Family doctor shortage complicates access to 'life-changing' device for B.C. diabetes patient

This story is part of Situation Critical, a series from CBC British Columbia reporting on the barriers people in this province face in accessing timely and appropriate health care.

The red tape that B.C. physicians say is blocking access to vital diabetes drugs and devices becomes almost impossible to navigate without a family doctor, according to one patient.

Sanda Mcculloch says her diabetes became much easier to manage a few years ago, when she started using Dexcom continuous glucose monitoring, which tracks her glucose levels every few minutes.

"It is life-changing," Mcculloch, a 63-year-old semi-retired former journalist in Nanaimo, told CBC.

"It gives you a whole lot of information on how to be generally healthier."

At first, she had a bit of extra money from an inheritance to cover the $300 monthly subscription fees. Then last year, B.C. announced that Dexcom could be covered under PharmaCare through the special authority system, which allows coverage for some patients when a request is made by their doctor.

Mcculloch says she was "thrilled" when her family doctor got her approved for coverage about six months ago.

But since then, in an experience familiar to many British Columbians, her doctor has retired. When she went to the pharmacy recently to get a new box of sensors, she was told it would cost $300.

"I said, how can that be? It's on prescription," Mcculloch said. "They said, 'oh the special authority has expired.'"

Without a family doctor, she hadn't been alerted to the upcoming expiry date, and she didn't have anyone who could navigate all the paperwork and phone calls required to renew her special authority. 

"It's a bit of an affront, when I'm just trying to keep myself out of hospital … and alive," she said.

Life-threatening emergency

As CBC previously reported, doctors who specialize in diabetes say the process has become increasingly onerous, and many patients have been "serially denied" special authority, with constant requests for more information.

For Mcculloch, trying to get her coverage renewed has meant lining up outside a walk-in clinic for two hours before it opened for a chance to see a doctor who could start the process. But she's been told there's a six-week backlog, and she has no sense of how far along her request is.

"I tried to make some calls because I believe in taking ownership of my own stuff … but it seems like that link of not having a doctor in the middle, there's nobody really to fill you in," she said.

In the meantime, Mcculloch's financial situation has changed, and she says she hasn't been able to justify paying the $300 out of pocket. Instead, she's checking her glucose levels the old-fashioned way, with a finger-prick test.

That means there's no way to keep track of her glucose levels while she's asleep, which can have dangerous consequences.

On Wednesday, Mcculloch says she woke up feeling very unwell, and when she tested her blood, her glucose had reached dangerously low levels.

"Low glucose can kill you pretty quickly," she said. "In a way, it's my fault. I can say, geez I should have taken better care, how did I let it get low? But on the other hand, the Dexcom would have had a sensor go off … that would have woken me up to go get some sugar in me."

A spokesperson for the B.C. Ministry of Health wrote in a statement that the province is working on a system that would directly alert patients to special authority decisions through their Health Gateway account.

"We understand the frustration patients may feel when seeking special authority coverage renewal when they do not have access to a regular primary care provider," the statement says.

It goes on to say that the B.C. government is committed to improving access to family doctors as well as other primary care providers through urgent primary care centres.

CBC asked Health Minister Adrian Dix this week about Mcculloch's case, and he replied that "I'm happy to look at the case if people have concerns about how it worked for them."

But Mcculloch says that isn't good enough.

"There's a lot of people in my position. What's he going to do for everybody?" she said.

"How do you address this problem rather than putting out the one fire that's coming across your desk one day?"