedure that’s unlike anything we’ve ever done before and it’s terribly stressful and it’s very difficult for both providers and families,” Larson Soles said.

“We absolutely support providers being paid for the work that they do, but as the Doctors of B.C. body, we work within a system that does things in a certain way.”

Larson Soles said the fees take effect in mid-July, but will be reviewed in three months to determine if they are adequate. “This is a process, it’s not a done deal.” Some doctors have applied for money from the Right to Die Society to cover travel costs.

The society’s president, Ruth von Fuchs, said the organization has donated about $11,000 to four doctors to complete long-distance trips so someone can die with dignity in their home.

Dr. Tanja Daws, a family doctor based in Courtenay, said she has performed 25 assisted deaths, most of which meant a financial loss to her practice when she takes into account the $60-an-hour it costs to run her office.

In March, Daws travelled to Quadra Island to perform an assisted death, which took her 5 12⁄ hours. She billed MSP $440 but she was told she would only be paid $171 for the 75 minutes she spent with the patient.

“I absolutely worked for a total loss that day,” Daws said.

She said there are serious consequences if doctors are forced to rush through assessments or medically assisted deaths because of poor pay.

“The consequences of us doing shoddy work is we can go to jail,” she said.