Long wait times for elective surgery in Canada’s health care system made a teenage boy in Peachland, BC, feel like “the Hunchback of Notre Dame,” he said, as he waited nearly two years for surgery to treat his scoliosis.
Cael Perry’s journey through BC’s health care system highlights public health shortcomings for many types of elective surgeries, experts say. According to data from the Canadian Institute for Health Information (CIHI) and analyzed by CBC, nearly 30 percent of Canadians did not receive their joint replacement or cataract surgery within medically acceptable timeframes in 2019 — even before the COVID-19 pandemic arrived. Today, many Canadians are still waiting longer than three years ago for these procedures.
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It is a crisis where some doctors are pushing for private care while others are urging Canadians to maintain their trust in the public system and push for better organization of the resources already available.
“We are now in a crisis. It has brought us to the brink. We are at risk of undoing a lot of the great work of public health in the past 50 or 60 years,” said Prof. Colleen Flood, University Research Chair in Health Law & Policy at the University of Ottawa.
Cael’s mother, Sharlene Perry, first noticed something wasn’t right while cutting her son’s hair in November 2020. He was 15 at the time and had just started grade 10.
“We took a picture and… you could see from both the back and the front that there was a twist, that he wasn’t normal,” she said, noting that his back had only looked quite right months before.
They made an appointment with their GP, who ordered X-rays of Cael’s back. The images confirmed that Cael had scoliosis. The C-curve in his spine was already considered severe at a 58-degree angle.
Cael’s GP referred him to a local orthopedic surgeon, whom he waited six months for.
“I don’t look too much in the mirror, especially with my shirt off,” Cael said. “I had noticed that the pain got more aggressive during school last year… Just getting through the day with a sore back and all.”
Cael waited until the end of May 2021 for the specialist appointment. New X-rays showed that his spine was twisted at an 80-degree angle at the time. He and his family were told the teen’s case was so serious that he had to be referred to BC Children’s Hospital in Vancouver for surgery.
Another five months passed before Cael was seen by an orthopedic surgeon at the children’s hospital in November 2021. It was then about a year since he was diagnosed and his spine had reached an 88-degree angle.
“It’s shocking that it can even bend that much,” Sharlene said. “I just can’t believe it’s so crooked and it’s progressed so fast in a year. It’s crazy.”
VIEW | Cael Perry and his family reveal how his scoliosis worsened while on a waiting list for surgery, as Marketplace investigates whether more private healthcare financing is the answer:
The family was told they would be called in a few months to book his surgery date.
“How do you know that [that to] a parent? There’s nothing they can do to improve their child’s health?” Sharlene said.
Sharlene says hospital staff told her staff shortages had led to surgical delays. They also told her that an electronic data update had also caused delays.
It wasn’t until late September 2022 that Cael was finally booked for surgery.
By the time of his surgery, Cael’s spine was in a 108-degree curvature.
Why the long wait?
When asked about the teen’s journey through the county’s health care system, BC Health Minister Adrian Dix said he could understand the family’s frustration.
“What we’ve been trying to do here in BC is to invest massively in new anesthesiologists, in new medical equipment processing technicians and 300 new surgical nurses,” he said. “We have significantly reduced the number of people waiting for surgery in BC during the pandemic.”
CBC reached out to BC Children’s Hospital to ask why Cael waited more than a year from being referred to their facility in May 2021 to undergoing surgery in September 2022. The hospital declined to comment. and instead CBC referred to comments made by Dix.
Waiting times increased even before the pandemic
Each province and territory must submit data to the CIHI, a national nonprofit organization that provides data on Canada’s health system, including analysis of wait times for elective surgery.
While CIHI doesn’t follow complex surgeries like Cael’s, the institute follows more common procedures such as knee replacements, hip replacements, and cataract surgeries. These procedures are some of the only ones in Canada that have established benchmarks for waiting times between when a patient is considered ready for surgery and when they actually have that surgery. For knee and hip replacements, it is 26 weeks; for cataract surgery it is 16 weeks.
