surgery waits leave patients in pain as ahs pushes ahead with chartered sites
10 minute read
alberta health paying for surgeries in private facilities did not achieve either of its most basic objectives: increase surgeries and reduce wait times.
sunmedia
colleen henning had always been a vibrant, active woman, even in her retirement years.
she and husband robin hornby often enjoyed days hiking in alberta’s scenic rockies, climbing the trails of kananaskis or walking the full 18 holes of their favourite golf courses — always making health, fitness and longevity a priority as they aged.
but early last year, henning suddenly started to feel pain in her left hip.
“i thought it was just a hip flexor. but it just wouldn’t go away.”
a visit to her family doctor and some x-rays revealed moderate arthritis in her left hip, but also mild arthritis in her right hip.
determined to manage her condition, which she says runs in her family, henning tried everything she could think of.
“i went to physiotherapists, chiropractors, i even tried cortisone shots,” she said.
“but the pain just kept getting worse.”
frustrated, and feeling helpless, hornby hated to see his wife suffer.
“we really did put in a lot of effort to prevent the onset of what ended up being a very, very serious condition. but it seemed nothing would help,” he said.
by the fall of 2023, just months after her initial pain, henning was struggling to walk, forced to use a walking pole to get across the street. she worried she might soon need a wheelchair.
a second round of x-rays showed the arthritis had become severe on both sides. henning’s doctor immediately put her in the system for a surgical consultation.
after suffering debilitating pain with a projected one- to two-year wait for hip surgery from ahs, colleen henning opted to seek private treatment in ontario, paying $55,000 out of her savings.
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brent calver/postmedia
but a letter from alberta health services indicated she would have to wait between 24 to 28 months just for the consult. and it would take at least another 24 months to get the much-needed surgery, henning said.
“as i waited for the consult i was getting extremely depressed,” henning said.
“i couldn’t sleep, i was in pain all the time. i couldn’t live my life.”
henning was prescribed painkillers and sleeping pills, medications she didn’t want to continue long term.
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“i thought, what if i get addicted to this stuff? this just isn’t manageable.”
as she waited, henning’s doctor contacted the alberta hip and knee clinic, trying to have henning’s case pushed up as urgent because of her rapidly increasing pain.
but it didn’t make any difference, hornby said.
“they just don’t even triage the cases. it’s absolutely ridiculous. there was no accountability as to why we were made to keep waiting for so long.”
ultimately, the couple felt they had no choice but to dig into their retirement savings and book a private surgery in toronto. the cost was $30,000 for the first hip surgery, done in january of this year, then another $24,000 for surgery on the second hip, done in april.
flights to toronto as well as hotel bookings over several days so henning could rest and recover added to the expense.
“we were obliged to take out of our retirement money to pay for this. but we had absolutely no choice, because it was agony,” hornby said.
“we have worked long and hard our entire lives paying into a system that is obviously not there for us when we need it.”
colleen henning with partner robin hornby in their calgary home.
brent calver/postmedia
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brent calver/postmedia
henning is thrilled to be back on the golf course now, and back to regular walking, hiking and a daily commitment to her physiotherapy.
“i’m excited i can get back to doing the things i love. it really does feel amazing.
“but i remain so disillusioned with our health-care system. the whole experience just really surprised me, that the system is just not there when you need it.”
health-care advocates across alberta say henning’s story is becoming increasingly common at a time when the pandemic’s surgical backlogs and drained workforce are mixing with historic population growth and the rising demands of aging baby boomers.
dr. paul parks, an emergency care physician in medicine hat who recently ended his term as president of the alberta medical association, says all those elements have created huge challenges that the province hasn’t tackled with the right resources or centralized co-ordination.
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and the result, he said, is increasingly limited access to basic care.
“it’s not about the quality of care — you get world-class care in alberta when you do receive it. it’s the getting access part that’s been growing more and more difficult, whether it’s emergency access, surgical care or cancer care.
“everywhere, access is really degrading,” parks said.
