TRUE TO THEIR OATH

Doctors Take Action Against Cuts To Refugee Health Care

Melanie Spence

Nights are busy at the Scarborough Volunteer Clinic for Medically Uninsured Immigrants and Refugees. “We’ve had a crazy time,” says clinic director and family physician Dr. Paul Caulford. “Our numbers are growing dramatically.”

Caulford opened the Scarborough free clinic in May 2000 in response to the large number of immigrants and refugees living and working in the area without access to public health care. As a result of new cuts to the Interim Federal Health Program (IFH) – Canada’s health insurance program for refugees – refugees are visiting the clinic in record numbers and are “in dire straits,” Caulford explained. “It’s almost like they are being bullied.”

The cuts, which were announced on April 25 and came into effect on June 30, restrict most health care services to “government-assisted” refugees – those referred by the United Nations for resettlement in Canada – who account for only a quarter of all refugees living here today.

Angry over the “abusive” cuts, Caulford started a blog called Refugee Diaries. Among the many entries is one documenting the story of a young woman who arrived at the clinic 35 weeks pregnant with severe abdominal pain. One week earlier, she had been surprised to learn from her obstetrician’s office that her IFH had been cancelled. “She was informed that to see her obstetrician she would now have to pay $130 per visit. And then there was the delivery and hospital costs. She stayed at home with her pain, unable to pay the $130. She then came to our clinic.”

Anticipating situations precisely like this one, Caulford joined a contingent of 90 physicians on May 11 to protest the cuts at federal cabinet minister Joe Oliver’s office in Toronto. Many of them crammed into Oliver’s office and stayed until the story made headlines.

For Caulford, protesting was a new experience. “When I was on the street I thought, what the hell am I doing here? I’ve never been out doing this.” He’s hardly alone. Physicians, nurses, dentists, optometrists, psychiatrists, social workers, midwives and occupational therapists have joined migrant justice advocates in an unprecedented mobilization to protect refugee health care services.

On June 18, more than 2,000 health providers demonstrated in 14 cities as part of a National Day of Action against the cuts. On July 5, a Montreal-based alliance of healthcare workers and migrant justice activists, the Health Justice Collective, launched a non-cooperation campaign called “We Refuse to Cooperate.” On July 15, Toronto-based migrant and health provider collective Health for All and refugee rights group No One Is Illegal joined the campaign, inviting health providers to publicly refuse to comply with the cuts.

Some have heeded the call. On August 21, the Toronto Star reported that Dr. David Wong, eye surgeon at St. Michael’s Hospital, refused to turn away and was thus able to save the vision of refugee claimant Daniel Garcia Rodriguez. In similar form, health providers across the country are interrupting government press conferences and public meetings to speak out – actions that Dr. Philip Berger, Chief of Family and Community Medicine at St Michael’s Hospital, promises will continue in an “unpredictable, periodic and indefinite fashion” until the cuts are rescinded.

Before the cuts, refugee health care coverage was similar to that which low-income Canadians receive through provincial/territorial health insurance plans: basic benefits such as physician and hospital visits and supplemental services including vision and dental care. As initially proposed, the IFH cuts restricted health coverage to urgent care, and for medications when deemed necessary to protect public health or safety.

Citizenship and Immigration Canada (CIC) claims the cuts are a necessary cost-saving measure that will ensure fairness for taxpayers. Government spokesperson Ana Curic alleges that Canadians “do not want illegal immigrants and bogus refugee claimants receiving gold-plated health care benefits that are better than Canadian taxpayers receive.” However, according to the new and growing group Canadian Doctors for Refugee Care, the projected savings of $100 million over the next 5 years doesn’t account for increased emergency care costs that will arise from untreated illness.

Physicians are critical not only of how much these cuts will hurt an already vulnerable social group, but also of new billing procedures that are confusing providers and deterring refugees from seeking care. “We are now asked to request preauthorization for patients before providing care,” explains Dr. Tarek Loubani, who works at a refugee clinic in London, Ontario. “The idea that the care I provide should be in any way contingent on what an insurance bureaucrat approves is abhorrent.” Most of all, says Caulford, “we’re being put at odds with our professional responsibilities.”

For these reasons, national medical organizations representing all practicing physicians in the country – the Royal College of Family Physicians and Surgeons of Canada, College of Family Physicians of Canada, and Canadian Medical Association – officially support the campaign against the cuts. The CMA and CFPC have requested but not yet been granted a meeting with CIC Minister Jason Kenney. In addition, Canadian Doctors for Refugee Care is documenting the cuts’ impacts through a cross-country survey.

The mobilization is expanding traditional notions of patient advocacy. In particular, health providers and migrant justice advocates are “inspiring each other and coordinating together,” explains Health for All member Nanky Rai. Pressure from these new coalitions led CIC to change their website on June 29, so it now indicates that government-assisted refugees are eligible for basic and supplemental health care services. Further website revisions in July state that protected persons and some refugee claimants are eligible for basic health care.

Although CIC said the revisions were undertaken to “clarify” the cuts, it’s difficult to contest the influence of health providers’ campaigning. “I’ve been practicing for 20 years and have never seen anything like it,” reflects Dr. Meb Rashid, physician and director of the Crossroads Clinic serving newly arrived refugees at Women’s College Hospital in Toronto. And the momentum seems to be growing. The July issue of Canadian Family Physician features a call to action from a group of physicians who claim “responsibility to use our expertise and influence to advance the health and well-being of individual patients, communities and populations.”

This response is encouraging for people concerned about broader CIC policy changes, such as the recent omnibus Bill C-31 that mandates detention for “irregularly arriving” refugees. Next on the watch-list for migrant justice advocates is the Designated Countries of Origin (DCO) policy, which will permit CIC to expedite processing – and therefore rejection – of refugee claimants from any country that the Conservative government deems adequately safe. Not only does the DCO policy dramatically understate the complex social divisions within countries that produce refugees to Canada, but when the policy comes into effect (likely before the end of the year) DCO claimants will be ineligible for all health care, except in the instance of a perceived threat to public health or safety.

In this context, many physicians have vowed to fight the cuts. “It felt right to stand with my colleagues,” reflected Caulford on his new involvement in political protest. “I needed to be part of this. I’m not finished yet.”

Melanie Spence is a Toronto-based writer and activist focusing on issues of health and social justice.