Michelle Dorey Forestell, Local Journalism Initiative Reporter, Kingstonist.com

In the weeks since Kingstonist first reported that Dr. Elaine Ma was facing a Health Services Appeal and Review Board (HSARB) hearing and stiff penalties from the Ontario Health Insurance Plan (OHIP), related to mass clinics she organized to give Kingston one of the fastest and most effective vaccine rollouts of the COVID-19 pandemic, the story has caused concern both locally and provincially.

Ma has been told she must give back $600,000 she received to cover the costs associated with running vaccine clinics at the height of the pandemic because those clinics did not occur within the walls of a doctor’s office and because medical students were employed to assist in administering the vaccines.

Since then, she has gained the support of local colleagues and the Kingston, Frontenac, Lennox and Addington (KFL&A) Medical Officer of Health (MOH), Dr. Piotr Oglaza. However, in conjunction with the local support came a strange comment from the Ministry of Health that was presented with absolutely no context or apparent justification.

Kingstonist contacted Ma to discuss the Ministry of Health’s allegations and find out how she is feeling following the conclusion of the HSARB hearings (the decisions of which have yet to be released).

First of all, Ma made it clear that she has felt encouraged in her struggle by the local support she’s received. 

“While I’ve been disheartened by the treatment [from] OHIP and the Ministry of Health, and the Minister of Health’s office, it has been so encouraging to me to hear not only the support of our medical officer of health and other local doctors who know that we were doing the right thing and following the rules as they were meant to be followed, and how everybody who wrote the rules at the time thought they were being followed — It’s the general public’s support that’s been phenomenally appreciated,” Ma said.

As noted in earlier coverage, Kingstonist began reaching out to several parties on Friday, Oct. 25, 2024: OHIP, the Ministry of Health, Health Minister Sylvia Jones, Member of Provincial Parliament (MPP) Ted Hsu (who responded in previous coverage), and MPP Ric Bresee (whose office indicated on two occasions that they would forward requests to the Ministry of Health). 

Five days passed with further follow-up emails when, on Wednesday, Oct. 30, 2024, Hannah Jensen, Communications Director for Minister Jones, finally responded via email and with a comment that included some questionable accusations.

“During COVID, a Ministerial Order was issued to set up special payments for physicians at designated assessment centres. The order offered an hourly rate for all insured services at assessment centres, including vaccinations. Physicians could also bill existing fee codes for vaccines given in their offices if they did them personally or if they were done by staff. If any physician failed to follow the Ministerial Order or incorrectly paid staff, they would need to return any improperly collected fees to the Ministry,” Minister Jones’s spokesperson relayed.

“No other doctor in the province who ran a mass vaccination clinic is having this issue. This doctor billed the Ministry for over 23,000 vaccines over five days, incorrectly billing the Ministry for $630,000, 21 times their eligible payments and used Queen’s medical students as volunteers to administer vaccinations, a misuse of the billing code above,” Jensen asserted.

Jensen also stated, without providing any verification, “The Ministry is further investigating a claim that the doctor paid the volunteers 20 per cent of the total claim and pocketed the remaining amount.”

Despite Kingstonist sending several follow-up questions, the Ministry of Health refused to explain these comments or the use of the word “pocketed,” which seemed to imply Ma had done something illegal.

Ma relayed her frustration saying, “First of all, the Ministry of Health has no idea what all my expenses were because they’ve only seen parts of them… Just as I don’t give the Ministry of Health a list of how much it costs me to run my office, I didn’t [tell] them how much it costs me to run a vaccine clinic.”

“So for the Minister of Health’s office to issue a statement that says they know how much these clinics cost me is impossible. They don’t know what the overhead expenses are… to rent my office, pay my staff, buy medical equipment, etc.,” the doctor continued.

“But even further, they are giving incorrect information by saying I billed for 21 times the eligible payments. First of all, I wasn’t eligible to bill for hourly pay; second of all, they don’t know what [the] hours [worked] are. So how could they say I billed 21 times an hourly rate when an hourly rate didn’t apply and they don’t know the hours worked?” 

The Kingston-based doctor also addressed the blatant accusation levelled by the Ministry of Health through its spokesperson.

