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Posts Tagged "delays"

28Apr

Surgery delays deepen over compliance letters B.C. government has forced on surgeons

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Dr. Amin Javer and his team perform sinus surgery on a patient at False Creek Surgery Centre in Vancouver. That is where Mr. Justice John Steeves had his sinus surgery under a contract with Vancouver Coastal Health. But the provincial government has severed contracts between health authorities and clinics that allow patients to pay for their expedited surgeries.


Arlen Redekop / PNG

Patients are waiting even longer for operations like sinus or breast reconstruction because of the latest government crackdown on private clinics and the surgeons working in them, according to affidavits filed in court.

Sinus surgeon Amin Javer says he can’t even begin to make a dent in the number of patients waiting. That’s because he only gets four operating room days at St. Paul’s Hospital a month, allowing him to handle just 12 to 16 cases monthly.

He also operated on patients at False Creek Surgical Centre. But last fall, the government ordered Vancouver Coastal Health to end its contracts with False Creek because the centre was also taking money from patients who were paying the clinic’s facility fees to get expedited surgery.

Javer was the sinus surgeon who operated on the judge in the continuing constitutional trial launched by Dr. Brian Day. The judge would not be able to get that sinus surgery today because False Creek can no longer do business with the government. Yet False Creek is the only private clinic in B.C. with the sophisticated equipment Javer needs to do delicate sinus surgeries.

Not only can Javer no longer perform publicly funded operations at False Creek, but he’s also doing fewer at St. Paul’s because, as the hospital struggles to deal with growing waiting lists, his operating room days have been cut to eight hours from 10.

He has about 300 patients on a pre-surgical wait-list and another 220 waiting for surgery. “It will take me about four years to get through my current surgical wait-list.”

He used to tell patients they’d get their surgery in 2.5 years. Now Javer, the head of the St. Paul’s Sinus Centre and co-director of ear, nose and throat research at UBC, says he has to tell them the waiting time has gone up to four years.

“There’s no outsourcing at all, so the wait-list at the hospital continues to grow. And there’s no extra time being given to surgeons at public hospitals. All that extra operating room time we were promised hasn’t happened,” he said.

Dr. Nancy Van Laeken, a plastic surgeon who performs breast reconstructive surgery on breast cancer patients, said in her affidavit that the government did not increase operating room time in public hospitals enough to compensate for the private clinic crackdown. That means that fewer surgeries are being done in B.C., she said.

Van Laeken said she has privileges to work at five hospitals but only gets four operating room days in total each month. She is willing to do surgeries 10 days a month, but can’t get more time.

“Because of the limited OR time in the public hospitals, the wait times for surgery … in the public system are very long. For example, many of my patients wait (up to) 48 months for breast reconstruction surgery,” she said in her affidavit, noting that is 42 months longer than the target.

For years, health authorities have paid several private clinics to help because of backlogs of scheduled surgeries. But most private clinics also take patients willing to pay out of pocket for expedited surgery. The NDP government argues it is illegal for clinics and doctors to take money from patients for operations covered by medicare and the government is determined to stamp out the practice.

Last fall, the government introduced so-called compliance letters. Surgeons who do any work at private clinics that have contracts with health authorities must sign statements promising they will not do medically necessary work in both the public and private systems. If they refuse, they are banned from doing publicly funded operations at those private clinics that have contracts with health authorities.

If private clinics don’t agree to the same conditions, they won’t get contracts from health authorities or could have their contracts cancelled.

There are only a few private clinics that have agreed to the terms, including View Royal Surgical Centre in Victoria and the ASC Vancouver Surgical Centre.

Javer and Van Laeken are among a group of surgeons who want B.C. Supreme Court Justice Janet Winteringham to issue an injunction to stop the province’s latest stab at clinics until the end of the Day trial, which is being heard by Justice John Steeves. Winteringham has reserved her decision.

The government’s unwavering approach doesn’t end there.

“Doctors who work at Cambie have received warnings from health authority executives that they may lose their surgical privileges in public hospitals if they continue to treat patients wishing to be treated quickly and privately at our facility,” said Day, co-owner of the Cambie Surgery Centre.

