In a 880-page judgment released September 10, B.C. Supreme Court Justice John Steeves dismissed the argument that the constitutional rights of patients and physicians were being violated by limits on access to privately paid surgical services.
The plaintiffs, led by Dr. Brian Day, chief executive of the Vancouver based for-profit Cambie Surgeries Corporation, sought to overturn provisions prohibiting B.C. doctors from accepting public and private pay, limit extra billing, and ban health insurance for services already covered under the public plan. The legal dispute started in 2009, entered the B.C. Supreme Court in 2016, and is expected to continue with an appeal to the Supreme Court of Canada. British born Dr. Day is a past president of the Canadian Medical Association. He was a pioneer of arthroscopic surgery and sports medicine in Canada.
“Politicians for many, many years have failed to deal with the health system,” Dr. Day said after the ruling. “They have failed to address its failings. The evidence at trial was overwhelming that the health system is in a state of crisis. Every politician knows that.”
Dr. Murray Trusler, a retired physician living in Fairmont, thinks an appeal by Dr. Day is the correct approach. “It is a national issue of great importance to all Canadians, not just the people of B.C.,” said Dr. Trusler, whose career as a physician took him all over Canada and the world. “It requires a Supreme Court of Canada ruling on the matter.”
Dr. Day argued that private clinics filled a gap left by the public health care system in which people suffered needlessly while on waitlists. Lawyers for the defendants countered that the case was more about physician greed, and that opening the door to a two-tiered system would make waiting times even longer in the public system. “Private healthcare can unload the public system for procedures such as diagnostic imaging (e.g. MRIs) and surgical procedures (e.g. joint replacements),” said Dr. Trusler. “But it won’t place a family doctor in Fort St. John or Inuvik.”
Will Justice Steeves’ decision have an immediate impact on Columbia Valley health care? “Nothing will change until the case is resolved at the federal level,” said Dr. Trusler. “It may take years.” Invermere doctors Dr. Walsh and Dr. Mannheimer declined to be interviewed for this story.
Canadians are fortunate to have access to publicly funded high-quality health care. But as Dr. Trusler reminds, it is far from perfect. “Our nation’s public system has many shortcomings. Thousands of Canadians do not have a family doctor. Wait times for many services are unacceptably long. My brother-in-law was 60 years old when he suffered a stroke in 1997 in Ontario. He could not get an MRI in Ontario for 11 months. He finally arranged one in a private clinic in Calgary.”
In other parts of the world, two-tiered health care systems work. “At the same time, my brother-in-law was waiting, I was working as a physician in the Middle East. My patients were getting MRI’s done in the private sector on the same day,” said Dr. Trusler. Developed countries around the world have successful two-tier systems. “Australia is a great example. For these counties, most allow their citizens to purchase healthcare insurance to access private healthcare in their own countries and abroad.”
At the conclusion of final arguments for the court case, lawyers for the defendants argued that allowing a two-tier system would give physicians the incentive to move to the private system from the public system. Theoretically, such a migration would worsen the standard of care in the public system and lead to longer waiting times. Robert Grant, a lawyer for the plaintiffs, criticized the defendants’ legal strategy. To media after the ruling, he said, “You can’t directly prove that something does not exist as you can’t measure nothing. You can’t observe nothing. The only way that you can prove that fairies don’t exist is to say that there is no credible evidence anyone’s ever seen them. And that’s exactly the same as the claim that private surgeries will increase the waiting times.”
Dr. Trusler also doesn’t think that longer wait times would happen. For 26 years, he ran a full scope family practice in Ontario. He also worked in family and emergency medicine in Northern Manitoba, the NWT, Alberta, B.C. and Northern Ontario for another 13 years. “So, I know that the Canadian public only system has served the country well in general. However, having worked in Saudi Arabia, the Sultanate of Oman and the United Arab Emirates for 9 years, I had an opportunity to work with physicians from around the world and to learn about their healthcare systems.”
At one point, Dr. Trusler was the director general of a small private hospital in Oman. “Our biggest business was laser eye surgery. We were the best in the country – a centre of excellence. I also had direct contact with the Mayo Clinic, which has a large presence in the Arabian Gulf. It is a world class institution run by a foundation. Its physicians are salaried. It funds a large research organization and is consistently rated one of the best medical institutions in the world.”
To Dr. Trusler, who later in his career received an MBA from the University of Toronto, there’s no reason why Canada couldn’t develop a similar type of institution to rival the Mayo Clinic. But a more accommodating attitude toward two-tiered health needs to happen first.
“Perhaps, we would be wise to explore joint partnerships between the public and private sectors. Not only would we be able to improve our own services, but we could build a business model that would benefit the country as a whole. Canada has an excellent reputation for health care around the world. Why not build on that and expand our healthcare system to include the private sector in a well managed structure that could provide world class healthcare services to Canadians and foreign patients?”