Ottawa woman ‘outraged’ at $110 charge at Appletree clinic for routine cervical cancer screening

Ontario’s Ministry of Health investigating the practices of an Appletree clinic after a woman was charged $110 to see a nurse practitioner.

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Published Mar 12, 2024 • Last updated 8 hours ago • 6 minute read

Eileen Murphy says she registered with the Appletree clinic near Carling and Woodroffe last year because both she and her husband were without a family doctor. She’s since been told the doctor she was registered with is now located in Northern Ontario. Photo by Jean Levac /Postmedia

Ontario’s Ministry of Health says it is launching an investigation into the practices of an Ottawa Appletree clinic after a woman was charged $110 to see a nurse practitioner for a routine cancer screening test.

Eileen Murphy says she registered with the Appletree clinic near Carling and Woodroffe last year because both she and her husband were without a family doctor. Their former doctor switched her practice from family medicine to dermatology in 2022.

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But when Murphy tried to make an appointment for a routine Pap test recently — part of the Ontario government’s preventative cervical cancer screening program — she was told the doctor she was registered with through Appletree was now located in Northern Ontario. She tried other doctors but they said they wouldn’t take her without a referral. She was told she could make an appointment with a nurse practitioner for the test at the Appletree clinic on Carling Avenue, where she had registered.

When she got there, she says she was stunned to see a “laundry list” of fees to access the nurse practitioner and have the test performed. In Murphy’s case, because she is over 50 and has an OHIP card, the fee was $97 — $110 with taxes. Patients under 50 are charged $49, plus taxes, for an appointment, Murphy saw.

The appointment consisted of a more general examination than just a Pap test and Murphy says she was referred on for several unrelated tests.

She was told that when the results of the Pap test were in, she could book another appointment to go over them with the nurse practitioner, for an additional $110.

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Murphy calls the situation outrageous and ageist, and has filed complaints with provincial and federal officials, but says she has received little or no response.

“I have contacted Health Ontario about this matter only to be brushed aside and told it is a matter I must deal with on my own with Appletree clinics,” she said.

On Tuesday, a spokesperson for provincial Health Minister Sylvia Jones, after being told of Murphy’s experience by this newspaper, said the ministry will investigate the practices of the clinic.

“We will not tolerate any clinics taking advantage of a loophole created by federal legislation and charging patients to access primary care,” said spokesperson Hannah Jensen.

Jensen also said the federal government needs to take action to close the “loophole.”

“It is federal legislation that sets out when and what services it is illegal to charge patients for, in other words, what violates the Commitment to the Future of Medicare Act. We hope the federal government will take action to ensure Ontarians and Canadians can access publicly funded care.”

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The Canada Health Act prohibits charging patients for medically necessary services that are covered under provincial health plans. Nurse practitioner services are not covered through the Ontario Health Insurance Plan the way physicians are and they can’t bill for individual services.

The South Keys Health Center at 1-2401 Bank Street in Ottawa. Photo by Tony Caldwell /Postmedia

Last year, Minister Jones said she would investigate another Ottawa nurse practitioner clinic, South Keys Health Centre, alleged to be charging a $400 access fee for primary care. It is unclear whether that investigation took place.

The Opposition NDP’s health critic, France Gélinas, said clinics cannot be allowed to charge desperate Ontario residents for primary care.

“This is illegal. You shut them down,” she said.

Gélinas said there are many nurse practitioners across the province who want to work but cannot find a salaried position and feel they have only one recourse — charging patients for their services.

“People are so desperate for care that they are willing to pay.”

She said opening significantly more OHIP-funded nurse practitioner clinics would help many of the 2.3 million Ontario residents without doctors. She noted that the province now has $5.1 billion in its contingency fund, according to a recent Financial Accountability Office of Ontario report.

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“The Ford government could do something.”

The Ontario Health Coalition, a group of advocates for accessible public health care, has called on the province to shut down South Keys and other clinics allegedly charging fees for primary care through nurse practitioners.

The group says the imposition of a $400 fee to access insured primary health services would be unlawful and would re-establish the two-tier health system that Medicare was designed to end in 1966.

“Premier Ford regularly repeats the claim that people in Ontario will not need their credit card to access basic health care — but the South Keys Health Center now boasts that they are happy to accept credit cards, cash, and other forms of payment to access their primary care program,” according to a recent report from the Ontario Health Coalition and the Ottawa Health Coalition.

Osman Nor, clinical director at the South Keys Health Centre, at Bank and Hunt Club, previously told this newspaper the clinic is filling a desperate need for primary care in the community and is doing so legally.

“This is something the community needs and we are here to help.”

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Nor acknowledged the clinic had received some patient complaints about the fee, but, as of the time of his comment, 10,000 people had signed on to pay the fee and get access to primary care through the walk-in clinic. The clinic will also charge patients a fee per visit, Nor said.

Murphy, meanwhile, said she is especially frustrated because she was never notified by Appletree that she had been “attached” to one of its family doctors — that information came from Ontario Health. But her doctor is a person she has never met and who is now located in Dryden, more than 1,700 kilometres away from her home in Ottawa.

“I am now in a pay-as-you-go system that I did not ask for or want,” she said. Because she is signed on with a doctor, Murphy couldn’t sign up with another family physician — if one was available. Some 2.3 million Ontario residents are without a family doctor and that number is expected to grow sharply in the next few years.

She said the situation is affecting her mental and physical well-being. “My anxieties over my husband’s health and now my own are causing continuing concern.”

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Murphy and her husband are both seniors and he has a number of chronic health issues.

The growth of fee-based nurse practitioner clinics has been in the spotlight in Ontario in recent months as growing numbers of residents are in need of primary health care.

Ontario has the most nurse practitioners in the country, and, in Ontario, nurse practitioners have an expanded scope of practice, meaning they can do many things that family physicians can. But, unlike doctors, nurse practitioners cannot bill directly to OHIP.

The only way their services can be supported through OHIP is if they work as salaried employees of a clinic. The province recently invested tens of millions of dollars in new interprofessional primary health clinics around the province, but those do not come close to meeting the needs, say health advocates and experts.

This newspaper made repeated attempts to contact an official from Appletree for comment on this story, including by phone, email and through its website, but failed to reach anyone. In an automated response to a message sent to an email address found on its website, the company said: “This email address is not monitored daily, please note that we do not respond to all inquiries sent via email.” Attempts to reach someone by telephone resulted in being left on hold, with a constant warning that the call volumes were higher than normal. No calls were answered nor was there anywhere to leave a message.

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