Selected Cases

A woman reached out to us after contacting the Ministry of Long-Term Care’s Action Line with concerns about her mother’s death in a long-term care home.

A woman whose daughter had to have an emergency root canal procedure – at a cost of $700 – sought our help in obtaining coverage through Healthy Smiles Ontario, a provincial program that covers dental care for eligible children and youth who are 17 and under.

A man was trying to renew a health card on behalf of his son, who has a disability and does not have a driver’s licence.

A pregnant woman who had tested positive for an infection contacted us when she received the results from Public Health Ontario and realized that the wrong follow-up test had been done.

We heard from a man who was still waiting for his semi-annual grant for ostomy supplies from the Ministry’s Assistive Devices Program.

A man contacted our Office after trying unsuccessfully to have his Trillium Drug Program deductible increased.

A man contacted us on behalf of his father, who was immunocompromised and receiving cancer treatments.

A man with ALS complained that when he moved into a long-term care home in 2017 due to his deteriorating condition, he become ineligible for the ventilator that he had been provided through the province’s Ventilator Equipment Pool program.

A woman contacted us after she missed several cheques from the province’s Assistive Devices Program (ADP), which she required to cover the cost of ostomy supplies.

A woman who has several health issues and relies on Ontario Disability Support Program benefits complained to us that her request for coverage of her medications had been denied by the Ontario Drug Benefit program.

A woman who had lived in Canada for 76 years sought our help when she attempted to renew her health card and discovered she did not have Canadian citizenship.

A truck driver who crosses the Canada-U.S. border weekly as an essential worker complained to us that a ServiceOntario location would not let him in and demanded he self-isolate for 14 days because he had recently crossed the border.

A patient contacted us after being told by their physician that a non-cosmetic dermatological treatment was not covered by OHIP, and could only be provided if the patient paid.

A cancer patient who had appealed OHIP’s decision to deny him coverage complained to us when he did not receive a response within the Ministry of Health’s posted deadline.

A woman sought our help after her application for an overnight accommodation allowance was denied by the Northern Health Travel Grant because she did not meet the minimum distance requirement.

A transgender woman complained that the Ontario Health Insurance Plan (OHIP) had improperly refused her application for prior approval for breast reconstruction surgery.

A concerned social worker at a psychiatric hospital asked us if we could help a patient whose OHIP coverage had been suddenly cancelled.

After waiting many months for a response from Ministry officials about his experience, a man who had to relocate from Northern Ontario to Toronto for a lung transplant finally had his voice heard through our Office.

A divorced recipient of Trillium Drug Plan coverage complained to us that his access to the benefit was affected because his ex-wife would not provide a letter stating that he was no longer covered by her private insurance.

A woman contacted our Office after learning her OHIP coverage had been suspended while she was studying outside of Ontario, despite the fact that she had emailed her renewal documents to OHIP several times.

A woman whose migraine medication is covered through the Exceptional Access Program contacted us because she was worried about how long it was taking the program to approve a renewal of her prescription.

A man who had lost all of his identification a few years earlier sought our help because he was unable to get health coverage through OHIP.

A senior contacted our Office after restrictions were placed on his visits with his wife at her long-term care home, after he raised concerns with a nurse about his wife’s care.

A man whose home and important documents were destroyed by fire complained that he was having trouble renewing his Ontario health card.

After the Trillium Drug Program denied a woman drug benefits that she had previously received, our staff raised the case with a senior analyst at the Ministry, who found the information she had submitted about her private insurer’s drug coverage had been inconsistent.

A woman complained to our Office on behalf of her 34-year-old daughter, who requires a specially-made drug at a cost of $200 per month.

A mother whose son has a developmental disability and is medically fragile complained that her son’s medication costs were no longer being covered since he had been placed in a group home funded by the Ministry of Community and Social Services.

A mother was concerned about the lack of support and funding for her 19-year-old son, who has autism and aggressive behavioural issues. He had recently been taken to hospital by police after an incident when he became agitated and violent.

The aunt and uncle of a 16-year-old boy with Down Syndrome needed help finding the boy a place to live after his mother died of cancer. They were concerned that they would not be able to care for him because they lived 270 kilometres away, both worked odd hours, and, due to their age, wouldn’t be able to look after him on a long-term basis.

A woman whose teeth had been damaged as a result of physical abuse by her partner years earlier contacted the Ombudsman for help in obtaining funds to have them fixed.

A woman who was experiencing a third occurrence of HER2-positive breast cancer was denied funding by the Ministry for the chemotherapy drug Kadcyla, although it was prescribed by her oncologist. The Ministry would fund the drug for women experiencing a second occurrence of the disease, but not a third – despite scientific evidence that women with third and even fourth occurrences did benefit from the drug.

A 62-year-old woman with Crohn’s disease required infusions every eight weeks at a cost of $4,542.76 per treatment. The woman’s private insurance covered 80% of the costs, while the Trillium Drug Program reimbursed her for the remainder, but she was reaching the lifetime maximum for her private insurance coverage and it was about to end.

After the removal of a benign brain tumour, a woman in her 20s suffered a stroke that left her unsteady on her feet, needing assistance to use the bathroom, and with speech difficulties. She had to be hospitalized several times and was placed in the complex care unit of a local hospital for four months.

An inmate was told after a colonoscopy that he likely had bowel cancer and would need surgery immediately – within a week. However, the jail’s doctor told him the facility had no paperwork from the specialist, and it would be up to four weeks before he could even get an appointment for surgery.

An inmate had been waiting for months to have a wisdom tooth extracted and was in severe pain, to the point where he had fainted and had to be sent to hospital.

After a woman was denied funding for a drug to treat neuropathic pain, her husband came to the Ombudsman for help. The woman has a rare neurological disease and her condition, which is considered palliative, means she has considerable muscle and nerve pain. One of the drugs that helped her pain, Sativex, was only approved for patients with multiple sclerosis, or palliative cancer patients with refractory pain.

 

The owner of a home for adults with mental health issues contacted the Ombudsman, frustrated that he couldn’t get ODSP or Developmental Services Ontario (DSO) to provide funding to take one of his residents to her cancer treatments.

A mother complained to the Ombudsman after she was forced to pay $7,000 for a spot for her adult daughter in a residential treatment program for women with substance abuse issues.