Posts Tagged "private"


False Creek private surgery clinic sold to Toronto equity company

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Dr. Amin Javer and his team perform sinus surgery on a patient at False Creek Healthcare Centre in Vancouver.

Arlen Redekop / PNG

A Toronto private-equity company has bought False Creek Healthcare Centre in Vancouver, one of B.C.’s first private surgery and diagnostic facilities.

In a memo to employees obtained by Postmedia, the owner of the facility and four others in Canada — Centric Health — says the deal is expected to close at the end of September. The buyer is Kensington Capital Advisers.

Doctors and patients can expect a “business as usual” transition followed by an improvement in facilities and quality of care, according to Kirk Hamilton, vice-president of Kensington. The company, which describes itself as an investor in “alternative assets” bought the clinics in Vancouver, Calgary, Winnipeg, Toronto and Mississauga for $35 million. The clinics will be owned by the Kensington Private Equity Fund.

False Creek was opened in the late 1990s by an entrepreneurial Vancouver anesthesiologist, Dr. Mark Godley. In 2011, he sold the Vancouver centre and a sister facility in Winnipeg to Centric Health for $24 million.

The surgical clinics have apparently been a drag on Centric’s financial bottom line. In the memo to employees, David Murphy, the Centric CEO, said the “bittersweet” transaction is the culmination of a year-long review to improve the company’s financial health.

The decision was made “that the most viable path forward was to divest some of our businesses and pursue a more focused strategy built around our seniors’ pharmacy business.”

Murphy nevertheless told employees the growth potential for the private surgery business is “immense” and that Kensington is “the right owner for this business” as it is committed to increasing investment in each of the surgical sites.

“I am confident they will partner with you to help this business realize its tremendous growth potential.”

In B.C., changing government policies initiated by the NDP have been destabilizing the private surgery business. There is the uncertain outcome of the continuing B.C. trial into the constitutionality of paying privately for expedited surgery in such clinics. Closing arguments in the three-year-long trial will not be made before the fall and a judge’s decision is not expected until sometime in 2020.

Murphy mentioned B.C.’s political and legal situation in the company’s latest quarterly report in which Centric cites risks in the private surgery business, including the B.C. trial and NDP government policies.

Asked about the wisdom of buying a private surgery centre in B.C., Hamilton said in an email: “The acquisition includes multiple facilities across Canada and isn’t limited to False Creek. Currently, the False Creek facility does not provide any services to the B.C. government. However, we would be open to providing similar patient services to the B.C. government in the future.”

He was referring to the fact that for many years, health authorities have paid several private clinics to help clear backlogs of scheduled surgeries. But most private clinics also take patients willing to pay out of pocket for expedited surgery, something the government maintains is illegal.

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 won’t do medically necessary work in both the public and private systems. If they refuse, they could be banned from doing publicly funded operations at private clinics that have contracts with health authorities.

Vancouver Coastal Health has contracted out elective surgery cases to the False Creek clinic in the past, but last year, Health Minister Adrian Dix instructed VCH to sever its contract with False Creek because an audit showed some patients were paying privately to get expedited access, contrary to provincial law.

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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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Dr. Derryck Smith: B.C. government unethical to deny patients the right to buy private care when public system fails to address their suffering

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Psychiatrist Dr. Derryck Smith argues that it is unethical for the provincial government to deny patients the right to hire private medical services when the waitlists for public care are too long. (Les Bazso/PNG FILES)

Les Bazso Bruce Edwards / PROVINCE

I recently testified at the Cambie Surgery Centre trial in B.C. Supreme Court. This legal action was against the government of B.C. to determine whether the citizens of the province have the right to pay privately for insured medical services. At issue is the unacceptably long wait lists for many orthopedic procedures. Individuals who require joint-replacement surgery often suffer excessive wait times for surgical treatment while struggling with severe, unrelenting pain and the resulting disability.

Until now, patients who are able to pay could elect to go through a private surgical clinic to have their surgery, which offers rapid pain relief, gets them moving again, and reduces their risk of other serious illness associated with inactivity. The provincial government is wanting to deny citizens access to privately funded services such as orthopedic surgery and magnetic resonance imaging. If waiting lists were reasonable, individuals would not pay thousands of dollars for a service that would be free in the public sector.