Rob Grant, a lawyer for Day, the Cambie Surgeries Corporation and other plaintiffs, calls the government’s actions “authoritarian” and counter-productive because surgeons get a limited amount of time — often only a day a week — in hospital operating rooms. Private clinics have, for over 20 years, allowed surgeons to use their excess capacity to help more patients, he said.

According to the government, the new contracting out policy has not hurt patients and “more scheduled surgeries are in fact being performed.” In the Vancouver Coastal Health region, however, the latest figures show about a third of patients who were waiting for surgery in the last nine months of 2018 were waiting for more than 26 weeks — triple the target numbers. While  86.4 per cent of scheduled operations were completed within 26 weeks, the target is more than 95 per cent.

In Fraser Health, the latest report also shows targets not being met.

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Twitter: @MedicineMatters




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13Mar

Private medical clinics get year-long reprieve as Victoria delays medicare amendment

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Dr Brian Day says Day said the fact that the cabinet order was passed was proof the medicare amendment was unnecessary in the first place.


Nick Procaylo / PNG

Private diagnostic and surgical clinics have won another reprieve, this time from their nemesis — the provincial government, which would prefer to see them shut down.

It means that doctors providing care to patients seeking expedited treatment at private clinics across B.C. can continue doing so for at least for another year, as long as they don’t double bill both the government and patients.

The government has put off bringing into force a Medicare Protection Act amendment that would have harshly penalized doctors who provided expedited care to patients in private clinics. The decision was in the form of an NDP cabinet order and there was no press release announcing the decision.

The amendment — which allowed for fines and even criminal fraud charges — were supposed to take effect last October and could have forced dozens of clinics to close.

But surgery clinics won an injunction in November that effectively ordered the government not to enforce the amendment until after the marathon trial over medicare that began three years ago, initiated by lead plaintiff Dr. Brian Day, is over sometime this year or next.

The government tried, but was denied, to get leave to appeal the injunction two months ago.

Since the injunction dealt only with private surgery clinics, it left diagnostic clinics offering private MRI, CT and PET scan imaging out. The government had said that on April 1, diagnostic clinics would have to comply with the act.

Dennis Hummerston, senior director of Canada Diagnostic Centre, said diagnostic clinics were planning their own injunction application but then got word about the cabinet order.

The amendment is now scheduled to take effect on March 31, 2020, which means private facilities have at least another year in business. The clinics have always disputed the rationale for “draconian” fines and penalties and maintained the legislation would force them out of business.

Hummerston said he’s not aware of any clinics that have gone out of business but said some have lost administrative staff, technologists and radiologists due to the legal uncertainty.

Stephen May, a spokesman for the Ministry of Health, said the government changed the date when the Act will take effect because of the medicare trial and the injunction.

“Consistent with the court’s decision to grant an injunction in a similar case, section 18.1 of the Medicare Protection Act will not come in to force until March 31, 2020 — after the expected completion of the Cambie Surgeries trial. This decision respects the court’s prior decision. … (But) we are committed to stop extra billing.”

May said the government has put an additional $11 million into magnetic resonance imaging in the public system to reach a total of 225,000 MRIs in 2018-19.

“This is approximately 35,000 more MRI exams than the previous year. We are ahead of these targets with hundreds of more operating hours added across the province and more MRI machines running 24/7 than ever,” he said.

Day said the fact that the cabinet order was passed was proof the amendment was unnecessary in the first place.

“The action confirms that there is, and never has been, any health-related rationale for pursuing these amendments. They were merely aimed at prohibiting patients from accessing private options to care for themselves, especially when the actions were taken during the course of a trial aimed at discovering the legality of those prohibitions. It is a perfect example of ideology taking precedence over reason and logic, not to mention ideology trumping the rights of suffering patients.”

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Twitter: @MedicineMatters




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19Nov

Vaughn Palmer: B.C. bill just delays ride hailing even more

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VICTORIA — After taking every opportunity to study, consult and otherwise delay, the New Democrats finally introduced the legislation Monday for a “made-in-B.C.” version of ride hailing.

