Winnipeg Free Press

Winnipeg Free Press (Newspaper) - January 16, 2025, Winnipeg, Manitoba THINK TANK COMMENT EDITOR: RUSSELL WANGERSKY 204-697-7269 ● RUSSELL.WANGERSKY@WINNIPEGFREEPRESS.COM A7 THURSDAY JANUARY 16, 2025 Ideas, Issues, Insights Subsidizing insurance rates by denying brain injury claims H OW angry would you feel if someone you love suffered a serious brain injury in a car accident and Autopac wouldn’t provide appropriate compensation for rehab and daily-liv- ing support? If we suffer serious vehicular injuries, don’t we all expect the support and compensations we receive from Manitoba Public Insurance (MPI) will be proportionate to the harm we suffer? That even if our serious injuries are complex and per- sistent, the support for assessment and rehab will be ongoing, comprehensive and adaptive to our needs? That’s not happening. We’ll explain why. First: some background. Recent signals from the previous and the new provincial governments have suggested attitude change towards MPI and Manitoba Hydro. The province seems to want greater engagement with Crown corporations. After media investigations in 2021 and suc- cessive Public Utilities Board rulings raised questions about MPI’s actions and spending plans, a formal corporate review was announced in 2023 by the previous Conservative minister. This action, and subsequent actions by the NDP, signified stronger cabinet interest in better MPI accountability to cabinet. Accountability for what? For how the board and senior managers manage the corporate insurance monopoly. Some of that attitude change suggests that cabinet believes the Crown corporations have been setting performance targets at “low bar” levels. The province seems to want them to do better. Other changes imply that some Crown corporation operating protocols and methods are inscrutable to government. Cabinet appears con- cerned that it doesn’t understand how the Crown corporations do what they do. And what they don’t do. Both Manitoba Hydro and MPI are locked into a structural conflict of interest. Both Crown corporations are required to, and diligently do, focus on cost control and rate-growth minimiza- tion. They do this while simultaneously promising high levels of public service. But this structural conflict affects every individual’s daily experi- ence with MPI and Hydro. The public is skeptical there’s as much “excellence” in the services provision as the corporations claim. Regarding MPI, there’s a significant public view that claims minimization and rejections, to limit costs, is the sole overarching goal. Given these Crown corporation conflicts of interest, the province needs to get the balance of these competing objectives right. It must create the right policy environment for the corpora- tions to do their process management. Crown corporations in B.C. and Saskatchewan seem to have greater public accountability in how their monopoly public insurance corporations meet performance goals. But the PC and the NDP governments’ apparent dissatisfaction with MPI’s effectiveness and transparency suggest a desire to catch up. The plight of motor-vehicle accident victims suffering head trauma is one sad area of Crown corporation performance badly needing attention. MPI labels complex head-trauma impacts like concussion as merely transient “whiplash.” It jus- tifies this by relying on an obscure sports-med- icine diagnosis guideline. And it rejects special- ists’ medical evidence showing these complex brain-trauma injuries can persist much longer than “whiplash.” It decides claims using a “bal- ance of probabilities.” But it never provides the estimated “probabilities.” And it never explains how it determines their “balance.” It rejects new medical evidence in support of claims. All this lowers MPI’s claims costs. Every hasty, simplified classification (or rejection) of a complicated head-injury claim leads to under-di- agnosis of trauma. It causes under-estimation of its persistence, and of medical rehabilitation costs. This ruthlessness of cost-cutting wastes human capital. MPI’s website says over 100 cases of “serious” brain injury occur every year. Medical statistics suggest four to six times more of so-called “mild” traumatic brain injuries. Such head trauma causes misery and extensive costs to families. It creates ongoing costs to the health-care system. How MPI manages its brain-injury claims consti- tutes a significant, immoral and hidden subsidy to the insurance rates of non-injured people. How does MPI choose the anonymous medical specialists it selects to evaluate head-trauma claims and the supporting medical evidence sub- mitted by claimants? Why are so many of them sports-medicine doctors? Why doesn’t it ensure current medical best practices are applied to the challenges of diag- nosing and treating brain injuries? Why isn’t there a Science Advisory Panel that periodically updates MPI’s case-management procedures for assessing brain-injury claims? Why won’t the MPI use a “weight of evidence” approach, across a range of multidisciplinary medical expertise, in diagnosing head-injury traumas? Why won’t MPI insist that medical experts use best practicable technology for head-trauma assessment? Why does it rely primarily on only a single discipline (neuropsychiatry)? On what legal basis can MPI case-management officers repeatedly reject new medical evidence supporting an ongoing claim? Just because of a hasty initial (and self-serving) judgment of “no causal effect?” Just “because?” Nobody knows. Worse, the government doesn’t know. And it should. MPI’s current claims-management system is unjust. A grey fog obscures the province’s rela- tionship with MPI. It needs to be removed. Better oversight of MPI procedures is necessary. Surely the government can demand greater cost-ef- ficiency by MPI bureaucrats without treating brain-injured people as if their human capital didn’t count. MPI is a Crown monopoly. We are all forced to use it. As we have no choice, we deserve to believe that we can rely on receiving the full services we’ve paid for when we need them. Including when we’re rear-ended at stop lights or T-boned and our brains are damaged. It is unrea- sonable, even immoral, for MPI claims-manage- ment procedures to be as inscrutable, unscientific and outdated as they are because of case manag- ers’ ruthless incentives to cut costs. This dishon- ours the government. The new government ran on a health-care-sen- sitive