Inquiry testimony suggests pricey private clinics – nudge-nudge, wink-wink – really can engineer preferential access

Wheeling and dealing: Staff of private clinics use advanced clinical techniques to decide which patients go to the front of the line for quick medical tests. Alberta medical insiders may not appear exactly as illustrated. Below: Retired judge John Vertes, Alberta Health Minister Fred Horne.

What appears to be the first confirmed example of methodical and systematic queue jumping uncovered by Alberta’s Health Care Preferential Treatment Inquiry emerged this week and, lo and behold, it involved the operations of a private medical clinic.

This should not surprise us. After all, in a fair and well-run public health care system, what else do these private, for-profit clinics that are cropping up throughout Western Canada have to offer for the thousands of dollars in annual fees they charge patients other than insider connections and the promise of preferential treatment?

Still, the story of how patients – or perhaps we should say customers – of the exclusive Helios Wellness Centre in Calgary got enhanced and accelerated access to colonoscopy tests at a publicly run cancer screening clinic is an intriguing one, and we can only hope the inquiry led by former justice John Vertes will see fit to probe, as it were, a little deeper.

Testimony to the inquiry earlier this week outlined how non-urgent patients referred by Helios to Calgary’s Forzani and MacPhail Colon Cancer Screening Centre were fast-tracked for tests after waits of about three weeks, while other patients had to wait up to three years for non-urgent tests.

A former clerk from the Forzani and MacPhail clinic, run by Alberta Health Services and the University of Calgary Faculty of Medicine out of Calgary’s Foothills Hospital, testified that her bosses ordered her to move patients from Helios – located in the same building – to the head of the public line.

Referrals from Helios were booked as urgent, testified the former clerk, Samantha Mallyon. “It was just common practice with the Helios patients to make sure they were a priority,” Ms. Mallyon explained. Helios paperwork even had its own special tray.

Other clerks offered similar testimony, and told of being discouraged from making a big deal of the way things were run.

In response, a Forzani clinic manager opted for the tried and true managerial defence and accused the staff of going rogue – a suggestion Mr. Vertes seemed to find quite fanciful.

Be that as it may, over the past few years a slew of private clinics have opened in this part of the country, taking healthy amounts of cash up front from what one witness at the hearing termed well-heeled “executive patients” for a range of personal care services plus health care treatments that the clinics can bill back to the public health insurance system.

The additional fees these clinics charge, generally, are for non-medical services such as such as diet advice, fitness coaching, genetic testing, chiropractic treatments, acupuncture, cosmetic procedures or whatever their operators wish to provide – up to and including tarot card readings, presumably.

Naturally, they offer a nicer ambience than the average doctor’s office or walk-in clinic, and some of them, no doubt, even have free Starbucks coffee in real china cups.

A recent advertorial misleadingly published as if it were legitimate news by the Edmonton Journal for the Copeman Clinic, a controversial example of this type of enterprise, tried to take advantage of criticism of its business model by misrepresenting the arguments of critics of two-tier health care as being only about the clinic’s décor and ambience – using that as a setup to brag about the clinic’s décor and ambience.

The true substance of the criticism of this approach is that in return for the steep up-front service fee, clinic doctors are able to use the public health insurance system to subsidize enhanced access for those with the ability to pay extra – which opponents of these clinics argue is a violation of the Canada Health Act.

To be covered by medicare, services covered by public health insurance must be must be billed in exactly the same way as any other physician’s bills, according to the same rules. Those rules certainly include no queue jumping for tests and treatments.

Regardless, the clear implication of the clinics’ pitch to potential customers goes far beyond just quick access to a doctor and a nice chair to sit in while you’re waiting. Never stated explicitly, but as clear between the lines as a nudge and a couple of winks, is the implication they can get you quicker and better access to insured medical services as well.

Now we can all see, thanks to this week’s line-jumping inquiry testimony, that there may in fact be more than a little truth to this.

