For nearly three months, the Winnipeg Regional Health Authority billed people for medical abortions at Health Sciences Centre, despite a provincial regulation stipulating the service would be offered for free at that location.
The province’s largest health authority offered no reason for the error, telling the Free Press in a statement: "We regret that this insured service was not immediately made available at no cost."
Mifegymiso is a long-awaited $350 abortion drug regimen approved nearly two years ago by Health Canada. Instead of having surgery to remove a fetus, the patient takes six pills.
Two mifepristone tablets are taken under doctor supervision and four misoprostol tablets are taken at home the next day. The mifepristone kills the pregnancy, while the misoprostol removes the fetus.
The WRHA says most of the patients who received the drug were covered by third-party insurance. However, it is asking anyone who paid directly for a medical abortion at HSC between July 19 and Oct. 3 to get in touch with the women’s program.
"Due to the sensitive nature of the procedure and the confidentiality agreement committed to when they entered the clinic at HSC, we will not be reaching out to patients," said the WRHA, which has only been offering free medical abortions at HSC since Oct. 3.
The health authority’s error is compounded by the fact neither of the other two locations Rochelle Squires, the Manitoba minister responsible for the status of women, said in July would offer medical abortions for free have begun offering them.
Prairie Mountain Health blamed the national shortage of Mifegymiso for the lack of medical abortion services at Brandon Regional Health Centre, while the Women’s Health Clinic in Winnipeg pointed to confusion over what the government would — and wouldn’t — cover.
"It’s illustrative of this government’s lack of commitment to overall reproductive health for Manitoba women," said MLA Nahanni Fontaine, the NDP’s spokeswoman for status of women.
"You make an announcement and, three months later, that announcement still isn’t being executed."
Theresa Oswald, director of the Women’s Health Clinic, said she was pleasantly surprised when Squires announced the funding plan in July. However, she said as the clinic worked through the processes required to start offering Mifegymiso, she realized there wasn’t actually new funding beyond the province covering the cost of the drug.
It became clear, Oswald said, what money the clinic would have spent on a surgical abortion would have to go to cover a medical abortion instead. She said that was financially difficult for the clinic given staffing and other support requirements that come with both procedures.
That confusion was cleared up earlier this week, she said, when a representative of Manitoba Health reached out to say "we would be funded in full."
It’s unclear exactly what’s changed, only that it has.
A spokeswoman for Squires redirected inquiries to Manitoba Health. A spokeswoman for Manitoba Health said regional health authorities have always been responsible for funding the services people receive when they get an abortion, regardless of whether it’s surgical or medical.
"It has always been our intention to work with Women’s Health Clinic to ensure patients have access to Mifegymiso at no charge to them," the WRHA said Tuesday in a statement. "We were able to clarify that with WHC yesterday and confirm our commitment that the drug would be funded by WRHA for their clients."
Oswald said the clinic is "pleased that the details of the funding arrangement have been sorted out."
The clinic expects to start offering medical abortions as early as next month, although it may be pushed back to mid-November.
"This is the kind of thing where you only get one chance to make a first impression," Oswald said. "We want to make sure that nothing goes wrong."
The national shortage of Mifegymiso, at least, should no longer be an issue.
In an email, the drug’s manufacturer, Celopharma Inc., said there is no longer any shortage, noting it shipped new packets of Mifegymiso to Manitoba this week and wholesalers should have it in pharmacy by Friday. The WRHA says it should have enough in stock right now to cover the city until the next batch arrives.
Outside of the three free locations, patients can still access Mifegymiso at other locations if the doctor there has undergone the federally mandated six-hour training program. However, if people are not on social assistance, they will have to pay some or all of the cost.
Still, Celopharma Inc. said the number of times it’s been asked to ship directly to clinics or individual health professionals in the province is quite low, "very few, if at all."
That’s part of the problem, according to Fontaine.
"For women in rural areas, women in First Nation communities, it is a game-changer in respect of access to abortion and offering women and girls a full range of choices," she said.
The government, she went on, missed the mark in its first announcement about which three sites would offer Mifegymiso for free and now its apparent it has missed the mark again with delays in offering the abortion pill.
"It’s insulting," Fontaine said, rejecting any idea the government plays no role in the confusing rollout and delays in making Mifegymiso free at HSC.
"This government has a very bad habit of projecting all of their mismanagement or lack of commitment onto everybody else," she said. "To dismiss and project that fault onto the agencies..., the hospitals that are doing really critical work and helping women and girls navigate what is a really difficult decision to make — to blame them — is just irresponsible."
Since March 2017, the WRHA says 71 people have received a medical abortion at HSC.
The WRHA asks patients who are impacted by its failure to offer Mifegymiso for free over the summer to call client relations at 204-926-7825.
Read more by Jane Gerster.