By Bonnie Hedrick

Haines residents traveling to Whitehorse for medical care could be denied treatment unless their needs are urgent under malpractice insurance guidelines adopted last year.

The new rules mean that Haines women can no longer deliver babies at Whitehorse General Hospital except in case of emergency. They also eliminate the option of elective medical procedures for any non-Canadian.

"It’s a bummer," said Joy Hussain, a doctor at Haines’ SEARHC clinic. "I looked into it myself because I’m pregnant and wanted to deliver in White-horse...There’s not a whole lot of choices."

The new restrictions are being driven by the Canadian Medical Protective Association, a national nonprofit physicians’ group that provides malpractice insurance and legal protection to most doctors in the country. The rules do not apply to dentists or dental specialists.

The CMPA last year revised its guidelines for treating non-Canadians, advising doctors that their insurance might not cover lawsuits filed by international patients.

"Where the matter is brought in the United States of America or in another foreign jurisdiction, the Association will generally decline to extend assistance" to the physician, a CMPA bulletin about the new policy says. "Legal actions in the United States, in particular, can be prohibitively costly."

Although the new guidelines took effect in January 2004, they were implemented by doctors at Whitehorse General Hospital last fall, said Dr. Wayne MacNicol, president of the Yukon Medical Association.

Until then, U.S. patients were required to sign a waiver agreeing to settle any future dispute in Canadian court. Now that’s not seen as adequate protection, MacNicol said.

Although no patient will be denied emergency care, which is clearly covered under CMPA guidelines, coverage of routine or elective treatments is less certain, MacNicol said. Doctors are also banned from advertising for customers in the U.S.

"If care could reasonably be expected to be provided in the U.S., then we may not be protected legally against an action brought against us by an American patient," he said, a sobering prospect for a physician. "American patients are seen as more litigious than Canadians."

So far, family practice physicians in Whitehorse are still accepting patients for standard office visits, but any procedure that requires a specialist, such as an obstetrician, is being denied.

"It left us high and dry not to have the obstetrical people backing us," said family doctor Sally MacDonald, who delivered many Haines babies before discontinuing obstetric care last year.

MacDonald said family doctors have been given verbal assurance that their legal needs will be covered, but that assurance is lacking for specialists.

"There’s a discrepancy in the advice family doctors are being given and the advice specialists are being given," MacNicol said.

Eliminating specialist care for U.S. citizens "has quite far-reaching implications," and is an issue that Yukon physicians would like the CMPA to reconsider for residents of Haines and Skagway at the group’s quarterly spring meeting. MacNicol said Yukon doctors would like to see an exemption to the malpractice rules.

"We’d like to explain the special situation for these two isolated communities that don’t have easy access or road access to anywhere in the state for medical care," MacNicol said. "But until we get clarification, we’re in a very difficult situation."

MacDonald said the uncertainty makes her job difficult. "It’s extremely hard because a lot of us have lived in the community for a lot of years and have longstanding patients (in Haines and Skagway)… This doesn’t build bridges in a time we should be building bridges."

Hussain said the policy shift is a loss for Haines residents, especially those who pay for care out of pocket. Medical procedures are often considerably less expensive across the border.

"Last year, I would have said, ‘Let’s consider Whitehorse,’ when evaluating choices," she said. "Now we can’t give those options…It’s something that a lot of people are shocked by when we tell them."