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Ontario Supports OHIP’s Rejection of Claim by North York Ma

An advocate called for an immediate review of the standards and guidelines OHIP uses to decide who gets reimbursed for out-of-country treatments// .

Ontario Divisional Court supported OHIP's rejection of the claim of a North York man who hoped to recover the $450,000 cost of his life-saving liver transplant in England. The retired high-school teacher will not be able to recoup any of his health-care costs, the Ontario Divisional Court has ruled.

This week's 33-page decision is a letdown for the North York man, Adolfo Flora, 57, who was told by specialists at Toronto General Hospital, at the time of his diagnosis of advanced liver cancer in November 1999, that he would be lucky to live another eight months.

He was also told that he was not a suitable candidate to receive a deceased donor's liver because the advanced stage of his cancer made his chances of survival slim.

But while exploring other options, a team at Cromwell Hospital in London, England, did a partial transplant from a living donor – his brother, a physician. Flora was given a better than 50% chance of survival.

On Feb. 22, 2000, Flora's physician completed a form seeking OHIP reimbursement for the treatment in England - It was denied because of chemoembolization, one of the procedures performed, which was considered experimental and not part of the insured services.

"I'm disappointed in the outcome," says his lawyer, Mark Freiman, in a telephonic interview yesterday. "It has a very far-ranging impact in terms of defining the obligations of government and the lack of obligations of government in the areas of health care."

The case demonstrates very clearly some of the flaws in the public health system when it comes to covering the cost of medical treatment outside Canada, said George Marcello, the 51-year-old head of Step by Step, an organ transplant advocacy group, who has had two liver transplants himself.

"Let's review the whole standard of who should be able to be medically covered in situations like that," he said.

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