개인클리닉에서 한 환자의 보호자 출입금지 내려
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위니펙 남부에 있는 개인 클리닉(private clinic)인 레이크우드 메디칼 센터(Lakewood Medical Centre)는 진료예약을 하고 약속을 지키지 않은 한 환자의 보호자와 분쟁끝에 예약취소 벌금(cancellation fee) $120 을 포기하는 대신 환자의 보호자가 클리닉에 출입하는 것을 금지했습니다.
수잔(Suzanne Macduff)
레이크우드 메디칼 센터(Lakewood Medical Centre)와 분쟁을 일으킨 환자의 보호자는 수잔(Suzanne Macduff)으로 치매를 앓고 있는 90대의 어머니가 아파서 병원에 못가게 되자 진료예약 1시간전에 취소를 했는데 병원 예약담당자(receptionist)는 진료시간 전에 취소전화를 했어도 24시간전에 예약을 취소해야 한다는 클리닉 내규때문에 $120 벌금을 내야 한다고 말했습니다.
그리고 아무 연락도 없이 몇 달이 지난 후 어머니를 모시고 그 클리닉에 갔는데, 클리닉의 의사가 밀린 벌금 $120을 내지않으면 진료를 할 수 없다고 진료를 거부해서 그곳에서 45분간 설전을 벌였고, 불편사항을 WRHA(위니펙지역 보건당국)에 신고하여 그 내용이 신문에 나갔습니다.
클리닉은 다시 수잔(Suzanne Macduff)하고 의견을 조율하여 벌금을 $60로 감액하여 주었으나, 계속 분쟁이 있어서 결국 벌금을 안받는 대신 수잔(Suzanne Macduff)이 병원에 출입하는 것을 금했습니다. 그리고 클리닉은 수잔의 90대 어머니는 수잔말고 병원에 같이 올 다른 사람을 찾아야 할 것이라고 말했습니다. 수잔은 어머니 곁에 자기말고는 다른 자식이나 친척이 없다고 이 조치에 대하여 부당다고 호소했습니다.
병원에 따르면, 24시간안에 예약을 취소하지 않으면 일반예약(regular appointment )은 벌금 $60, 그외 complete physical/counselling/specialist 예약은 벌금 $120 을 받고 있으며, 전문의(specialist)의 경우 매니토바 주정부에 많게는 $200 을 진료비로 청구한다고 합니다. 또한 24시간전에 예약을 취소하면 다른 환자를 받을 수 있는 것도 한 이유라고 합니다.
이상 위니펙 프리 프레스 기사 요약함.
좀 돈이 나가게 되서 억울하게 되었지만 규정에서 벗어났으니 수긍하는 차원에서 원래 벌금 $120 대신 깍아준 벌금 $60 을 내고 병원과 타협하여 잘 지내면 될 것을 왜그리 억지(?)를 쓰는지... 그런 것이 억울하면 개인 클리닉(private clinic)이 아닌 퍼블린 클리닉(public clinic)에 다니면 될 것을...
우리 교민분들중에 그런 사람은 없기를 바랍니다. 이곳 캐나다문화가 예약문화여서 개인집을 방문하든 회사를 방문하여 특정 사람을 만나려면 사전에 예약을 하는 것이 예의이고 관례입니다. 일반 상점이 아닌 개인 집을 연락없이 방문하는 것은 무례한 일이 될 수 있고 이번 신문에 실린 기사처럼 예약을 하고 안가는 것은 예의에 어긋날 뿐더러 클리닉 이용내규에도 어긋납니다.
가정의(Family Doctor)가 있는 개인 클리닉들은 대부분 예약취소를 24시간안에 안하면 벌금이 있으니 가정의가 있는, 자주 가는 클리닉의 예약내규를 알아보시길 바랍니다. 그리고 개인적인 일이든 비즈니스적 일이든 예약후 못가게 되면 반드시 예약취소를 하시는 습관을 가지시길 바랍니다.
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다음은 지난 몇 주 동안 올라온 위니펙 프리 프레스 신문 기사입니다. 참고하세요.
Private clinic bans patient after fee tiff
A south Winnipeg clinic has banned a woman who recently criticized its policy of charging patients after her elderly mother was turned away due to an unpaid cancellation fee.
