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Tuesday 9 January 2001

Health-insurance board says no to deaf boy

Girl's implants spark uproar
The Gazette

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Frank Duchoeny says a cochlear implant would allow his son Ryan to hear. The 9-year-old communicates in sign language.
Questions swirled as Quebecers struggled yesterday to under-stand why the cash strapped Régie de l'Assurance Maladie du Québec paid for breast implants for a 15-year-old girl after her psychiatrist deemed them necessary for her mental health.


Perhaps the most pointed questions were raised by the family of a deaf Laval boy who was told that the provincial health-insurance board won't cover a cochlear implant that would allow him to hear.


"It's a sad joke," Frank Duchoeny said. "I read the story (about the girl's implants) and was totally flabbergasted. I'm outraged."


Duchoeny's son Ryan, 9, has been examined by specialists at the New York University School of Medicine as well as specialists in Toronto who determined that the inner-ear implant would help him, Duchoeny said.


The out-of-province specialists were consulted after the one Quebec hospital that performs the implants rejected Ryan.


Among the considerations: his age and the fact he is able to communicate in sign language.


The health board then said it would not pay for the operation, which would cost about $40,000 U.S. if done in the United States and about $27,000 in Canada, Duchoeny said.


"My son is asking for the operation. He is begging to hear," said Duchoeny, who couldn't understand how taxpayers are asked to pay for breast implants but not ear implants.


The one official at the provincial health-insurance board designated to discuss the breast-implant case could not be reached for comment yesterday despite repeated attempts.


Spokesmen for provincial Health Minister Pauline Marois referred reporters to the board official, saying that neither they nor Marois would have any comment on the matter.


In the absence of details, experts in mental health and adolescents yesterday struggled with the sketchy outline of a case, which - the Quebec Plastic Surgeons' Association says - has set a dangerous precedent.


Although girls as young as 14 are legally allowed to undergo the procedure on their own, Louise Duranceau, head of the surgeons' association, strongly recommends that girls be at least 18 before taking such a huge step.


The health-insurance board apparently denied the girl's parents request for reimbursement because the surgery - done in a private clinic at an estimated cost of $5,000 - was considered purely cosmetic. But the board reversed its opinion when the parents presented a note from a psychiatrist.

Cause for Concern

That outline was enough to set off alarm bells within McGill University and its affiliated hospitals.


But opinion was unanimous in one respect: if the breast-implant surgery was done for essentially cosmetic purposes no matter what the psychiatrist's note said the Quebec taxpayer should not foot the bill.


"If it was not done for therapeutic reasons, then it is totally outrageous," said Margaret Somerville, founding director of McGill's Centre for Medicine, Ethics and Law.


"I think if (the surgery) was purely cosmetic surgery, it shouldn't be done on a 15-year-old girl."


She and other experts consulted yesterday stressed that they don't know the details of the case. They also noted that any matter involving body image and adolescents, as well as the issues of informed consent and what the state should pay for, is by its very nature complicated.


But questions were raised about the relationship between the psychiatrist who provided the note and the girl and her family.


"Did the board ask for a second opinion (from another psychiatrist) or their own specialist?" asked Joel Paris, chairman of the psychiatry department of McGill University.


If the girl was a patient of the psychiatrist, he or she might have been "almost forced" to provide the note, Paris said.


A psychiatrist must put the patient's interests first and would find it difficult "to say to the patient, 'No, you can't have something that you think you need' because it may put an end to their relationship," Paris said.


But in the current case it isn't known whether there was an ongoing relationship or she went to the psychiatrist with only the desire to get a note, he said.


Body image is such a touchy issue that even grown women who are considering cosmetic surgery are often advised by plastic surgeons to get counselling before the procedure, Paris noted.

Common Complaint

Almost 90 per cent of the 4,000 outpatients treated at the Montreal Children's Hospital adolescent clinic are girls and recurring complaints involve their breasts, Dr. Franziska Baltzer said.


The most common complaint is that the breasts aren't the same size. Other grievances involved grossly malformed breasts or breasts that are too big or too small, she said.


The notion of surgery is raised by the girls, not the doctors, she said. Surgery is viewed as the last resort, Baltzer said.


There have been no breast implants done at Montreal Children's, she said, but there have been a few instances of breast reduction in cases where extreme breast weight was causing back and spine problems.

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