Victoria doctor backs off from charging $125, plans to leave MSP altogether

Days after telling patients she would hold off on her plan to charge them $125 a month, Victoria-based family doctor Dr. Perpetua Nwosu has announced she will unenrol from the Medical Services Plan.

As of Nov. 1, 2022, she won’t be part of public universal health care, though she wrote in an email to her patient list that she still plans to operate a fee-based practice.

“Dr. Nwosu is now repositioning the practice to be able to provide more patient-centred services using a team-based approach,” the email reads. That language is similar to how she described the goal of her retainership scheme, but includes no prices or proposed services.

Neither Dr. Nwosu nor her office responded to inquiries from Capital Daily about what services she plans to charge for.

The question her patients are left with is, is this legal?

“She seems to be sort of pushing all the boundaries to see how far she can go,” said one patient, who we’ve interviewed throughout this process. We’ve been calling her Hayley to protect her from being dropped as a patient for speaking out.

“Either we pay cash and we get reimbursed, or maybe we pay cash and there is no reimbursement, like it's totally private. But I didn't think that that was permitted,” she said. “But I don't really know when I haven't seen anywhere where it specifies that no, this is absolutely not allowed.”

Is it legal?

Both Hayley and I have done a lot of digging in the past two weeks to learn what physicians are allowed to do in BC in terms of billing. And both of us are perplexed.

“You would think that this is something that should be straightforward. Either you can or you can't,” Hayley told me Thursday afternoon. Hayley and her husband, who has complex medical needs, were seriously considering paying the $125 monthly fee, even though she said it felt like blackmail.

Within the Medical Services Plan (MSP), a physician can either “opt out” or unenrol. Most general practitioners in BC are “opted in,” which means they bill MSP directly for patient visits and other services covered by MSP, and the patient doesn’t pay at all. An opted-out physician (also called a hard opt out) will charge the patient for the same rate MSP pays, and the patient gets reimbursed by MSP. This is unusual, but happens in some circumstances, especially for services like chiropractic care, or acupuncture that are partially covered by MSP.

An unenroled physician has nothing to do with MSP, so they charge patients directly, and patients will not be reimbursed by MSP. And, they can charge whatever they want.

It took a couple of days to get an answer from the Ministry of Health, and in the meantime other organizations—College of Physicians and Surgeons, Doctors of BC, and BC Health Insurance (they administer MSP)—struggled to answer our basic query: is this allowed, and what can a doctor not affiliated with MSP charge?

Finally, the Ministry sent an email that included among other answers, one key line: "There are no limits in relation to private charges for unenroled physicians."

Dr. Nwosu also runs Perpetual Beauty and Wellness, a private cosmetic treatment clinic, which does not provide any services covered by MSP.

The initial proposal Dr. Nwosu released was referred to the Medical Services Commission. The College of Physicians and Surgeons referred us to MSP. A BC Health Insurance representative, which administers MSP, said they’re awaiting direction from the Ministry of Health.

Doctors of BC shared a statement from its president, Dr. Ramneek Dosanjh. “While we understand the frustrations doctors are feeling right now and see how this could lead some to consider de-enrolling from MSP to charge patients, it has always been Doctors of BC’s position that all British Columbians have—and continue to have—broad access to free health care. The vast majority cannot afford to pay which creates disparities and inequities, and adds to an already dire doctor shortage. This is just one of the many reasons we are working hard with government on concrete solutions to the primary care challenges BC doctors and patients are facing.”

The email to Dr. Nwosu’s patients, sent early Thursday morning, said, “existing clients will have the option to find a new family doctor, use local Urgent Primary Care Centres, or available walk-in clinics for their ongoing medical needs.”

New clinic focused on seniors' care

Perpetual Health Centre is a fairly new clinic that took over a practice from a family doctor who was semi-retiring, Dr. Amarjit Nirwan. Dr. Nwosu did not take on all of Dr. Nirwan’s patients, but says she chose the ones most in need.

“I refused to take anyone that had no health concern, I prioritized the elderly because I knew these groups of patients needed me more,” she wrote on Facebook last week.

At least one patient reached out to say that’s not true. Sukhvir Virk’s 95-year-old mother was dropped as a patient when Dr. Nwosu took over from Dr. Nirwan. She has a congenital heart condition and renal problems, which requires frequent medical attention.

“It is unbelievable that Dr. Nwosu, knowing the fact that this is a complicated patient, she basically didn't want to even have anything to do with it,” he said.

Virk and his wife and three kids were also dropped as patients. Through a family friend on the mainland, Virk was able to get a long-distance family doctor to treat his mother, but he sees it as a temporary measure.

Since his family aren’t patients, however, he was surprised to get that first email from Dr. Nwosu earlier this month informing him of her “retainership scheme” to provide team-based care.

“She goes on to say that she's going to want to give a team-based care. That in itself is the very essence of the MSP program. She cannot offer those services outside of the MSP. It seems illegal under the universal care act. That's the point I'm trying to make,” Virk said.

Initially, he phoned the Canadian health ministry to ask about her plans. He says they agreed that a scheme like this is “completely against the idea of universal health care.” In BC, the Ministry of Health is aware of the situation and has referred it to the Medical Services Commission, which will not comment until the review is complete.

Health Insurance BC operators are awaiting direction from the Ministry of Health on this case but have been fielding calls from concerned and confused patients. Their advice was to request an “extra billing investigation.”

A 2018 information sheet about extra billing investigations says the government updated the Medicare Protection Act to, among other things, clarify “that selling priority access to medically-necessary care is extra billing.”

Doctors who bill clients for services covered by MSP, or for priority access to insured services, can be fined as much as $20,000 for repeat cases, and even expelled from MSP.

Dr. Nwosu gave her patients just over two months’ notice saying that will allow for a “safe transition for all existing patients.” But with an estimated 25% of Greater Victorians already without a family doctor, and the fact that 70% of her client base is elderly people with multiple health concerns, a safe transition seems unlikely. Unless many choose to stay and pay.

“This is literally going to privatization of health care for profit,” Virk said

“This is something we cannot take lying down as Canadians. We have to stop this. If we allow this particular person to do this, then it's a very slippery slope. So we need to get the likes of Adrian Dix to put a real pin in this right away.”

This article was updated on Aug. 22 to include a key answer from the Ministry of Health.