# 2015-138 - Medical Treatment

Medical Treatment

Case Summary

F&R Date: 2015–08–25

The grievor received medical treatment for a wrist injury, including two surgeries. As she was still experiencing pain, the CAF referred her to a specialist surgeon in the private system for evaluation. After examining the patient, the doctor recommended very specialized surgery. The grievor made a request for services as a Canadian Armed Forces spectrum of care exception, and her request was denied. She chose to proceed with the surgery regardless and assumed the $9,000 cost. The grievor was of the opinion that the CAF should reimburse her for the costs of her surgery, as the results had been positive. She also maintained that the surgery was essential in order to avoid permanent damage.

The initial authority was unable to make a decision before the deadline. The IA considered compensating the grievor in an amount equal to what a similar surgery would cost within the public healthcare system, but the file was sent to the final authority at the grievor's request.

The Committee found that the grievor was not entitled to be compensated for the care received, as it was not part of the spectrum of care and she had opted to proceed with the surgery even though her request had been denied. The Committee pointed out that the provincial healthcare system did not compensate anyone for care received from a doctor who did not work in the public healthcare system. Nevertheless, like the IA, the Committee acknowledge that the CAF would have continued to offer the grievor care, including another surgery, and deemed the IA's offer to be adequate. The Committee recommended that the grievor be partly reimbursed in the amount of what the surgery would have cost in the public healthcare system.

FA Decision Summary

The FA agreed in part with the Committee's findings but did not agree with it's recommendation to partially uphold the grievance. According to the FA, D Med Pol never stated what would have been the wait time in the public system for the surgery the grievor underwent through a private clinic. Furthermore, the reference material on which D Med Pol's decision was based contained erroneous information, as the grievor required an operation by an orthopedic wrist specialist, not a hand surgeon, which result in differing wait times. Consequently, the FA found that D Med Pol should have approved the surgery from the beginning and was happy that the Deputy Surgeon General had finally approved full reimbursement of the surgery.

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