A provincial program that claims to help amputees cover three-quarters of the cost of their prostheses is far falling short of that promise, according to people who have tried to access the financial aid.
On its website, the Ontario Ministry of Health and Long-Term Care’s assistive devices program (ADP) claims to cover “75 per cent of the cost for equipment and supplies,” including artificial limbs.
However, the program sets limits on the value of the devices it covers.
The ADP’s approved prices for limb prostheses was last reviewed in 2012, but advocacy groups including The War Amps say even then, the prices were severely out of date.
“We think Canadians would be shocked to learn that if you lose a limb, you may not receive appropriate coverage for your artificial limbs,” said Annelise Petlock, a lawyer with The War Amps.
Ontario lagging: reports
Petlock, who uses a prosthetic hand, said in practice the policy permits only partial coverage of the most basic prostheses.
For example, amyoelectric hand prosthesis with a simple open-and-close function like the one Petlock uses typically costs about $24,000, but the ADP’s maximum contribution is currently $10,208 — less than half the actual cost.
An independent study released last fall concluded Ontario’s support program for amputees is less generous than those in other high-income jurisdictions such as England, Norway, Italy and New Zealand.
The 2018 Ontario auditor general’s report found the ADP “does not have fully effective systems and procedures in place to meet the needs of Ontarians with long-term physical disabilities.”
For Emilio Dutra-Lidington and his family, that reality is just starting to set in. Last August, the 19-year-old lost his right leg at the hip and all four fingers on his right hand to the propeller of a boat that plowed over him on Lac Pemichangan in western Quebec.
His recovery, including 16 surgeries, has been long and painful.
“I kept having dreams where I was playing basketball and I was moving quickly,” Dutra-Lidington recalled of his hospital stay. “Then I would wake up and be like, how would I even do that?”
Last month, Dutra-Lidington took one small but important step when he crossed the finish line of the Canada Army Run 5K, his good hand on his father’s shoulder for support. The prosthetic leg he was using was a loaner from the Ottawa Hospital Rehabilitation Centre.
But chafing from the plastic socket that fits around his groin caused an uncomfortable rash, forcing him to go without the prosthesis for a few days while the skin healed.
Ideally, the teen needs an artificial limb that not only bends at the knee, but also reproduces his hip and ankle movement. The one he’s borrowing now contains a microprocessor-controlled knee joint module, which by itself sells for more than $63,000.
A fraction of the cost
The Ministry of Health lists a “Knee Unit, Swing And/Or Stance Phase Control” as having a maximum value of $4,298, toward which it will contribute 75 per cent, or $3,223.50 — a tiny fraction of the true cost.
A quote prepared for the teenager’s family prices the whole prosthetic leg at $91,577, toward which the ADP would contribute just $6,792, or about seven per cent.
“They get it wrong. Even if there is a policy in place, it’s often outdated,” Petlock said. “As an amputee myself, it’s evident that they’ve never spoken to an amputee in the creation of this policy,”
Compounding the problem is the fact that many insurance policies limit coverage to a single purchase, when in fact most artificial limbs need to be replaced every few years.
The ministry says the kind of leg Dutra-Lidington hopes to buy is atypical, and maintains the ADP does cover a significant portion of the cost of most prostheses.
“A microprocessor knee is not the standard type of knee prothesis used by the majority of individuals with amputations who receive funding from ADP,” said spokesperson David Jensen.
But Petlock insists the main benefit of the microprocessor knee is added safety.
“All that does is send a little signal to prevent the knee from snapping shut like a cheap suitcase and having you go down hard,” she said.
Inadequate artificial limbs have also been known to cause degenerative joint disease, osteoarthritis and overuse injuries.
‘You’ve got to just move on’
It’s not clear when Dutra-Lidington will have to return the leg he’s currently borrowing, or when he does, how he’ll be able to afford one that works half as well.
“You’ve got to just move on, you know?” he reasoned.
After months of intense worry, Dutra-Lidington’s parents are just now starting to grapple with the potential cost of the prostheses that will help restore even some of their son’s former mobility.
“As his parents, we want to try to give him those basic things back,” said Robert Lee, the teen’s step-father, who said he’s been warned by prosthetists that a leg and hand “set” could cost as much as $250,000, and would need to be replaced every few years.
“They’re massive, they’re very big costs,” Lee said.
The War Amps adult amputee program, which provides some financial assistance toward the cost of artificial limbs, may help, and a crowd-funding campaign started by Dutra-Lidington’s family in June was already at $130,000 earlier this week. As well, a civil lawsuit has been filed against the owner of the boat that caused the injuries.