Ian Mulgrew: Government in denial over medicare crisis

The B.C. government just doesn’t want to admit how wide and deep the crisis of waiting for diagnostic and surgical services in this province really is.

After three years of legal wrangling, the final summations in the marathon B.C. Supreme Court medicare constitutional trial are making clear the length and seriousness of health care lineups in B.C.

How threadbare is the government’s defence?

It boils down to little more than don’t blame us — it’s those greedy doctors who don’t act appropriately, exaggerate their waiting times and fail to hire good office staff or those patients who don’t follow the best self-help

The government even insists the detailed data it has been collecting for more than a decade from every B.C> hospital on every surgery shouldn’t be trusted.

In the landmark challenge over provisions of the Medicare Protection Act that curtail access to private care, the plaintiffs’ lawyers this week are reviewing the mountain of evidence that has been presented.

And it is damning.

Lawyer Selina Gyawali enunciated the harms caused by the lengthy queues for diagnostic and surgical services — potential risks to life 
and long-term heal, pain, disability.

As everyone who has suffered waiting for treatment can attest, it isn’t just a matter of inconvenience or impatience.

“Waiting for medically necessary treatment causes emotional and psychological distress and prolonged physical suffering, creates dependence and 
immobility, and leads to risks of permanent physical degeneration and of death in 
the case of life-threatening conditions,” Gyawali told Justice John Steeves.

Yet in spite of benchmarks and targets for treatment having been set and refined over a generation, the province isn’t meeting them.

Gyawali pointed out Victoria’s own witnesses testified and the data showed that B.C. has failed and continues to fail to provide medically necessary care within its targets. Thousands of patients are routinely waiting beyond the maximum acceptable waiting times for their procedures, across all priority areas, every year, she said. The data for all surgical specialties across all priorities shows that B.C. patients frequently wait many months for a consultation and many months for surgery.

“These failures continue in the face of a 20-year government effort across different federal and provincial governments to address the issue of patients waiting too long for medical care in the 
public health care system,” she added.

Government lawyers, however, throughout have tried to suggest “there really isn’t a universally accepted method of establishing wait-list benchmarks.”

They played down the significance of the waits by referring to them as being “non-emergency” surgeries and cast aspersions on the Surgical Patient Registry that tracks every operation.

The government, which parses waiting time into different phases, does not publicly report but collects the time it takes to see a specialist, called Wait 1, or the time lined up for diagnostic testing (Wait 3), though the wait for each of these can be many months.

The main performance measure is from the patient’s decision to have the operation until surgery (Wait 2), which represents only part of the actual time awaiting treatment.

“Although the defendant’s witnesses could not identify any established problems with the Wait 1 and Wait 3 times, the province repeatedly claimed that it is not reliable,” Gyawali noted.

“It has not, however, done anything to test or correct the anecdotal claims of unreliability. By claiming that the information is unreliable, the government can justify not reporting or using the information. Obviously, these numbers would show even longer wait times.”

From the patient’s perspective, the wait begins with a referral from the general practitioner to a specialist, the time to an appointment with the specialist, the delay while diagnostic procedures are performed and lasts until treatment by the specialist.

Still, the data across all specialties and priorities between 2011 and 2017 show well over 30,000 patients (or more than 40 per cent) were waiting beyond the target on the last day of the last quarter of each year, Gyawali told Steeves.

Between 2011 and 2017, more than 16,000 patients (more than 22 per cent) were waiting each year beyond the longest maximum acceptable wait time of 26 weeks. Even for serious 
procedures like hip replacements and cancer therapies, a 2018 report showed fewer patients were receiving treatment and those who did were waiting longer.

“This counters the B.C. government defensive suggestion that while wait times continue to be unacceptably long, the number of procedures performed is increasing,” Gyawali said.

As he has throughout, government lawyer Jonathan Penner objected to pretty well all of it.

“All right,” Steeves said. “Well, I hope I made it clear 
before that I am not going to do a forensic 
accounting of the hundreds of thousands of 
surgeries in this province, so — and as our 
recent exchange, I’m not sure it matters.”

“The document I’ve actually been 
able to present to you was a document tendered for 
the truth of its contents and it’s a ministry 
document,” Gyawali replied.

“The document agreement was very 
clear,” Penner complained. “The truth of the contents relates to 
facts, not opinion. This is expert opinion.”

This wasn’t anyone’s opinion, it was the government’s own data.

“What is clear from this data is 
that despite all the initiatives undertaken by the federal government, the province, and health 
authorities and the physicians, since the Chaoulli decision in 2005 and in particular over the past 
several years in B.C., there has been no meaningful 
progress in reducing wait times, even for the 
focused procedures such as hip and knee 
replacements and colonoscopies,” Gyawali concluded.

“It is clear that 
the government will never provide the timely 
diagnostic and surgical services that each and 
every patient needs to alleviate their suffering and protect their health.”

The summations continue.



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