Received Fairness Letter......Seeking guidance for reply

[jen3014]

Does your e-CAS say "medical results have been received"?

yes it says they have been received. Hopefully it's good news.

 

[computergeek]

yes it says they have been received. Hopefully it's good news.

If those are posted and you didn't go through the fairness process, the only news is good news. Issues that require fairness letters mean that the medical results are NOT posted to your file. So yes, it means you're fine (medically).

 

[salem10]

If those are posted and you didn't go through the fairness process, the only news is good news. Issues that require fairness letters mean that the medical results are NOT posted to your file. So yes, it means you're fine (medically).

I have received fairness letter two or three weeks after "Medical Results Has Been Received" line added to my ecase.

 

[Apirant]

Jen, You have already responded to Fairness letter and received "Medicals have been received" in ecas after 7 months and hence I believe you have passed medical and they should be starting security shortly.

Which is your Visa office?.

 

[whatever_281]

Hello everyone, we have done the medicals and also the further test for my husband who was found to have HBsAg positive.
After they upload the medical report to CIC, I have seen the report by myself that doctor diagnosis my husband as “HBV carrier” and he wrote that:
“ Diagnosis: HBV carrier
Treatment and suggestions: Currently there's no basis for the patient to have anti-virus treatment，Every 6 months he should follow up the liver function ，HBV-DNA, HbsAg, HbeAg, etc. if HBV-DNA>10000IU/ml with elevated ALT level, anti-virus treatment is recommended.
Prognosis: It is not infectious in daily life, The 5-year cumulative incidence for chronic hepatitis B (without treatment) developing into hepatic cirrhosis is about 10%, the 5-year case fatality rate <2%”

But last week, we received a fairness letter that VO diagnose my husband as chronic hepatitis B as following:

I have determined that you are a person whose health condition might reasonably be expected to cause excessive demand on health or social services in Canada. An excessive demand is a demand for which the anticipated costs exceed the average Canadian per capita health and social services costs, which is currently set at $6387.00 per year. Pursuant to subsection 38(1) and section 42 of the Immigration and Refugee Protection Act, it therefore appears that you may be inadmissible on health grounds.
You have the following medical condition or diagnosis:

Diagnosis: CHRONIC HEPATITIS B (070.3)
Narrative:
Applicant has a diagnosis of CHRONIC HEPATITIS B. His diagnosis was confirmed based on all information gathered. Hepatitis B is an infectious disease affecting the liver caused by the Hepatitis B virus (HBV), which can often be asymptomatic and go unnoticed, but which will eventually usually cause chronic liver disease and if left untreated, can progress to portal hypertension, liver fibrosis and cirrhosis, hepatocellular carcinoma and even liver failure requiring liver transplant. HBV infection can be treated and the aim of the treatment is to impede progression of the patient's liver disease by obtaining a sustained viral eradication or suppression of viral replication

Applicant's hepatitis B profile showed the HBe Ag marker to be reactive. Hepatitis B DNA viral load was 45,000,000 IU/ml. The liver enzyme ALT was 30 IU/L. Mr. XX is HBeAg positive with an elevated viral load, which indicate the presence of active Hepatitis B virus replication and high infectivity. Patients who are HBeAg positive usually require prolonged treatment with antivirals to decrease the viral load and maintain it at a level that decreases the risk of progression. Often patients who are HBeAg positive experience suboptimal response or a relapse of the chronic hepatitis B on one antiviral and must be switched to either another more expensive antiviral or a combination of antivirals long term. In the Canadian context this applicant would likely be offered long-term treatment with anti-viral medications (e.g. Adefovir, pegylated interferon) to maintain a surpressed HBV viral load. This is required in order to prevent progression to liver failure and the development of liver cancer. The treatment for chronic active hepatitis B is expensive and publicly funded.

Can someone please suggest how to go about responding to this letter or someone should please share a similar experience. Your comments and suggestions are welcome please.

