Immigrant teen fighting cancer faces OHIP red tape
18-year-old needs surgery but coverage won’t start for weeks and appeal to reduce wait denied
Roman Orlov needs urgent surgery to remove the cancerous tumours in his abdomen, but the 18-year-old newcomer must wait until Sept. 13 to get OHIP coverage for the operation.
In a decision issued this month, a provincial tribunal rejected an appeal by Orlov’s family to waive the threemonth wait for OHIP in order for the Ukrainian teen to get the treatment he requires for an aggressive metastatic Ewing’s sarcoma, a rare cancer that usually affects people between the ages of 10 and 20.
“Our big concern is any delay in treating his cancer is going to compromise Roman’s health and recovery,” said Orlov’s stepfather, Pavel Kozakevich, a Canadian citizen who flew his wife, Tetiana, and her son to Canada as visitors last October and submitted their permanent residence application here in February.
Critics warn that delayed treatment can worsen and complicate a patient’s health and could end up costing the system more money later on, when the provincial insurance coverage kicks in after three months. Ontario, Quebec and British Columbia are the only provinces with such a requirement.
“Everyone living in the province should have access to health care,” said Nisha Kansal of OHIP for All, a grassroots advocacy group, which estimates at least 500,000 Ontarians are without OHIP due to their immigration status.
Orlov started to have blood in his urine and suffer serious pain in his upper back about a month after his arrival. A walkin clinic sent him to the Mackenzie Richmond Hill Hospital, where doctors in December had to remove his right kidney, which had grown to twice the normal size due to the cancer.
With the generosity of the physician and community fundraising, the family had to pay only half of the $16,000 in surgical expenses out of their own pockets. In April, Orlov got sick again as his cancer had now spread to his liver, bowel, the remaining kidney and throughout his abdomen. Chemotherapy treatment ensued. Including other care costs, the family has since accumulated a $22,000 medical bill.
The Richmond Hill family doesn’t know how much the upcoming surgery will cost until doctors can conduct a thorough assessment, which will take place when Orlov’s OHIP kicks in. In the meantime, treatment has been kept to a minimum.
Kozakevich said he applied for OHIP for his wife and stepson as soon as they passed the first stage of their permanent residence application on June 13. Although by law they knew Orlov must wait three months — until Sept. 13 — to get his health insurance coverage, the family decided to ask OHIP to reduce or waive the waiting time.
OHIP rejected the request and the family took the case to the Health Services Appeal and Review Board, which upheld the effective date for Orlov’s health coverage as Sept. 13, saying the law does not give OHIP or the board the power to make exemptions on the basis of compassion or financial hardship.
“It was apparent to the appeal board that the appellant is gravely ill and that any delay to his treatment could have serious consequences. It was also apparent that the appellant’s family is struggling to pay for the cost of the appellant’s treatment,” the tribunal said in its decision on Aug. 10.
“This is undoubtedly a very difficult and potentially tragic situation and the appeal board would express its hope that something can be done to provide the appellant with the care that he so urgently requires.”
Orlov’s physician Dr. Abha Gupta said care providers have not offered procedures such as a bone scan, bilateral bone marrow biopsies and echocardiogram to the teen because of the cost and his lack of OHIP coverage.
They have also limited the total number of doses of grastofil, a medication that helps the bone marrow produce white blood cells to fight infection, due to the cost.
As a result, Orlov has to go in and out of hospital to be treated for fevers.
“Not having OHIP has already made substantial compromises to his treatment such that he is not receiving the treatment for Ewing’s sarcoma that is considered standard of care throughout North America,” said Gup- ta, an oncologist at the Hospital for Sick Children.
“This man is very young, only 18 years old, with a potentially curable disease, but will need very aggressive, timely intervention in order to offer him this chance.”
Orlov has lost 20 pounds since he started chemotherapy in mid-May and says he is in constant pain and must struggle with the side-effects of the treatment.
“I have lost my appetite and must force myself to eat to keep my weight from falling,” said Orlov, who, at five foot eight, weighs only 110 pounds. He says he is hopeful he will win his health battle with the support of his parents and looks forward to returning to school soon to study psychology.
Perry Brodkin, who has practised medical law for more than 40 years and was a lawyer for OHIP, said there have been hundreds of failed appeals similar to Orlov’s since 1994, when Ontario started requiring new immigrants and returning Canadians to wait three months after their arrival in the province for their health coverage.
When contacted by the Star, the Ministry of Health said it would look into Orlov’s case, but was unable to comment on the tribunal decision on Monday.
Brodkin said the province should review the policy and decide whether to give the appeal tribunal power to grant exemptions to the waiting period or simply scrap the “useless” appeal process to redirect savings to front-line health care.
Kozakevich, who has been forced to reduce his work as an engineer to part-time hours to care for his family, said he is grateful friends and supporters have set up an online fundraising campaign, which so far has collected $6,000 to help cover Orlov’s medical bills.