Psychiatric evaluation after intial medical examination

[CanadianInKorea]

Hello,

I am sponsoring my wife for PR and we sent in our documents August 1, 2019. In the middle of December, she went for her medical examination. During the exam she disclosed to the doctor that she suffers from depression and is taking medication for it. No big deal... so we thought.

About a week ago we received a notice that immigration is requesting additional evaluations. We contacted the clinic where she initially had her medical exam and they told us my wife is required to take a mental health evaluation. Apparently it's standard procedure to get additional testing if the sponsored person has a current medical condition, which honestly sound perfectly reasonable to me.

We were finally able to get in touch with the psychiatrist that the clinic recommended and he says his fee is between $1,600 - $2,000 for this type of evaluation! Ummm... WHAT?! That's more money than everything we've paid so far combined for my wife's application. We are not able to afford this type of expense as I am in school and my wife is not currently working. The doctor said we might be able to apply for some sort of aid to bring down the cost by $400 or $500 but that is still well over $1,000 for the evaluation. We CANNOT afford this.

What are our options here? I was thinking of contacting the clinic to see if there's another doctor who can perform the evaluation, but the doctor we spoke with made it seem like this type of fee is not unusual. I was also thinking of contacting immigration to see if this examination is really necessary. My wife just takes anti-depressants. She's never been hospitalized for her mental health, never attempted suicide, and is in no way a risk to public health... so much for de-stigmatizing these types of conditions.

It really seems like we are being taken advantage of. It makes us feel like my wife shouldn't have disclosed this information to the doctor. Would really appreciate any advice here.

 

[Crystel13]

Call another clinic. It sounds extremely expensive for a simple evaluation. My husband needs to see a specialist at the hospital every once in a while. He doesn't have insurance and they only charge him the hospital fee (around 100ish) and the doctor salary (less than 200ish).

 

[CanadianInKorea]

Thank you for your comment. I'm sure everyone's situation is different and requires different doctors, but the cost you mention is about what I expected to pay. Which is already a lot considering we paid $300 for the initial medical exam.

From what the psychiatrist told us it's a pretty comprehensive examination and includes a lengthy report. But $2000 is absurd.

 

[Crystel13]

Thank you for your comment. I'm sure everyone's situation is different and requires different doctors, but the cost you mention is about what I expected to pay. Which is already a lot considering we paid $300 for the initial medical exam.

From what the psychiatrist told us it's a pretty comprehensive examination and includes a lengthy report. But $2000 is absurd.

Unless she needs a medical evaluation over a period of many sessions (like a therapy), there is no reason for a psychiatrist to ask 2000$ unless he is trying to rip you off ... and he definitely is.

 

[canuck78]

Agree. For someone without a complex psychiatric history it shouldn’t be that expensive or time consuming for the doctor.

 

[CanadianInKorea]

As I understand it, the purpose of the medical background is to ensure a sponsored person is not a threat to public health/safety and would not be a financial drain on the Canadian healthcare system. I don't understand how a case of depression, for which my wife has been receiving treatment, falls into either of these categories. Does anyone have any insight whether I may be successful in pleading my case to Immigration to have them drop the request for the psych evaluation?

As of December 31, 2019 we were given 60 days to complete the request from Immigration. The clinic we used for the initial medical exam found the psychiatrist for us and said that not many doctors like to perform these evaluations. He also said under regular circumstances it could take up to 4-6 months to schedule an appointment with this type of doctor.

My wife and I have a feeling that the clinic and the psychiatrist may be working together.

 

[armoured]

Does anyone have any insight whether I may be successful in pleading my case to Immigration to have them drop the request for the psych evaluation?

As of December 31, 2019 we were given 60 days to complete the request from Immigration. The clinic we used for the initial medical exam found the psychiatrist for us and said that not many doctors like to perform these evaluations. He also said under regular circumstances it could take up to 4-6 months to schedule an appointment with this type of doctor.

My wife and I have a feeling that the clinic and the psychiatrist may be working together.

You may wish to look at this document and the section I've linked to especially on fees:
https://www.canada.ca/en/immigratio...ls/panel-members-handbook-2013.html#chap3.4.8

The section notes that the fees should be reasonable and be posted; $2k for this type of evaluation does sound high, but I don't know what's involved. Do you have a document that outlines in more detail what the evaluation must cover?

