With 4,000 people waiting for orthopedic surgery in the capital region alone, solutions must be found or people will seek out private care — be it in the United States or elsewhere, says a Saanich clinic operator.
Stefan Fletcher, CEO of RebalanceMD at Uptown, an orthopedic clinic with surgeons and physiotherapists, was reacting to the B.C. Court of Appeal decision to uphold a lower court’s dismissal of a Vancouver surgeon’s challenge of the Medicare Protection Act.
The Court of Appeal agreed that bans on extra billing and private insurance do not violate the Charter.
Dr. Brian Day had challenged the act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights.
The takeaway from Friday’s ruling, said Fletcher, is that greater emphasis must be placed on using surgical facilities outside of acute-care hospitals to help relieve the backlog. Fletcher said his clinic receives about 1,600 new referrals each month, with 25 to 30 per cent requiring surgery. “But we’re not doing enough surgery to cope with the number of people coming in the door.”
On Vancouver Island, there are only a handful of private clinics. They mostly perform plastic and cosmetic surgery. The only two private surgical centres on the Island — View Royal Surgical Centre and Nanaimo’s Seafield Surgical Centre, operated by Surgical Centres Inc. — were absorbed by Island Health just weeks ago at a cost to the province of about $11.5 million.
Health Minister Adrian Dix has said the move would increase surgeries and endoscopies by 2,300 for each facility annually and reduce waiting.
At the time, Fletcher believed the province needed to utilize more private clinics for publicly funded procedures.
With that no longer an option on the Island, the immediate fixes include increasing the capacity and complexity of procedures delivered at View Royal and Nanaimo centres, he said.
The biggest challenge for surgeons is postponed and cancelled procedures due to a lack of hospital beds and staffing, he said.
When RebalanceMD opened, wait lists for hip and knee surgery were up to 18 months in the capital region, which the clinic brought down to 18 weeks, said Fletcher, but with the challenges COVID imposed on the system and the GP shortage, those wait times are back to where they started.
“There’s about 4,000 people waiting for surgery in the Capital Regional District and that’s just in orthopaedics — that’s a big number,” said Fletcher.
The dedicated surgical centres need “protected surgical beds” that are not subject to the fluctuating needs of hospitals, he said.
“If they fail to deliver and increase surgeries — then local patients will go to the U.S.A., Mexico, India, even places in Europe,” said Fletcher, who suggested a new surgical centre might be one solution.
“We’re at a crisis point,” he said. “To get out of this is going to be years of work, but also I think that’s why this conversation [around the B.C. Court of Appeal decision] is very important because you’re not going to get transformation unless you get crisis.”
Dix said despite the pandemic, the province did more surgeries and diagnostic tests in May and June than ever before. Almost all surgeries postponed during a series of COVID-19 waves and extreme weather events have been completed, he said.
In written reasons for the B.C. Court of Appeal’s Friday decision, Chief Justice Robert Bauman and Justice David Harris said the purpose of the Medicare Protection Act is to ensure that access to medical care for everyone who is eligible in the public system is based on need, not a patient’s ability to pay.
Dix said the ruling emphasizes the importance of a strong public health-care system, which is a cornerstone of Canadian identity: “We will continue to vigorously defend our publicly funded and administered health-care system, which values equity and fairness over profit.”
The B.C. Nurses’ Union said nurses have been “gravely concerned about private medical clinics’ billing practices,” and Friday’s judgment confirms “they are a direct threat to medicare and the health and well-being of Canadians.”
Dr. Melanie Bechard, chair of Canadian Doctors for Medicare, said there is no question that the public health-care system is under strain, but there are efficient, evidence-based solutions that are proven to reduce wait times and improve the quality of care “in an equitable way.”
The B.C. Health Coalition, among intervenors in the case, said the decision comes at a time when all efforts need to be made “to strengthen and enhance our public health care system rather than dismantle it.”
Hospital Employees’ Union secretary-business manager Meena Brisard said the ruling is “a stark warning that the federal and provincial governments must commit to reducing barriers to timely access to surgeries and other procedures.”
— With files from The Canadian Press
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