Fraser Heatlh is under fire for ordering its surgeons to reassess patients in an attempt to avoid steep fines for failing to complete surgeries within one year.
Leaked documents released by the Canadian Taxpayers Federation show Fraser is already facing fines of more than $2.5 million for 650 scheduled surgeries that were waiting more than a year as of Oct. 9, while another 4,124 surgeries have waited six to 12 months.
A Nov. 4 memo to surgeons directs them to begin reassessing patients who have waited more than 40 weeks.
“It is imperative for the interest of all, including our patients, that we use every available strategy to avoid penalties,” Dr. Peter Blair, Fraser Health’s medical director for surgery states in the memo, which is also signed by Judith Hockney, Fraser’s executive director for surgery programs.
The memo says long waits have eased somewhat, with 4.5 per cent of surgeries now exceeding 52 weeks compared to 10 per cent a year ago.
But there are still excessive waits triggering financial penalties, which are levied by the health ministry under its pay-for-performance system.
In an interview, Blair defended the decision to reassess patients and rejected suggestions from CTF B.C. director Jordan Bateman that the move is strictly a tactic to skirt fines by either resetting or pausing the waits in long-delayed cases.
“What we’re trying to do is remind the surgeon that that patient has been there for 40 weeks and they better be getting them done,” Blair said, adding he’s upset with the CTF accusation.
He said the patient doesn’t lose their place in line, nor is their recorded wait frozen to avoid a fine.
Bateman argued reassessments are unnecessary and wasteful, accusing Fraser of “playing games” with patients.
“We already know these people need surgery,” he said. “Having a reassessment is throwing money away for no reason instead of doing a surgery or finding an operating room you can open.”
But Blair said reassessments are justified, not just to nudge surgeons to get long-delayed patients scheduled but also to ensure the paperwork is in order and that a patient’s condition or medications haven’t changed.
If new medical tests are needed and that’s not discovered until the day of surgery, he said, more delay could result.
Health Ministry Terry Lake also defended the reassessments.
“People’s conditions change,” Lake said. “If you’ve got a knee surgery, for instance, it’s important you make sure the need is still there. People may have undergone physiotherapy and reduced the need for surgery in some cases.”
He said Fraser is “doing the right thing” by reminding patients to “redouble efforts” to get surgeries scheduled for patients waiting more than 40 weeks.
Under the province’s pay-for-performance system, health authorities can access extra funding beyond their budget if they meet targets.
In the case of surgeries, each patient who waits longer than a year means $1,400 in additional funding is withdrawn by the province.
Dr. David Jones, the former medical coordinator at Burnaby Hospital, said it appears officials are blaming surgeons when hospital simply aren’t given enough resources to shorten wait lists.
He said Lake is correct that some surgeries may prove unnecessary if patients’ conditions change.
“That’s possible,” Jones said. “Or they may have died waiting too.”
Hospitals with surgeries waiting more than a year
(as of Oct. 9)
Surrey Memorial – 226
Burnaby – 143
Peace Arch – 128
Jim Pattison Outpatient – 70
Abbotsford Regional – 32
Royal Columbian – 20
Delta – 11
Eagle Ridge – 8
Chilliwack General – 6
Ridge Meadows – 4
Langley Memorial – 1