Medicare wait-lists leave hundreds to die due to staff shortage, court told
Anesthesiologists sound alarm on lack of ‘reasonable access’ to their expertise
People are waiting too long for health care in B.C., hundreds even dying, but it’s not because doctors are providing private care, provincial anesthesiologists noted in their closing submission to the marathon medicare constitutional trial.
Closely involved with virtually every patient undergoing surgery, the specialists intervened in the B.C. Supreme Court challenge because there aren’t enough of them available to meet surgical demand — and there has been a dire provincial shortage for at least 15 years.
“The evidence at trial demonstrates that hundreds or possibly even thousands of patients are dying annually on the wait-list for surgery,” Dr. Roland Orfaly underscored in his summation for the B.C. Anesthesiologists’ Society.
“In 2015-16 in Fraser Health alone, there were 308 patient deaths amongst those wait-listed for scheduled surgery.”
There simply aren’t enough anesthesiologists, he asserted.
“The undisputed evidence in this trial demonstrates that patients are not achieving reasonable access to the medical care of anesthesiologists,” Orfaly said.
“Evidence of this lack of reasonable access has included facts about closed operating rooms, cancelled surgeries, excessive wait times and growing waitlists.”
Even if there were reasonable access to the government’s priorities of hip and knee replacements and cataract surgeries, he added, there wasn’t reasonable access for patients who require other types of surgeries, including cancer surgeries.
Orfaly told Justice John Steeves that never mind private clinics — medically necessary surgery was already a two-tier system functioning within the public health care system.
“There is one tier of patients who are waiting for surgeries determined by government to be priority procedures, and this tier receives additional resources, operating time and access,” he explained.
“There is then a lower tier for patients waiting for medically necessary surgeries determined by the government not to be priority procedures. These include cancer surgeries, aneurysm surgeries, brain surgeries and many others. These patients receive less attention and uneven allocation of resources as compared with their neighbours by government priority.”
At the end of the first quarter last year, Orfaly said 85,468 were waiting for surgery. Of those, 35,335 patients or 41.3 per cent had already waited longer than the Ministry of Health’s benchmark maximally acceptable wait time.
He said a key barrier to solving the crisis was the scarcity of anesthesiologists and the government has known that since November 2004.
In 2015, the health ministry cited the shortage as a reason only 82 per cent of operating rooms were regularly staffed.
While the shortage was long-standing and provincewide, evidence also showed that other provinces did not have the same supply problem.
“Both Ontario and Alberta attract multiple anesthesiology candidates,” Orfaly said.
“In contrast to other provinces, the shortage of anesthesiologists in B.C. has resulted in hospitals recruiting anesthesiologists who are not yet certified to Canadian standards, either because they have been trained outside Canada or because they were trained in Canada but had yet to pass their Canadian certification exams.”
Until they successfully complete their exams, these doctors are credentialed to provide care only under the supervision of a certified anesthesiologist.
Orfaly attacked Victoria’s claim that allowing practice in the public and private sector will damage the public system in part by increasing competition for surgeons, anesthesiologists and nurses.
He pointed out the Medicare Protection Act ban on dual practice only targets doctors.
“The impugned provisions of the act against dual practice apply only in our understanding to medical practitioners and not to all health care practitioners such as nurses,” Orfaly said.
Yet the evidence of a shortage of operating room nurses was uncontested.
“While the defendant and the two other intervener groups argue the harm to the public system of dual practice (by doctors), in fact there’s nothing in the act or otherwise preventing nurses in B.C. from engaging in dual practice,” Orfaly said.
“A registered nurse at a hospital in B.C., for example, could leave work, cross the street and offer his or her services privately for whatever compensation the market dictates. This private nursing care could be offered, for example, to a private nursing home or even a private residence.”
If the alleged harms of dual practice justify limiting the right to access private care by physicians, Orfaly said the same limits can be justified on access to private care by nurses.
The MPA provisions under scrutiny are overbroad and unjustified, he said, especially in the face of such pernicious waits for patients: “They’re experiencing pain and suffering, irreparable harm ... Instead of access to care based on need, access is simply determined by the government’s willingness and ability to deliver a certain volume and mixture of priority and non-priority health care services.”
Ottawa, however, doesn’t believe this case has anything to do with wait times, whether they are harmful or whether people are dying in the queues.
‘That’s the plaintiffs’ spin on why they brought this case,” said federal government lawyer BJ Wray.
“Those are not questions that are properly before this court. Those are questions that the government may wish to inquire into through a public inquiry or some other public forum ... the existence of wait times and whether or not they cause harm is material for a commission of inquiry. It’s not the issue to be adjudicated in this case.”
Final summations in the threeyear-old trial continue.
Evidence of this lack of reasonable access has included facts about closed operating rooms, cancelled surgeries, excessive wait times ...