Special U.S. medical deal for border-town Manitobans needs rewrite, minister says

A special deal crafted nearly 20 years ago that gives border-town Manitobans access to emergency health-care just south of the border is poorly defined and probably needs a rewrite, the province's health minister says.

Believing they were covered by the long-standing Altru Agreement between Manitoba and Minnesota's governments, several Manitobans in recent years were instead stuck with big medical bills after emergency stays in the U.S.

Health Minister Kelvin Goertzen blames the source of the confusion on the agreement itself.

"It doesn't specify which services are particularly available, it doesn't specify who is actually covered under the agreement, so I think that if the agreement changed it would take care of a lot of these situations," Goertzen said Friday.

"It's three pages; you couldn't buy a car for a three-page agreement these days. When you look at the agreement there's no dispute mechanism, there's no appeal mechanism within the agreement."

Robin Milne, 60, Andrew Thiessen, 69, and Verna Kittleson, 62, were collectively left with more than $200,000 Cdn in medical bills over the past two years after receiving emergency treatments in Roseau, Minn., and Grand Forks, N.D.

Should be retiring

"We should be at retirement age, not taking out a mortgage on our home," said Kittleson, who was ultimately left to pay about $63,000 in medical bills after pericardial heart surgery in Grand Forks in 2015. "We paid it and now we're going to be working for 10 more years."

In each case, the dual citizens say doctors in Roseau recommended they head to North Dakota.

All three live in or around Sprague, Man., about four kilometres from the U.S. border and just over 20 kilometres from the nearest hospital in Roseau.

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The Altru Agreement has been around for years but was most recently revised in 1998. Under the agreement people living near the border in southeastern Manitoba can access primary or emergency medical services at hospitals in Roseau or Warroad, Minn. Manitoba has no such agreement with North Dakota.

Heart surgery in N.D.

Kittleson was first diagnosed with congestive heart failure in July 2015 in Roseau and was referred to a specialist in Winnipeg. In August that year she was advised to get surgery in Grand Forks by a Roseau doctor to reduce inflammation around her heart. 

I just wish [the province] would realize we don't want special treatment, we just want to get treated the same as everybody else in the province.- Verna Kittleson

Her condition worsened in December when she went back to Grand Forks again, this time to have excess fluid drained from her lungs. 

She received similar procedures nine times between December 2015 and February 2016, which the province eventually covered, while waiting for another surgery in Winnipeg in March. 

Kittleson was told she had to pay for her U.S. surgery, so she appealed but was shut down. The province ultimately brought the fee down from $90,000 to about $63,000, Kittleson said.

"I just wish [the province] would realize we don't want special treatment, we just want to get treated the same as everybody else in the province," Kittleson.

More big bills

When Thiessen, a cancer survivor and diabetic, experienced kidney failure in 2015, and when Milne suffered a heart attack last fall, both were rushed to hospital in Roseau.

Unable to perform an emergency stent procedure, Milne's Roseau doctor called St. Boniface Hospital in Winnipeg and requested a Lifeflight.

In such cases, the Altru deal states U.S. medical professionals are to contact Winnipeg hospitals and request a Lifeflight air ambulance be sent down to pick up the patient and fly him or her back to the city for care. In the meantime, the U.S. doctors are to stay on the line with Winnipeg medical professionals and get the recommended treatments from them.

Ninety minutes after the initial call to St. Boniface, Milne said his doctor instead sent him to hospital in Grand Forks because no one with St. Boniface or Lifeflight had called back to confirm an arrival time in Minnesota.

Two nights in hospital saved Milne's life but he was billed close to $118,00 by the Grand Forks hospital and the American emergency air ambulance company that flew him there. His wife is working a second job and the couple is mulling whether to take out another mortgage on their home.

Andrew Thiessen was left with nearly $40,000 in U.S. medical bills in 2015. He has already paid the bills but had to sell a parcel of his land that straddles the U.S.-Canadian border to do it — land he intended on passing down to his children.

Milne received a note in the mail from Manitoba Health Wednesday saying the department plans to negotiate with U.S. health officials to lower his fees.

Kittleson and Thiessen have received no indication they will ever be reimbursed. 

Minister Goertzen hasn't said when a review of the Altru Agreement or appeal process will take place.