“On top of that, the term ‘pocketed’ does imply more than ‘get paid,’ and instead implies something improper happened,” she said, declaring that the suggestion of anything illegal or untoward was unfounded. “That’s not what happened. What happened was that billing codes were provided for us, work was done, and billing codes were submitted out of those expenses for pay.”

Ma said she felt “very disheartened” after the OHIP hearing in Toronto on October 22, 23, 24, and 29, 2024, which ran from 10 a.m. to 4:30 p.m., taking her away from her practice and home life. Her feeling was that the board wasn’t interested in hearing from her. 

“It was very clear to me that OHIP was only there to claw back [the $600,000],” she said, noting that they seemed more interested in “protecting the public purse, paying as little as possible, as opposed to paying appropriately [for services rendered].” 

Ma pointed out that the services she provided with her vaccine clinics led to hundreds of thousands to millions of dollars’ worth of “cost-saving measures by prevention.” Fewer people in the Kingston area were infected with a disease that caused the deaths of over 50,000 people in Canada alone, and fewer people in eastern Ontario were hospitalized, saving the province millions.

At the HSARB hearing, Ma said, OHIP focused most of its arguments on a 2001 INFOBulletin’s definitions of “employee” and “workspace.” Because of this decades-old memo, Ma’s use of Queen’s medical students to vaccinate people at clinics didn’t occur in her office, which meant she had not followed agreed-upon standards.

It should be noted that the OHIP hearing focused on 2001 definitions despite new pandemic-related rules being issued in 2021. Kingstonist could not find the Ministerial Order given in 2021, although a copy of it from the Minister of Health’s office was requested multiple times — but there were numerous OHIP INFOBulletins issued from the Ministry of Health to physicians in 2021. 

One of them explains that “Physicians providing COVID-19 vaccination services at a Ministry designated COVID-19 Assessment Centre (mass vaccination site) may claim the temporary… sessional codes for remuneration. This includes any sites where a hospital or Public Health Unit (PHU) coordinates COVID-19 vaccine delivery and includes physicians deployed as part of a mobile team at an eligible COVID-19 Assessment Centre.”

As to using medical students to administer thousands of injections under her supervision, Ma pointed out that as part of Ontario’s Employee Standards Act, one of the definitions of an employee is “a person who receives training from a person who is an employer, if the skill in which the person is being trained is a skill used by the employer’s employees.”

The fact that the OHIP definitions do not match the Employee Standards Act, the current definition provided by the Ontario government, seemed to make no difference at the hearings, Ma said, nor did the fact that the work was done in a time of global emergency.

Furthermore, Kingstonist confirmed with Ma that she had spoken to Premier Doug Ford weeks before the hearing. On September 25, 2024, “I went online, got his cell phone number and called him, and his voicemail said… to send him a text message. So I did,” Ma disclosed. In the text, she explained who she was and the problem she was dealing with.

Later that same evening, the premier called her back and left a message. Ma then called him back and left a message, and he called her again.

Ma said she was impressed: “He listened to me, and then he said, ‘That just doesn’t seem right.’”

According to Ma, Ford said he would get back to her; then, “He called me back a little bit later and told me he had called [Ontario’s Chief Medical Officer] Dr. Kieran Moore to verify what I was telling him… We had a good little chat about Dr. Moore and how much [Ford] respected [Moore’s] work through the pandemic. [Ford] told me that, once he had verified that, he called Sylvia Jones [the Minister of Health].”

“At that point, Sylvia Jones had said, ‘Well, let it run the process first,’ and [Ford] told me, ‘Well, that’s ridiculous. This just needs to be taken care of.’ This is all hearsay because this is what [the premier] told me. He told me that he had directed Sylvia Jones to end this, and I would be hearing [from someone] shortly,” Ma said.

She felt confident that something would be done within a week or so. However, it was not to be.

Ma texted Ford again on October 3 and 8, but received no answer. Then, on October 24, on her way home from the OHIP hearing, she texted him again, reminding him of what was happening and that he had promised action, and telling him she had been forced to cancel her clinic planned for October 25, 2024.

