Off-Hours Use of Hospital Machines Raises Questions of Queue Jumping in B.C.

By DIRK MEISSNER

VICTORIA (CP) – It should be simple to figure out whether people are jumping the queue in Canada’s public medicare system.

But a jumble of legalities, ethics, financial realities, all simmering in political spin, make it much more complicated to sort out whether the Canada Health Act’s promise of universal publicly funded care is being respected.

In British Columbia, health investigators are trying to untangle that web to determine whether patients who pay to get diagnostic tests, and the hospitals that have provided them, violate the act.

It comes down to what is a queue and isn’t.

That Pandora’s box was opened after reports surfaced of patients paying private health companies up to $1,400 each to use public diagnostic equipment, such as MRIs, within days while others wait months for the same procedures.

Is this queue jumping – a Canada Health Act and B.C. health policy no-no? Or is it a second lineup that is separate from the public queue?

The Opposition New Democrats say it’s a clear case of queue jumping. At least one prominent health policy analyst agrees.

After an investigation by his deputy minister, B.C. Health Minister George Abbott said the case at St. Paul’s Hospital in Vancouver may not have been in compliance with the Canada Health Act.

He said the investigation also showed cases where the use of other diagnostic equipment, like ultrasounds and CT scanners, at St. Paul’s and St. Joseph’s hospitals may not have been in compliance with the act.

The minister said the incidents were minimal.

The hospital and the private health-care provider at the centre of the debate are adamant that no public patients were held up or booted from their place in the public line, so there’s no way someone cut into the lineup.

There are two lines, they say, and the lines do not meet or influence each other.

One is the public line where patients wait their turn – usually months – for an appointment. That’s because the B.C. government doesn’t pay for machines like MRIs to run 24 hours a day at hospitals.

The second line is the private one where patients pay private health insurers to get quick treatment at public hospitals by using the hospital’s equipment during off hours.

The hospitals and the private insurers argue the private line does not slow down the public queue because private patients have their appointments when the public machines are shut down.

“That jumping-the-queue thing kind of implies that some person used our facility and an MSP (medical services plan) covered person was bumped. That hasn’t happened,” said Shaf Hussain, spokesman for St. Paul’s Hospital.

At St. Paul’s, there are two government funded MRIs. One runs from 7 a.m. to midnight, the other from 6 a.m. to 6 p.m.

But Heidi Bozek believes she did bump a public patient from the queue by paying a private health insurer $1,400 to get the diagnostic procedure done quickly.

Bozek said she was called to St. Paul’s for a 10 a.m. weekday appointment for a Magnetic Resonance Imaging scan days after paying Vancouver medical broker Timely Medical Alternatives to find her a quick appointment.

Bozek, who suffers from painful tumours on her hands and knees, was told earlier she would have to wait months for a public MRI.

Hussain of St. Paul’s argues Bozek didn’t jump the public line even though she had a morning appointment booked during the time when the hospital’s MRI machines were serving only public patients.

Private patients, who are primarily insurance and workers’ compensation cases, only end up at the hospital during working hours if they fill a last-minute cancellation in the public line, he said.

“We try and fill it with an acute patient if it’s needed, an emergency patient,” said Hussain. “We go through that whole process, and if we can’t get anybody in time before that time slot comes then for the last one we’ll say, ‘let’s move what we were going to do tonight into that spot.’ At no time are the number of people that are supposed to go, the MSP people, not done.”

Timely Medical’s spokesman Richard Baker says Bozek and others he sends to St. Paul’s or other public hospitals in Canada are not queue jumpers. They don’t push public patients to the side or delay their appointments, he insists.

“It is not queue jumping,” said Baker, who describes himself as a supporter of the public health care system.

“If I thought for one second that any single referral of ours was bumping somebody in line, I would have ceased long ago to refer people to St. Paul’s,” he said.

Baker said his patients fill in what he calls dead time on machines because his referrals use them after the hospital has shut them down to the public.

“To my knowledge we’ve never had a client displace anybody else,” he said. “That is queue jumping and I do not endorse that and I would not participate in that.”

Baker said what he’s doing is paying money to help the hospital run its machines, which depend on government funding to operate.

“The public hasn’t taken the time to think this through as to what’s actually happening, that it’s a good thing that we’re infusing revenue into the public system,” he said.

The Opposition New Democrats are using the issue as an opportunity to attack the government for what they believe is inadequate health funding. Publicly at least, they aren’t buying the explanation of how a person using a private provider might come to have a primetime appointment.

“There’s no question it’s a case of queue jumping,” said NDP health critic Adrian Dix. “They didn’t have it done at one in the morning on a Saturday. They had it done at 10 in the morning on a Thursday.”

The three hours it took to provide the 10 a.m. MRI for one private patient could easily have been used to reduce the public line, he said.

“In the case of Heidi Bozek, on the wait list for November, she paid $1,400 and she gets an appointment in three days at 10 a.m. on a Thursday. I don’t know in what planet that isn’t queue jumping,” Dix said.

Dr. Michael Rachlis, a health policy analyst from Toronto, says it is a breach of the Canada Health Act.

“The Canada Health Act is clear that just because you have more money you should not be able to get better services than your neighbours,” he said. “It seems very clear that if you are not a member of one of the excluded groups in the Canada Health Act, and you pay for an MRI, that is queue jumping.”

The former Conservative government in Ontario dealt with similar allegations of queue jumping in the late 1990s by private clinics by putting more money into public health care, Rachlis said.

The extra money was used to buy more machine time at public hospitals, cutting out the private clinics, he said.

B.C.’s health minister said he wants to hear from private health companies about their work with public hospitals, especially their opinions of queue jumping.

They could face fines, he said.