Doctors warn ruling dangerous for Ontario, rally behind Kingston physician

A petition supporting Kingston family doctor Dr. Elaine Ma gained over 1,000 signatures in the first 24 hours after Dr. Sohail Gandhi posted a link to it on his popular medical blog, JustAnOldCountryDoctor.com.

In a December 3, 2024, blog post, Gandhi referred to the recent events involving Ma, saying, “Last week, the Ontario Health Sector (sic) Appeal and Review Board (HSARB) denied the appeal by Dr. Elaine Ma in her fight against the Ontario Health Insurance Plan (OHIP). At the risk of upsetting Dr. Ma and many (? all) of my colleagues,” he wrote, “that decision actually was legally appropriate. HSARB can’t actually look at whether a case is reasonable or not; their job is to go by what’s written in bulletins/updates.”

However, Gandhi made it very clear he believed the case should never even have appeared before the HSARB: "The real affront to physicians is that it should never, ever have gotten here in the first place," he wrote. And he should know. The “Old Country Doctor” is a former president of the Ontario Medical Association (OMA). 

Gandhi did not mince words in an interview, calling the ruling and the "persecution" Ma has endured "cruel."

“The militancy of the Ontario bureaucracy leading to this is astounding, and [it] should never, ever have come to this stage. But now that it's at this stage, the right thing for the government to do is to apologize profusely to Dr. Ma," Gandhi said. "She's owed an enormous apology by the health minister and by the premier."

But, he went on, “I don't think that's going to happen. I don't think that's in their guts to do so.”

In the weeks since breaking this story, Kingstonist has sent multiple questions and requests for interviews to Health Minister Sylvia Jones, Chief Medical Officer Dr. Kieran Moore, and Premier Doug Ford. Except for one brief and questionable statement from a Ministry of Health staffer that included unsupported claims about Ma "pocketing" some of the payment for vaccination clinics, political staff have made it clear they would not allow access to their superiors, even going so far as repeating the same statements and noting the Ministry would not address this further.

Gandhi is unsurprised. 

“That is just bureaucracy hunkering down. That tells me they realize they've screwed up. They want the problem to go away, and they're hoping it will. They're hunkering down, saying, 'Don't bother us anymore,' hoping that the problem will go away,” he said.

"They screwed up [and want] to avoid apologizing, which is cowardly on their part. I think that the health minister owes [Ma] an apology. The premier owes her an apology. And, at the very least, they need to acknowledge now that the bureaucrats have got their pound of flesh where they can say, ‘See, legally, we were right. We technically followed the law. But you know what? Don't bother recouping the funds.'”

The petition mentioned above was created by The Ontario Union of Family Physicians founder, Dr. Ramsey Hijazi. Physicians can't legally form a union, but this is a grassroots movement of over 2,100 Ontario family physicians who want to effect change for a better, more sustainable health-care landscape.

Hijazi started the advocacy group in 2023 because he and his colleagues were frustrated that, despite Ontario’s family doctor crisis, they were not seeing any fundamental changes “to help family docs in family medicine, to recruit docs to do family medicine and to have them stay in family medicine.” He didn’t perceive any help from the government of Ontario that would effect change.

As far as the Ontario Medical Association is concerned, Hijazi said, “Although they're supposed to represent us, they've been kind of quiet and absent in their advocacy.”

So when a friend sent him a Kingstonist article on Dr. Ma’s struggle with OHIP, he found it “absolutely shocking.”

“First, the government labelled us as ‘health care heroes,'” he said. "But then months later, someone... stood up to take action, to try and help the government and deliver on getting COVID vaccines to as many people as possible through innovative ways, and at the end of the day [the government] punished them for it? It's shocking.” 

“So we started the petition because I feel a duty to try and help [Ma] out,” Hijazi explained. Though he is not acquainted with Ma, Hijazi said he admires her efforts during the pandemic and recognizes she must be under an "awful" amount of stress.

He emphasized that “any OHIP fraud, any kind of trying to game the system, is an absolute no-no. I'm 100 per cent against it. But this is not what this case is about at all.”

Gandhi expressed similar sentiments in his blog post: “Let’s be clear about this. There is zero tolerance in the broader medical community for misappropriation of funds/intentionally fraudulent OHIP billing. Zilch. Nada.”

"But," he stressed, "there is a recognition that the imperfect OHIP billing schedule needs to be interpreted with reason, especially when times are unreasonable --- and what could possibly be a more unreasonable time than a once-in-a-lifetime pandemic?”

In conversation, Gandhi pointed out, “There's the letter of the law, and there's the spirit of the law, right? And the letter of the law is very, very particular. It's written down. But sometimes, an injustice can happen if you look at just the letter, as opposed to the spirit of the law. And that's what's happened to Dr. Ma.”

“And that's why it's not just me. Many, many physicians around the country, not just Ontario, have read about this story and are really upset and just furious --- because we're talking about a situation where the actual spirit of the law, the spirit of being just and fair, has not been followed by the Ontario government," he said, re-emphasizing that he considers this “an Ontario government problem.”

“Before the government decided to hound Dr. Ma, they would have sent it up the chain of their bureaucrats, right? So it would have gone to the deputy health minister if not the health minister herself. So this is a problem where the government is hounding someone for doing the right thing, if not necessarily by every tiny little technicality. And so this is very, very offensive to me. It's offensive to physicians.”

