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Ontario doctor moving to United States after prolonged battle with authorities

As Americans get set to vote in what is in part a referendum on Obamacare, Canadians continue to wrestle with the question of what universal health care means exactly.

The debate often focuses on the role of private health care. While privately owned clinics and labs operate within the public system, the provinces have tried to curb Canadians' ability to pay directly for privately delivered services that should be covered under medicare, which violates the Canada Health Act.

A 2005 Supreme Court of Canada decision in what's known as the Chaoulli case, which found that prohibiting Quebecers from buying private medical insurance violated both the Quebec and Canadian Charter of Rights and Freedoms, was expected to open the door to more private care. But the two sides seem just as entrenched, as a review done for Parliament in 2005 outlined.

Vancouver surgeon Dr. Brian Day has battled the authorities for years over the operation of his Cambie Surgery Centre in Vancouver. Day launched a constitutional challenge in 2009, claiming B.C. legislation barring residents from paying for private care violates their rights, according to the Toronto Star.

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Dr. Karen Dockrill is paying a price for her belief that she should be allowed to provide patients in her pediatric clinic with services over and above what's covered by medicare, and charge for them.

The Whitby, Ont., doctor has spent hundreds of thousands of dollars fighting the Ontario College of Physicians and Surgeons over operation of her "Mom and Baby Depot." Patients who joined her practice were required to pay between $500 and $2,200 a year for services such as access to dieticians and breast-feeding consultants, 24-hour telephone access and a kiddie gym, according to the National Post.

Although many of her patients reportedly loved the extra-cost services, the college found Dockrill guilty of violating its policy prohibiting "block fees."

Under a settlement with the college, Dockrill was suspended for a month, ordered to take an ethics course and submit to inspections by a regulator for at least nine months, the Post reported.

The fight has been costly. The Post said Dockrill has been living in the clinic after being forced to sell her house to pay legal bills. Her lawyer advised her to leave the province or face years of monitoring from the college.

Instead, Dockrill has decided to move her practice to nearby Buffalo, New York.

"I'm bruised, financially impacted, but I firmly believe that what we did was the best quality of care I've seen in a very long time," Dockrill told the Post.

"Every one of us wants a really strong universal health-care system, but I believe it requires some patient responsibility, and it cannot provide everything. We can do better than what we're doing now."

Supporters of doctors such as Day and Dockrill argue that private care still has a role in system that enshrines universal access, fostering innovation and relieving pressure on publicly-funded services.

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But critics say Dockrill could not be allowed to demand a fee as a precondition for seeing a taxpayer-funded doctor, even if that charge was to cover extra services.

"She chose to go ahead and build a business model that was in flagrant violation of the ethical standards the profession has clearly set out," Dr. Danielle Martin of Canadian Doctors for Medicare, told the Post. "This is not a grey-zone example."

Dockrill said she believes growing numbers of doctors are doing what she did.

While Dockrill opted to give up her fight despite promises of support from private-care advocates, the battle continues.

Day's fight with B.C. health authorities is working its way through the courts.

In an editorial earlier this month, the Victoria Times Colonist conceded that ways have to be found to lessen wait times for surgery or to see specialists.

But the problem with Day's clinic (and you could also say Dockrill's practice) was how it mixed publicly funded and private services. An audit apparently found evidence Day's clinic may have double-billed the province and the patient in some cases.

Private health care is fine, as long as it's truly private, the Times Colonist said.

"This isn't really private medicine at all. It's a moneymaking scheme for a few, piggy-backed on a public health system we all pay for."