Suzanne Macduff said she has been barred from Lakewood Medical Centre just two weeks after she fought the clinic over its refusal to waive a $120 fee billed to her mother, who is in her 90s and suffering from dementia.
Last week, Macduff said her mother got a letter from the clinic's manager saying they will waive her previous "no-show fee" but she must book her own medical appointments and find someone other than her daughter to accompany her to the clinic. The letter, dated Aug. 30, states Macduff is "no longer allowed to attend Lakewood Medical Centre."
Macduff said the clinic is punishing her for speaking out against its policy of charging for missed appointments.
Clinic manager Daisy Michasiw sent an email to the Free Press saying the patient in question was discharged after she violated the clinic's policy prohibiting violent or abusive patients and visitors. Michasiw's statement said "she was well aware of our clinic policies and was in clear violation," and was unable to elaborate further due to privacy concerns.
Macduff denies being violent or abusive, and said "I just spoke up on my mother's behalf."
Two weeks ago, staff at Lakewood refused to let Macduff's mother see a physician due to an unpaid fee from a previously cancelled appointment her mother was too ill to attend. Macduff claimed she wasn't told about the hefty fee when she first booked the appointment and thought the clinic would waive it due to her mother's worsening dementia.
The issue ignited a debate over the ethics of charging patients, and prompted the College of Physicians and Surgeons of Manitoba to remind doctors to consider the circumstances and the patient's ability to pay before issuing a penalty fee.
"I'm being punished. I acted as an advocate for my mother and now I'm being denied access to my own doctor at the clinic," Macduff said, noting her family doctor also practises at Lakewood. "There are no other children, I am the only child. There are no other cousins or friends who are going to phone and book their appointments."
Macduff called the situation "ludicrous." She filed a second complaint against the clinic with the College of Physicians and Surgeons of Manitoba. College deputy registrar Dr. Terry Babick said he thinks the clinic acted appropriately by waiving the cancellation fee, but could be struggling over how staff felt about the disagreement with Macduff. He said private clinics must have a good reason for banning people.
"It would be optimal, I think, if there could be some form of resolution and mutual respect so as not to interfere with the provision of care for this lady," Babick said.
Use cancellation fees with care, MDs warned
Service denied over missed appointment
No Manitoban should be denied medical care because of one missed appointment, says the regulator of the province's physicians.
Manitoba's College of Physicians and Surgeons deputy registrar Dr. Terry Babick said doctors can charge patients a fee for missing appointments, but are expected to consider why the patient was unable to attend and "act reasonably." Babick said there is a difference between a no-show and a cancellation, and physicians must carefully review and consider the patient's ability to pay before they issue a penalty fee.
The Free Press reported Thursday that staff at Lakewood Medical Centre refused to let Suzanne Macduff's elderly mother see a physician due to an unpaid $120 fee from a previously cancelled appointment. Macduff phoned to cancel her mother's appointment with a specialist last week because her mother, who is in her nineties and suffering from dementia, was too ill to attend. She said she wasn't told of the hefty fee when she first booked the appointment and thought the clinic would waive it due to her mother's condition.
She was shocked when clinic staff refused to let mother see her family doctor this week until the fee was paid.
Macduff said she has lodged a formal complaint with the college.
The college will not comment on the case or confirm if they are investigating the complaint, due to privacy.
"Illness, I think, is different than 'I just forgot' and 'I just forgot once' is different than 'I forgot for the fifth time,' which is different from 'It's not convenient for me so I'm not coming,'" Babick said. "At the end of the day, we expect physicians to look at each circumstance and react reasonably.
"The college would expect that a patient would not be denied care because of an isolated missed appointment."
Macduff's case has ignited a debate about the ethics of billing patients who don't show up or cancel medical appointments. Fees are not regulated, and physicians must use discretion and advise patients in advance of any penalties for missed appointments and how much notice they need to give to avoid a charge.
Babick called the issue a "dilemma," saying there are patients who frequently miss appointments and fees are meant to compensate for a physician's lost time. However, he said doctors should understand when unexpected illnesses or emergencies surface.
"We would expect a physician who deals with sick people all the time to understand that a patient couldn't make it that day because they were ill," Babick said.