When CBC analyzed a decade of data from the CIHI, it found that wait times were getting longer in the decade leading up to the COVID-19 pandemic. The percentage of patients undergoing knee, hip or cataract surgery within the benchmark period decreased by 11 percent between 2010 and 2019, from 82 percent to 71 percent.
That means that in 2019, nearly 30 percent of Canadians did not receive their joint replacement or cataract surgery within medically acceptable time frames.
“[If] these benchmarks aren’t being met, what’s happening?” said Flood, who would prefer to see incentives and rewards for counties and health care providers tied to these time frames.
“You want to reward those who achieve those goals.”
Fast forward to late 2021 (CIHI’s most recent data analysis): Hip and knee replacements were still not at pre-pandemic levels, while cataract surgeries for most counties have returned to their pre-pandemic rates.
According to CHI, almost 600,000 Fewer surgeries were performed in the first 22 months of the pandemic than in 2019.
Is more privatization the solution?
dr. Brian Day, an orthopedic surgeon and owner of the Cambie Surgery Center in Vancouver, has argued for more than a decade that Canadian health care condones pain and suffering. He says patients who have to wait in long lines for surgery should have more options to pay for faster care.
“When you have a deformity like this that’s progressive, it’s just unacceptable,” Day said, showing X-rays of Cael’s spine. “These kinds of pictures should be shown to the politicians and shown to the judiciary and say, ‘Are you condoning this?'”
Day filed a lawsuit in 2009 challenging sections of the county’s Medicare Protection Act (MPA) that prevent doctors in BC from charging patients more than the rate paid through the Medical Services Plan (MSP), and that prohibit the sale of private insurance that covers treatment provided under the MSP.
A judge of the Supreme Court of BC these claims rejected in 2020 and the case was again dismissed by the BC Court of Appeal earlier this year. In the decision of the judges in 2022, they wrote that while long waiting times for treatment have denied some patients their charter rights to life and safety of the person, these violations are allowed under the principles of fundamental justice.
Flood disagrees that private healthcare will provide the solutions, as some people seem to believe. “It’s a snake oil solution,” she says. She has studied health policy for more than two decades and argues that a two-tier health care system will only benefit those who can afford it, and that it would drain valuable resources from the public.
“What we’re seeing from the evidence around the world is that where that happens, it always means you’re actually taking something away from the public health system,” she said.
Good governance, more incentives and accountability
Flood believes this is a pivotal time when Canadians should rely on public health and push governments towards solutions that make it stronger.
“We are currently in a crisis,” Flood said. “People are desperate and very concerned, so I think the solution has to be for our governments to come together and work on this… to help Canadians who really feel like they’ve lost their faith.”
Flood, as well as several health policy experts with whom CBC spoke, pointed to a pooled referral system as a way to organize — and reduce — wait times. In this system, patients needing similar surgeries are brought together and then sent to the first available surgeon in their area.
“If I have to refer a patient to a surgeon…I have very little, if any, view of how long that person’s wait time is, or if there might be someone else in the region who can perform the same procedure or surgery but has a shorter waiting time,” said Dr. Danielle Martin, a family physician and the chair of the Department of Family and Community Medicine at the University of Toronto.
Experts say pooled referral systems for certain procedures are happening across the country, but not on a larger scale.
Flood also points to the idea of a care guarantee. Popular in other countries like the UK and Finland, it’s a concept that could be adopted here.
Unlike the pan-Canadian benchmarks that have no built-in incentives or consequences, these countries set targets with clear consequences when health care providers and agencies fail to meet target wait times. Flood believes this should be implemented here.
Day agrees that this could work in Canada, pointing out that similar concepts were implemented in the UK in the early 2000s.
Meanwhile, Cael was released from BC children’s hospital a week after his surgery. He is more than four inches taller than before. The teen is now recovering at home and while his muscles are still twitching and stretching, he is feeling much better.
“I’m relieved. It’s been a long journey and I’m finally glad it’s over,” he said.