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As surgical wait lists grow, Canada’s private clinics cash in

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It’s a contentious reality in a country with a universal medicare system: Canadians can pay to sidestep the queue for surgeries with long waiting lists, such as hip and knee replacements.

Private clinics across Canada are advertising to prospective patients that within weeks they can get surgeries that typically take six months or more under provincial health plans. The price for a single hip or knee replacement runs in the range of $20,000 to $28,000, depending on the clinic.

In the wake of the COVID-19 pandemic driving up surgical wait times, there’s some evidence suggesting a growing number of Canadians are pulling out their wallets to pay privately.

The trend is raising concerns about the potential for private clinics to drain more health professionals away from the already strained public system, and it’s provoking fears that two-tier health care is becoming a reality.

The private Duval Clinic in Laval, Que. — where surgeons only do hip and knee replacements for fee-paying patients — has seen a significant increase in demand over the past few years, says its medical director, Dr. Pascal-André Vendittoli.

“We’ve quadrupled the number of cases we do at the clinic,” said Vendittoli in an interview with CBC News.

“There are more and more patients willing to pay for their hip or knee replacement because they see that it is almost impossible to get their treatment in the public system.”

‘Best investment’ says patient

Mike Johansen, 62, of Edmonton spent $23,500 for a hip replacement at the Duval Clinic.

“Best investment I ever made,” Johansen said in an interview. “I don’t look at myself as a person who jumped to the front of the queue, I got out of the queue.”

Mike Johansen is pictured walking down a staircase in his home.
Mike Johansen, 62, of Edmonton spent $23,500 to get a hip replacement at a private clinic in Quebec rather than wait 18 months for the surgery through Alberta’s public health system. (Scott Neufeld/CBC)

Before the operation, Johansen’s hip problem made just about any movement painful.

“About 70, 80 per cent of the time I was laying in bed. That was the only way that there really wasn’t a whole lot of pain,” he said.

His doctor told him his wait for surgery through Alberta Health Services would be 18 to 24 months. He got into the Duval clinic in just two months.

The Clearpoint Health Network building on Dixon Road in Toronto.
Clearpoint Health Network is the largest chain of private surgical clinics in Canada, with 53 operating rooms in 14 locations, including this one in Toronto specializing in orthopedic surgery. (Paul Smith/CBC)

Hip and knee replacements are among the most frequently performed surgeries in the Canadian health system, and come with some of the longest wait times.

Hospitals did nearly 139,000 joint replacements in 2019-2020, according to the Canadian Institute for Health Information (CIHI). Its research puts the average cost per operation at $12,223, which means the private clinics are charging patients roughly double what the surgery costs provincial medicare systems.

CIHI’s most recent wait-time figures show that just 65 per cent of hip replacements and 59 per cent of knee replacements were done within the national standard of six months after consultation with a surgeon.

The private sector’s potential role in tackling surgical wait lists is firmly in the spotlight right now:

  • Ontario unveiled a plan last month that opens the door to for-profit clinics performing endoscopies and hip and knee replacements, paid for by the Ontario Health Insurance Plan (OHIP).
  • Both Manitoba and Saskatchewan are attempting to deal with backlogs by paying private clinics outside the province to do surgeries.
  • Alberta announced in January that it’s contracting Canadian Surgery Solutions to perform more than 3,000 orthopedic surgeries covered by the provincial medicare plan.

Canadian Surgery Solutions is a Calgary branch of a company called Clearpoint Health Network, the country’s largest chain of private surgical clinics.
Nearly 140,000 people get a hip or knee replacement each year in Canadian hospitals and wait times can run to more than a year. Private surgical clinics around the country are advertising that patients can get surgeries done in just a few weeks, if they pay.

Clearpoint is wholly owned by Kensington Private Equity Fund, and it was created in 2019 through a $35 million purchase of private clinics.

The company announced an expansion in January, taking Clearpoint to 53 operating rooms across 14 surgical clinics, touching every province from British Columbia to Quebec.

Most patients must leave home province to pay

Clearpoint officials did not respond to repeated requests from CBC News for an interview.

While the company says 90 per cent of the surgeries it performs are publicly funded, Clearpoint also markets to Canadians waiting for care in the public system that they can get hip and knee replacements done much faster by paying privately.

“Avoid long wait times,” says the website of Surgical Solutions Network, a division of Clearpoint. “After your initial surgical consultation, surgery can generally be scheduled within a few weeks.”

