Opposition Health Critic Comments on Cambie Clinics Case

On Monday, October 20, Opposition health critic Judy Darcy raised the Cambie Clinics case and the need for public solutions to wait times in a private members statement in the Legislature. Here is the draft Hansard transcript of her statement:

J. Darcy: If you ask British Columbians and Canadians what they cherish most about the society we live in, the majority inevitably say that it’s our cherished public health care system.
We are passionate about it. It’s central to who we are. We have a health care system, a medicare system, where the quality of care you get does not depend on the size of your pocketbook. If you visit a doctor’s office or an emergency room, if you’re scheduled for a diagnostic test or a surgical procedure, you’re asked to show your CareCard, not your credit card — for now, that is.
But this fundamental value that we share as British Columbians is under threat. It’s being challenged in a court case launched by Dr. Brian Day and his associates at Vancouver’s for-profit Cambie surgical clinic and specialist referral clinic. These private clinics have been actively flouting the law in B.C. for many years by extra-billing patients for medically necessary procedures, and they’ve been getting away with it.
The goal of their legal case is to allow a parallel U.S.-style private insurance scheme to flourish for essential medical services, the kind of system that has driven U.S. health costs up 50 percent higher than ours, while leaving millions of Americans underinsured or uninsured.
After many delays the Brian Day court challenge to the B.C. Medicare Protection Act was scheduled to be heard last month. But now

it has been postponed until March 2015 “for the purpose of seeking a resolution.” Negotiations between Brian Day and the government of B.C. have now moved behind closed doors, and British Columbians are deeply concerned about what’s happening in those secret negotiations.
I have personally heard from over 1,500 individuals about this. British Columbians are worried about whether the B.C. government will defend their interests in these secret negotiations. They want Dr. Day and his clinics to be held accountable for breaking the law. They say that patients who’ve been illegally double-billed deserve restitution. They believe, as my colleagues and I and the official opposition do, that a full and comprehensive audit of all of Dr. Day’s clinics and physicians must be conducted to get a full picture of the extent of unlawful billing.
A partial audit from 2012 showed that in just a 30-day period, the Cambie Surgery Centre billed patients half a million dollars for services that were publicly insured. The clinic was ordered to stop double-billing, yet almost three years later it continues, and no one has been held accountable for violating B.C.’s laws.
We’re talking about, potentially, tens of millions of dollars in double-billing. If the B.C. government is negotiating a settlement with Dr. Day and his clinics, it must surely include a permanent injunction prohibiting them from continuing to break the law, and the Medical Services Commission should be proactively monitoring all of B.C.’s private clinics in order to ensure compliance with the law.
Now the Minister of Health has said that it is his government’s responsibility to uphold the integrity of the Medicare Protection Act, but to date we have seen no action. Talk is cheap. Action speaks louder than words, and what British Columbians want is action. They want an end to two-tier health care. But it’s not just legal action that they’re calling for. They also want action to improve wait-lists, and they don’t believe this government is listening.
I hear cries for help literally every day from people across B.C. who are waiting far too long to get access to critical medical procedures. I’m talking about patients who are waiting as long as six months for colorectal screening. Colorectal cancer is the third most common cancer in Canada and the second leading cause of cancer death in men. We know that early screening and detection saves lives, and after a public service campaign was launched by the member for Vancouver-Kingsway the government finally announced the creation of a provincewide screening program last year. But now, today as we speak, people are relegated to wait-lists of up to six months when the government’s own recommended wait time is a maximum of eight weeks. That is simply unacceptable, and we must do better.
I hear from people across B.C. who have waited over a year to see an orthopedic surgeon and then waited another 12 to 18 months for their surgery — this despite the fact that the government websites say that wait times are a few months at most.
In the meantime some of these patients live with unbearable pain, unable to walk, sometimes unable to work and support their families. The longer they wait, the costlier it is for everyone. It means that the patient’s condition can deteriorate. Their recovery can take longer, and the loss of income affects not just the patient and their family; it also affects the B.C. economy with a loss of hundreds of millions of dollars of government revenue. Surely we can and must do better.
According to the national Wait Time Alliance, in the last year wait times in British Columbia have increased in several critical areas — for cataract surgery, for cancer care, for knee and hip replacements. And we are still not measuring wait times at all in critical areas like treatment for chronic pain or disc problems or receiving psychiatric care for major depression.
The government likes to brag about balancing the budget and eliminating the deficit, but the reality is that it is doing so at the expense of people’s health, and we are accumulating a huge social deficit. Surely as a province we can do better.
But the answer to wait-lists is certainly not to allow a parallel private system to flourish. Despite claims by Dr. Day, the Fraser Institute and the musings of some liberal MLAs that a parallel private system shortens wait times, international studies show that wait times become longer because the private clinics draw doctors and nurses out of the public system. The for-profit clinics are also focused on the easier-to-treat patients, leaving the more complex and costlier cases to the public system.
Isn’t there something terribly wrong with the notion that if you can afford to pay $1,000 or several thousand dollars for an MRI or for colorectal screening or for hip surgery that you should be able to go to the front of the line? Surely we can do better than credit card medicine in the province of B.C.

