Winston Bharat Profile picture
Sep 11, 2020 17 tweets 5 min read Read on X
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... Image
...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? Image
Yet even with higher priority patients, defined like this, nearly half were missing benchmarks. Not 2 or 3 percent, rather 49%. Image
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. ImageImageImageImage
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.

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More from @WinstonBharatMD

Oct 23, 2020
It seems Air Canada has managed to convince the federal government to employ rapid testing as an opt out of quarantine on the basis of preliminary results from a massively flawed study.

Seems like a bad idea. @BillBlair @marcomendicino @celliottability @IrfanDhalla

1/n
First, Australia and New Zealand remain the gold standards for the “Western world” in regards to COVID response. Both had mandatory hotel (not home w/relatives) quarantine at port of arrival, before going anywhere, mandatory testing AND drastically reduced int’l flights. 2/n
Australia diverted ALL international flights out of Victoria when Melbourne’s numbers skyrocketed in 2nd wave and cut total international arrivals by 40% concurrent with other restrictions. This is what happened after. 3/n
Read 18 tweets
Oct 22, 2020
Cannot emphasize this enough. Our wait times were often terrible before the pandemic, anyone can review the data here:

hqontario.ca/System-Perform…

The wave 1 shutdown was an added burden in a system with heavily rationed OR availability to surgeons. #covidontario #waittimes 1/n
As noted in the editorial, “elective” is often a misnomer. I saw a neighbour go from walking dogs kilometres at when referred to ortho for a joint replacement to essentially immobile by the time of surgery nearly 2 years later. This is in the GTA. Haven’t seen him out since. 2/n
The BC Supreme Court in the Day case acknowledged that Charter rights to security of person can be infringed when health worsens due to wait list delays. So what is an “elective surgery”? 3/n
Read 8 tweets
Sep 25, 2020
Somehow nobody is talking about acute bed capacity.

Unlike the first wave, Ottaw public health is now reporting 100% of acute beds occupied despite only 14 COVID admissions. Image
Peel public health is reporting 92% acute beds full and 82% of ICU beds full Image
Toronto public health is doing a bit better at 89% acute bed occupancy and “only” 60% of ICU capacity full. Image
Read 5 tweets
Jul 13, 2020
Disappointed to see the continued racist depictions of BIPOC victims of crime in the mainstream Canadian media after @CTVToronto @CP24 and @CBCNews used a mugshot in stories of a murder victim in Toronto meanwhile this is how white suspects of murder were depicted last year. ImageImage
Yet this is how someone who killed a cyclist while driving impaired is depicted after allegedly violating parole while speeding up a major highway impaired again. Has anyone seen Marco Muzzo’s mugshot? ImageImage
Here’s CP24’s depiction of a smiling serial killer Bruce McArthur.

The author of this piece is listed as the author of the (now edited) Mohamed Sow piece linked from the @CP24 tweet:

Image
Read 4 tweets
Jul 11, 2020
While Canada continues to import cases via the dozens of international arrivals daily, perhaps if we’re lucky by October the CBSA will catch onto the whole asymptomatic/presymptomatic thing.

Take the UP express, subway then 3 buses, what could go wrong?
The CBSA website and actions in relation to travellers arriving from out of Canada by air is a joke compared to what can be found in New Zealand.

Canada: “Please answer these honestly then be on your way”

NZ: mandatory direct managed isolation/quarantine AND COVID test 4 all.
health.govt.nz/our-work/disea…

The transparency and data release is foreign to what we could expect here.

Yes, NZ is a small country. It’s also done this better than pretty much any other country in the world.

@Travisdhanraj here’s something to ask about at those pressers! ImageImage
Read 6 tweets
Jul 6, 2020
This might be the single most asinine thing I’ve seen written by an individual with *some* subject matter expertise in the last 3 months. It’s in relation to the #sickkids report on school opening precautions. Image
It’s comically hypocritical as the author of this statement appears to have absolutely no background in child health or education whatsoever, but claims to be able to weigh the impact of months on end better than report authors who are ID docs AND paediatricians.
Nothing to see here folks, totally inconsequential.

(>20% of kids in Toronto love below the poverty line, nearing 50% in some wards)
Read 4 tweets

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