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French River couple loses fight over $12K ambulance bill

After emergency during trip to Cape Breton, they're shocked to learn cost not covered by OHIP
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Dean and Erla Wenborne speak with Nickel Belt MPP France Gélinas following their meeting with the Health Services Appeal and Review Board, in this photo from Nov. 8. The board denied their appeal in a decision released last week. (File/Arron Pickard)

An elderly French River couple have lost their latest legal fight aimed at convincing the province to pay the cost of a $12,000 out-of-province air ambulance ride.

Dean and Erla Wenborne, who are both in their 80s, were hit with the bill after a trip to Cape Breton in October 2017. When Erla became ill – it later emerged she had a heart attack – she was taken by ambulance to hospital in Sydney.

A pacemaker was put in and her condition stabilized, but had to be flown to Halifax 400 kms away for followup tests. She was there for 36 hours before being taken back to Sydney in a land ambulance.

When they returned home, however, they received a bill for all the ambulance trips, including $12,000 for the air ambulance. While health care is free for Canadians under inter-provincial agreements, that coverage doesn't extend to ambulances.

The couple appealed to the Health Services Appeal and Review Board, and had a hearing last month. Dean Wenborne used the example of an Alberta mother who, in 2015, went into early labour while visiting family in Timmins. She was flown by air ambulance to Health Sciences North, as the Timmins hospital wasn't equipped to deal with premature births before 32 weeks gestation. The family was stuck with a $30,000 bill.

In May 2018, the governments of Ontario and Alberta agreed to split the cost of the bill, even though out-of-province residents are required to pay the cost of an air ambulance in Ontario unless it's between two hospitals and they return to the first one within 24 hours.

In response, the Ministry of Health and Long-Term Care, represented by Susan Croft, Kathryn Fleming and Linda Lalani, said while Erla was covered by OHIP and the transfer by air ambulance and land ambulance were medically necessary, neither of those ambulance services are certified under provincial legislation. 

While there are interprovincial agreements to cover medically necessary hospital costs, there is no such agreement regarding air ambulance services.

In its ruling, however, the board said it has no authority to direct OHIP to cover costs not mandated by legislation. In this case, the air ambulance provider was not licensed in Ontario, which means the board has no jurisdiction to order the province to pay the costs for the couple.

In the case of the Alberta woman, the board ruled that it did not set a precedent of OHIP being ordered to cover the ambulance cost. Instead, it was a separate deal between the two provinces that didn't involve legislative changes.

“The Appeal Board finds that the costs incurred by the appellant for ambulance services in the province of Nova Scotia are not insured services of OHIP and are not eligible for reimbursement,” the board said in a ruling dated Dec. 7.




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