Publicly funded surgeries at private clinics in B.C. double while waiting times stagnate
The number of publicly funded surgeries at private clinics in British Columbia has more than doubled in the last four years without significantly reducing lengthy waiting times, the medicare constitutional trial has heard.
A two-page briefing note with appendices prepared last fall for NDP Health Minister Adrian Dix indicated the public system relied on the private facilities to deal with lengthening surgical queues.
And the data appears to fly in the face of the NDP administration’s decision to clamp down on the clinics starting Oct. 1 by penalizing doctors with heavy fines under controversial provisions of the Medicare Protection Act under challenge in B.C. Supreme Court.
Two of the private facilities, which have existed for decades, and a handful of patients say the act’s constraints on access to private medical care are unconstitutional, and introduced the document and other reports challenging their justification.
The briefing note — summarizing “data on overall surgical volumes and high-profile surgeries” — provided figures broken down in each region for hip and knee replacements, dental surgery and cataract surgery.
Across the province, it said publicly funded surgeries performed at private clinics increased 109 per cent from 2013-14 to 2016-17, primarily in the Fraser, Vancouver Coastal and Northern regional health authorities.
In 2013-14 there were 5,503 publicly funded surgeries, and by 2016-17 that number had grown to 11,485.
Total surgeries performed in B.C. hospitals increased yearly by two to three per cent, rising to 588,487 in 2016-17.
“Hips, knees and cataracts have seen substantial increases in wait times in many health authorities in the past five years even though the numbers of procedures have increased during this time,” the internal analysis stated.
The number of cases waiting for surgery at the end of each year nevertheless increased
15 per cent from 74,759 in 201213 to 85,757 in 2016-17.
The median waiting time for scheduled cases remained steady at 11 weeks over the five-year period, while the waiting time for the outlying 90th percentile cohort dropped from 51.7 weeks in 2013-14 to 39 weeks in the years afterward.
Government lawyer Kate Saunders repeatedly insisted some of the information may be unreliable even though the Surgical Patient Registry was “developed by the Provincial Health Services Authority staff in consultation with health authority and Ministry of Health representatives.”
Similarly, she maintained the government had not yet provided other requested documents because it had yet to find them, even though the trial is in its third year of proceedings.
One of the reports concerns the paralyzed teenager who was the face of the litigation before his health problems prevented it.
Walid Khalfallah waited 13 months to see a specialist and another two years for spinal surgery before ending up paraplegic.
Health authorities promised Children’s Hospital would begin to track waiting times, operating room capacity, etc., in respect of these pediatric patients to ensure such a tragedy did not happen again.
The Provincial Health Services Authority in a June 12, 2012 letter said hospital leaders would regularly review that information with department heads “to provide detailed reports and to develop appropriate action plans for patients who fall outside of those targets.”
“If B.C. Children’s Hospital is unable to meet the targeted timelines (for surgery), then as part of a patient-centred care a process to refer patients to another suitable service provider who can provide care in a timely manner should be established,” the health authority said in the letter.
Not one of those reports has been produced.
“The health authority’s position is they don’t feel as a non-party that they should be put to the trouble of searching for and producing documents that are provided to the Ministry of Health. And so they say all these reports have been provided to the Ministry of Health, and then we ask the defendant for the documents, they say ‘Well, we don’t seem to be able to find them,’” plaintiff lawyer Robert Grant complained. Saunders obfuscated. “I understand that the province has been searching for the documents based on the descrip- tion that has been provided by the plaintiffs,” she said. “To date, nothing has been found and my friends have been informed of that.”
It has become clear that the waiting lists are amorphous and the data behind them bedevilled by changing definitions, the failure to collect or collate relevant details and problematic information that exists within official databases.
In 2009, for instance, the government permanently stopped counting patients who had deteriorated so badly on the waiting list that surgery was no longer possible, patients who died while waiting, and patients who opted for private surgery. Similarly, a 2017 government document emphasized it only publishes waiting times counted from the date the hospital receives a surgical booking form until the operation, not from the date surgery is deemed necessary.
“Using the decision date rather than the administrative booking form received date will increase reported wait times dramatically for both cases waiting and cases completed,” concluded the report about changing the definition of “wait time.”
Sandra Feltham, director of the government hospital and diagnostics analytics team, testified as an adverse witness — which says volumes about the government’s attitude toward having its policy scrutinized.
She insisted some of the data cited may be unreliable because the doctor and hospital records don’t marry up with corresponding MSP billing records: 30 per cent of the Surgical Patient Registry records do not have a corresponding physician bill on or in 21 days before or after their referral, and 32 per cent did not have an MSP bill for a visit with the specialist within 21 days of the consultation date.
The median waiting time was four weeks, but if you exclude the outliers or those without an MSP bill, the waiting time went up 10 per cent to 4.4 weeks.
She explained there were such “serious issues” with the data, her group did not recommend using the new definition based on the decision date because more steps were needed to “improve the quality of the data.”
She was unaware of any action taken to resolve the concerns.
As a result, the waiting time spent between a doctor’s referral and the specialist consultation still isn’t included in the waiting time calculation or made available to the public, she added.
Another problem, she said, was that every three months the government needed to “scrub” the waiting lists, but “from time to time wait-list cleanups aren’t done. Some of these people aren’t actually still waiting for surgery but they haven’t yet been removed from the wait list.”
The trial continues.