The company explains a catch to patients who want to pay: they’ll likely have to leave their home province for the operation.

An image captured from a webpage with a stock photo of surgical staff.
The website of Surgical Solutions Network, a division of Clearpoint Health Network, describes how Canadian patients can pay privately for surgery by travelling to another province. (surgicalsolutionsnetwork.ca)

The Canada Health Act prohibits extra-billing. What that means is doctors are banned from charging patients more than the medicare rate for an “insured service” — any medically necessary procedure that is covered by provincial health plans.

In provinces other than Quebec, where the system differs, private clinics get around that ban by operating only on patients from other provinces.

This loophole is opened up by how the Canada Health Act and the provinces define an insured service.

A medically necessary non-emergency surgery such as a hip replacement is an insured service when you’re in your home province. When you visit another province, non-emergency surgery is not insured.

The upshot: a doctor in a private clinic in Toronto cannot charge an Ontario patient for a hip replacement, but can charge someone who has flown in from any other province for that very same operation.

CBC News obtained an email from a Clearpoint official to a prospective hip replacement patient in Ontario.

Dr. David Urbach is pictured inside an operating room at Women’s College Hospital in Toronto.
Dr. David Urbach, who leads the department of surgery at Women’s College Hospital in Toronto, says private pay clinics are making wait lists worse in the public system. (Mike Crawley/CBC)

“Unfortunately, due to government regulations, you are unable to have private surgery in your home province. You would need to travel to Calgary for the procedure,” said the email, which also priced the surgery at $28,000.

“It’s not in keeping with the principles of the Canada Health Act,” said Dr. David Urbach, chief of surgery at Women’s College Hospital in Toronto.

Urbach argues that the growth in private-paid surgeries worsens wait lists by luring medical staff away from public hospitals.

“It increases wait times for the rest of the people who are still in the public system because of the loss of resources from that public system into the private system,” said Urbach in an interview.

He says governments should not be looking to the private sector to shorten surgical wait lists, but could achieve the same goal by better investing in public hospitals.

As evidence, Urbach gestures at the location of his interview: a state-of-the art operating room, not in use for surgery on a weekday morning, because medical staff aren’t available.

A doctor looks at a computer screen showing images of a patient's knee replacement surgery.
Hospitals did nearly 139,000 joint replacements in 2019-2020, according to the Canadian Institute for Health Information. (Louis-Marie Philidor/CBC)

“If the hospital had funding, if this hospital had staffing, it could be used to provide all sorts of surgical procedures,” he said.

‘No way I could afford … that’

The growth in private surgical clinics leaves Saskatchewan resident Vicki Macdonald, 59, worried for the future of the health system. In the birthplace of Canadian medicare, Macdonald spent two years waiting for knee surgery.

“I got slower and slower in my walking,” said Macdonald in an interview at her home in Kronau, Sask.

“When you are in that much pain, it really takes a toll on your emotional and mental well-being.”

She found out that people were shortening their waits by paying for their surgeries in private clinics outside the province, but dismissed the idea for herself.

“There is no way I could afford to do something like that,” Macdonald said. “Those that can afford it can get it, and then we who need it just as bad are getting left behind.”

Vicki Macdonald is pictured in her home.
Vicki Macdonald waited two years for a knee replacement in the Saskatchewan public health system and says there was ‘no way’ she could have afforded to pay privately for the surgery. (Richard Agecoutay/CBC)

Urbach says the apparent rise in people willing to pay privately for surgeries saddens him.

“What it tells me is we’re not addressing the needs of the population. We should be able to provide the services that people need in a reasonable time frame,” Urbach said.

“What we need to do is create the types of system changes so that people aren’t driven to pay out of pocket or seek out two-tiered care.”

The only jurisdiction where residents can opt for private surgery without leaving the province is Quebec, a result of a 2005 Supreme Court of Canada ruling that applies strictly to the Quebec health system.

In British Columbia, Dr. Brian Day has attempted to persuade courts that patients should have the right to pay for private care when wait times in the public system are too long.

Day, owner of the private Cambie Surgery Centre, lost at the B.C. Court of Appeal in July 2022 and is asking the Supreme Court of Canada to consider his case.

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Jade Eagleson, MacKenzie Porter, the Reklaws among leading CCMA nominees

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Jade Eagleson and MacKenzie Porter are the leading nominees at this year’s Canadian Country Music Association Awards.