D. Bing: On behalf of my constituents in Maple Ridge–Pitt Meadows, it is a pleasure to rise and to respond to the private member’s statement made by the hon. member for New Westminster entitled “Keeping Public Health Care Strong.”
As a health care provider in the province for many years myself, I can personally attest to the importance of health care to all British Columbians. It is something that we all value very deeply. That is the reason why our health care system strives to provide a high quality of service to ensure the best outcomes for our friends and family regardless of where they live in this province.
It is a fact that B.C. has one of the best overall health care systems in Canada. Last June British Columbia was rated number one in Canada for health care, according to data released by the Organization for Economic Cooperation and Development, the OECD. B.C. was also the only province to receive an overall A grade by the Conference Board of Canada in May 2013.
Furthermore, British Columbia is recognized worldwide for being progressive and a leader in many areas, including the best care for HIV/AIDS because of innovations that expand access to medications and treatment. We are also recognized for some of the best cancer outcomes and the highest heart attack survival rates in the country.
It is also no secret that British Columbians live longer than people in any other province — 82.65 years, to be precise. While this may be due to more active lifestyles, a great deal can be attributed to our government’s investment in preventative health care measures.
However, when we do need care our health care system is ready to respond. In terms of wait times, B.C. is recognized for being one of the leaders in managing wait-lists. In a 2013 report card the Wait Time Alliance gave B.C. the grade of A in four priority areas: cardiac, radiology, hips and cataracts. Even in B.C.’s busiest emergency rooms, 90 percent of patients see a doctor within the time frame established by the Canadian Association of Emergency Physicians.
It is a fact that jurisdictions all over the developed world are experiencing greater demand on their health care systems because of aging population. That is a reason why the government makes plans over the long term to provide high-quality health care in a timely fashion.
While critics may measure success by how much we spend on health care, it’s more important to measure success by health outcomes. That is what is important to British Columbians. A single health care dollar well spent is far more valuable than simply making bigger and bigger increases and hoping for the best.
We are fortunate in British Columbia to have a strong economy and a balanced budget. By eliminating the deficit we’ll have more money to spend on things like capital investment for new hospitals, increased access to primary care and community care, new medical equipment and innovative approaches that will improve health care outcomes even more.
This government understands that every tax dollar counts. We’re committed to getting British Columbians the best value possible for their health care dollar. Our government has worked hard over the past decade to build one of the most efficient health care systems in Canada, and we will continue to strive to produce the best outcomes. I thank you for your time.

J. Darcy: You know, the fact is we do still have serious problems with wait-lists here in British Columbia. The member opposite referred to a 2013 report. If he looks at the 2014 report, he’ll see that in fact wait-lists have gotten longer in several critical areas, as I mentioned in my opening remarks.
The solution, however, is not more private, for-profit care, as Dr. Brian Day has proposed. But neither is it burying our heads in the sand, making self-congratulatory statements and saying that we don’t have a problem, as the B.C. Liberal government is unfortunately fond of doing, which just allows credit card health care to flourish. Frankly, it delays us finding the innovative solutions that we need in order to ensure more timely access to health care.
[R. Chouhan in the chair.]
What are those innovative solutions? Well, many of them are right here in front of us — in other provinces and some of them right here in B.C. We need more specialized public surgical clinics, with a shift to more team-based care, making better use of nurses and other health care workers every step of the way. Evidence shows very clearly that this would mean that patients are better prepared for surgeries, that operations are less likely to be cancelled, that ORs operate more efficiently and that hospital stays are shorter.
We need, frankly, proactive wait-list management in all health authorities, where we shift responsibility for managing wait-lists from individual surgeons to health authorities, which means that patients can access the first available surgeons, and health authorities, in turn, can make sure efficiencies and best practices from individual hospitals are applied right across the system.
We also have operating room capacity sitting idle in virtually every major hospital across B.C. because of staffing shortages and underfunding at the same time as we pay a whole lot of money to contract out surgeries to private clinics. We have MRIs that sit idle for many hours and entire days of the week. Doesn’t it make sense to use more of our existing capacity in our health care system in order to shorten wait-lists for people who are waiting too long?
One of the major reasons that our wait-lists are so long is that we have far too many patients taking up acute care hospital beds who could be cared for much better, much more humanely and far more cost-effectively elsewhere. Doesn’t it make sense to make those strategic investments in residential care beds and home support programs and in community-based preventive health care that our seniors desperately need?
Yes, there are innovative programs that can reduce wait-lists and improve health care in place in other provinces as well as in B.C. We’ve seen a whole lot of excellent pilot projects come and go in B.C. . . .

Deputy Speaker: Thank you, Member.

J. Darcy: What we need now is not more pilot projects. We need system change. Enough of saying one thing and doing another. We need bold leadership from the province to improve public health care in British Columbia.

D. Bing: The importance of keeping health care strong is without question. Quality health care is something that all British Columbians value very highly. As the member for New Westminster has stated, Canada’s medicare system is cherished and is one of the things that define us as a country. Although British Columbia is highly regarded . . .

Deputy Speaker: Member, you have already spoken on this issue, haven’t you? Thank you. Take your seat, Member.

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