Surgical interventions, transplants, chemotherapy: at the University of Montreal Hospital Center (CHUM), operations had to be postponed because patients could not afford to pay for their mandatory dental care before their interventions.
Posted at 12:00 a.m.
” It’s revolting. It puts us in very difficult situations, ”denounces the Dr Matthieu Schmittbuhl, head of the dental medicine department at the CHUM.
To reduce the risk of complications, patients awaiting transplants, cardiac surgery and oncology patients who will have to receive chemotherapy must systematically follow preventive oral care, including dental cleanings and extractions.
“The dental check-up and the restoration of the mouth are essential, otherwise it can have very serious consequences for the patient”, explains the Dr Schmittbuhl.
Recently, an immunosuppressed patient from the CHUM was hospitalized in intensive care for pneumonia and pericarditis, an inflammation of the membrane that surrounds the heart. These complications were most likely related to a dental infection.
Currently, only adult patients with head and neck cancer requiring oral care are covered by the Régie de l’assurance maladie du Québec (RAMQ). All the others are not, much to the dismay of the Dr Schmittbuhl.
PHOTO ALAIN ROBERGE, THE PRESS
The Dr Matthieu Schmittbuhl, head of the CHUM dental department
This is not comfort care, it is basic required care.
The Dr Matthieu Schmittbuhl, head of the CHUM dental department
Every week, the specialist meets patients who are unable to pay these fees. “Sometimes, in the urgency of a situation, we do pro bono care, but we can’t do it all the time. It’s unbearable to discuss money with someone who is waiting for a transplant. It doesn’t make ethical sense,” he said.
Waiting for funding
In January, a team of CHUM specialists asked the Ministry of Health and Social Services (MSSS) to set up an oral care program for these uninsured patients. The Ministry did not respond to their request.
“On the medical, ethical and deontological level, it seems to me that it is a minimum that we provide this care when everything else is covered”, judges the Dr Schmittbuhl.
According to their estimates, this program could involve approximately 200 patients per year, or an annual budget of $100,000. “It’s a very modest budget. It’s a drop in the ocean of the health budget and we can’t get it,” he says.
The Dr Schmittbuhl maintains that postponing operations for lack of oral care is much more costly for the health system. In fact, the annual cost of dialysis for a patient awaiting a kidney transplant is $100,000, while the cost of a kidney transplant is $66,000 the first year and $23,000 the following years.
Delaying a heart transplant or surgery or keeping a patient in intensive care entails frightening additional costs for the health system.
The Dr Matthew Schmittbuhl
For several years, the Ordre des dentistes du Québec has demanded that medically required dental care be covered by the public plan. “The Order believes that dividing health care between those that fall within the domain of medicine and those that fall within the domain of dentistry causes situations that are completely unacceptable from a strictly human point of view,” said the director of public affairs and communications, André Lavoie.
The Federation of Medical Specialists of Quebec (FMSQ) also considers that the care required before surgery should be covered by the RAMQ. “Some treatments require preoperative examinations and good oral health, and Quebec patients should be able to receive this oral care without paying any costs,” said FMSQ spokesperson Sacha Lubin.
For its part, the MSSS maintains that this file is currently being analyzed. “A committee to guide a medically required oral care program […] was put in place, but the pandemic delayed the finalization of the work,” said spokesperson Marjorie Larouche.