“on the surgical front, in the simplest of terms, our population is booming and many are aging baby boomers . . . so on the demand side, things have really skyrocketed.
“but on the supply side, the pandemic has pushed everything over the brink — we still have backlogs and our workforce is depleted.”
the excessive stresses of covid-19 saw multitudes of health-care workers either leave the province or the profession altogether, parks said.
and many of those who are left in alberta, he added, have been lured away from the public system into chartered private surgical centres as part of what the ucp government dubbed the alberta surgical initiative.
announced in 2019, the initiative was created by ahs, in partnership with alberta health, to address surgical backlogs and reduce wait times for non-life-threatening surgeries such as hip and knee replacements.
dr. paul parks, former president of the alberta medical association.
supplied/andrea krause photo
it aimed to better co-ordinate services and improve patients’ surgical journeys, from the time they sought advice from a family doctor to their referrals to a specialist, then surgery and rehabilitation.
but covid-19 halted everything. soon after, alberta’s population boomed and wait lists still grew, so the ucp ramped up efforts in early january 2023, vowing to contract out 3,000 orthopedic surgeries to private facilities, aiming to cut the then-6,000-person wait list in half.
it would mean the surgeries would still be publicly funded but would be conducted at private facilities, putting less strain on public hospitals.
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but parks said those same private facilities can also continue private surgeries for out-of-province patients — those willing to pay and jump ahead in the queue.
and it remains unclear what percentage of surgeries at the chartered facilities are actually publicly funded and how many are paid for privately, parks added.
at the same time, health care staff are flooding into the private facilities, parks said, because the work is less stressful and more predictable, meaning public hospitals are losing staff and resources.
“if you have the choice of working in a chartered surgical facility, monday to friday, it’s very organized, with predictable schedules, working 7 a.m. to 5 p.m. it’s very straightforward care.
“or, compare that to working in a hospital, which means being on call, going in at 3 a.m. to do unscheduled, unpredictable trauma care.
“so, obviously, many health-care workers are choosing to move to the chartered surgical facilities.”
as a result, hospital operating rooms are often sitting empty, parks said, with not enough staff to book orthopedic surgeries in a public setting.
a study released by the parkland institute in may 2023 found that the alberta surgical initiative and its emphasis on surgical delivery in private facilities haven’t had the desired effects.
the report’s data — obtained through freedom of information requests, statistical analysis and research literature — showed the initiative has diverted too many resources from the public system and, as a result, has failed to increase provincial surgical activity from pre-pandemic levels and has failed to improve surgical wait times.
“alberta has now among the worst performance in reducing surgical wait times in canada,” said the report’s author, andrew longhurst, a health and policy researcher with simon fraser university.
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instead of providing a solution, the growth of the for-profit sector is creating a whole new set of problems, longhurst added, including exacerbating ahs staffing shortages and constraining surgical activity in public hospitals.
“there is a limited pool of specialized health-care professionals,” longhurst said. “outsourcing surgeries leads to competition between public and for-profit sectors for the same professionals.”
since the introduction of the alberta surgical initiative in 2019, the parkland report concluded that the number of contracted surgical procedures performed in chartered surgical facilities has jumped from 29,052 to 43,078, an increase of 48 per cent.
in the meantime, ahs facilities — which were already operating at only 70 per cent of their capacity — saw the number of surgeries performed decline by 12 per cent, the report states. and by prioritizing for-profit surgical delivery, nearly 30 per cent of public operating room capacity remains unused.
but ahs insists the program is working.
after repeated requests for an interview, ahs calgary zone would only provide an emailed statement.
“we have increased orthopedic surgeries significantly, with nearly 35,000 completed in the 2023-24 fiscal year — an increase of approximately 2,800 from the previous year and 5,000 more than pre-pandemic levels,” the statement said.
“we’ve expanded the use of chartered surgical facilities (csfs) to provide publicly funded surgeries, alleviating pressure on hospitals and increasing surgical capacity.
“we are also piloting rapid access clinics and implementing the facilitated access to specialized treatment program, which centralizes intake and offers access to surgeons with shorter wait times.
