Thread by @WinstonBharatMD

Anybody trumpeting their Cambie decision as some sort of victory needs to read this.

“ I have also found...provisions have the effect of limiting the right to security of the person individuals who are suffering from degenerative/deteriorating conditions and waiting for...

...elective surgery in the public system beyond their wait time benchmarks associated with their diagnostic priority codes, even though the patients are available for surgery...

Specifically, some of these patients will experience prolonging and exacerbation of pain and diminished functionality as well as increased risk of not gaining full benefit from surgery.

However, I have found that the plaintiffs have not demonstrated that this limit on the right to security of the person of some patients is not in accordance with the principles of fundamental justice.”

Our wait lists, which often exceeded benchmarks before COVID, cause enormous suffering. This isn’t being discussed at all by those celebrating this decision and it’s unbecoming of those who have pursued a healing profession.

You cannot position yourself as dedicated to the health and well-being of Canadians and celebrate this decision without also raising concern over the plight of those trapped waiting for “elective” surgery for conditions that are extremely debilitating in many cases.

And if the current framework “must” be protected (damn the consequences) despite decades of evidence to the contrary from multiple European systems with universal coverage, what’s the solution?

There is no finite cap on resources, we are talking about tax dollars thus politics.

If the ability to pay is first and foremost, why are 65 year old millionaires paying next to nothing for their drugs purely on the basis of age while so many working poor cannot afford medications? Where does fundamental justice fit in here? Eye care? Dental care? Physio?

Fundamentally, politicians decide how much tax $ will go to healthcare. But this number isn’t static. It’s not immutable. The pool of tax $ and/or portion that goes to the OR services could go up for example. This is politics, not a reflection of absolute resource limitations.

Let’s not pretend the Canadian health care aystem is based on need: It’s based on need only for in-basket services and that is and always has been a moving target. We have among the highest OOP payments in the developed world despite this “fundamental justice”. And horrid waits.

And yet the same people opposing this case are championing a pharmacare plan that unlike *universal-coverage* European jurisdictions with means tests, would shift >$9B paid by insurers to the *public purse*, further reducing $ available for things like surgical wait list efforts.

And these aren’t small numbers.

Percent of priority 2 cancer patients in Ontario exceeding benchmark waits:
Bone*: 15
Breast: 53
Eye*: 12
GI: 19
GU: 38
Gyne: 41
H&N*: 21
Liv/Pancreas: 28
Lung: 63
Neuro: 4
Prostate: 38
Thyroid/endocrine: 50
*priority 3

Have a kid? Percent exceeding benchmark waits (**prior 2, ***prior 3)

- cardiac: 7**, 67***
- general: 47**, 44***
- gyne 37**, 15***
- oral: 69**, 73***
-neuro 54**, 33***
- ophtho: 27**, 69***
- ortho: 46**, 51***
- ENT: 52**, 73***
- plastic: 23**, 48***
- GU: 14**, 65***

The wait list categorization is foolish. Somehow we’ve convinced ourselves that most people referred for hip replacement should wait 182 days *before seeing a surgeon*. What family doc refers someone to have a surgery that causes med students to pass out in the OR based on this?

Yet even with higher priority patients, defined like this, nearly half were missing benchmarks. Not 2 or 3 percent, rather 49%.

Then after waiting to see the surgeon, 45% of hip arthroplasty patients missed “time to OR” benchmarks.

These patients suffer. This is not OK. It’s not something to celebrate.

This happens in a system in which surgeons are lucky to get a couple 8am-4pm OR days a week.

I have no clue what the corresponding BC data show, but I do wonder if a case similar to #Cambie were brought in Ontario whether a judge would look at these waits and find infringements on security of person to be “proportionate” to legislative purpose.