I WAS DENIED SURGERY

So I had gone through the entire application process last year at the TWH. I was denied 8months(Oct 2010) later for reasons that were rediculous

1) I smoke (Iv NEVER BEEN A SMOKER)
2) I am a single mother and
3) I Dont drive( I live in Mississauga and can take the train there, or get a ride from a friend)
When I tried to call and talk about these reasons I was only directed to the receptionist who stated all decisions are FINAL even though I said they must have wrong Information.

These reasons angered me so much, considering I had been going through the process for 8 months. This seemed as if they were just trying to FIND reasons to cut me loose. Well Iv gained even more weight and need this surgery.

Does anyone know how to repeal the desision? Or will i have to start all over agian and wait another year?

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Oh, I'm so sorry this has happened! I don't know the process in Canada, but I would think you can appeal. Can your surgeon's office help?

Keep advocating for yourself!

Call the Ministry of Health and Long Term Care through Service Canada.   Maybe they can offer some suggestions or perhaps your referring doctor can help.  I have not heard of anyone being denied for this for those reasons.  Don't stop here, where there's a will there's a way.  Also, come over to the Ontario board.  There might be people who can offer suggestions as we've all gone through the same system.  Best of luck to you.

Wow.  I don't know how it works in Canada but is there  no way to appeal?  I mean, many surgeons in the US won't operate if you are a smoker, but if you're not a smoker then it makes no sense for them to say that's why they denied you.

What does being a single mother or not driving have to do with it?  Do they really use those things to determine if you can have a particular medical procedure in Canada?  That scares the crap out of me!  Shouldn't they just be considering the medical issues?

Hi Kelly,

Just a quick FYI. In Ontario last year they rolled out a comprehensive province-wide bariatric program for the Roux-en-Y surgery (more on this in a minute). You get referred by your family doctor to an assessment centre and are evaluated by a Nurse Practitioner, Social Worker, Nutritionist, Psychiatrist and have any tests that may need to be done before surgery through the centre, such as sleep tests or ultrasounds, EKG, whatever is necessary in your case to get you as healthy and stable as possible before surgery. You also take a nutrition class and surgery education class. If any of the professionals have concerns you may be asked to meet with them again before they will recommend you for surgery. After you've seen everyone, they get together and discuss your case, as long as no one raises serious concerns, you're green-lighted for surgery and referred to a surgeon. It sounds complicated but it usually only takes a few months to get through all your appointments (I did mine in about 8 weeks) and over 98% of people are put through to see the surgeon.

Before this was put in place people were just referred ad-hoc, usually out of province, for surgery and had very little preparation and very little aftercare. This program is meant to address that by better preparation and better follow-up.

Currently, you cannot be 'referred' for any other type of bariatric surgery but the RNY in Ontario. You can only have the VSG if the RNY is not medically advisable or possible, and that must be decided by the surgeon after your assessment, sometimes only during surgery. The DS is currently reserved for very special cases, usually revisions where the patient is still/again MO and these cases are referred to Dr. Gagner in Montreal. I'm currently trying to fight this as I am a 42 BMI surgery virgin who wants a DS. Things are slowly changing, but more for those who want the VSG than the DS. This is because the province has spent enormous resources setting up this program and only has one DS surgeon who doesn't even perform the DS regularly anymore as he is inundated with RNY surgeries.

Bariatric surgery is a special case, any other surgery is done the old fashioned way, referral from your doc to the surgeon and you meet with the surgeon and set a procedure and date.

And most of what you're telling me makes sense.  I don't think it makes sense that so few people can get VSG or DS; I don't think RNY is the best surgery for everyone, or even for most people.

The rest makes sense.  But is someone at the assessment center checking to find out if patients are single parents and weeding them out if they are?  Are they asking to see a driver's license and refusing to allow patients to have surgery if they do not drive?  And if that's the case, then that would mean, for instance, visually impaired people would be denied WLS since they could not drive.  Would that be legal in Canada?  It sure wouldn't be legal in the US.