Thanks

 

[computergeek]

Hello everyone, we have done the medicals and also the further test for my husband who was found to have HBsAg positive.
After they upload the medical report to CIC, I have seen the report by myself that doctor diagnosis my husband as “HBV carrier” and he wrote that:
“ Diagnosis: HBV carrier
Treatment and suggestions: Currently there's no basis for the patient to have anti-virus treatment，Every 6 months he should follow up the liver function ，HBV-DNA, HbsAg, HbeAg, etc. if HBV-DNA>10000IU/ml with elevated ALT level, anti-virus treatment is recommended.
Prognosis: It is not infectious in daily life, The 5-year cumulative incidence for chronic hepatitis B (without treatment) developing into hepatic cirrhosis is about 10%, the 5-year case fatality rate <2%”

But last week, we received a fairness letter that VO diagnose my husband as chronic hepatitis B as following:

I have determined that you are a person whose health condition might reasonably be expected to cause excessive demand on health or social services in Canada. An excessive demand is a demand for which the anticipated costs exceed the average Canadian per capita health and social services costs, which is currently set at $6387.00 per year. Pursuant to subsection 38(1) and section 42 of the Immigration and Refugee Protection Act, it therefore appears that you may be inadmissible on health grounds.
You have the following medical condition or diagnosis:

Diagnosis: CHRONIC HEPATITIS B (070.3)
Narrative:
Applicant has a diagnosis of CHRONIC HEPATITIS B. His diagnosis was confirmed based on all information gathered. Hepatitis B is an infectious disease affecting the liver caused by the Hepatitis B virus (HBV), which can often be asymptomatic and go unnoticed, but which will eventually usually cause chronic liver disease and if left untreated, can progress to portal hypertension, liver fibrosis and cirrhosis, hepatocellular carcinoma and even liver failure requiring liver transplant. HBV infection can be treated and the aim of the treatment is to impede progression of the patient's liver disease by obtaining a sustained viral eradication or suppression of viral replication

Applicant's hepatitis B profile showed the HBe Ag marker to be reactive. Hepatitis B DNA viral load was 45,000,000 IU/ml. The liver enzyme ALT was 30 IU/L. Mr. XX is HBeAg positive with an elevated viral load, which indicate the presence of active Hepatitis B virus replication and high infectivity. Patients who are HBeAg positive usually require prolonged treatment with antivirals to decrease the viral load and maintain it at a level that decreases the risk of progression. Often patients who are HBeAg positive experience suboptimal response or a relapse of the chronic hepatitis B on one antiviral and must be switched to either another more expensive antiviral or a combination of antivirals long term. In the Canadian context this applicant would likely be offered long-term treatment with anti-viral medications (e.g. Adefovir, pegylated interferon) to maintain a surpressed HBV viral load. This is required in order to prevent progression to liver failure and the development of liver cancer. The treatment for chronic active hepatitis B is expensive and publicly funded.

Can someone please suggest how to go about responding to this letter or someone should please share a similar experience. Your comments and suggestions are welcome please.

Thanks

The response to this will potentially be complex. First, the medical officer is assuming a treatment that is not in line with clinical guidelines. "The NIH also indicates that immediate therapy is not routinely indicated for patients who have the following[5] : Chronic hepatitis B with high levels of serum HBV DNA but normal serum ALT levels or little activity on liver biopsy (immune-tolerant phase)".

Note that an ALT level of 30 IU/L is normal and thus would not generally require treatment. The medical officer's analysis is thus flawed. To rebut this, you should seek medical opinions from doctors confirming that treatment is not indicated in the particular case.

See: http://www.cic.gc.ca/english/resources/tools/medic/admiss/index.asp - there is a wealth of information. I noticed that the fairness letter did not include any cost information. That is required, and a reasonable first step is always to request that information from the visa officer.