Or so they said.  On closer reading, the legislation turned out to be mainly a front for further considerations, consultations, regulatory dodges and delays.

Bill 55, the Passenger Transportation Amendment Act, amends eight pieces of legislation, runs to some 46 pages and dozens of clauses, sub clauses and explanatory notes.

But the bottom line on the entire package emerged during the technical briefing when reporters tried to nail down precisely when British Columbians will enjoy the same ride-hailing services that are already in place elsewhere on the continent.

The New Democrats have suggested for some time that things should be ready in late 2019. But when reporters pressed the point, they learned maybe, maybe not. Can’t make any promises. Might be 2020.

The legislative text starts on a puckish note with the New Democrats choosing to redefine the two most common terms associated with the ride-hailing controversy.

No longer shall we refer to taxis or ride-hailing vehicles. Henceforth both are to be known as passenger-directed vehicles or PDVs.

As for the commonplace ride-hailing app, accessed on a smartphone, that is now defined in law as a transportation network service, or TNS.

With terms out of the way, the legislation moves to greatly strengthen the regulator of the aforementioned TNSs and PDVs, the Passenger Transportation Board.

“The board will expand its role in receiving applications and setting out terms and conditions of licences, including taxis, ride-hailing, and passenger-directed vehicles,” according to the briefing notes.

“The board will have authority to determine the rates charged to passengers, as well as the supply and operating area of vehicles (for) transportation network services.”

Supposedly the board will gather the necessary data on the supply of vehicles within a given operating area and be guided by considerations like “public need” and “sound economic conditions.”

But that could prove to be a lengthy, contentious and ultimately subjective determination.

Moreover, the cabinet itself will have a hand in shaping the process. The board chair and members will all be NDP appointees. Perish the thought that well-connected New Democrats would already be angling for one of those board appointments.

Plus the cabinet has reserved for itself rules of practice and procedure for the board, and to place limits on its ability to recover costs for its regulatory processes. Indeed, the legislation assigns broad-brush regulatory powers to the cabinet to be determined after the fact — setting fees, defining terms, delegating powers and specifying geographic areas and classes of vehicles.

Another undefined consideration is a special fee, to be charged per trip, to fund accessibility options for people with disabilities. At this point, the size of the charge is anyone’s guess.

From the briefing notes:  “With these legislative changes, government expects applications from ride-hailing companies wanting to enter the market will be submitted to the Passenger Transportation Board (PTB) by fall 2019.”

Except that there still is the not-small matter of the necessary insurance for any new ride-hailing service.

The legislation enlists the services of the Insurance Corp. of B.C. in developing such a product. But it adds little in the way of specifics, nor does it establish a hard and fast deadline for implementation.

While ICBC is said to be already working on such a product, the technical briefing shed no light on how far along it has got.

In fairness to the folks at the government-owned auto insurance company, they have some other things on their plate — like an NDP-ordered top to bottom makeover of rates, rate structures, coverage, payouts and the like.

Supposedly ICBC will have something ready on the ride-hailing front his time next year, after, natch, the usual back and forth with government and those in the business.

Once approved by ICBC, it will then have to be approved by the independent B.C. Utilities Commission, before it can be offered to any would-be operator seeking to get into the ride hailing business in B.C.

Given all those uncertainties, the New Democrats are making no promises about this thing being operational before 2020.

Still, they are thinking ahead in one respect. Tucked inside the enabling legislation is a commitment to strike a committee of the legislature in early 2022, following the next provincial election.

Its mandate: “Review these changes to make sure the government is on the right track with modern, safe taxi and ride-hailing service.”

Related

Having delayed the thing through most of their first term of government, the New Democrats are now promising to revisit it in a hoped-for second term.

All by way of reinforcing the NDP line that this ride-hailing thing needs to be approached with supreme caution.

Sure, they wasted no time launching a half-baked speculation tax and in stacking the deck in favour of electoral change.

But implementation of a service that is already in place in comparable jurisdictions all over the world?  Some things just can’t be rushed.

Hence another round of stalling and excuse making, all in the name of crafting a Made-in-B.C. solution to a problem that has already been solved pretty much everywhere else.

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