No, nothing like that is happening. It would have to be first brought up by the patient as a concern, and then explored as to whether the concern could be overcome. If you mentioned that you were a single mom and the Social Worker asked you, "do you have some family or friends to help support you while you are recovering from surgery", all you would have to say is 'yes' for that to be the end of the story. If you said 'no', then there would be concerns.

Like I elaborated in my other posting they would be looking to make sure you have adequate post-op support. This would be for yourself and also your kids if you bring up concerns about them. This would also mean ensuring that you have the means to get to and from follow-up appointments and purchase your protein/supplements. If you told them, "I'm a single stay at home mom on ODSP (disability payments) barely making ends meet with no other family or friends to help me with my kids or support me (physically, emotionally, financially) after surgery" then they would have concerns. But this would not automatically bar you from surgery, you'd just have to work with the team on a plan to have that support post-op. They will help you as far as you are willing to help yourself. (Also - fyi, if you were blind you would qualify for the government assistance program where they will drive you to and from your appointments at no or very little cost).

They will do anything they can to help you, even transfer your file to another hospital in another city to help you be closer to a support network in the immediate post-op period. They want to be able to approve people for surgery and it is rare when they don't.

Wow, I am glad that I am not in Canada.  I never would have gotten through that system - I am a single female, live alone. I have no family that lives anywhere near me so there is no family help.  I do drive.  I have very limited funds - on social security disability - so yes, paying for supplements is very difficult at times.  The do not drive makes no sense, what ever happened to public transportation, taxis or buses - getting rides from friends?  Just because she doesn't drive herself, doesn't mean she is a couch potato, she must get places somehow.

I also have a problem with going through the entire process for months before you even meet your surgeon.  I want to pick my own surgeon and before I start the process. If I don't like him or feel is qualified, then I can move on and go to another surgeon and go through that program.  I finally got wise to this after sitting through 4 orientations - by the 5th office, I refused and said I want to see the surgeon first and if  I like him and he accepts me, then I will proceed,. They agreed and he ended up being my surgeon.  It took me 2 years and lots of research until I found a surgeon that I felt was experienced enough to operate on me.  I am very picky and have a very complicated medical and surgical history.

Your support system does not have to be family. Most surgeons in the US also require that you demonstarate a support system and the ability to handle the post-op appointments and supplementation. Any surgeon who doesn't do this opens himself up to charges of negligence. The difference in Ontario (not all of Canada, as I said before) is that there is a system of professionals set up to help you to ensure these things. I think someone who cannot find the assistance and means to have proper post-surgical care, follow-up and supplementation should not have the surgery, they are simply being set up for failure or worse. No one in Ontario has ever been denied surgery for being a single mother or for not being able to afford a bus pass. They may have been denied because they demonstrated an unwillingness to address concerns about after-care and supplementation.

In Canada, you don't really choose your surgeon. You need to be referred to a surgeon (for any surgery) by your primary physician and in the case of bariatric surgery the hospital you are referred to is a complete bariatric program with multiple surgeons. You can ask to see a particular surgeon, but that often increases your wait time and usually people are concerned with having surgery ASAP. In my case, as I want to be evaluated for the DS, I requested to see the surgeon who performs the DS in Ontario - no problem, just waiting for the file transfer and then I can set an appointment time.

Should you meet with the surgeon and have an issue with him/her, you can ask for someone else. I really don't think it much matters who is doing your surgery really - you're only ever going to see them for surgery unless you have surgical complications, its the rest of the bariatric team that you follow up with otherwise.

Canada has very rigorous board exams and requires greater proctoring before people can perform surgery on thier own. All Canadian surgeons are essentially employed by the government adn the government is eager to avoid costly lawsuits. The only surgeons in private practise are those doing cosmetic procedures or elective surgeries selectively covered or not covered by the government. There is simply no need to worry about the experience and qualifications of your surgeon here. Most of the Ontario WLS surgeons also correct hernias and perform general abdominal surgery as well. This is handly when you can get your gallbladder out and a hernia repaired all while having your WLS done.