MONTREAL - Raymond Malo was a fit 50-year-old veteran mountain climber with a clean bill of health when, while scaling one of the world's highest peaks, he had a stroke.
The incident in the Himalayas left the former civil servant partly paralyzed, unable to work, and in a legal battle for a $130,000 medical bill his insurance refuses to cover.
He's warning hundreds of thousands of other federal workers that they could find themselves stuck in the same position.
"I didn't want it to happen and I definitely didn't want it to happen in Asia," Malo said recently from his home in Montreal.
"But it did."
Now, Malo wants other federal government employees to know that their coverage under the Public Service Health Care Plan may not give them the standard of care they expect when abroad. Some 544,000 federal employees and pensioners are members of the plan.
"People need to be protected when they're travelling overseas and there's a serious situation," Malo said.
His story begins on Sept. 15, 2006.
British doctor Chris Imray happened to be on Cho Oyu mountain, near Everest on the Himalayan range, conducting research into strokes at high altitude.
He received a radio message requesting help for a French-Canadian climber - Malo - who had just had a stroke. Imray acted quickly to get him off the mountain and into treatment.
Malo has no memory of the week following the incident.
But he was carried by stretcher to the Tibet-Nepal border by his guide and a team of sherpas and Tibetans, and brought to the Norvic International Hospital in Kathmandu.
Meanwhile, in Montreal, Malo's wife France Pontbriand was frantically trying to get information on his condition.
Finally, eight days after the stroke and on the recommendation of his Montreal doctors, Pontbriand decided to repatriate her husband.
Because Malo was paralysed on his right side, unable to speak or eat properly, disoriented and needing constant medical care, he couldn't fly commercial.
"I couldn't have a taken a commercial flight one, two weeks later, even with someone accompanying me," Malo said.
So World Access - which handles out-of-country claims for the Public Service Health Care Plan - helped Pontbriand organize an air-ambulance for the 25-hour journey.
Pontbriand paid almost $125,000 for the air ambulance, confident she would be reimbursed by the insurance company, which offers federal employees covered by the plan up to $500,000 for overseas treatment, including medical emergency evacuations.
Now, almost four years later, he's still partially paralysed on his right side, has lost some vision in his right eye, his speech remains affected and he was forced to retire from the Canadian Competition Bureau.
And the couple still owe $130,000 in medical bills after Sun Life Insurance - which is the administrator for the Public Service Health Care Plan - refused their compensation claim on the grounds that he was receiving adequate care in Kathmandu.
"In principle, I was covered," Malo said. "They are saying I was fine there."
It's a claim disputed by doctors involved in the case.
Jeanne Teitelbaum, a director of the stroke program for the Montreal Neurological Institute, looked into the treatment Malo received in Nepal at the couple's request. She said it was below Canadian standards and may even have had a negative impact on his recovery.
"He wasn't receiving proper care there," she said. "He was receiving basic care. He would have been at risk of another stroke."
The Nepalese doctors gave Malo fluid with sugar and failed to correct his dehydration, which could have led to another stroke, she explained.
"Sugar can increase the size of a stroke," she said. "And they didn't correct the dehydration fast enough. They didn't take care of that, or even diagnose it."
He was also being given solid food - a choking hazard because paralysis affected his swallowing.
She thinks Malo should have been brought home as soon as he'd been stabilized in the Nepalese capital, instead of almost 10 days after the stroke. She says he needed treatment beyond the emergency care he received.
"The other therapies are less acute but can change the outcome by 20 per cent," she said. "These are simple measures but not given everywhere. That's what he lost out on."
Imray, the British researcher, also submitted a report criticizing the care Malo received in Kathmandu. He noted that the Norvic hospital provided good emergency care but fell short in other areas.
"The request for an urgent transfer to Montreal was not only a reasonable request, but probably the only approach if Raymond Malo was to be offered appropriate care," he wrote.
The couple have now reached a dead end in their fight for reimbursement.
According to rules laid out in their health plan, claimants only have one chance to appeal a ruling by the Public Service Health Care Plan Trust. And that appeal process is final.
So the couple went to the Quebec Superior Court but the judge refused to hear the case, arguing it was a labour issue. They are appealing, but both Pontbriand and Malo know it's a long shot.
"We don't even have the chance to go to court and plead our case," Malo said.
Sun Life Insurance refused to comment directly on the claim due to the appeal, but issued a statement to The Canadian Press.
"Patient care and recovery are the most important factors in these emergency situations. Sun Life Financial's role is to ensure the patient is receiving the appropriate assistance and medical care," it said.
"Generally, ambulance services can be covered if, according to the assessment made, the necessary medical care is not offered in the location where the incident happened. "
Sun Life declined to clarify what it considered "necessary medical care."
Now, Malo and Pontbriand's only recourse is their union - the Professional Institute of the Public Service of Canada - and possibly their local MP.
The former civil servant said he's not hopeful he'll ever be reimbursed. He hopes at least his story will lead other federal employees to take a closer look at their coverage plans.
"If I had broken a leg, an arm, it would have been different," Malo said. "But it's a stroke. It's much more serious. And they just left me there."