Naturally, some of the usual suspects – Alberta Health Minister Fred Horne, for example – say that are shocked by this, and offended as well. But the true test of the level of their concern is yet to come – what they’re prepared to do about it.

In the mean time, Mr. Vertes and his inquiry owe the people of Alberta more than just this glimpse behind the usually closed doors where the wheeling and dealing among medical insiders goes on.

We need to know who scratched whose back, and how, to get preferential Helios patients jumped to the head of the line.

From there, we might be able to figure out if it’s happening elsewhere, and what to do about it.

But to get there, inquiry counsel is going to have to smarten up and adopt a less passive and incurious attitude than they have shown up to now.

This post also appears on Rabble.ca.

2 Comments on "Inquiry testimony suggests pricey private clinics – nudge-nudge, wink-wink – really can engineer preferential access"

  1. Mark Roseman says:

    CPSA rules say you can’t discriminate how you handle referrals based on where a patient is coming from (e.g. geography, referring clinic, etc.), and this applies to both ‘public’ facilities like a hospital colonoscopy clinic or ‘private’ facilities like my wife’s solo private psychiatry office. You can discriminate based on clinical urgency, often subjective, or scope of care (e.g. patients with some diseases but not others).

    Most specialist services service are much in demand. Taking my wife’s practice as an example, there are very few psychiatrists in St. Albert, she’s one of the very few who sees a wide variety of patients and does substantial amounts of psychotherapy (something most doctors don’t do, and most people can’t afford to pay for a psychologist). Plus, to put this delicately, some of the other psychiatrists in the community don’t always share her thoroughness when it comes to diagnosing patients. Needless to say, she has a huge wait list.

    Every doctor that takes referrals though is used to getting calls/pleas from referral sources to take their patients faster, make a small exception, etc. And truthfully, a doctor advocating for their patient to get the referral seen more urgently will have an impact. This is true whether the referral source is a ‘membership-fee-required’ clinic or any other doctor’s office.

    And 99.99% of the time, nobody is going to be scrutinizing how a particular clinic runs their waiting list, which more often than not involves loosely organized piles of dog-eared faxes with scribbles all over them, teetering on the edge of the desk of some low paid clerk.

    The example of automatically triaging all patients coming from a particular clinic as urgent is blatantly stupid of course, no matter how you look at it.

    I guess what I’m saying is, the main issue is still as always far too limited supply of caregivers, with the secondary issue being that our medical ‘system’ is anything but a single cohesive system. It’s also demonstrably clear that adding more member-only primary care options just makes both matters worse.

  2. Sam Gunsch says:

    re ” Naturally, some of the usual suspects – Alberta Health Minister Fred Horne, for example – say that are shocked by this,”

    This would be the point man, Horne, lead man a couple years back of the Tory’s ‘patient-centred’ crusade, for one all new big encompassing ‘patient and family-centered’ healthcare legislative package, (and as per subsequent leaks to the press of internal docs: providing maximum privatization flexibility)

    Now as Minister in Court, said gentleman and AB’s health system apparently continue to function under the PC/Calgary executive class joint venture governance model for Alberta:

    re: corporate health system code of practice… ( note: not in the public version of the Patient Charter)

    “Where possible in privacy, all decisions to be centered on the patient’s pocketbook.”

    dictionary definition found here:
    Cultural Dictionary ( or Alberta’s political culture dictionary)

    http://dictionary.reference.com/browse/all+animals+are+equal,+but+some+animals+are+more+equal+than+others

    note: Alberta/Calgary head-office version first line engraved on Jack Davis’s old desk:

    “All patients are equal, but some patients are more equal than others.”

    that is:
    “A proclamation by the rightful corporatist governors in the Calgary executive suites who control the government in the corporate province of Alberta.The sentence is a comment on the hypocrisy of governments that proclaim the absolute equality of their citizens but give power and privileges to a small elite.”

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