Surgical procedures, transplants, chemotherapy: At the University of Montreal Hospital Center (CHUM), surgeries had to be postponed because patients could not pay for their mandatory dental treatment before the procedure.
Posted at 12:00 p.m
Alice Girard-Bossé La Presse
“It’s disgusting. That puts us in very difficult situations,” criticizes Dr. Matthieu Schmittbuhl, head of the dental department at CHUM.
To reduce the risk of complications, patients awaiting transplantation, cardiac surgery and oncology patients who need to receive chemotherapy need to systematically perform preventive oral care, including tooth cleaning and tooth extraction.
“The dental check-up and the preparation of the mouth are essential, otherwise it can have very serious consequences for the patient,” explains Dr. Schmittbuhl.
Recently, an immunocompromised patient at CHUM was admitted to the ICU with 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 head and neck cancer patients who require oral care are covered by the Régie de l’assurance maladie du Québec (RAMQ). Everyone else doesn’t, much to the chagrin of Dr. Schmittbuhl.
PHOTO ALAIN ROBERGE, THE PRESS
dr Matthieu Schmittbuhl, head of the CHUM dental department
This is not comfort care, but basic care.
dr Matthieu Schmittbuhl, head of the CHUM dental department
Every week, the specialist meets patients who cannot pay these fees. “Sometimes, in the urgency of a situation, we’ll take care of it for free, but we can’t always do it. It’s unbearable to discuss money with someone waiting for a transplant. It doesn’t make ethical sense,” he said.
Waiting for funding
In January, a team of CHUM specialists asked the Department of Health and Human Services (MSSS) to establish an oral care program for these uninsured patients. The ministry did not respond to her request.
“Medically, ethically and deontologically, it seems to me the minimum that we should provide this care when everything else is covered,” said Dr. Schmittbuhl.
According to their estimates, this program could involve about 200 patients per year or an annual budget of $100,000. “It’s a very modest budget. It’s a drop in the bucket of the healthcare budget and we can’t get it,” he says.
dr Schmittbuhl argues that putting off surgeries due to a lack of oral care is far more costly to the healthcare 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 in the first year and $23,000 in subsequent years.
Delaying a heart transplant or surgery, or keeping a patient in the ICU comes at a staggering cost to the healthcare system.
dr Matthew Schmittbuehl
For several years, the Ordre des Dentistes du Québec has required that medically necessary dental treatment be covered by public funds. “The Order believes that the division of healthcare between those who fall within the field of medicine and those who fall under the field of dentistry creates situations that are totally unacceptable from a purely human point of view,” said the director for public affairs and communications. Andre Lavoie.
The Quebec Medical Association (FMSQ) also believes that pre-surgery care should be covered by the RAMQ. “Some treatments require preoperative evaluation and good oral health, and patients in Quebec should be able to receive this oral care without incurring any costs,” said FMSQ spokeswoman Sacha Lubin.
The MSSS, for its part, claims that this file is currently being analyzed. “A committee to direct a medically necessary oral care program […] was set up, but the pandemic delayed the completion of the work,” said spokeswoman Marjorie Larouche.