Some Alberta doctors are pushing back against recommendations in the recently released Alberta Health Services performance review that call for cutbacks and even the removal of government funding for dozens of surgeries.
One section of the $2-million report, conducted by Ernst and Young for the Alberta government, takes aim at a list of 44 surgeries (more than 50,000 cases) defined by the U.K.’s National Health Service as “of limited clinical value.”
The report recommends a targeted reduction could result in $47 million to $100 million in savings.
The review also recommends working to remove these procedures from Alberta’s list of insured services — something the province is now saying won’t happen.
Adult abdominal hernia repairs, which were performed 8,658 times in Alberta in 2018-19, top that list.
Some of the procedures listed as having “limited clinical value” in the AHS Performance Review report conducted for the province by Ernst and Young. (Ernst and Young)
“This section of the report paints a picture that’s not accurate at all,” said Dr. Parveen Boora, a general surgeon at the Chinook Regional Hospital in Lethbridge.
According to Boora, the NHS recommendations cited in the report — and used to justify targeted cuts — contain the same criteria doctors here in Alberta already use.
Surgeons, he says, are fixing hernias only when it’s medically necessary.
“It doesn’t say not to fix them. It doesn’t say fixing them all is of limited clinical value. It basically says that if they are of a certain subtype or if they are symptomatic or if they have caused complications, they should fix them,” he said.
“And that’s already the criteria we use to decide on fixing hernias.”
The AHS review defines “limited clinical value” as “procedures where the evidence of clinical effectiveness is deemed to be weak or absent. Many times, alternative therapeutic approaches exist that reduce the risk of patient harm and promote more efficient use of OR capacity.”
It goes on to say that detailed clinical reviews “alongside AHS’s clinical experts” are required to adequately assess the appropriateness of the procedures.
Boora says its clear to him that the authors of the report are not doctors and don’t understand Alberta’s medical system.
“They did not go and audit 8,700 charts and determine whether or not it met the NHS’s criteria. They just word matched,” he said.
“People who work in the field of medicine would see something like that and right away they’d be like, ‘you’re not interpreting that right. There’s something wrong here.’ So when you see something like that in a report, it would suggest to me that there wasn’t somebody there who knew how to interpret the guideline.”
Dr. Sean Gregg, a Red Deer surgeon, says he performed two life-saving abdominal hernia surgeries last week and he believes most, if not all, of the adult abdominal hernia repairs done in Alberta are medically necessary. (Submitted by Dr. Sean Gregg)
‘Life-saving’ surgery
Dr. Sean Gregg, a Red Deer surgeon, has similar concerns.
“I did two hernia surgeries last week. Both of those patients would have died within several days because their bowel was dead. It was stuck in their hernia, How could you ever say that’s not of clinical value?” said Gregg.
“Those lives were saved.”
According to Gregg, most, if not all, of the abdominal hernia surgeries performed in Alberta are medically necessary.
“I am extremely pessimistic about the ability to translate these recommendations into the kind of numbers that they’re predicting because the low value care that they’re talking about. It just doesn’t exist in real life,” he said, pointing to the report’s suggestion that a targeted reduction of this surgery list could net a savings of up to $100 million.
Gregg believes that while the AHS performance review may contain some important recommendations, it missed the mark when it comes to surgery.
Dr. Fiona Mattatall, a Calgary-based gynecologist, says tubal ligation is mostly used as a form of contraception in women for whom other forms of birth control have failed and also for women who can’t afford other birth control methods. (CBC News)
Tubal ligation
The list also includes female sterilization (tubal ligation), a procedure that was conducted 1,095 times in Alberta last year
“My first response was disbelief. My second was anger,” said Dr. Fiona Mattatall, a Calgary-based gynecologist who was shocked when she read the report.
“‘Limited clinical value’ would be the opposite of how I would describe this surgery. It’s of significant clinical value both for a woman to be able to control her birth control but also … risk reduction for ovarian cancer.”
According to Mattatall, tubal ligation is done mostly for contraception in women for whom other forms of birth control have failed and also for women who can’t afford other birth control methods.
Tubal ligation is the only funded form of birth control for women in Alberta
“I think it’s important both for reproductive freedom for women but particularly for women of limited socio-economic status,” she said
Mattatall says the criteria recommended by the NHS and cited in the report as a reason for reducing these surgeries are already being used by physicians who perform tubal ligations.
She notes the Alberta health-care system is different.
“What’s different in the NHS is that under their program, all contraception is paid for by the NHS. So a woman can have an IUD, or birth control pill, condoms, tubal, her partner can have a vasectomy — all at no cost to the patient. Very different here in Alberta.”
No plans to delist
Alberta’s Health Minister, Tyler Shandro, insists the province has no plans to stop funding the surgeries listed in the report.
In a statement emailed to CBC News, Shandro’s press secretary, Steve Buick wrote: ” We’re not de-insuring hernia repairs, mastectomies or any of the procedures listed in the report.”
To be absolutely clear: this does not mean de-listing or de-insuring these procedures. In fact <a href=”https://twitter.com/AHS_media?ref_src=twsrc%5Etfw”>@AHS_media</a> has already been doing this work for a long time and this section of the report builds off of that work.
Buick said the list reflects the NHS’s concerns about inappropriate use or overuse of some procedures in the U.K. and “the AHS review recommends that AHS continue its own work to ensure appropriate care in Alberta, in consultation with clinicians.”
He pointed to work that’s been done for years by AHS and doctors to reduce the use of MRIs, CT scans and anti-psychotic drugs in continuing care as examples.
“Decisions on the appropriateness of surgery for a patient will continue to be made by medical professionals at AHS, not by politicians,” he said.
Health Minister Tyler Shandro says the provincial government has no plans to delist any of the surgeries noted in the AHS performance review report. (CBC)
Opposition not convinced
Despite the minister’s commitment to maintain coverage for the surgeries, NDP Leader Rachel Notley continues to raise questions about the aim of the report.
“I’m very concerned that we’re actually looking at delisting or reducing coverage for any kind of health-care procedure that makes a difference in the lives of Albertans,” she said.
“They’re identifying them as procedures that they need to look at whether they’ll continue to offer,” Notley said. “If they’re not offering them, then presumably people will have to buy them.… I’m not at all comforted by the assurances of the minister.”
The review is now in the hands of AHS officials, who have been given until May 13 to develop an implementation plan.
For his part, Boora says the problems he sees with the report’s recommendations on surgery are making him question the work behind dozens of other recommendations found in the review.
“It does make me then wonder: So what else in this report is being put forward without an understanding of how to interpret recommendations, for example, or how to actually provide health care. That’s … what stood out to me.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
