B.C. doctors criticize 'top-down' approach and government secrecy as minister defends surgical strategy

Two doctors’ associations are calling for more transparency and collaboration with government around plans to catch up on increasing surgical backlogs, but B.C.’s health minister is defending the current level of disclosure and engagement with frontline medical personnel.

Thousands of non-urgent, scheduled surgeries have been postponed or cancelled in successive waves of the pandemic, and while they’re seeing wait lists grow longer with patients reporting more time waiting to get on the list at all, doctors don’t know exactly how many people are waiting or for how long, because the Ministry of Health won’t provide the information to them. 

“We have a dashboard of COVID-19 data for the province, and if we had a public dashboard of surgical data, that would allow us to really, in a detailed kind of way, look at where improvements are most needed,” said Dr. Roland Orfaly, CEO of the BC Anaesthesiologists’ Society. 

He said the current information is insufficient. The province provides outdated information about the last phase of a patient’s path to the operating room, but the “hidden wait list” of patients who aren’t yet on a wait list for surgery isn’t disclosed, and the people on it can end up waiting for weeks or months before joining the official wait list.

“They’re waiting to see the surgeon, they’re waiting to get their imaging or laboratory test, they’re waiting to get all the things that need to be done before getting on the wait list,” explained Orfally. “It’s the number of people that we don’t even know about that do need surgery and will need surgery because we need to build the system for that need, and not just the need that’s in front of us.”

The call for more transparency comes as the president of the General Surgeons of British Columbia reveals that frontline medical staff found out about the plan to catch up on pandemic-related delays at the same time as the public, in May 2020. They also learned of more postponements to scheduled surgeries on Dec. 21, when the health minister gave a news conference.

“We have to tried to engage with them so we can offer collaboration, and it has not been forthcoming – I get told the plan will be announced to us,” said Dr. Daniel Jenkin, who described a one-directional approach to decision-making that doesn’t involve frontline doctors or nurses, who he said have plenty of ideas for how to be more efficient and get more patients the procedures they need.

"It's a very top-down, ‘We're going to go in our boardroom and give you the plan,’ (approach),” he said. “Well, how can you give us the plan if you don't know what's happening on the ground?"

Both doctors described wait lists they see growing since the Omicron wave of the pandemic began, with few suggestions for efficiencies or innovations adopted by decision-makers as they fly blind about where the biggest chokepoints are in the system.

THE MINISTER RESPONDS

The province’s own data published online documents 12,000 fewer scheduled surgeries performed in 2020-21 compared to the prior fiscal year. That’s despite $250 million promised by the health minister toward catching up on some 30,000 non-urgent surgeries postponed during the first wave of the pandemic.

In a one-on-one interview, Adrian Dix pointed out that there have been successive waves of COVID-19 impacting the health-care system, and that there were 22,000 more hours of operating time with a knock-on effect on successive patients, but didn’t address whether the quarter billion dollars in funding had been spent. 

“Overall I think it’s an exceptional thing that overall … there had been 99,800 on the wait list, there are 84,000 today,” he said. “Ninety-nine per cent of the people who had their surgeries cancelled in the first wave have had their surgeries done, 96 per cent of people who had their surgeries cancelled in the second and third waves have had their surgeries done.”

When CTV News raised the issue of health-care workers frustrated that the front line hadn’t been consulted or even notified about the aggressive plan to ramp up surgeries beyond pre-pandemic levels, or the decision to delay them once again, Dix defended his approach. 

“Sometimes, you do have to make decisions and you have to make them quickly," he said, insisting that there has been plenty of discussion with stakeholders in advance of the NDP government’s original surgical renewal after the party took power.

“The surgical renewal at its core has been planned since 2017, has been put in place, so we prioritized hip and knee replacements based on the advice of doctors," said Dix. “The transformative things we've done in the system have come from surgeons and from administrators and from health-care workers and from patients who've expressed their views to us."

He emphasized that wait times are tracked the same way across the country and disputed radiologists’ insistence that medical imaging backlogs are growing. Dix was adamant that the waits are shorter with more machines running, and that the health-care system is performing well considering the strains of the pandemic.

“When there’s tough news to deliver, I’m not delivering it somewhere else, I’m not having someone else to deliver it, I’m not making you FOI it, I’m going on TV and saying, ‘This week, this is how many surgeries were delayed,’” said Dix, ending the interview with a promise to patients.

“I see them and I see their concern and every one of them we want to get to as soon as possible.”