Editorial: We all have a stake in making health care work for everyone

A 13-year-old girl from Saskatoon, who was flown to Vancouver’s Children’s Hospital for surgery, ended up being sent home without the operation. The circumstances are troubling.

The child, Bronwyn Joanis, has a rare condition that distorts the curvature of her spine. She has already undergone numerous less-serious surgeries to limit the malformation, but another operation is needed to prevent a life-altering progression of the condition, and to relieve her daily pain.

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Moreover, there are significant time limits here. If the surgery is delayed too long, the girl’s spine will have contorted past the point where corrective measures would work.

Dr. Firoz Miyanji of Children’s Hospital pioneered a procedure believed by her family to be Bronwyn’s best option. Called vertebral body tethering, it avoids the insertion of rods and pins, and the recovery time is much faster.

Miyanji deemed the surgery “urgent,” and Bronwyn underwent five hours of pre-operative preparation.

Then, just 36 hours before the operation was scheduled, Bronwyn’s family learned it had been cancelled. The date was March 17, the day “non-urgent” surgeries were postponed provincewide due to the COVID-19 outbreak.

There are a number of separate, though related, concerns here. First, on compassionate grounds alone, how could such a decision possibly be justified?

True, once you start making exceptions, there is no end to the process. But Bronwyn’s case had been classified as urgent. Surely that was sufficient reason to proceed.

In addition, after her father asked when the operation would be rebooked, he alleges he was told that Bronwyn’s being from out of province would play a part in that decision.

The Provincial Health Services Agency, which runs Children’s Hospital, has failed to confirm or deny that allegation, though it says Bronwyn’s condition is being monitored.

Certainly residents of B.C. should be given priority. But there is a long tradition of patients from one province being treated in another if specialized medical expertise is required.

That is how our national health-care system works. That is how our nation works. Or should.

The next question is who makes the decision about what counts as “urgent,” and which criteria are used?

The need for such decisions arose because in preparation for an anticipated flood of COVID-19 patients, about 30,000 operations were postponed, along with tens of thousands of diagnostic scans such as screening colonoscopies and mammograms.

The B.C. Health Ministry, in consultation with hospital staff, divided surgeries into three categories — emergency, urgent and scheduled.

The first of these is self-explanatory. “Scheduled” means the operation is needed, but the patient is in no immediate danger.

The ministry defines urgent as any operation that would normally be booked no more than 12 weeks in advance.

But that only works if appropriate wait times are in place. They are not. For years, B.C. has failed to meet nationally set standards for appropriate wait times across a variety of surgical procedures.

As a result, once the COVID-19 outbreak began, health authorities had to decide for themselves which surgeries and scans to postpone. Is it possible the long-term shortage of surgical capacity forced what should have been urgent cases into the non-urgent category?

We would argue that Bronwyn Joanis’s cancelled operation at least suggests the possibility.

Lastly, there is the concern that little or no effort has been made to explain to the public, and in particular to patients whose procedures were cancelled, the specific basis for individual decisions. Surgical operations and screening scans are at the very heart of modern medicine. If they are to be postponed, with the risk of serious and possibly fatal consequences, we are entitled to know why these choices are made.

Many experts believe we will see a rerun of the COVID-19 outbreak later this year. In preparation, the Health Ministry should bring in an outside investigator to conduct a thorough inquiry into the surgeries and scans that were cancelled.

The purpose is not to attribute blame. This was an unprecedented emergency.

In part, it is to determine if the choices that were made stand scrutiny, and if not, what improvements should be made. Specifically, would surgeries classified as non-urgent meet national standards?

Equally as important, it is to provide transparency for patients whose physical or mental well-being has been compromised.

The health-care system belongs to all of us. If life-altering decisions must be made on the scale we are living through, our community and the individuals potentially affected need to be part of the process.

We all have a stake in this. Should there be a renewed outbreak of COVID-19 this fall, now is the time to begin developing a more responsive system that gives all of us a say.

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