The HSARB decision argues that Ma could not have supervised the number of students she used, but both doctors expressed that that argument is patently ridiculous.

Gandhi, who taught medical students for 30 years, explained that supervising medical students doesn’t mean always looking over their shoulders or holding their hands. 

“One of the things that's really important is to gauge how far along the medical student is in terms of their expertise… You've watched them perform a procedure once, twice, three or four times; then, at the end, [you see] that actually that medical student can do that procedure.”

At that point, the physician supervises at a distance, Gandhi said. Then, “You always have to be available for the medical student, if there's an issue or a concern. You need to make sure you're available to help out.”

In Ma's case, not only was she on hand to supervise the entire clinic, but the colleagues she paid and her employees, who were also licensed physicians, were also there to supervise, along with nursing professionals. On top of all of this, Ma took on all the liability for every clinic, so had anything injurious happened, it would have been her responsibility, the doctor explained.

Hijazi agreed, pointing out, “This has very, very significant implications for all doctors practising in Ontario… Family docs are so demoralized working in the system right now, and to have something like this, the decision for the government to pursue this attack on Dr. Ma... an attack on a physician, and her having to fight to get paid for work that was done, is just so demoralizing, and only speaks to the antagonistic relationship the government has with physicians and really has had for a long time.”

Gandhi went so far as to call the case "proof that the Ontario government is unfriendly to physicians" and said that letting the case play out how it did was "unnecessarily cruel."

Hijazi reiterated the implications of this ruling and the provincial government's lack of movement on it.

“It sets a really, really dangerous precedent for all physicians in Ontario. I think it's going to make a lot of physicians question the safety of practising medicine in Ontario as well as taking on learners and training new physicians --- which itself should be a huge concern for not only the general public but even the government, who's trying to push increased education. This sets a horrible precedent,” he said.

“It sets a precedent for the government to audit anyone on a whim and then use any technicality of language to recoup those billings back, even when it's beyond reason, like giving vaccines in the parking lot as opposed to in the clinic, in the context of the pandemic. It does not make any sense."

Gandhi agrees that, during a crisis when many are without family physicians, this decision “paints Ontario in a very bad light."

"It paints Ontario as a place --- especially in this day and age when so many other provinces cooperate with their doctors on many issues --- where doctors maybe shouldn't consider setting up shop.”

Local doctors circulate petition in support of Dr. Ma

The same petition Dr. Hijazi started is being circulated among those in the local medical community, as well as throughout Kingston and the KFL&A region, as local doctors rally in support of Dr. Ma.

In an email to Kingstonist, the local chapter of the Ontario Medical Association, OMA District 7, shared the petition, explaining the collective of medical professionals locally is aiming to garner more than 20,000 signatures. The OMA District 7, whose Executive Board has voiced opposition to the OHIP's demands for repayment and in support of their colleague prior to the release of the HSARB decision, includes the Leeds and Grenville Medical Society, the Lennox and Addington Medical Society, and the Kingston Academy of Medicine.

Asked why the doctors are circulating the petition and why they feel is it important to support Ma, the OMA District 7 Executive Board responded with agreed-upon statements. The OMA District 7 Executive Board is made up of Dr. Joy Hataley (Chair), Dr. Ani Garg (President of Kingston Academy of Medicine), Dr. Veronica Legnini (Past OMA District 7 Executive Board Chair), Dr. Cameron MacLean, Dr. Siobhan Muldowney, Dr. Omar Islam, and Dr. Lysa Lomax. And like Drs. Ghandi and Hijazi, the District 7 Executive was direct and did not mince words.

"As your local community of physicians, we believe the most straightforward resolution to this miscarriage of justice lies in the citizens of Ontario urging Premier Ford and Minister Jones to take action. The government has the authority to overturn the HSARB ruling against Dr. Ma, and we strongly advocate for them to do so," the local physicians organization stated.

"Our concerns are multifaceted, but central among them is that this ruling is rooted in technicalities rather than ethical principles or fairness. While we respect and value the Ministry of Health’s role in safeguarding public funds, extraordinary circumstances — such as the innovative and effective mass vaccination and drive-through clinics organized by Dr. Ma, with full accountability and liability — deserve recognition, not punitive measures like clawbacks or public censure. To penalize such efforts on technical grounds during a global pandemic feels unjust and counterproductive."

The OMA District 7 Executive went on to say the ruling of the HSARB "sets a troubling precedent for medical education in Ontario," a sentiment of concern Dr. Ma herself pointed to immediately following the release of the board's ruling.

"Physicians who supervise medical students assume full accountability and medicolegal responsibility for the care provided under their supervision. If educators are denied the ability to bill OHIP for this patient care, it risks creating an insurmountable disincentive for teaching future healthcare professionals — a loss that would ripple through the province’s healthcare system," the Executive said.

Finally, the collective of local doctors expressed solidarity with their fellow Kingston-based physician in the face of the pointed persecution against her, saying, "When the government targets one of us, it feels like an attack on all of us."

"As Ontario’s physician community, we stand united in our commitment to addressing this issue. We will remain steadfast until this case is resolved in a way that upholds fairness, supports our ability to teach and provide care, and ensures the well-being of the people of Ontario," the District 7 Executive said.

"As such, we urge our community members to sign this petition and to share it with their networks across Ontario."