You should research the costs. While they do vary a bit from province to province, the Province of Quebec publishes a comprehensive list. Search using your favourite search engine "RAMQ Medications List" and you should find the page. That list is updated on a regular basis. Note that even if you are not immigrating to Quebec, their pricing data can be used (as you could purchase prescription medications from a pharmacy in Quebec, regardless of where you live).

Cost analysis also depends very much on the province where you intend on living, as the coverage for drugs differs from province to province. Thus, even if the cost of medications is the only consideration (and from what the letter says, that's the only concern of the medical officer), the portion public funded will depend upon the coverage in the province.

My advice: hire an attorney with experience in excessive demand medical inadmissibility. A good response is likely to overcome the medical officer's opinion in this case. If you decide to respond to this on your own, I would suggest attacking the medical officer's opinion on treatment: letter(s) from your husband's doctor indicating that treatment is not indicated and is not expected to be necessary in the next five years would be ideal. A corroborating letter from a doctor in Canada with expertise in treatment of HBV would be ideal. This is one reason why I suggested working with an attorney, as they will have a list of experts they've used in the past.

You should also request additional time to respond to the letter. While they tell you 60 days, they should provide you with additional time to respond upon request. That gives you time to do the analysis, obtain supporting letters from doctors, etc. If you engage an attorney to assist, they will likely submit that request on your behalf.

You should ALSO make sure to order the medical officer's notes for your case (via the ATIP process). This is another thing that an attorney would do, as they may contain additional information about the medical officer's thought process.

 

[whatever_281]

The response to this will potentially be complex. First, the medical officer is assuming a treatment that is not in line with clinical guidelines. "The NIH also indicates that immediate therapy is not routinely indicated for patients who have the following[5] : Chronic hepatitis B with high levels of serum HBV DNA but normal serum ALT levels or little activity on liver biopsy (immune-tolerant phase)".

Note that an ALT level of 30 IU/L is normal and thus would not generally require treatment. The medical officer's analysis is thus flawed. To rebut this, you should seek medical opinions from doctors confirming that treatment is not indicated in the particular case.

See: - there is a wealth of information. I noticed that the fairness letter did not include any cost information. That is required, and a reasonable first step is always to request that information from the visa officer.

You should research the costs. While they do vary a bit from province to province, the Province of Quebec publishes a comprehensive list. Search using your favourite search engine "RAMQ Medications List" and you should find the page. That list is updated on a regular basis. Note that even if you are not immigrating to Quebec, their pricing data can be used (as you could purchase prescription medications from a pharmacy in Quebec, regardless of where you live).

Cost analysis also depends very much on the province where you intend on living, as the coverage for drugs differs from province to province. Thus, even if the cost of medications is the only consideration (and from what the letter says, that's the only concern of the medical officer), the portion public funded will depend upon the coverage in the province.

My advice: hire an attorney with experience in excessive demand medical inadmissibility. A good response is likely to overcome the medical officer's opinion in this case. If you decide to respond to this on your own, I would suggest attacking the medical officer's opinion on treatment: letter(s) from your husband's doctor indicating that treatment is not indicated and is not expected to be necessary in the next five years would be ideal. A corroborating letter from a doctor in Canada with expertise in treatment of HBV would be ideal. This is one reason why I suggested working with an attorney, as they will have a list of experts they've used in the past.

You should also request additional time to respond to the letter. While they tell you 60 days, they should provide you with additional time to respond upon request. That gives you time to do the analysis, obtain supporting letters from doctors, etc. If you engage an attorney to assist, they will likely submit that request on your behalf.

You should ALSO make sure to order the medical officer's notes for your case (via the ATIP process). This is another thing that an attorney would do, as they may contain additional information about the medical officer's thought process.

Thank you so much for your quick reply. Could you please refer any good attorney to me?

 

[Dr.Ss11]

Hello everyone

Does anyone has information regarding non-alcoholic fatty liver disease..will it affect medicals or any senior gone through with this and cleared medicals??

