Juno News - Canadians are dying while waiting for surgery

00:00:00.000 So obviously we've been talking a fair bit this show and in the past several months about

00:00:10.820 COVID and its effect on healthcare, but issues that existed before the pandemic and will continue

00:00:17.020 to exist after are still very much going on. And one of the big ones, which we have talked about

00:00:21.680 on the show in the past, is the issue of wait times, healthcare wait times, not just in isolated

00:00:27.940 provinces, but across the country. This was put into sharp focus by a report that was just put

00:00:33.600 out this week by Second Street, died on a waiting list, a name that I think is exactly as blunt as

00:00:40.280 it needs to be here. The report's author, Colin Craig, the Second Street president, joins me on

00:00:45.220 the line now. Colin, good to talk to you. Thanks for coming on. Well, thanks for having me, Andrew.

00:00:49.980 Now, one thing that I think is important to put into perspective here before we delve into the

00:00:54.480 story that's being told. This is not wait list to do with COVID. This is an issue that existed before

00:01:00.160 the pandemic, correct? That's correct. The data that we obtained was from the 2018-19 fiscal year.

00:01:08.040 And what's the story here? I mean, what's actually happening?

00:01:11.960 Well, we've certainly heard for many years now, Andrew, cases where patients sadly have passed away

00:01:18.720 while waiting for surgery. You know, one very popular, well-known example from Ontario was

00:01:25.760 Laura Hillier, a young 18-year-old girl. She was fighting cancer. She had a bone marrow donor

00:01:31.900 lined up and ready to go. A surgeon was ready, but the government hadn't rationed enough funding

00:01:36.620 for healthcare to get her that surgery in a timely manner. So she ended up waiting seven months.

00:01:42.700 Sadly, she passed away. And, you know, stories like that that are pretty heartbreaking. We thought,

00:01:48.900 well, how big is this problem in Canada? So we filed freedom of information requests with health regions

00:01:53.880 and hospitals across the country, just asking for data. How many surgeries have been cancelled

00:01:59.420 because the patient has passed away? And we also sought some additional information. And we ended up

00:02:04.460 finding that there were 1,480 cases where patients died in that one year because they were on a waiting

00:02:11.540 list. And that figure came from hospitals and health regions that cover less than half of Canada's

00:02:18.120 population. So if you extrapolate it across the country, the real figure is probably closer to

00:02:23.480 around 4,000. So this is important to note here that we have in your numbers almost 1,500, but not

00:02:31.700 at all exhaustive as far as the country or the hospitals in the country are concerned. How easy was it for

00:02:37.560 you to get these figures? Were hospitals trying to block this? Because I know FOIs, freedom of

00:02:42.280 information requests, are oftentimes hit or miss when dealing with a lot of sensitive figures, which

00:02:46.780 I think are important. Yeah, it was actually pretty challenging because, first of all, a lot of

00:02:52.340 hospitals and health regions, they just don't even track it, which seems incredible in its own right

00:02:57.940 that they're not tracking data on why particular procedures are being cancelled. I would think it would

00:03:03.700 be important to know if the patient had died, especially if they had died longer than the

00:03:08.320 medically recommended maximum waiting period. But that was the case, you know, 29 out of 50 health

00:03:14.120 bodies that we contacted just simply said they don't have the data. And then the ones that did have

00:03:18.480 the data, sometimes they had good data, which was pretty uncommon. And then a lot of them just kind

00:03:24.800 of had like little dribs and drabs of data, but they were able to tell us the number. So there's really a

00:03:30.480 lot of room for improvement here. I know it's difficult with that sometimes spotty data to

00:03:36.580 really understand the whole story. But I want to see, I mean, as much as you can, are we talking

00:03:41.980 about cases here where that surgery would have saved someone's life? Because we know there are

00:03:47.680 situations, however rare they might be, where someone could on Monday be put on a waitlist for

00:03:52.380 a hip replacement and on Wednesday they get into a car accident and die or something like that,

00:03:56.780 whereas the cause of death might not have been prevented or even related. Do we know or do we

00:04:01.920 have the ability to know how many of these surgeries could have or would have had an impact in the

00:04:07.140 death? Yeah, that's a great point. And we do discuss that a bit in the report because it is

00:04:12.200 important. And I don't want to leave your viewers with the wrong impression. We're not seeing that

00:04:15.420 all 1,480 of these people died because they didn't receive surgery in a fairly quick amount of time.