Certain groups, including the RCMP and WorkSafeBC patients are exempted from the prohibition of privately paid medical treatment and have guaranteed access to privately funded services on an expedited basis.

I am fully supportive of publicly funded healthcare, having provided psychiatric care for 35 years as part of the Canadian Medicare system. However, it has become nearly impossible for general practitioners to access timely psychiatric care for their patients. Patients who suffer from serious mental illnesses such as schizophrenia, bipolar disorder or depression and remain symptomatic for an extended period, do much worse than patients diagnosed, treated early and completely. Lengthy periods of untreated illness are associated with a greater likelihood that treatment will not be effective, increased functional impairment and heightened risk of suicide.

Access to psychiatry is limited by a number of factors. To see a psychiatrist, a family practitioner must determine if a referral is appropriate and necessary. They then send a referral to the psychiatrist, asking them to accept the patient for assessment. A large percentage of patients in B.C. do not have a family doctor and rely on walk-in clinics, where they see a doctor who has no long-term knowledge of their health. GPs working at walk-in clinics may not have a well-established referral network.

In 2006, the Canadian Psychiatric Association set ideal maximum wait times for patients with serious psychiatric illnesses. The guidelines stipulate that the most seriously depressed patients should be assessed within 24 hours. In B.C., patients in a psychiatric crisis can be assessed in a hospital emergency room, although waiting times in emergency rooms are excessive and for many, intolerable.

The association recommended that patients who are in an “urgent state” should be assessed by a psychiatrist within two weeks. Patients with depression who are in a “scheduled state” with “tolerable symptoms or disability,” should be assessed and treated within four weeks. It is my clinical experience that the current waiting list for patients to be referred to psychiatrists for major depression is frequently four to six months or even longer.

In 2011, prominent psychiatrist Dr. Elliott Goldner published his research on access to psychiatric care in Vancouver. Goldner created a fictional case of an adult male patient presenting with depression seeking a referral to a psychiatrist from their family doctor. The researchers called all 297 psychiatrists practicing within the Vancouver area. Of the 230 who were successfully contacted, 70 per cent said they were unable to accept the referral, 30 per cent indicated they might be able to consider accepting a referral after they had reviewed a detailed written referral note. Furthermore, they would not provide an estimate of the wait time, even if the patient was to be accepted. Only seven of the 230 psychiatrists offered an appointment time. Their wait times ranged from four to 55 days.

This research documents the real-life challenge that GPs and their patients face when trying to access timely psychiatric care. Family doctors do not have the time or resources to contact every practicing psychiatrist in their community to determine who will accept their patients. Typically, they try one psychiatrist, and if the referral is rejected, and it may take days or weeks to receive a response, then they move on to a second psychiatrist. There is no central registry for psychiatric referrals. Likewise, there are little or no private psychiatric services available, so patients with depression must waiting inordinate amounts of time for appropriate assessment and treatment.

British Columbia should establish a central registry of psychiatrists who are accepting patients, as well as a central intake number where GPs can refer their patients, who would then be matched to a psychiatrist who can see them in a timely fashion.

This centralized system would also allow the health authorities and the public to have access to real-time statistics related to psychiatric care. If the maximum ideal waiting time for a patient with depression is consistently exceeded additional psychiatric resources should be funded. Alternately, patients should be allowed to access private services.

I primarily discuss psychiatric services in this article. Readers should know that our government wants to eliminate any access to private health care using prohibitive fines for doctors who provide private services. This is in spite of the fact that 80,000 adult patients in B.C. are currently waiting for non-emergency surgery. This draconian measure is both unethical and constitutes a threat to our collective health.

If our publicly funded healthcare system cannot provide timely medical services, using well established guidelines for maximum waiting times, then individual citizens should be allowed to use their own funds to access appropriate healthcare. This is the case in almost every other healthcare system in the world.

We need to urgently discuss these issues with our elected representatives.

Dr. Derryck Smith is a clinical professor emeritus in the Department of Psychiatry at the University of B.C.

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