Patients face challenges when seeking medical care not offered in Nova Scotia: audit

HALIFAX – Patients in Nova Scotia seeking medical care not offered in the province often face an unclear and difficult route to receive treatment, the province’s auditor general says.

Kim Adair released a report Tuesday that includes eight recommendations aimed at improving Nova Scotia’s out-of-province and out-of-country medical claims program. In Nova Scotia, patients who need treatment for eye cancer,  gender dysphoria or a lung transplant, among some others, typically need to leave the province to access care.

The audit was requested by Premier Tim Houston after the Supreme Court of Nova Scotia determined in 2024 that two women seeking out-of-province medical care were unfairly rejected.

“While the (Health Department) did interim changes to respond to the judicial review decision, the change did not resolve the barriers to accessing care,” Adair told a new conference Tuesday. 

Houston apologized after the court decision criticized his government for what it called a flawed and discriminatory process. The decision cited the cases of Jennifer Brady and Crystal Ellingsen, who were both rejected for coverage of out-of-province treatments.

Brady had sought reimbursement for a $60,000 surgery in Japan to treat painful lymphedema in her legs, and Ellingsen sought treatment outside of Nova Scotia for lipedema in her legs and arms. 

The summer before the court made its decision, Brady had applied for medical assistance in dying due to “indescribable” pain from her condition.

The court found the women were discriminated against, based on their rare medical conditions, adding that they had been treated in a “procedurally unfair manner.”

Adair’s audit said the women had obtained referrals from several physicians and caregivers, but none of their applications were accepted because these health-care providers were not recognized as specialists for these conditions.

As well, the audit says that since the court’s 2024 decision, the auditor general’s office was informed of another patient suffering from a condition for which no Nova Scotia specialist exists. 

“At the time of our audit, this patient was experiencing similar challenges accessing medical care,”  the report says.

Health Minister Michelle Thompson said that in situations where there is no appropriate specialist in Nova Scotia, her department also has the option of seeking help from a medical professional through a virtual consultaton. 

The audit also found that a duplication of efforts by the Health Department and the program administrator had slowed response times, and information about the program was not readily available to physicians or the public.

Adair’s recommendations include identifying cases where no appropriate specialist exists in Nova Scotia and implementing an “alternative pathway” for these patients to have their eligibility assessed. Thompson said she agrees with this recommendation’s objective, but she said the department will not create a separate stream to address the issue.

“We want to enhance the pathway, we agree with that, but we want one pathway,” the minister said.

The audit also recommends establishing a clearly communicated appeals process.

Thompson said she wants Nova Scotians who must travel outside the province for medically necessary care to have “absolute confidence” that the program for medical claims is fair and effective. 

“Other improvements are coming in the months ahead to ensure we meet the needs of Nova Scotians who need care,” she said.

The department said in the audit it has already completed one of the recommendations, and intends to finish the rest by September 2028. 

Thompson said she expects the recommendations will be implemented before that target.

Nova Scotia’s NDP health critic, Rod Wilson, said he’s seen firsthand how challenging the process can be for patients.

“It’s really stressful for people,” said Wilson, who is also a doctor. “The burden is on them to prove why they need the care (and) where they should get the care. They often have to bring forward their whole case and often educate the service provider.” 

Wilson also said the department’s timeline for completing these recommendations is too long.

This report by The Canadian Press was first published Sept. 15, 2026.