Throughout the pandemic, hospitals across the country have been seeing people who are in the midst of a mental health crisis. Among them was Ella, a foreign student from Nigeria studying science at the University of Manitoba in Winnipeg.
The aspiring medical student, who asked CTV News not to use her last name, says she never had mental health problems before. But after almost a year of lockdowns, disrupted classes and isolation, the then-22 year old says she slipped into depression at the end of 2020 and felt suicidal.
“I kind of felt that I needed help. And I felt that my life was in danger,” Ella said in an interview with CTV News.
When she called Winnipeg police for help on Dec. 29, 2020, it led to a nine-day hospital stay, some of it under a forced “involuntary psychiatric” hold, and then a shocking $38,311 bill for her medical care.
Ella has since had to deal with a credit agency, an immigration investigation, renewed depression and regrets over calling for help.
“I know there’s nothing I could have done,” she said. “I couldn’t have stopped my mental breakdown but I also blame myself for everything.”
Ella was taken to Winnipeg Health Sciences, where she says emergency room doctors stabilized her with what she recalls was an injection. Her mother, Paulina, living in Toronto, spoke to her by video the next day.
"I was happy she was alive," Paulina told CTV News. The single mother of three who fled Nigeria because of violence also asked CTV News not to disclose her last name.
But her biggest worry aside from her daughter’s health was the cost of the hospital stay. Ella had no health insurance.
Health insurance for foreign students is usually covered by tuition. Ella’s school bills had been paid for by her mother, once a corporate lawyer in Nigeria. But after being granted asylum in Canada, Paulina’s income dropped and her part-time job was shuttered by COVID-19. Ella was only registered in one class and a minimum of three classes was required for her health insurance to kick in.
"I was really, really worried because I knew that we couldn’t afford her stay in the hospital. I didn’t know what the hospital bill was," said Paulina. She says she was reassured by hospital staff there would be no cost. “They kept on saying that they were going to find a way to help: ‘Oh, no need to worry.’”
Ella, too, had been pushing to leave the hospital. She said she felt better after the second day and asked to be discharged but staff kept her in hospital under an involuntary psychiatric order.
Manitoba’s Mental Health Act allows people to be kept involuntarily if medical staff believe the person is "likely to cause serious harm to himself or herself or to another person, or to suffer substantial mental or physical deterioration if not detained in a facility."
Ella said she was told that, to get discharged, she had to file an appeal to the Manitoba Mental Health Review board. She showed CTV News the application she filled out, dated Jan. 1, 2021.
She was discharged Jan. 6, after nine days in hospital.
"I wanted to go and I was also kind of concerned about what the bill might be. Because I didn’t want any debt or anything," said Ella.
Ella and her mother both told CTV News that Ella rebounded after her hospital visit and was doing well. They say doctors followed up on Ella’s condition by phone. But Ella said they never received a bill. Emails confirm she contacted the hospital on Jan. 19, 2021 to find out about the cost. But she says it was only later, in February, when she received a notification that her credit score had dropped because of an unpaid debt.
After contacting the hospital again, she discovered the total amount owing was $38,311.
"I was shocked, I was really sad. I just knew there was no way I could pay that amount," Ella told CTV News. "I don’t think I should have to pay all of it. Because I feel like we were not informed what the rates were."
A copy of the bill provided to CTV News shows the charges from Shared Health, which runs Winnipeg Health Sciences.
- $1,077 for Ella’s emergency department visit
- $5,322 per night for seven nights in a hospital ward bed
The hospital confirmed to CTV News these are the charges for patients from outside of Canada. Patients within Canada who have a valid health card would not be charged anything.
Over the past year, Ella and her mother tried to negotiate a payment plan. They showed letters and emails to CTV News. One, from Shared Health sent last October, called the total debt "non negotiable.”
Another note said that the family’s request to “reduce the outstanding amount unfortunately cannot be accomodated” and that payments "must begin as soon as possible.”
In November, another email from Shared Health suggested an immediate payment of $1,916.55 and then “payments of the balance within six years in instalments of $506.76 per month.”
Ella, who has a part-time job, and has returned to classes, says she can’t afford that. Her mother, who is working and attending school herself, also says it’s too high a price.
Ella said she is now depressed and feels traumatized. Her mother worries about her daughter’s mental health. “I don’t want to lose my daughter. I’m scared,” said Paulina.
"This health-care system is supposed to be designed on a principle of do no harm. This system has done harm to this young woman," said Mark Henick, a mental health advocate in Toronto who says he was shocked by the hospital administrators’ handling of the situation.
"This is essentially a fine for getting sick because they’re being held against their will and then billed for the privilege of being held against their will. That is deeply unfair," he said.
In a statement to CTV News, Shared Health spokesperson Kevin Engstrom said that “while we are not able to speak to specific details of an individual case… we can confirm both our patient relation and finance teams have been in contact with this individual and their family to address their concerns and discuss payment options."
The spokesperson also said Manitoba’s health-care system “regularly invoices non-residents for the care they receive.”
The province of Manitoba told CTV News it can’t discuss the case because of the Personal Health Information Act.xjmtzyw
After her hospital stay, Ella was also devastated to learn that Canada Border Services Agency was investigating her student visa. Hospital officials told CTV News that CBSA has a mandate to deport non-residents who have not paid significant medical bills.
“It’s a mental health issue in which she was held involuntarily, and it’s just a shocking thing that the hospital has done,” said Dr. Paul Caulford, a physician who treats uninsured people in Canada. His clinic, the Canadian Centre for Refugee and Immigrant Health Care in Toronto, petitioned Ontario to waive all fees for those without health insurance during the pandemic.
"Canada as a nation really, actually advertises and seeks out foreign students for its universities…. Then (Ella) got ill because of the pandemic and then to be penalized and threatened that Canada border surveillance agencies are going to be called….it really screams of investigation as to what hell is going on," said Caulford.
Ella is back at university. She obtained resident status in Canada on Nov. 23 and to her knowledge, CBSA is no longer investigating.
But the hefty bill remains in dispute, and Ella says her concentration and academic work is suffering because of the stress.
Her mother is also working and completing her requirements for becoming a lawyer in Canada. They are still hoping to negotiate with the hospital for an affordable monthly payment, closer to $100.
Both know the debt will affect Ella’s ability to secure student loans, and possibly employment for years ahead.
"It’s really devastating for me as a mother in watching my daughter go through this,” said Paulina.
Henick, meanwhile, has set up a GoFundMe to help Ella with her massive debt.
“(Ella) is incredibly brave, to be able to not only open up about her story like this, but to be able to try to help other people who I’m sure are falling into similar circumstances. This is a good thing that she’s doing to try to help people.”