While the requirement to post costs may not apply to specialist referrals and reports (I do not know), you could look into what other psychiatrists would charge for this. Note also that there are regional medical offices overseeing the work of panel physicians, perhaps contacting them is possible (I do not know).

Also note that there is language here about psychiatric conditions that are evaluated, and it refers to _major_ depression. I have no idea what the definition / distinction is between depression and major depression, but you possibly have an opening there to push back (esp if her case is simple e.g. the anti-depressant medications are routine and she works or studies or whatever). I do not know but would expect that most general practitioners should be able to distinguish/recognise signs of major depression for referral, and - to discuss with a doctor - anti-depressant medication prescription is not sufficient on its own to be considered 'major'. (My point being I don't personally think it's proper for the panel physician to refer for a full-blown psych evaluation just because a person is on anti-depressants and ticked a box admitting this - they should be doing a bit more work to check whether signs of major depression or not. This is only my view though, the service standards may spell out what is to be done. Would also be relevant how much time the medical exam spent on this subject).

Also presumably you have an existing doctor or psychiatrist - perhaps they could help? They may be able to speak to the costs question (esp if they can see the document outlining what evaluation is required). They may also know the actual psychiatrist or be able to look them up (or even contact them - stranger things have happened than one doctor contacting another and the price changing).

Please note, I'm not an expert on this at all, just recalled having seen this document that outlines the service standards and some other aspects of the work of the panel physicians. Hopefully it will provide you a starting point to check into.

 

[armoured]

A follow-up to my own:
https://www.canada.ca/en/immigratio...manuals/panel-members-handbook-2013.html#app4

There are technical instructions at bottom that refer to psychiatric conditions. Note of importance is that the panel physicians do not/cannot refer to specialists without the regional medical offices. So that should be taken into account, this was not the panel physician referring on his/her own.

There is some more detail there that may be of use.

Anyway as I said, not an expert but hope this documentation helps in some way.

 

[Western Mountain Man]

As I understand it, the purpose of the medical background is to ensure a sponsored person is not a threat to public health/safety and would not be a financial drain on the Canadian healthcare system. I don't understand how a case of depression, for which my wife has been receiving treatment, falls into either of these categories. Does anyone have any insight whether I may be successful in pleading my case to Immigration to have them drop the request for the psych evaluation?

As of December 31, 2019 we were given 60 days to complete the request from Immigration. The clinic we used for the initial medical exam found the psychiatrist for us and said that not many doctors like to perform these evaluations. He also said under regular circumstances it could take up to 4-6 months to schedule an appointment with this type of doctor.

My wife and I have a feeling that the clinic and the psychiatrist may be working together.

Doesn't surprise me but the clock is ticking.
I wouldn't ' plead your case ' to immigration unless it was to explain some reasonable delays.
You should make some inquiries at other clinics and see what they have to offer. Does your wife have family doctor that can help?
Specialists and forms are expensive.... Maybe you can negotiate with them?
They know this process is stressful and can cause much anxiety.

 

[CanadianInKorea]

@armoured

My wife and I have reviewed the document. As I understand it, the panel physician is screening for two things: risk to public safety and the demand on medical/social services. This same document also states how depression is the most common psychiatric illness and for this reason I simply cannot understand why a detailed psych evaluation is necessary. My wife was able to hold a job back in Korea and work with no issues while taking the same medication. Simply taking SSRIs should not be grounds for a full blown psychological evaluation.

Furthermore, when screening for public safety risks, the doctor is specifically supposed to look for the following:

• Delusional behaviour, or a diagnosis of schizophrenia or schizoaffective disorder
• Antisocial, violent, or impulsive behaviour (including impaired driving)
• Paranoid ideas or odd beliefs
• Homicidal or suicidal thoughts
• Substance use disorder
• Memory disturbance
• Psychological or physical trauma, including post-traumatic stress disorder (PTSD)
• Aberrant sexual disorders, such as pedophilia

None of which my wife has EVER experienced. Also, spouses are an exception to the inadmissibility rule concerning demand on health/social services, so I don't believe they can request an exam based on that.

The following statement in the Panel Members' Handbook is what has me most upset:
"PP should indicate if an evaluation in psychiatry is suggested to further evaluate the client. PP’s must not refer clients to specialists unless instructed by the Regional Medical Office."

