CANADA: Alberta called weak on rules for private clinics

Alberta has one of the “weaker policies” governing private clinics such as the Helios clinic, which has drawn much attention during the preferential health access inquiry, and authorities lack the will to enforce those rules, an expert testified Tuesday.

By Jamie Komarnicki, Calgary Herald February 27, 2013 | Alberta’s regulations around private medical clinics are weak compared to elsewhere in Canada and authorities lack the will to enforce the rules, a bioethics expert said Tuesday during a panel discussion at the province’s queue-jumping inquiry.

Dr. Lynette Reid, associate professor at Dalhousie University’s department of bioethics, told the inquiry she’s studied the policies provincial physician regulatory colleges have on concierge clinics and found most lay out clear rules instructing patients on their rights to say yes or no to paying for non-insured services while still receiving care from the health centre’s physicians.

But Alberta has “one of the weaker policies,” and its rules are difficult to interpret, Reid said, speaking before the inquiry’s commissioner, retired justice John Vertes.

“One clause says you can’t kick people out of your practice or refuse to let them in because they don’t pay up, but it also says only if people can’t get appropriate care from someone else does it become a problem,” said Reid.

“I don’t know how to reconcile those particular statements.”

She said that regulatory bodies, such as the College of Physicians and Surgeons of Alberta, tend to be complaint-driven, and citizens aren’t likely to lodge complaints on private clinics.

Concerns around private clinics — which typically bundle physician access with uninsured services such a massage therapy and dietitians for a membership fee — have been centre stage at the queue-jumping inquiry in recent weeks.

Clerks and doctors have testified that patients at the private Helios Wellness Centre were systematically fast tracked for screening at the public Forzani and MacPhail Colon Cancer Screening Centre, receiving treatment within weeks or months when the wait list for similar cases was more than two years. The screening centre’s founder and medical director have disputed those claims, along with staff from Helios.

While the colonoscopy controversy has engulfed the hearings in recent weeks, the inquiry has also heard an array of testimony on different instances of potential preferential access from doctors, nurses and health executives during three months of hearings.

Vertes heard evidence about a special H1N1 immunization clinic set up in 2009 for the Calgary Flames and their families, and cases of public health nurses providing after-horus shots to friends and acquaintances with doses they feared would otherwise go to waste.

Several Alberta medical staff witnesses described pressure they felt from their superiors to treat prominent people differently, including requests from vice-presidents for bedside visits to high-profile patients’ besides and regular after-hours calls from a health region CEO to check on VIPs.

One Calgary surgeon, Dr. Nicholas Mohtadi, told the inquiry last month that queue-jumping remains unavoidable today because the province’s medical system is overrun with patients and wait lists are badly managed.

Tuesday’s expert panel included testimony from prominent Toronto emergency physician Dr. Brian Goldman, and Pam Whitnack, the one-time CEO of the former Chinook Health Region and past executive vice-president with Alberta Health Services.

The experts said the concept of preferential access to health-care is nuanced, and it’s difficult to even come up with a standard definition.

The public also plays a significant role in determining what type of preferential access may be acceptable, such as health-care workers jumping the queue, noted Goldman.

The Toronto physician also weighed in on “professional courtesy,” a topic that’s emerged during the inquiry.

“Most physicians I know would consider it an honour to treat a colleague,” said Goldman.

But Reid argued such a practice is damaging to the system and erodes the will of health professionals to deal with changing the system for the better.

With long wait lists, queue-jumping isn’t always clear cut and presents an ethical dilemma, said Reid.

“Wherever you have a shortage, wherever you have a list, however fair or not fair those wait lists may be, people may feel the call of loyalty to do something for someone.”

The chairman of the provincial health authority, meanwhile, said the queue-jumping inquiry has affected the reputation of the superboard and promised action.

Stephen Lockwood said Tuesday that AHS council is closely monitoring the evidence given at each day at the inquiry.

“Once the evidence is in … we’re not going to wait to do anything until a report is written,” Lockwood told the Herald editorial board on Tuesday.

“When the evidence is done, our management team will sit down and say ‘what did you hear?’ Are we going to have conflicting stories? Everything I read is there’s sort of maybe more than one story going on. So we’ve got to get to the bottom of the stories.”

Lockwood said he’s not prepared to pass judgment on whether the Helios clinic was causing the queue-jumping to occur, but it appears that patients “were not going through the same process that the typical Albertan would go through.”

“Therefore, they were seen and had their tests earlier than they would have if they had been in the queue, and I don’t find that acceptable at all.”


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