00:04:22.320 And that's not true. The types of surgeries that people were waiting for ranged from

00:04:27.540 procedures that could have saved their life to procedures where it would affect their quality

00:04:33.540 of life. So it would be everything from, say, some kind of heart procedure to something like

00:04:39.880 getting your hip or knee done. So, you know, you may not die because you don't get your hip or knee

00:04:44.680 done in a fast or short period of time, but it would certainly affect your quality of life if you're

00:04:50.140 stuck for the final year or two or three or whatever it is of your life stuck in your apartment

00:04:55.220 living in immense pain because you haven't received hip surgery or knee surgery. I mean,

00:05:00.260 that's certainly disturbing too. Did you find that there were any particular provinces that had

00:05:06.980 a better or worse record on this? Or was it really more specific to individual hospital groups or

00:05:14.160 individual hospitals and kind of a patchwork across the country?

00:05:17.480 Yeah, it's really hard to compare because the data was just, to be blunt, really bad. Governments

00:05:23.800 have very poor data in this area. Nova Scotia actually had very good data and their numbers

00:05:30.940 were not good. There were, I believe it was over 400 patient deaths during that one year while they're

00:05:37.660 waiting for surgery. And in most cases, they had waited longer than the maximum medically recommended

00:05:43.240 time period. So the numbers weren't good from Nova Scotia, but the quality of the data was good. So

00:05:48.920 I think, you know, if any province that had poor data or is looking for someone to copy, we would say,

00:05:54.360 well, look at what Nova Scotia is doing because they at least have good data. When you have good data,

00:05:58.200 you can understand where the problems are and you improve accountability for the public.

00:06:03.340 And one other thing I would note for your viewers is that the amount of time that patients waited,

00:06:08.740 it really ranged. In some cases, they had only been on the waiting list for a short period of time.

00:06:13.840 And then on the other end of the spectrum, some patients have been on the waiting list for

00:06:17.400 more than eight years. And those were a couple outliers, but it goes to show you that there's a real

00:06:22.060 range in terms of how long people were waiting before they passed away.

00:06:26.380 Was there a median or at least a kind of a general area of where a lot of them fell as far as wait times go?

00:06:32.980 You know, again, that too is it's hard to calculate because in many cases, we just we

00:06:38.080 weren't even given those numbers. And some provinces, the numbers that we got, we know that

00:06:43.980 they were lowballed. So early on, we asked the Alberta Health for data on hips and knees. And

00:06:51.000 they said, well, here's the data. These are the numbers that we've got. But we would note that

00:06:54.700 in many cases, you know, it's just simply not tracked. It's not always kept that data is not

00:06:59.840 always kept carefully. Some systems may not have that option. So it could be within one province

00:07:05.880 where you have some procedures where when you're entering in the cancellation cause, there is an

00:07:10.680 option for noting that the patient passed away. And for some other procedure, there may not might

00:07:14.920 not be. So there I think governments would really do well to standardize and start tracking this

00:07:20.140 information and disclosing it. And one of the things that we point out, which is really crazy,

00:07:24.500 if you think about it, some provincial governments will require private businesses to report and

00:07:31.580 disclose workplace accidents that are pretty minor. So there's one example from BC where you

00:07:37.440 could go on the government's website and see read about how a private business had an accident,

00:07:42.540 a worker fell and had some bruising. So that's their threshold for businesses is you have to report

00:07:48.160 on bruising. And yet you have patients dying in the health care system. And there's no disclosure.

00:07:53.560 It's not something that governments report on proactively each year. So what we've kind of

00:07:58.020 pointed to is, hey, governments, you know, if you would meet the same standard that you expect

00:08:01.620 private businesses to meet, it would be very helpful, I think, for patients and researchers

00:08:06.620 and people who want to address these problems. And it's actually a really interesting point you

00:08:12.100 raised, because when I started reading the report, it seemed like the big conclusions were going to be

00:08:16.940 about how to make the health care system better, which is still a big part of it. But it was amazing how

00:08:21.700 data collection became one of the key takeaways as well. And you see that near the end of the report

00:08:27.060 where, you know, to really tackle a problem, you have to have the numbers on it. And if you don't

00:08:31.700 have that, it makes it very difficult to get a lot of stakeholders, notably politicians, to agree

00:08:36.520 that there is a problem here.