By my understanding of this, the panel physician recommended that my wife required a psych evaluation and sent this recommendation to the Regional Medical Office, and this is why it is now being asked of us. I believe this was irresponsible of the doctor as my wife told me he barely asked about her condition just how long she took medicine and was treated back in Korea. Now he refers us to a psychiatrist that is asking for $2,000 for the evaluation.

@Western Mountain Man

Even if we were able to negotiate a 50% discount (which I highly doubt the doctor would go for), $800-$1,000 is still too much money. We haven't contacted other clinics or psychiatrists yet, but some research online says this type of detailed evaluation can be expensive, but I'm not sure exactly what it should cost. I believe it was irresponsible of the doctor in the first place to recommend my wife for this evaluation.

I feel like I'm just ranting, but we can't afford this. Everything in our application was meticulously put together over the course of several months. We went over everything with a fine-toothed comb and provided extra documentation explaining every potential discrepancy. And now our application is being threatened because some doctor who talked to my wife for 5 minutes thought she should have a detailed psych evaluation? This is unfair.

 

[CanadianInKorea]

As a follow up, does anyone know if it is possible to launch a formal complaint against a panel physician? I'm going to call the clinic today to speak with them because I don't think my wife has been treated fairly.

 

[Western Mountain Man]

They know your situation and are in a good position to make some extra money.
You may waste a lot of time and effort with formal complaint. They are just following procedures.
Going to have to find another solution....Immigration can be expensive and things don't always go as expected !

 

[armoured]

As a follow up, does anyone know if it is possible to launch a formal complaint against a panel physician? I'm going to call the clinic today to speak with them because I don't think my wife has been treated fairly.

Your wife must have been treated by the doctor who prescribed her anti-depressants. I'd still suggest speaking to him whether (under the DDM methods) a 'major depression' diagnosis is at all warranted. Perhaps he can intervene in some way, or provide some short opinion on the nature of her condition.

You could also ask that doctor whether the type of testing should possibly cost what they are quoting. And then see if there is any other doctor or clinic that can do this testing at a more reasonable rate. I see in Korea there are many approved panel physicians, don't know if there's a way to see one of them or make use of that knowledge.

I don't know but perhaps there is a way to contact the regional medical officer. The price does not seem reasonable per the standards.

Now, on launching a formal complaint: that is the nuclear option and I'm not sure it makes sense to go there this early, particularly without supporting information (including e.g. price comparisons).

If you do this, it may throw up barriers early in a process in a way that will not help you. The doctor accused will certainly defend - and will know enough of the details of procedures to claim their decision was correct and justified. There may be a more formalistic approach on the part of the medical check system - which may not lead to any result that helps you.

Perhaps it will make sense to do so later. But document everything you know, find out more, and recognise that a 'successful' formal complaint procedure may not benefit you in any way other than satisfaction that e.g. the doctor got some mild punishment / kicked out of the approved physicians' list, and could well delay your application longer.

 

[CanadianInKorea]

@armoured

The doctor my wife was seeing was in Korea. I'm not sure he will be able to help. We're in Canada now applying inland.

Talked to the clinic briefly and he said we're welcome to find a psychiatrist to perform the evaluation but the one he referred us to is the only one in the GTA willing to do it. Apparently the doctors assume all the liability if something should happen down the road and they made the decision that an individual was fine.

And I agree that the complaint route is the nuclear option. What I need to find out is whether the panel physician recommended a psychiatric evaluation because I don't feel he properly talked to my wife about her condition at all. If he had asked about her condition and current treatment it would be clear that my wife is in control of it.

I'm going to call the regional medical office which I believe is in Ottawa for inland applications. I'm not sure if they can do anything but maybe they can reassess the situation if we plead our case. Our main point is that based on the risk criterion (public safety and demand on health/social services) we don't think it is fair to have my wife take the evaluation. She takes SSRIs... she's not addicted to drugs, or psychotic, or violent or what have you.

 

[CanadianInKorea]

Does anyone know if there is a contact number for the Regional Medical Office in Ottawa? All I can find is an email address and a fax number. I would really like to speak to a person.

When I call the general Immigration hotline (1-888-242‑2100) there are no options to talk about medical examinations or anything related to medical. It mainly seems to be about checking the status of your application or providing additional information to Immigration.