Pubdate: Thu, 12 Nov 2015
Source: Standard, The (St. Catharines, CN ON)
Copyright: 2015 St. Catharines Standard
Contact: http://www.stcatharinesstandard.ca/letters
Website: http://www.stcatharinesstandard.ca/
Details: http://www.mapinc.org/media/676
Author: Cheryl Clock
Page: A3

METHADONE DOCS HIT BY FUNDING CUTS

Criticize Province for Hurting Vulnerable Patients

Two doctors have left in frustration. And the remaining physicians 
who treat drug-addicted patients with methadone at Segue clinics 
across Niagara will see their income cut by nearly 30 per cent.

But unlike speculation by other clinics in Ontario that funding cuts 
by the province will force them to close, those in Niagara will stay 
open - for now, said Dr. Robert Fallis, a Seque partner and 
addictions physician.

"It depends on what happens next," said Fallis. "And we don't know 
what's happening next."

What's happened since February is this.

The Ontario government has cut its funding to doctors by nearly seven 
per cent. It's happened in stages and covers things like fees for 
services and continuing medical education. Then in October, there 
were more cuts that targeted specific services.

At issue for methadone clinics are the cuts in funding for urine 
screening tests, says Fallis.

Patients at methadone clinics must submit to regular urine tests to 
ensure they aren't using street drugs. Methadone is used as a 
substitute drug to treat addiction to opioid drugs like heroin. It 
helps to prevent symptoms of withdrawal and drug cravings.

Visits and services at methadone clinics are covered by OHIP. A drug 
like methadone is covered through the Ontario Drug Benefit Program to 
people on Ontario Works or the Ontario Disability Support Program.

The five Segue clinics in Niagara, and two in Hamilton and Stoney 
Creek, generate hundreds of urine tests every month, he says. They 
are a staple of methadone clinics.

"Urine drug screens for us are like taking blood pressure for a 
cardiologist," Fallis said.

With two weeks warning, the Ontario Ministry of Health announced fees 
paid to doctors for urine tests were being cut in half, he said.

The methadone clinic will lose about a quarter of its revenue, he 
adds. After spending considerable time and money to open a new clinic 
this week in Thorold, Fallis says he's disappointed the government 
has "changed all the rules."

But his frustration spreads beyond dollars and cents.

Two of the addictions doctors at Segue have left since the spring, 
both due to frustration with the province.

"They don't want to be a doctor in Ontario," said Fallis.

As a result, the remaining four physicians have had to take roughly 
300 additional patients into their own practices and have extended 
hours to deal with the increased caseload. "We all have to see more 
people and run faster," he said.

As yet, it has not affected the quality of patient care, Fallis said.

Over at the Niagara Health System, funding cuts are not impacting patients.

"The NHS methadone clinics have not experienced any reduction in 
services," said spokesman Steven Gallagher. A doctor was not 
available for comment. The NHS treated 435 patients at its three 
methadone clinics last year.

And at the On Trac Clinic on St. Paul Street, Jeff Spence, 
vicepresident of Community Outreach and Development for Towards 
Recovery offered this in an e-mail: "Other than to say that despite 
the financial impact, our intention is to continue to provide current 
levels of service, a decision was made that we did not want to 
comment further."

Problem is, it's tough enough attracting doctors to the addictions 
field, said Segue's Fallis. Patients can be challenging. Add 
frustrations with the government and it's been near impossible to 
find replacements for the two doctors who have left, he said.

It's not about trimming fat from the system, said Fallis.

About 40 per cent of a family doctor's income goes to paying for 
overhead - everything from nurses to cleaning staff, rent to paper 
for the photocopiers.

"The government never releases those numbers," he said.

Across Ontario, there are some 250 addiction physicians, 221 clinics 
and 40,000 people on methadone.

Eventually, it will become a patient care issue.

"If they make the system too difficult, so physicians don't find it 
worthwhile doing it any more, eventually the patients won't get the 
care," he says.

"We'll have 5,000, 10,000, maybe 20,000 people on methadone, who 
aren't on methadone anymore. And how is that going to impact society? 
That's the problem. They don't think about the human component."

Especially, he added, when patients don't have a voice.

"Our patients are some of the most vulnerable in the province," he said.

"Frankly, they really have very little political clout. My patients 
don't complain. They don't go to their MP or MPP and complain about issues.

"It's an easy thing to cut back in areas where people are the most 
vulnerable. They don't have the power to complain."
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MAP posted-by: Jay Bergstrom