platform. It’s looking for some “low-hang- ing fruit” to show healthcare improvements. Given that it’s already concerned about how MPI does what it does, if the government wants a quick political — and ethical — “win” in the public-health front, why not take a hard look at how vulnerable brain-injured people are forced to subsidize the rates of uninjured drivers? Why not probe MPI’s hard resistance to obvious neces- sary improvements in these claims-management practices? Even a small population of victims deserves to be treated as if they mattered. Voters elected this government to improve health care. That includes health care for people with injured brains, dam- aged through no fault of their own. Barry Waito is a former international forest-management company executive, and then a respected national forestry consultant, before acquiring a traumatic brain injury when rear-ended by a semi in 2016. He needed, and received, substantial assistance in developing this piece from supportive members of the community. Saving my own life by taking drastic, unusual action RECENTLY, my PTSD alarm bell went off, upon hearing that yet another human being died waiting for medical care at the Health Sciences Centre Emergency Room. Why? Because I, too, found myself in this posi- tion, on Dec. 31, 2023. I had awoken feeling off. I fell to the bathroom floor with this swirling sensation, depleting me of all energy. I already had my appendix removed — check. I’ve experienced a kidney stone before and this didn’t feel like that — check — it’s getting worse. I had my husband call an ambulance. The first one took me to the HSC ER. If one lives in Tuxedo, that is now where you go unless you have obvious heart issues. (How many living in Tuxedo know that fact?) Just get me there as I’m certain there is something seriously wrong with me. I arrived, am triaged and placed on a gurney in the hallway, joining the masses. Initially, I had blood taken. But the rest of the eight hours I spent there were nothing short of hellish. Paramedics were bringing in prisoners hand- cuffed to their gurneys. I overheard them saying that the wait times at the Grace Hospital were running up to 32 hours. I start my numerous attempts to stop any nurse passing by to stop and check my vitals. But they make no eye contact, ignore my arm pleading for assessment, as they walk on by. Thank God I was lucid. The tornado-like feeling was still there, but carries a force to be reckoned with. What the hell is going on inside my body? I ask the triage nurse how much longer? She doesn’t even look at me and says a lot longer. What were my options, as I intuitively felt my fate was destined, if I didn’t act immediately. Sadly, I was right. So I asked the nurse again in the hopes of receiving some help, “Is it safe for me to leave?” Surely she will advise me that I have yet to see a doctor and I’d be leaving against the advice of the hospital, upon my own recognizance. But no that’s not what happened. “Leave if you want!” Dr. Shawn Young, the CEO of the HSC, has been quoted in the Free Press indicating that those brought in assessed as low acuity are checked every couple of hours. I read that in total disbelief. In eight hours, I was not assessed even once, despite my best efforts for attention. I mustered all my strength to leave. I was placed in a wheelchair as I could barely walk by then. I fell onto the floor and the triage nurse asked me to get off of it. My husband is placed in a horrible position to comply with my request to go home and call another ambulance. There are no other viable options left to me. He reluctantly complied. We made it home with him witnessing me in such a horrific state, but once there, we again call 911. They arrive swiftly, only this time their re- sponse is noticeably different. They immediately check my vitals. They are made aware I have already been to the ER. With great compassion and concern, they carry me downstairs and place me inside, sirens a-blazing. One of them radios ahead to the same hospital who had no issues with me leaving. “We have a 64-year-old female with perforated bowel and in septic shock. Get an operating room ready.” I felt emotionally numb. My instincts were right about the dire need for medical attention. But I’m not a doctor. The reality that I had to advocate for myself in order to save my own life set in. I know I’d have died on that gurney in the hallway if I hadn’t left to call for some intervention. We arrive and I’m being very quickly prepped for emergency surgery. A doctor comes up to me saying: “Do you know how seriously ill you are?” “That’s why I came back!” I am then advised that I might want to make a call to my kids to say goodbye! Oh my God, I thought, I’m really dying. I retrieved my records months later and I had signs of mottling (end of life) on my feet and hands. I remember nothing else, as I had a four-hour surgery, resulting in a reversible ileostomy, 11 days with some close calls in the ICU and very questionable practices. Then I spent close to a month on the ward with very disturbing care. But that’s another story. There was a third ambulance called, as I was released severely dehydrated and with thrush in my mouth. Shockingly, I had never been officially dis- charged. If I had not requested my file, no one would ever have noticed that the GP on the ward never filled out those documents. So 17 weeks post-discharge, he was completing that task. I wonder what his recall was? It’s noted that I had an uneventful stay on the ward. I myself wouldn’t call dry-wretching for a month, plus losing 20 pounds, uneventful. He called both my husband and myself to apologize for the delay. Then in a surreal manner called again the next day, first to my husband, then to me, asking if I was going to be taking le- gal action. I responded that, respectfully, I would not be responding and wished him well. Am I alone in that situation? Never has any physician made such an inquiry of me. Are you getting a sense of our health-care system by now? The main inexcusable part of this near fatal tale, is that one shouldn’t have to leave an ER, return home in order to call another ambulance, to save one’s life. Surely we can do better than this! Harriet Berkal writes from Winnipeg. MIKAELA MACKENZIE / FREE PRESS FILES The MPI head offices in downtown Winnipeg. Critics charge that the insurer is taking advantage of brain-injured Manitobans. BARRY WAITO HARRIET BERKAL ;