HOSPITALS ACROSS CANADA ARE PROVIDING OPERATING ROOMS FOR COSMETIC, PRIVATELY PAID SURGERIES WHILE SOME CANADIANS HAVE TO WAIT MONTHS FOR MEDICALLY NECESSARY OPERATIONS, A POST SURVEY FINDS.
Nip and tucks occupy ORs as sick patients wait
While some Canadians wait months to undergo medically necessary surgeries, public hospitals across the country are routinely providing operating-room space for cosmetic, privately paid operations, a National Post survey reveals.
Breast enhancements, nose jobs and other esthetic procedures are being carried out during daytime hours — employing the same facilities and support staff used for heart bypasses or liver transplants, hospitals and surgeons confirm.
Of 15 hospitals or health regions in seven provinces that responded to questions from the Post, 11 said they permit at least some cosmetic surgery cases, with one recording 168 such cases last year.
The institutions stress it’s still a small fraction of the total number, but the phenomenon underscores a surprising reality of Canada’s health-care system: despite the demand and long queues, governments often don’t provide enough money to fill standard operatingroom hours — typically 8 a.m. to 3:30 p.m. — with medically necessary surgeries, the facilities say.
That means there’s room to allow patient-paid, nonmedical work without affecting wait lists at all, they say.
“It’s quite obvious that we could be utilizing those operating rooms for a longer period of time for performing medically necessary surgeries,” said Dr. Mitchell Brown, spokesman for the Canadian Society of Plastic Surgeons. “All you have to do is look at the waiting list for surgeries.”
Indeed, the delay even for heavily funded “priority” treatments like hip replacements remains daunting.
More than 20 per cent of those patients in 2016 waited longer than the recommended six months after first seeing an orthopedic surgeon, according to the Canadian Institute for Health Information.
Meanwhile, while most hospitals say they charge patients who have cosmetic work done in their ORs, one surgeon says the fees are often less than what’s demanded by private clinics with more limited facilities.
Others have begun to see it as a means to bolster stretched budgets.
“I can see how in certain segments of society (esthetic surgery in public facilities) would raise eyebrows,” said Dr. Brian Bottenberg, an otolaryngologist — ear, nose and throat specialist — based in London, Ont. “I can also see this is a means for hospitals to raise revenue.”
The Post contacted a sample of 19 hospitals or health regions to ask about their experience with cosmetic surgery, all but four responding.
Eleven said they allow from a few to scores of cosmetic procedures every year.
North York General in Toronto, for instance, said that 168 esthetic procedures were performed in 2016, out of 16,000 operations. The cosmetic work did not bump any medically necessary treatment, said spokeswoman Nadia DaniellColarossi.
“NYGH was not funded to run the ORs for the times that the (non-medicare) procedures took place, which allows us to make those ORs available,” she said.
In fact, Daniell-Colarossi said North York has among the best surgical wait-times in Ontario.
“These procedures are performed in otherwise unused blocks of operating room time,” echoed Matt Haggerty of Southlake Regional Health Centre in Newmarket, Ont.
Southlake does about 120 patient-paid cosmetic surgeries a year, just under one per cent of the total, he said.
The Calgary region’s hospitals did 110 cosmetic procedures in 2015-16, well under one per cent of all operations, said Alberta Health Services spokesman Bruce Conway.
London Health Sciences Centre in Ontario hosted 74 cosmetic operations last year, out of 27,000 procedures, while the William Osler Health Centre’s two Toronto-area hospitals recorded 150.
Brown noted that Canadian hospitals have spare, unfunded slots despite the fact they keep much more limited operating hours than their American counterparts. Many U.S. surgical facilities run for twice as long — from 7 a.m. to midnight, he said.
Cosmetic procedures take place in public hospitals when it might be unsafe to do so in a private clinic; when they’re tacked onto a medicare-covered operation; or in smaller centres where there are no private surgical facilities, said Dr. Eric Bensimon, president of the Canadian Society for Aesthetic Plastic Surgery.
Some plastic surgeons or their patients also just prefer the operation be in a hospital, not a stand-alone clinic, said Brown.
But are patients who undergo, say, breast-lifts or tummy-tucks in taxpayerfunded facilities at least compensating them properly?
Hospitals should actually charge higher fees than clinics, since patients are tended to by larger medical staffs and more sophisticated equipment, says one ear, nose and throat (ENT) specialist in Ontario.
Yet often the levies are less than those in clinics, suggesting public institutions may sometimes be subsidizing cosmetic work, said the surgeon, who asked not to be named because of his junior status. And when the esthetic procedure is done at the same time as a medical one — meaning the patient should pay for part of it — the lines can be blurred, the specialist said.
“Not infrequently, the hospital may not be aware that any of that surgery is cosmetic,” said the ENT physician.
Alberta Health Services actually does not charge patients who undergo cosmetic procedures in a hospital, said Conway.
Other centres have traditionally billed “moderate” fees but most are beginning to increase their rates, now seeing it as a way to offset costs of medicare-funded work, said Brown.
William Osler raised its charges last year to “better reflect accurate cost recovery,” said spokeswoman Alineh Haidery.
In fact, the facilities may have little choice.
“Hospitals are pretty much all working in the red,” noted Bottenberg, “and this is a source of revenue for them.”