The Appeal CommissionThe Workers Compensation Act of Manitoba

Applicable Legislation:

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors. Subsection 27(1) provides that the board may provide a worker with such medical aid as the board considers necessary to cure and provide relief from an injury. Subsection 27(12) provides that the injured worker may select a physician of their choice for the provision of medical aid.

Policy 44.120.10 Medical Aid (the "Medical Aid" Policy) related to travel expenses provides in part:

3. Expenses

a. Expenses Incurred to Attend Compensable Medical Treatment

i. The WCB will reimburse an injured worker's actual reasonable expenses related to travelling to medical treatment (wage-loss, travel, accommodations, meals and reasonable telephone charges) which are in excess of costs normally incurred by the worker while travelling to and from work.

The Medical Aid Policy further provides

iii. All travel reimbursements should be based on the most cost-effective alternative and take account of the injured worker's medical functioning level.

Worker's Position:

The worker attended the hearing with legal counsel who made a presentation on behalf of the worker. The worker answered questions posed by his counsel and the panel.

Counsel submitted that the worker was unable to secure a family physician in his home community due to a lack of available physicians. As well, the worker's complex and extensive file made it difficult for him to provide an overview to walk-in or hospital physicians. Counsel submitted it was reasonable for him to travel to The Pas to secure a family physician who would provide prescription refills of heavily controlled narcotics in relation to his compensable foot injury. Counsel noted that support for provision of travel expenses is found in part 3 a) iii of the Medical Aid Policy by applying the implied two-fold test of the use of the most cost-effective alternative that is reasonable for that worker's medical functioning level.

The worker answered questions from his counsel about his medical functioning level. He indicated that he also suffered from conditions in his spine, joints in his upper and lower extremities and that he continues to attend monthly appointments with his family physician for those specific conditions.

The worker indicated he has seen many physicians since his original foot injury and that in his home community, the family physicians eventually move away to take up practice elsewhere. He said that since his last doctor had moved:

"I've been unable to get a family doctor there, and new doctors that come in didn't want to take me on as a patient because of my long file with WCB. Didn't want to prescribe narcotics and stuff like this here, and another one would only be able to see me every six months…I had to go to The Pas to find a family doctor, and basically that's where it stands right now."

The worker indicated that since finding a family physician in The Pas he has returned to the home community clinic numerous times to find a physician who would take him as a patient but has been told that he already has a doctor in The Pas.

Counsel submitted a comprehensive list of medications that the worker indicated were from his medical file. The worker was able to identify some of those medications and their purpose but for many others he was unclear as to what they were related to and when he began or ceased taking them. He indicated his current medications included narcotic medications related to his foot injury. He said he also took medications for cholesterol, arthritis, depression, intestinal problems and anti-inflammatories for other pain sources.

In response to a question posed by counsel of his attempts to have his narcotic prescriptions written in a walk-in clinic he responded, "No they won't. They won't even look at it." When asked if some doctors flatly refused to prescribe medications he replied:

"Quite a few of them actually…the newer doctors that come in don’t want to look at me because with the - like I said, for medication wise, and then when they see my file from Compensation…I was lucky enough to get the doctor in The Pas to take me on as a patient, knowing my background."

In relation to his foot injury, the worker said he is being treated by a specialist who prescribed the original narcotic medication and provided the refill prescriptions during the time he had no family physician. He stated he now sees the specialist only when things change or get worse and his family physician provides the narcotic prescription refills every three months.

Analysis

The panel notes that the WCB has consistently taken a pragmatic approach to the application of the Medical Aid Policy regarding the most cost effective alternatives in respect to the nearest care provider. The panel also notes that when an injured worker has provided sufficient valid and compelling evidence to support seeing a health care provider who is not the nearest or most cost effective, consideration has been given to extending travel expenses for those visits.

In order for the worker's appeal to succeed, the panel must find that it is reasonable for the worker to travel to The Pas, Manitoba to attend a family physician for the purpose of prescription refills for narcotic medication related to his compensable injury. After reviewing the evidence in its entirety, the panel is able to make a partial finding in the worker's favour.

Evidence on the file and presented at the hearing confirmed that the clinic the worker had been attending up to November 2009 had closed and a new clinic opened as part of the Regional Health Authority (RHA) in the worker's home community. At the new clinic, the worker's evidence was that he was unable to find a physician willing to take him on as a patient and all physicians he had attended were not willing to provide him with prescription refills for his narcotic medications.

It was also the worker's evidence that his relationship with the family physician in The Pas was for his other conditions and personal health matters mainly and in relation to his compensable foot injury, she just wrote a refill prescription once every three months.

In making our findings the panel relied on the information received after the hearing from the RHA clinic and the chart notes provided from the earlier clinic. The earlier chart notes indicate that at four visits, March, April, October and November 2009 the worker was advised to see another family doctor for his prescription refills. The panel notes in particular, the letter from the RHA clinic confirmed that:

• The worker's chart status at the new clinic is considered active;
• Although an active chart, he has only been seen by a doctor one time in March 2011;
• The RHA clinic, as of the November 17, 2011 letter, is in the process of having their policies and procedures approved by Senior Management so were unable to provide information regarding reassigning patient files when a physician closes their practice;
• The RHA clinic has two physicians at the walk-in facility and operate Monday to Friday 9:00 am to 4:30 pm unless both physicians are away/unavailable;
• The prescribing of narcotic medication through the walk-in clinic is at the walk-in physician's discretion;
• The RHA clinic is unaware of the previous community clinic's policies on reassigning patient files or narcotic medication.

On questioning by the panel the worker's evidence was that his last visit to the RHA clinic was in April 2011 and the conversation was:

"I'm looking for a family doctor. I'm going back and forth to The Pas. It's a long trip. It's getting harder to travel back and forth. He said, well, you already have a family doctor. You might as well continue with her because she knows my situation."

When the panel reviewed the information received after the hearing, the RHA walk-in clinic chart has the following entry:

S (subjective complaints)
no medical concerns today come to ask for family doctor while his is seen by his Family doctor Dr [name] in the (sic) Pas

O (objective exam)
Patient informed that double doctor is not allowed,
Advice to F/U wi his Family doctor in the (sic) Pas.
If she needs some investigation or Refill while he is in [home community] that could be done as walk in clinic.
All results or manage will be sent to his Family Doctor

A (assessment)
Patient has Family doctor in the (sic) Pas Dr [name]

P (plan)
F/U with his family doctor [name]

The panel finds that the chart provides an accurate account of the walk-in physician's instructions. The panel also notes that these instructions were not referenced by the worker at the hearing, perhaps due to the passage of time. The panel does, however, accept the chart notes as being an accurate representation of a conversation between the physician and worker.