 

[computergeek]

Does anyone has information regarding non-alcoholic fatty liver disease..will it affect medicals or any senior gone through with this and cleared medicals??

It would depend upon the expected treatment, which would depend upon the specific patient. Medicals are about ensuring that someone immigrating to Canada does not burden the health care system.

 

[Apirant]

Hi Computergreek,

Does the response to PF goes to CIC in canada or Is it being reviewed and finalized by the Visa officer in New Delhi. As I submitted by response to PF 7 months back and there are no update in GCMS as of Feb, 2015 and also no response from Visa officer for more than 4 to 5 CSE's that has been sent over the past 7 months.

 

[computergeek]

Does the response to PF goes to CIC in canada or Is it being reviewed and finalized by the Visa officer in New Delhi. As I submitted by response to PF 7 months back and there are no update in GCMS as of Feb, 2015 and also no response from Visa officer for more than 4 to 5 CSE's that has been sent over the past 7 months.

The visa officer will finalize it, but cannot do so until the decision comes back from the medical officer. Thus, what's likely holding this up is review by the medical officer.

 

[milsv]

Hello everyone,
I'm a FSW 2014 applicant waiting for medicals request.

A post by whatever_281 earlier prompted me to do some tests because I am a Hepatitis B carrier too.
The results:

HBsAg (Australia Antigen) -- >250 (Reactive)
HBeAg -- 0.02 (negative)
SGPT Serum -- 24.3 (negative as it is <30 u/L)
HBV DNA Load Log Value -- < 5

My liver function test is also normal.

Can someone please comment if this will allow me to pass the medicals? My doctor is confident I do not have any chronic HBV infection.

Thanks

 

[asp123]

I yes to get the fairness letter. But I think I'm on track for it.
I took my medicals in early Dec and have not received the third line update yet. My GCMS notes status "commenced in emed".
My Case : I'm diabetic and my A1C is 6.5. This is above the normal. One of cholerstral is also slightly above normal. Im taking medications for both and both these medicines costs less than $100 a month in US.
Im sure this could certainly raise alarms with the medical officer. My question is its been like six months since I took the medical. Is it pending with the medical officer or the VO is holding it because they are busy. I dont have to rush to do things after I get the fairness letter. Is there something I could do and be prepared if they issues me a fairness letter.

 

[computergeek]

I yes to get the fairness letter. But I think I'm on track for it.
I took my medicals in early Dec and have not received the third line update yet. My GCMS notes status "commenced in emed".
My Case : I'm diabetic and my A1C is 6.5. This is above the normal. One of cholerstral is also slightly above normal. Im taking medications for both and both these medicines costs less than $100 a month in US.
Im sure this could certainly raise alarms with the medical officer. My question is its been like six months since I took the medical. Is it pending with the medical officer or the VO is holding it because they are busy. I dont have to rush to do things after I get the fairness letter. Is there something I could do and be prepared if they issues me a fairness letter.

If the cost is < US$1200 per year, you won't be anywhere NEAR the excessive demand threshold. Cases that require review do take longer, however, so that is probably why there is a delay.

 

[TreYke]

Hi Computergeek,

Just need some enlightenment.

Medical exam were done on 05 May 2015. My son undergone open heart surgery way back 2008, he is now 7 years old. On January 2015, we had our son admitted in the hospital for work-up check-up (lab tests, xray, 2D echo) all results were unremarkable. We got from his Pedia Cardio a MedCert indicating that my son has a normal life expectancy and that the surgery was successful w/out complication.

Thus, during medical we submitted the following: Medical Certificate, Abstract Clinic, Discharge Summary, 2D Echo result, and Prognosis (latest MedCert).

Our eMedical were submitted on 12 May 2015 (no 3rd line ECAS). Based on the above, what is our chance of getting our Medical passed?

Please advise. Best regards..