On October 29, after the hearings were over, Ma texted Ford again. In brief, that text reads: “It makes me extremely sad to have heard that OHIP cares more about the definition of employee and office than they care about work done. OHIP and, by extension, the Ministry of Health and provincial government, don’t care about the context of the COVID-19 pandemic and how we were trying to work as quickly as possible to get shots into arms as you asked us to do. Mr. Ford, after talking with you, I truly believe that you care about the work that health care workers did during the paramedic.”

Ma’s message continued, “I need your help. I’m facing a decision that will not only demoralize family physicians in this province, but will make it impossible to train medical students. There are far bigger issues at stake.” 

Ma said she also sent the premier a copy of a Kingstonist article.

Since the first Kingstonist story on this matter and right up until another request was issued on Monday, Nov. 18, 2024, neither Ford nor his office has responded to our requests for statements or interviews with the premier.

Still, Ma is grateful for the public’s and her colleagues’ response and support. MOH Dr. Piotr Oglaza even went to the hearings in Toronto to show his support for Ma. 

“He travelled to Toronto for this,” she said. “He stood up and said, ‘Wait a minute, we’re forgetting the context in which all of this happened. And where is Chief Medical Officer Dr. Moore in this?’” 

Ma said Oglaza was significantly cut off from speaking at the hearing. Oglaza wanted to talk about the context of the phone calls with retired General Rick Hillier, who chaired the COVID-19 Vaccine Distribution Task Force, “about how [we] were told, ‘Get it done. We will make it right,’” Ma said. 

However, although not all aspects of the letter Oglaza submitted to the HSARB were addressed during testimony, his opinion on the matter was expressed in full in that letter and through comments provided to Kingstonist.

On Monday, November 18, Oglaza told Kingstonist, ”I continue to stand by the statements I made in the letter that I submitted to the Health Services Appeal and Review Board (HSARB) and made in the media following the hearing. I believe that a ruling against Dr. Ma would have far-reaching implications that would impact the way we respond to future public health emergencies. I believe Dr. Ma’s clinics were safe, effective, and prevented hospitalizations and saved lives at a time it was most needed.”

Kingstonist has also attempted to reach out in multiple ways to Hillier, but there has been no response to date.

On November 4, 2024, Kingstonist contacted the Health Services Appeal and Review Board. As an independent quasi-judicial tribunal, its hearings are supposed to be a matter of public record. On November 4, Alpha Aberra, a Case Management Coordinator for the Health Board Secretariat, acknowledged receipt of the email with instructions on how to order a transcript. Those instructions were followed that day and requested the transcript of the hearing was reuested,

Three days passed. On Thursday, Nov. 7, 2024, Ashvini Jeyanthan, a Case Officer with the Health Board Secretariat responded, “The Board does not provide transcripts of the hearings; however, you would have to contact the court reporter who was in attendance for the hearing.” Apparently the government doesn’t “provide transcripts,” but it does hire someone to create them.

We did as instructed and were promptly informed that the total price for the transcript, including HST and service fee, was $6,378.8, due before “beginning transcription.”  It appears, then, that somewhere there is a recording of the hearing that has not yet been transcribed for public record. Kingstonist is attempting to procure the records through a Freedom of Information request.

Ma, for all her perseverance, is dismayed. 

“I am still struggling to understand how this has gotten this far, and how a branch of the Ministry of Health has forgotten about COVID… that we were in a pandemic and it wasn’t safe to be inside the four walls of our office with mass numbers of people. [It’s] unbelievable to me,” she expressed.

“It also surprises me that the people in question at OHIP are based in Kingston, so they knew of these vaccine clinics, presumably at the time they were being run. I’m fairly certain most in Kingston knew that there were multiple large volume vaccine clinics being run in parking lots, outside.”

One has to wonder if any of the Kingston OHIP staff might actually have received a vaccination from a Queen’s medical student in a parking lot at that time, Ma expressed.

This issue has far-reaching implications beyond just financial ones, as MPP Hsu noted when reached for comment.

“There is a deeper issue here. In the next public health emergency — and they are surely coming — do you want our doctors worried about a fight with OHIP and fair payment for work done?”

Kingstonist will continue to provide coverage of this matter as more information becomes available.

Learn more about our News Monitoring here.

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