Nova Scotia mom says she owes $80,000 after paying for surgery but ‘I can play with my kids’ SaltWire

Jennifer Brady made her final request to the Nova Scotia Secretary of Health.

Brady’s letter to Michelle Thompson in June came 19 months after her condition hospitalized her with a potentially fatal blood infection.

It came 14 months after a Montreal lymphedema specialist examined her and said she needed surgery.

The surgery she needed is not available in Atlantic Canada, and the handful of surgeons who are able to do it in the country, including the surgeon she saw in Montreal, are booked with her own patients for at least two years.

Brady found a clinic in Japan willing to do the job, but the Nova Scotia government refused to pay the cost.

The minister was her last option. Thompson has the authority to overrule the department’s decision and have the province pay the cost of an out-of-province operation.

Brady made an impassioned appeal to Thompson. The single mother of two is still waiting for an answer.

The process is already complete and costs Brady $80,000. She scraped together the money by taking out a loan on her house. She was so weakened by her condition that she could no longer wait for the province to decide whether she would take over the procedure.

Lymphovenous anastomosis

The procedure, the lymphovenous anastomosis, is performed all over the world. It connects damaged lymph vessels to a nearby vein. A healthy lymphatic system recycles everything that leaks from veins, arteries and capillaries.

If it doesn’t work, it can cause swelling and repeated blood infections, which in Brady’s case landed her in the hospital. Her lymphatic system had been damaged after cancer surgery.

Brady has been treated but is not done with Thompson and the Nova Scotia government.

Late last month, she requested a judicial review from the Nova Scotia Supreme Court. The courts will determine whether the province’s handling of Brady’s case was fair, reasonable and lawful. Her case will be heard in September.

“In the short term, I want the surgery to be covered,” Brady said. “Long term, we need research and an effective treatment for lymphedema in Nova Scotia.

“We have to start taking it seriously. We need to change provincial insurance policies so that people with lymphedema can get the care they need.”

She is not only committed to people with lymphedema. She says the policy needs to be broad enough to ensure everyone has access to medically necessary care. If they can’t be treated in Nova Scotia, the province has to pay to have them done elsewhere, argues Brady.

Their years of struggle underscores the lack of opportunities for people suffering from lymphedema in this province.

No specialists in Nova Scotia

The treatment available in Nova Scotia is minimal and is only intended to treat the symptoms of the disease. It includes expensive clothing and specialized massage therapies to help manage fluid retention.

For Brady, the cost runs into thousands of dollars a year.

Now she owes $80,000. Nova Scotia’s Health and Insurance Act states that out-of-province procedures are not covered after the fact.

But Brady argues that the province never presented a realistic chance for her surgery to be approved. The law states that in order to qualify for an out-of-province procedure, a referral must be from a Nova Scotia specialist. But there are no doctors here who specialize in lymphedema, so she went to Montreal.

Nova Scotia would not accept this doctor’s recommendation for the procedure.

dr Joshua Vorstenbosch is the specialist Brady visited in Montreal in June 2021. Vorstenbosch, who is also an assistant professor of surgery at McGill University, says simply that conventional therapy is no longer sufficient for Brady. She’s not just struggling with pain anymore. Brady suffers from episodic infections and is a good candidate for surgery.

“It’s one thing to have lymphedema interfering with your daily activities, but it’s another when it actually makes you sick with infections,” Vorstenbosch said. “If it requires antibiotics and hospitalizations, that’s a big deal.

“These patients are desperate, they are unhappy. They become completely different people. They just long for the day when they don’t have to put on that sleeve or that piece of clothing.”

Since the surgery, Brady says her symptoms have improved and she has regained her life.

“My legs are getting better,” she said.

“I have the assurance of not being in constant fear of blood infections and not in constant pain.

“My legs aren’t that swollen…I can play with my kids; I can go for a walk in the evenings.”

Uphill litigation

Wayne MacKay, a law professor at Dalhousie University, credits Brady with taking her fight to court, but says she has an uphill battle ahead.

“We give the legislature and executive branch (over) the medical system (spending) a lot of discretion, and the courts are reluctant to step in,” MacKay said. “That’s the bottom line.”

Nonetheless, her case still has merit. Nova Scotia has few treatment options, no specialists and the type of surgery she needs is not offered here.

The involvement of the courts draws attention to these shortcomings, he said.

“It can be a good nudge for government officials and policymakers to say, ‘Look, we have to do better. We can’t just ignore these people.”

On the same day that Brady filed for a judicial review, another lymphedema patient did the same.

The Chronicle Herald asked the health department several questions, including why Brady’s surgery wasn’t covered and whether the minister was reviewing her case.

A spokesman said the department would not respond as the case had gone to court.