Dr. Brian Day is an orthopedic surgeon living and practicing in Vancouver, British Columbia. He built his medical practice in 1995. The goal was to provide private medical care on a fee for service basis. These same patients/residents could, of course, have their care provided in the normal course but that would mean waiting in line. Dr. Day and his clinic, on the other hand, would treat you much faster.
Dr. Day opened his center and proceeded with his business plan in 1996. He promoted the practice to out-of-province patients and visitors from other countries. In addition, he accepted provincial patients despite the law and proceeded to treat and charge them privately.
The provincial Medicare Protection Act prohibits doctors from registering in both the private and public streams at the same time. It prohibits publicly-enrolled doctors from charging for services that are publicly funded. It also prohibits the issuance of private insurance for medically necessary care that is a part of the public system.
For the next twenty years, the clinic operated in accordance with the business model and treated all comers for a fee. The provincial government took no action and left things as they were despite the infringement of the law.
Dr. Day decided that he had had enough of politics and undertook to challenge the provincial legislation under the Charter of Human Rights and Freedoms (Charter). The battle has been waged for a decade now. The matter is now before the trial judge who is about to hear the parties’ final submissions before making a decision.
Other parties have intervened, including the federal government, the BC Health Coalition and the BC Nurses Union. One such party was “Canadian Doctors for Medicare” whose concern is expressed as follows:
I think all Canadians should be very concerned because it’s in the very fabric of who we are as a nation that we provide care for one another when we need it.
The concern is that if successful, the result will be a further deterioration of the current healthcare system. Health care professionals will be drawn to such clinics where they can choose their cases and make more money. The harder cases will be left for the public system.
Dr. Day, on the other hand, sees it differently. He is not interested in dismantling the medicare system, he just feels that there should be more private options for care in conjunction with the public system. He reminds us that the system has worked just as he has always said it would over the last twenty years when he was left alone, and the law was not enforced. Why would we want a system that delays treatment, and potentially causes further harm, all for the sake of an ideological commitment to equal access? After all, the reality of many people's experience is that the system does not provide that care on a timely basis.
What the year-long trial, with over one-hundred witnesses, has cost both sides is unknown. The government has not and will not release its numbers. Dr. Day, on the other hand, has been supported by the Canadian Constitution Foundation which has raised money to help him prosecute the matter.
Dr. Day’s interest in the case is obvious. There were however patients of his who testified on behalf of both sides to the dispute. Those opposed wanted faster service within the current system at no cost to them. Those in support had had their conditions deteriorate while waiting for care. The government and the intervenors appear solely interested in preserving the system and have not put forward a solution that would better serve the patients of British Columbia. Politics aside, the journey is expected to be a long one that will eventually be resolved by the Supreme Court of Canada. We will keep a close watch on this case and update it as necessary.
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The Chief Medical Officer of Health for Ontario has issued an updated Directive #2 (dated May 26, 2020) for Regulated Health Professionals in the province.
Pursuant to the updated Directive #2, all deferred non-essential and elective services by health care providers may be gradually restarted – subject to the rest of the requirements set out in the Directive.
The updated Directive #2 does not provide particularly detailed guidance to health professionals on how to proceed, likely because it applies to such a broad spectrum of health care and health professionals. It does, however, provide some principles to assist health care providers in making decisions as we enter this transitional period.
In addition to the mask and hand sanitizer shortages, Ontario’s response to COVID-19 highlights the need for more frontline health care workers. Each regulated health profession’s college responded differently, and we have discussed some of those changes in other posts to keep you apprised.
Today, we focus on the College of Physicians and Surgeons of Ontario (CPSO), who set out to increase the number of available and licenced physicians out on the frontlines through certificates of registration that authorize supervised practice of short duration. The temporary licences authorize practice for 30 days.
Undoubtedly, COVID-19 has affected how health professionals practice. Pharmacists across the country are not only experiencing changes in how they practice (for example, accepting emailed prescriptions, where appropriate) but the scope of their practice as well. The latter change is not permanent, although the disruptions in practice may be felt long after the COVID-19 emergency subsides.
On March 19, 2020, Health Canada issued a short-term section 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) that would authorize pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (the CDSA Exemption).