“as a result of these efforts, we are seeing positive results: in one of the highest recorded 12-month periods leading up to april 2024, we performed over 16,000 hip and knee surgeries. median wait times for hip surgeries are now at 14.4 weeks and for knee surgeries at 20.9 weeks — one of the lowest wait times in five years.”
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still, thousands of albertans remain on wait lists for orthopedic surgery.
according to ahs, wait lists as of mid-september indicated 4,401 albertans waiting for hip arthroplasty and another 10,429 waiting for knee arthroplasty.
a hip replacement surgery takes place at the ottawa hospital.
trevor lush photo/courtesy the ottawa hospital
and advocates say the recent dismantling of ahs as a service delivery model is only adding to challenges and limited access to care.
last fall, premier danielle smith said the role of ahs would be spread across multiple new service delivery agencies, such as moving underperforming urban hospitals to third-party providers or directing more surgeries to chartered private facilities.
but chris galloway, executive director with friends of medicare, argued that instead of prioritizing private surgical facilities and dismantling ahs, the ucp should fund public operating rooms to do more procedures and hire more staff.
“we have the space, we could be using it right now. we could be doing more surgeries, opening our operating rooms 24/7. but we just don’t have the staff,” he said.
“we are in a workforce crisis across the country. but other jurisdictions, other provinces, are acting with robust plans in terms of recruitment, retention, incentives and connecting that to training.
“we are not doing any of that here. and so we’re losing staff to other provinces.”
ahs would not provide data on staffing levels, how many doctors and nurses are available for orthopedic surgeries, and how that has affected access to care.
but galloway pointed to the ucp government’s 2023-24 annual report on health, which shows the proportion of surgeries being completed by private, for-profit facilities in alberta grew from 16.2 per cent in 2022-23 to 20.5 per cent in 2023-24.
at the same time, the data shows alberta saw an actual drop in surgical procedures, with 4,800 fewer surgeries being completed in the public health-care system last year compared to the previous fiscal year.
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“the government’s own data clearly shows that expanding for-profit surgical facilities has led to reduced surgical capacity in our public hospitals, with thousands fewer surgeries being completed in the public system last year,” galloway said.
“a private surgical centre doesn’t create more nurses, doctors, anesthesiologists or any of the other health-care workers necessary to provide surgical care.
“instead, private facilities siphon limited health human resources out of our public system, regardless of when and where they’re most needed.”
the result, galloway said, is a growing number of albertans who either feel forced to pay for private surgeries, or albertans who cannot afford them left to wait and suffer.
“it’s absolutely unacceptable that people are left waiting so long in pain, long after medically recommended standards. and it’s unethical to be left in situations where they feel like their only option is to pay if they can.
“they shouldn’t have to pay. they should be able to get the procedure they medically need in the amount of time that it should happen in.”
galloway added the most common complaints heard by friends of medicare advocates are in fact seniors waiting for hip and knee replacements faced with increasing pain because they can’t afford to pay for a private surgery.
“when people are left waiting longer than they should — that has an impact on their health. other complications come up; their mobility is impacted. and as they wait, they get sicker, they can’t work, they can no longer go out.
“and their mental health is impacted, to be left waiting with an unknown. they don’t even have a date. so, you can’t even look to the future. and that is so harmful to people’s health.”
after repeated requests for an interview to discuss surgical wait times, health minister adriana lagrange would only provide a brief emailed statement.
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“reducing surgical wait times is a top priority for alberta’s government, and we continue to make significant progress.
“in 2023-24, we performed nearly 35,000 orthopedic surgeries by expanding the use of chartered surgical facilities to increase capacity and alleviate pressure on hospitals.
“currently, we are investing $618 million to improve operating rooms and $159 million to upgrade medical device reprocessing, aiming to see a six per cent increase in surgeries performed from 2022-23.
“these efforts, alongside capital projects, new programs, and a refocused health-care system will help ensure albertans get the surgical care they need faster and more efficiently.”
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