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Posts Tagged "medicare"

18Jul

Ian Mulgrew: Medicare expert, lawyer spar to end landmark trial

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The B.C. Government’s defence in the landmark three-year-old Medicare constitutional trial in B. C. Supreme Court is ending not with a bang but a testy, two-day courtroom sparring match involving one of its experts.

Dr. Gordon Guyatt gave as good as he got, repulsing a prolonged assault on his objectivity and left the stand Thursday having provided some last-minute fireworks but seemingly little insight on the key issue — wait-lists and the effects of constraints on access to private care in the provincial Medicare Protection Act.

“My perception is that there’s been a fluctuation of concerns with waiting lists and that governments have, to an extent, addressed things,” he said.

“Things can always get better … you have tensions — constant tensions — in every health care system in the world, and problems will never be solved.”

A specialist in internal medicine and, for almost 35 years, a health researcher at McMaster University, the argumentative Guyatt was assailed as more of an ideological warrior than a disinterested expert.

Robert Grant, lawyer for the two clinics and handful of patients behind the legal challenge over barriers to access to private care, portrayed Guyatt as a virulent opponent of the private clinics and Dr. Brian Day, the driving force behind the decade-old litigation.

Noting he had a duty to be impartial, Guyatt bristled at the broadsides aimed at impeaching his credibility.

“Given my, given that commitment, I do not see personally as relevant further pursuit of my opinions about issues beyond the issues that I’ve been asked to comment on in my deposition,” he complained.

“Thank you for that,” Justice John Steeves said. “In the meantime, just answer his questions.”

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Government lawyers vainly tried to halt the brutal cross-examination that battered Guyatt’s neutrality.

A self-described left winger who ran repeatedly as an NDP candidate, Guyatt has been a social activist for 40 years.

In 1979 he co-founded the Ontario-based Medical Reform Group, which disbanded in 2014 and was replaced by the Canadian Doctors for Medicare, which he joined.

He was also a director of the Ontario Health Coalition, an activist network, that along with its sister group the B.C. Health Coalition, is a member of the Canadian Health Coalition.

Doctors for Medicare and the B.C. coalition, under the banner of B.C. Friends of Medicare Society, have intervened in the challenge to support the government case.

Grant accused the groups of wrongly asserting Day seeks “U.S.-style health care for Canada, where people go bankrupt, lose their homes and life savings, or worse, because they can’t afford treatment when they need it.”

The B.C. coalition, he said, incorrectly claimed Day wanted a system where “international private insurance corporations run the show and patients foot the bill.”

Grant said the groups were fearmongering.

“It is an overstatement that this case could bring down single-tier Medicare,” Guyatt agreed, adding he also did not endorse the portrayal of Day and his supporters as “greedy, awful people.”

He maintained he was too busy to keep up with everything the groups did,  and distanced himself from the inflammatory rhetoric.

“The way I would put it is that we were advocates for equitable high-quality health care accessible to people without financial obstacles,” he said.

“So, specifically, as I have said previously, I believe that it is more appropriate to base care on the need — the medical need than on ability to pay — and I would like to work, continue to work, in a system where the patients I treat are treated on the basis of need rather than ability to pay.
”

“I understand,” Grant replied.

“But the point (of the trial) isn’t about what you want to do in your own practice; it’s whether or not increased private health care, and specifically private-pay surgeries, will be permitted or not. And you are opposed to increased private-pay surgeries. Isn’t that right?
”

“Yes,” Guyatt confirmed.

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Grant insisted Guyatt was a vocal opponent of Day within the Canadian Medical Association, seeing him as a “tragic choice” and “a complete disaster” as the organization’s president.

“I don’t recall active involvement in that matter,” Guyatt said, but again added such comments would be “hyperbolic.”

The Ontario specialist attacked the concept of using “benchmarks” to measure surgical waiting times — saying “not much” research has been conducted to establish what is acceptable and he suggested they were undependable tools set by “good old boys sitting around the table.”

But Guyatt has long minimized waiting lists and their ill effects — calling them “a problem that may be much smaller than we imagine” in 2004.

And he acknowledged he was not familiar with the circumstances in B.C.

“Certainly not in detail …. I do not know the details of the extent of waiting lists currently. I am sure that waiting lists remain a problem. … and that they’re not optimal … I do not know well enough to know whether it would be appropriate to characterize them as a serious problem or not.
”

The final witness John Frank, an expert on social determinants of health, took the stand later on July 18 and was to finish July 19 — day 179 of the proceedings.

“When this trial began I thought it would last up to 18 weeks (three times longer than the similar Chaoulli case in Que.),” said Day, founder of the private Cambie Surgery Centre.

“I am happy that — almost 3 years later — the witness phase is over. I am confident that the justice system will eventually grant all Canadians the same rights to protect their health that the Supreme Court of Canada granted to citizens of Que., and that the citizens of every other country in the world enjoy.”

Justice Steeves plans to hear final arguments this fall and begin deliberations in December.

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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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