The experience of Noah and Mathis’ families shows how complex and often opaque managing surgical waiting lists is. A situation that is at least partially explained by the lack of operational resources. However, a change in approach cannot be ruled out.
Posted at 5:00 am.
The President of the Quebec Orthopedic Association, Dr. Véronique Godbout, points out that surgeons usually set a target operation time for patients based on the severity of their pathology and its impact on their abilities, determining where they will be placed on the waiting list.
During the COVID-19 pandemic, non-urgent interventions, such as those often required in orthopedic surgery, have been “taken into the background” and priority has been given to cancers and urgent interventions of various kinds, the expert emphasizes.
Some of the orthopedic procedures that were performed on an outpatient basis were able to be covered, particularly through agreements with specialist clinics, but many more serious cases were delayed.
Dr. Godbout believes that an existing classification system, which assesses in particular the impact of the patient’s pathology on his mobility, his ability to maintain his usual activities, the level of pain experienced and the risks of mental illness, should be systematically taken into account for all types of Interventions to refine the analysis of files and identify priority cases.
Such an approach would allow young people like Noah Champigny to operate more quickly, emphasizes the specialist, highlighting the complexity of the factors that explain the length of waiting lists and their management.
The lack of human and material resources usually puts a strain on the available operational time.
The popularity of surgeons and the priority they are or are not given in surgery also influences the length of waiting lists in the public system, which in normal times are associated with them individually.
One system, two speeds
Some surgeons are trying to get around the problem by practicing full-time in the private sector or pausing their membership in Quebec’s health insurance for a limited period of time to offer patients surgery more quickly and for cash.
Martha Jackman, a law professor at the University of Ottawa, notes that excessive wait times in the public system theoretically open the door to legal challenges.
PHOTO IVANOH DEMERS, LA PRESSE ARCHIVE
Dr. Jacques Chaoulli, in 2007
In one by Dr. In the sensational case brought by Jacques Chaoulli, the Supreme Court ruled 20 years ago that unreasonable delays in orthopedic procedures could constitute an attack on the rights to life, liberty and security of the person enshrined in the Charter of Rights and freedoms. And that in Quebec this could justify lifting restrictions that prevent individuals from purchasing private insurance in order to receive, for cash, services normally provided by the public system.
Rather than lifting insurance restrictions across the board, the then Quebec government announced a series of measures to reduce surgical waiting lists, including partnerships with specialty clinics for some well-defined procedures.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVE
The Minister of Health Christian Dubé
Health Minister Christian Dubé, who is pushing a bill to improve the efficiency of the health system, recently announced a catch-up plan to reduce waiting lists after the pandemic. At the end of May they counted more than 155,000 people, including almost 40,000 in orthopedic care.
The government wants to increase the number of patients waiting more than a year for surgery from 14,500 to 2,500 by December 2024 and plans to invest almost $ 400 million, especially to pay overtime for the necessary staff.
Here, too, specialized private clinics are involved.
A doctor who runs a private clinic in British Columbia tried to invoke the precedent set by the Chaoulli affair to lift insurance restrictions in his province and strengthen private-sector procedures, but was ultimately fired in the spring after a long battle .
Patients faced with “irrational situations” should have the opportunity to report them effectively without having to go to court, stresses Ms. Jackman, who laments the lack of accountability of existing networks in Quebec and elsewhere in the country.