University of Manitoba medical ethicist Arthur Schafer said patients shouldn't be slapped with a fee for missing appointments.
"The whole policy is going to hit people who are poor or have modest means much more than people who live in Tuxedo, where the doctors live," said Schafer. "That's a lot of money for many people and contradicts the philosophy and spirit of medicare which is free access."
Schafer said the college should scrap its policy and the clinic should apologize to Macduff's mother and her family.
Lakewood Medical director Dr. Taras Gwozdecki previously said the fees collected are donated to charity and missed appointments increase wait times, and "rob other needy patients" of physician time.
Two former clinic employees contacted the Free Press to allege the fees collected did not go to charity. Gwozdecki has not responded to clarify which charity the money went toward and how much the clinic collects annually in missed appointment fees.
Care denied after fee not paid
Woman unable to see doctor thanks to outstanding cancellation charge
A local woman plans to file a formal complaint against a south Winnipeg medical clinic that refused to let her elderly mother see a doctor due to an unpaid $120 fee she was charged for cancelling a previous appointment.
Suzanne Macduff said she was forced to cancel her mother's appointment with a specialist at the Lakewood Medical Centre last week because her mother was too ill to attend. Macduff said her mother, in her 90s and suffering from dementia, didn't feel well enough that day to see a gynecologist over concerns her cancer has spread.
"She called me three times, very confused," Macduff said. "(My mother) didn't know why she had to go, she didn't feel well enough to go, she got all teary-eyed and upset."
Macduff phoned the clinic two hours before the scheduled appointment and said a receptionist told her she would have to pay a $120 cancellation fee. She said she wasn't informed of the cancellation charge when she first booked the appointment and she asked to speak to a supervisor about the "hefty fee."
Macduff thought the clinic would waive the fee due to her mother's worsening dementia, but a receptionist told her she had to pay.
Macduff said she never received a bill, and took her mother back to the clinic on Tuesday to see her family physician. Macduff said she was shocked when clinic staff said her mother couldn't see a doctor until the $120 fee was paid.
Macduff called the fee "ridiculous" and said both her parents are elderly pensioners on a limited income.
She said the clinic offered to cut the fee to $60, but told her her mother can't see the doctor until the bill is paid.
"She never got to see her doctor, they refused to let her see the doctor," Macduff said, noting she and her mother waited 45 minutes in the waiting room trying to resolve the issue.
"It's not like she just didn't feel like going or she is a slacker. When my parents have appointments, they go to them. That's how they were brought up. It was a bad day -- Alzheimer's (patients) have good days and bad days."
Macduff said her mother had previously never missed a medical appointment.
Macduff plans to file a formal complaint against the clinic with the College of Physicians and Surgeons of Manitoba.
The Lakewood Medical Centre's website says the clinic will charge $60 for missing a regular appointment and $120 for missing an appointment for a complete physical, counselling or to see a specialist. It says the fees apply to "appointments which are missed or not cancelled 24 hours in advance."
Dr. Taras Gwozdecki, director of Lakewood Medical, sent an email to the Free Press saying clinics are allowed to charge no-show fees because patients who miss appointments "increase wait times and rob other needy patients of valuable appointment time."
He said a specialist appointment can be billed to Manitoba Health for as much as $200, and a fee of $120 is "not only reasonable, but less than what could have been billed for the appointment."
Gwozdecki said the amount assessed for this particular patient was $60 and all no-show fees Lakewood collects are donated to charity.
The College of Physicians and Surgeons of Manitoba doesn't regulate how much doctors can charge for missed appointments, but a spokeswoman confirmed doctors must advise patients in advance of any penalties for non-attendance and should "consider both the nature of the service provided and the ability of the patient to pay" before fees are charged.
Macduff said her mother has many medical conditions and her dementia has recently become more severe. Macduff said when she picked her mother up to take her to the clinic this week "she didn't know who I was."
"Given the circumstances of my mother's dementia, I thought the clinic would understand," Macduff said.
"The physician doesn't even know the reason she didn't come. She doesn't know how severe her dementia has become, how much a handful it is for us as a family, and how we're trying our best just to care for her."
jen.skerritt@freepress.mb.ca
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