The singer-songwriters each received six CCMA nods, including for entertainer of the year and album of the year.

Eagleson is also nominated for male artist of the year and songwriter of the year, while Porter will be vying for female artist of the year and video of the year trophies.

Porter is also co-hosting the CCMAs with U.S. country music star Thomas Rhett in Edmonton on Sept. 14, with the bash set to air on CTV.

Sibling duo the Reklaws and last year’s leading nominee Josh Ross are each nominated in five categories, including entertainer of the year.

Rounding out the list of top nominees are Owen Riegling, Dallas Smith and the High Valley band, with four nods each.

This report by The Canadian Press was first published July 18, 2024.

The Canadian Press. All rights reserved.



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Bissell Recalls 3.3 Million Steam Cleaners Due to Burn Hazard

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NEW YORK — Bissell is recalling approximately 3.3 million “Steam Shot Handheld Steam Cleaners” across North America due to a burn hazard. The U.S. Consumer Product Safety Commission and Health Canada issued notices on Thursday detailing the risk, which has led to over 150 reported injuries.

The recall affects select models of the Bissell-branded steam cleaners, which can spew hot water or steam while in use or heating up. This malfunction poses a burn risk to users. Bissell has received 183 reports of hot water or steam expelling from the devices, including 157 minor burn injuries. Of these, 145 injuries occurred in the U.S. and 12 in Canada as of June 4, according to Health Canada.

Consumers are advised to immediately stop using the recalled steam cleaners. They should contact Bissell for either a refund or store credit. Impacted customers can choose between $60 (CA$82) in store credit or a $40 (CA$55) refund for each affected unit. Detailed instructions for identifying the recalled models, cutting the product cord, and uploading photos are available on Bissell’s website.

Bissell emphasized that “safety is our top priority,” and the company opted for a voluntary recall “out of an abundance of caution.”

The affected steam cleaners, manufactured in China, were sold at major retailers such as Target and Walmart, as well as online platforms including Bissell’s website and Amazon, from August 2008 through May 2024. About 3.2 million units were purchased in the U.S. and nearly 355,000 in Canada.

For more information on the recall and to register for a refund or store credit, consumers can visit Bissell’s website.

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Court Ruling on CRA Audit Condones Government Overreach, Says Leading Muslim Charity

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The Muslim Association of Canada (MAC) has expressed strong disapproval of a recent Ontario Court of Appeal decision, claiming it allows the federal government to violate Charter rights with impunity. The court’s decision upheld a ruling that permits the Canada Revenue Agency (CRA) to continue its audit of MAC, a process the charity alleges is tainted by systemic bias and Islamophobia.

MAC, an organization that promotes community service, education, and youth empowerment, serves over 150,000 Canadians through its mosques, schools, and community centers. The association argues that the CRA’s audit infringes on their Charter rights, specifically the guarantees of equality, freedom of religion, expression, and association.

The association initially sought to halt the audit through the Ontario Superior Court, arguing that the audit process was fundamentally biased. However, Superior Court Justice Markus Koehnen rejected their request last year, stating it was premature to intervene in the ongoing federal review. Koehnen acknowledged the validity of many of MAC’s arguments but emphasized that court involvement was inappropriate while the audit process was still active.

The Ontario Court of Appeal recently upheld Justice Koehnen’s decision, agreeing that the challenge was premature. The panel of judges found no error in the previous ruling, emphasizing the necessity of allowing the CRA’s internal processes to conclude before judicial intervention.

MAC’s representative, Sharaf Sharafeldin, criticized the decision, stating that the “prematurity principle” imposes significant legal and administrative burdens on charities. These costs, according to Sharafeldin, lead to financial hardship, reduced programs, and compromised charitable work, preventing effective challenges to Charter violations by the time the audit is completed.

In a statement, MAC highlighted that the decision disproportionately harms visible minorities and disadvantaged communities, who already suffer from systemic discrimination by government agencies.

The federal government has argued that the CRA’s selection of MAC for audit and subsequent review did not infringe upon Charter rights. The audit process includes potential internal appeals within the CRA, appeals to the Tax Court of Canada in the event of financial penalties, and to the Federal Court of Appeal if charitable status is revoked.

This ruling underscores the tension between government oversight and the protection of Charter rights, particularly for minority and disadvantaged communities. The outcome of this case could set a significant precedent for how charitable organizations can challenge perceived systemic bias and government overreach in Canada.

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