00:08:38.040 Yeah, exactly. I mean, it's mind boggling that, you know, some health bodies would just not consider

00:08:44.780 it important to track, you know, why it was that these cancellations occurred, like, you know,

00:08:50.500 especially from a customer service perspective. I mean, we as taxpayers are the customers.

00:08:56.380 Isn't the provider, the government concerned if they're not doing a good job, if they're getting

00:09:01.120 around to providing surgery after we've died. And in one case, we highlight in the report, there was a

00:09:07.320 patient from Quebec, 72 years old, he needed heart surgery within two to three months. He ended up

00:09:14.660 lasting five months on a government waiting list before he passed away. And then, according to media

00:09:19.780 reports, a few months after he passed away, the government phoned him to schedule his surgery. So, I

00:09:25.900 mean, the stories like that, it's just, it's crazy. And I think we really need to do a better job in this

00:09:30.520 country when it comes to tracking this information, and figuring out where the problems are.

00:09:37.260 Yes, and I would say that one important point here, and you note this in the report, is that

00:09:42.120 we live in a country in which healthcare is rationed by government. And a lot of the times people talk

00:09:47.740 about it being delivered by government, but that also means it's rationed by government. And we know

00:09:51.760 that at the best of times, we've had issues with empty ORs just because hospitals have burned through

00:09:57.100 their allotment. And typically, a lot of those are on procedures that are, again, more about quality

00:10:01.980 of life, like knee surgeries, than they are about emergency life-saving procedures. But even so,

00:10:07.740 and this year, it would be very interesting to see what happens, because this year, we know

00:10:11.820 that anything deemed elective was cancelled by most hospitals across the country. And you've got to

00:10:17.900 wonder, I mean, how many people were on wait lists that would have had potentially fatal consequences,

00:10:22.280 or, at the very least, as you note earlier, quality of life consequences?

00:10:26.580 Yeah, and you've touched on a very important point. And because of COVID, thousands of procedures

00:10:31.420 were postponed across the country. So you have your natural demand is building all the time,

00:10:36.840 because we have an aging population. And it's a reality that as you're older, you tend to require

00:10:41.000 more services. So you have that demand increasing naturally. And at the same time, we have all these

00:10:47.100 postponed procedures that are being put on top. So there's a huge backlog right now in the healthcare

00:10:53.220 system, I would bet it's bigger than ever. So sadly, we're probably going to see these numbers go up

00:11:00.240 where more people are going to be waiting in pain during their final years, they're going to be

00:11:04.520 struggling, they're not going to be getting the care that they need before they pass on. And, you know,

00:11:09.900 it's a really sad situation. We're talking about everyday people, their lives, you know, people that

00:11:15.840 struggle with walking across the room, because they're living with hip pain, that's so severe,

00:11:20.320 they're ending up with other health problems, because maybe they're on T3s, because they're to 0.95

00:11:27.680 address their pain. And then a year later, they end up with liver problems, because the government's

00:11:31.560 made them wait so long and rely on pain medication. So there's all these problems that really are

00:11:38.880 happening to everyday people. And I think we, more than anything right now, I think this is it should be

00:11:44.940 a priority for governments to figure out to focus on health reform, rather than, you know, these ideas

00:11:51.600 of great reset and everything else that's being talked about right now. Yeah, and I know it goes

00:11:57.020 away from this particular report. So I hope you'll indulge me for a moment, Colin. But I know when you

00:12:01.260 and I last spoke, it was about a previous Second Street report that looked at cross-border healthcare.

00:12:06.820 So people that were in Canada, specifically in border communities, but elsewhere as well, that were

00:12:10.900 going into the United States for medical treatment and medical care. And, and it's, I'd be interested

00:12:16.560 to see if it's possible to quantify this or track this, how many people that would have done that

00:12:21.580 this year couldn't because of the border closure and the effect that would have on healthcare, because

00:12:25.840 naturally, there are people in this country that are deselecting from Canadian waitlist by going

00:12:31.480 outside of the country, which is still technically possible with air travel. But for a lot of people

00:12:36.280 that would have just picked up and gone from, you know, Abbotsford to Bellingham, or would have gone

00:12:40.860 from Sarnia to Port Huron, I mean, that option hasn't been taken off the table. So you've got really

