Sleep doctors resign from backlog task force

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This article was published 18/04/2023 (873 days ago), so information in it may no longer be current.

Two sleep specialist physicians have resigned from the provincial COVID-19 pandemic backlog task force over concerns it is prioritizing privatization at the expense of patient care.

Long wait lists for sleep disorder treatment aren’t being resolved and there’s been no commitment to add staff or new equipment to Manitoba’s only accredited diagnostic lab at Misericordia Health Centre, said Dr. Eleni Giannouli and Dr. Nancy Porhownik.

Giannouli (Sleep Disorder Centre director) and Porhownik (co-section head of respirology in the University of Manitoba’s department of medicine) said their proposals to eliminate the backlog of sleep disorder tests with more staff and equipment, and oversight of outsourced private testing, have been “shelved” by the task force.

The pair also said an agreement to contract out at-home sleep studies was reached without their input, they were excluded from meetings, and their questions about how to provide follow-up care once the private studies were completed were ignored.

Giannouli and Porhownik resigned April 6 from their clinical advisory roles, after detailing their concerns in letters to Health Minister Audrey Gordon and task force heads David Matear and Dr. Peter MacDonald.

“By staying on as part of the task force, it implies that we’re part of the decisions that are being made,” Porhownik said. “It hasn’t been our experience.”

The pair first submitted their wait-list proposal last spring, before the agreement with Cerebra to provide at-home testing. The response the two physicians got indicated the task force found several “deficiencies” with their plan and kept sending it back for changes over the course of several months.

As of late March, their proposal was under review, according to a timeline of events signed April 14 by Matear and MacDonald, which the sleep physicians provided to the Free Press.

Porhownik and Giannouli are respirologists and certified sleep physicians who’ve been working to treat sleep disorders in Manitoba since before the 10-bed lab was established at Misericordia more than a decade ago. It is the largest sleep lab of its kind in Canada and was designed for centralized intake of new patients.

There are about 6,600 Manitobans waiting to be assessed for potential sleep disorders.

Giannouli and Porhownik proposed the lab could eliminate that wait list within three years. Part of their plan included private partners, but they wanted oversight and a transparent public tender process.

If it had proper equipment, the Winnipeg lab could handle about 120 new patients per week (70 in-lab studies and 50 at-home studies), the doctors said. They questioned how the lab would handle an anticipated influx of patients who completed sleep studies through a third party.

“We had a reasonable goal, something we could achieve, and it really just feels like it got shelved. And all of the attention instead has been for privatization. And even with that, a lack of meaningful engagement about how to provide care to any of these patients,” Porhownik said.

In statement provided Monday night, a government spokesperson disputed that stance, saying: “Patients who opt to complete a sleep study through the province’s agreement with Cerebra will have access to care prescribed without having to access the sleep disorder centre for treatment and follow-up care.”

Last fall, the province finalized a request for service agreement with Cerebra to provide 1,000 sleep studies. Before the contract expired March 31, only 158 studies were completed.

Cerebra president Patrick Crampton said the company received a total of 237 patient referrals (25 provided by the sleep lab, and the rest via the task force’s online portal). All but two of the studies were successful, and those patients were referred back to the sleep disorder lab for treatment, Crampton said.

The company wasn’t responsible for treatment or prescriptions for CPAP machines, so he doesn’t know how many of those patients who completed studies are still waiting for treatment, Crampton said.

Cerebra scheduled the sleep studies, which were scored by registered polysomnography technicians. Sleep doctors board-certified in Manitoba would review the results and send the information back to Misericordia’s sleep disorder lab, Crampton said.

However, this put more pressure on the lab and led to perceptions of “queue-jumping,” Giannouli said.

“We are concerned that all of this (gives) misinformation to the patient. We are concerned that the fundamental wait list issue has not been solved by any means, and we are concerned that our physicians have been placed in an ethical dilemma. Essentially, we’re being instructed to rearrange the waiting list and provide preferential access to patients studied by Cerebra ahead of those who we are testing,” the doctor said.

Opposition politicians decried what they described as the government’s focus on privatization rather than investing in the public health-care system.

Liberal Leader Dougald Lamont said not consulting or listening to front-line health professionals has been a pattern with the task force. “The government keeps defaulting to a private contractor, even though there’s a perfectly legitimate and essential public offering that’s going unfunded.”

“It shows that the PCs and their task force is not meeting the expectations of the experts that we have in our health-care system,” NDP Leader Wab Kinew said Monday. “But I’ll go a step further: the sleep disorder centre is the national best practice. Manitoba is the leader nationwide in this area, and the PCs approach here is putting that at risk, and that should concern all of us.”

Meantime, Crampton pushed back on privatization questions: “This isn’t privatization. This is increasing capacity and helping Manitobans with a three-year wait list for sleep studies… This is all publicly funded, the patients aren’t paying anything out of pocket.”

Cerebra had “phenomenal” feedback from patients, some of whom waited more than two years to be tested, he said.

The lack of uptake wasn’t due to lack of demand, he added, but because “there is a bit of ramp-up time” needed when introducing any new process.

katie.may@freepress.mb.ca