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| ATTORNEY GENERAL OF MANITOBA |
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September 5, 2005
The Honourable Gord Mackintosh Minister of Justice and Attorney General of Manitoba Dear Minister: Re: Health Services Insurance Act and newborn circumcision I am writing to request your assistance in finding out whether infant male circumcision is an insured service in Manitoba. The Manitoba Minister of Health and the Manitoba Medical Association (MMA) have given opposing answers to this question. The MMA has advised its members that “pursuant to the provisions of the Health Services Insurance Act, only medical services which are ‘medically required’ are insured services...therefore a circumcision that is not medically required is uninsured.” The MMA notes that “the vast majority of infant male circumcisions are not medically required” and recommends that practitioners direct bill the patient’s family for the service. The Minister of Health, on the other hand, states in recent correspondence that “until such time that a review is conducted, Manitoba Health will continue to insure circumcision for infant males.” The Minister explains that the tariff for circumcision of newborns does not require a medical condition to be reported on the claim for service. According to the Minister, “the fee for circumcision listed in the regulations under the Health Services Insurance Act does not imply that Manitoba Health considers this procedure to be medically necessary.” The Minister has not responded to requests for elaboration. Routine infant circumcision is not an insured service in any other province or territory. To assist me in understanding the policy on this issue in Manitoba, I would appreciate clarification of the following points:
I enclose copies of relevant material. Thank you very much for your assistance. I would appreciate a response at your earliest convenience.
Sincerely,
Enclosures:
September 14, 2005
Dear Mr. H.arrison: On behalf of the Honourable Gord Mackintosh, Minister of Justice and Attorney General, I would like to acknowledge receipt of your letter dated September 5, 2005. This matter falls under the jurisdiction of the Honourable Tim Sale, Minister of Health. I have taken the liberty of referring a copy of your correspondence directly to his office for consideration.
Your truly,
October 6, 2005
Dear Minister: Re: Health Services Insurance Act and newborn circumcision I wrote to you recently regarding the above. I asked whether the Health Services Insurance Act empowers the Minister of Health to insure services that are not medically required. I received a reply from your special assistant, Ms. Janis Bermel. She indicated that “this matter falls under the jurisdiction of the Minister of Health” and forwarded a copy of my correspondence to the Honourable Tim Sale’s office for consideration. But my question involved a point of law. The Manitoba Medical Association has publicly repudiated Manitoba Health’s policy of paying for infant male circumcision, on the grounds that a procedure which lacks medical indications is not an insured service under the Health Services Insurance Act. In such circumstances, I think it reasonable to ask for clarification of the legal foundation on which Manitoba Health’s policy is based. I believe this matter comes within the purview of the Minister of Justice. Subsection 2(b) of the Department of Justice Act, C.C.S.M. c. J35, imposes a duty on the Minister of Justice to “see that the administration of public affairs is in accordance with law.” Therefore I am once again respectfully requesting that you clarify whether the Minister of Health has the power to insure a service which is not medically required. Are other medically unnecessary services covered by precedent?
Sincerely,
January 6, 2006
Dear Minister: I wrote to you a few months ago regarding the Health Services Insurance Act. I asked whether the Act empowers the Minister of Health to insure medical services that are not medically required. The Manitoba Medical Association and the Minister of Health seem to have opposing views on this question. To date I have received no reply to the letter I sent you on October 6, 2005. I think my letter was reasonable and as it raised an important public issue, I am re-submitting it for a response. Thank you in advance for your reply.
Sincerely,
January 12, 2006
Dear Mr. H.arrison: On behalf of the Honourable Gord Mackintosh, Minister of Justice and Attorney General, I would like to acknowledge receipt of your letters dated January 6, 2006 and October 6, 2005 (which was not previously received in our office). As indicated in my letter of September 14, 2005 (copy attached), I have forwarded your correspondence to the Honourable Tim Sale, Minister of Health’s office for consideration.
Your truly,
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