In exceptional circumstances, Ombudsman intervention can result in an alternate solution when a complainant is denied a benefit.
A woman needed nephrostomy bags following cancer surgery. The woman’s condition was considered unusual in that her need for the bags was likely to be permanent. She applied to Alberta Aids to Daily Living for assistance. Alberta Aids to Daily Living provides similar bags for conditions such as incontinence, but the bags that met the woman’s needs weren’t on the approved product list. The organization’s approved products are aimed at permanent conditions. Nephrostomy bags are normally a short term need. For that reasons nephrostomy bags were not on the list.
We talked with Alberta Aids to Daily Living managers but based on the medical evidence before them, they could not find a way to make nephrostomy bags fit the approved product list. Our investigator traced the parameters of the program from the foundational legislation, through policy to the approved products list and concluded the organization’s decision was consistent with its legislated mandate. Alberta Aids to Daily Living managers were not without sympathy, however. They researched the possibility the bags could be supplied by Alberta Health Services. Their findings weren’t conclusive, but the investigator called the Patient Concerns Resolution Process which handles complaints from patients about Alberta Health Services (AHS) including hospitals and other health care facilities run by AHS.
The Patient Concerns Officer and a Patient Concerns Consultant reviewed the case. A suggestion was made that the woman document her need for the bags by providing a specialist’s report. When the information was provided, Alberta Health Services agreed to fund the bags.
As a result of the complaint, Alberta Aids to Daily Living and Alberta Health Services decided to conduct a review to see if nephrostomy bags should in the future be added to Alberta Aids to Daily Living’s approved product list. When the Ombudsman comes calling, sometimes authorities adjust to unusual circumstances and find an alternative solution to a complainant’s need.