00:12:45.820 this two pronged issue of losing some domestic options for care and losing that ability to go

00:12:51.560 abroad for travel, or for healthcare, rather. I think that's a huge problem. And there was a media

00:12:56.820 report from New York State, actually, where they looked at that, and they talked about how some

00:13:01.220 Canadians were having trouble getting across the border there. In one case, there was a cancer

00:13:06.220 patient who was trying to go from Ontario to New York, and received some kind of treatment. And

00:13:14.880 that patient had two family members with them, and they had to stop. I believe what happened was

00:13:19.940 they got to the border, and they were told they could only have one family member. So then they

00:13:23.180 had to, like, drive to a Walmart or something, drop the family member.

00:13:27.720 Throw grandma out in Buffalo, or I guess on the other side, in Niagara Falls, Ontario, and say,

00:13:32.860 sorry, we'll pick you up on the way back.

00:13:34.260 Don't put your family member. I mean, it's incredibly tough. If you think about it from

00:13:38.780 their perspective, right? Like, if you're not getting the care that you need, or that you feel

00:13:43.220 that you need in Canada, you're having to go across the border, that's going to cause all kinds of

00:13:47.380 anxieties as it is. Throw COVID on top, and then you're having to, like, leave a family member at the

00:13:53.180 last minute unplanned. It's one of those problems where I think you really have to go back to the root and

00:13:58.300 say, well, why is it that this person's having to leave their own country for health care? Why don't

00:14:02.220 they have the freedom to try to improve their care with their own money in their own country? I mean,

00:14:07.980 no other country on the planet does this, where we have this system that says, yeah, we're going to

00:14:14.380 force you to, in many cases, wait a long time for the procedure that you need, and no, you can't do

00:14:21.060 anything about it. You either have to leave the country, or you have to take what we're going to give

00:14:25.040 you. It's pretty incredible what goes on in this country compared to what's happening in other

00:14:30.940 countries when it comes to health care. Yeah, it is, and I mean, I don't want to bog people down too

00:14:36.220 much in the legal arguments, because we know there is the Canby case, which will be going towards the

00:14:40.820 Supreme Court at some point, and all of these, but for a lot of people, it's just, they don't care about

00:14:45.720 the politics of it. They want health care, and you know what? They're told that it's going to be there

00:14:49.340 for them, and when it's not, that's a failing of the system. If you're going to monopolize it, you have to

00:14:53.920 deliver. Yeah, and the interesting thing is that so often, at the end of the day, no matter where you

00:14:58.940 are on the spectrum, or where you are on this issue, once it hits your family, you do whatever

00:15:03.920 you can to try to help your loved ones, as so many of us would, right? Like, you do what you can if

00:15:09.040 your son or your daughter is sick, or a mom or a dad, or whatever, you do what you can to help, and when

00:15:14.620 you talk to guys, like you mentioned the Canby case, Brian Day was the plaintiff in that case, he'll tell

00:15:20.200 you that he's had people across the political spectrum in his clinic, he's had people that are,

00:15:26.080 I think, even fighting him in court that will come in because they don't want to wait to get their knee

00:15:30.220 done, or whatever. Like, it's just incredible, our approach to health care in this country, and how

00:15:35.640 different it is from the rest of the world, and we see that many other countries are providing better

00:15:42.040 services for a lower cost. They have a public system, they have private options, they're doing better,

00:15:48.140 and yet in Canada, we just kind of have this tunnel vision so often, where we don't want to talk about

00:15:52.720 those options. The opponents of change will always try to create this discussion of either we've got

00:15:59.020 Canada's system or the US system. They don't want people to realize that, say, Australia is doing

00:16:04.800 better, New Zealand's doing better, all these countries around the world that still have what I

00:16:08.500 think Canadians value, which is having that public system, but also having private options on the side.

00:16:14.200 The report is dyed on a waiting list, came out just this past week with secondstreet.org. President

00:16:21.680 and report author Colin Craig joins me on the line. Colin, good to talk to you. Thanks very much for

00:16:26.100 coming on. Thanks a lot, Andrew. Appreciate it. Thanks for listening to The Andrew Lawton Show.

00:16:30.860 Support the program by donating to True North at www.tnc.news.

Juno News - December 05, 2020

Canadians are dying while waiting for surgery

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