Hey there, time traveller! This article was published 18/4/2017 (1479 days ago), so information in it may no longer be current.
The prominent Manitobans flagged for "potential preferential treatment" while accessing MRIs haven’t necessarily done anything wrong but are emblematic of broader mismanagement in the health-care system, the province’s auditor general told the Free Press Tuesday.
Ninety-two high-profile donors, sports stars, politicians and senior Winnipeg Regional Health Authority officials found themselves on auditor general Norm Ricard’s confidential list, which was obtained by the Free Press Monday.
The reason, he said, is more likely administrative failings than disreputable attempts to game the system.
"There needs to be stronger, consistent processes," Ricard said in an interview.
Ricard first called for an overhaul of MRI management across the province in an unsparing report released nearly two weeks ago. He said some patients — professional athletes with private insurance and patients "with influence" — were being prioritized.
Of those receiving possible preferential access, the report notes roughly a third got scans the same day as they made their request, a dramatic difference from the average Manitoban’s 23-week wait. Half of the request forms for "patients of influence" also lacked priority codes, and in the cases where there was one "it often did not support the quickness of the scan," Ricard wrote.
Politicians reached by the Free Press Monday expressed surprise and dismay their names were on the list. They made very clear they had followed doctor’s orders and done nothing to try to get special treatment. Yet their files could have been flagged because they didn’t have a priority code, so the auditor general couldn’t confirm, without discussing an individual’s care with their doctors, their MRIs were warranted at the speed at which they got them.
They also could have been flagged because they were slotted in to fill no-shows or cancellations ahead of someone with a greater medical need, Ricard said.
"We’re concerned that process is how some persons of influence, as well as just regular citizens, are getting quicker access to MRIs… over and above people who are on the cancellation list," he said.
He noted in his report some patients made clear they "could be available with as little notice as 5-20 minutes," and one facility didn’t even have a cancellation list.
Arguably more worrisome is some prominent officials could have been receiving preferential treatment without even being aware.
"There’s no evidence that persons of influence demanded expedited access," Ricard said, but that doesn’t mean an intake clerk or a scheduling clerk didn’t recognize them and "perhaps gave them quicker access to the system than they should."
The Winnipeg Regional Health Authority is adamant that never happened.
Chief medical officer Dr. Brock Wright told the Free Press earlier this week the authority conducted its own internal audit into a small sampling of the people flagged by the auditor general, specifically the four senior WRHA managers, which included WRHA president and CEO Milton Sussman, who was the deputy minister of health at the time. That audit found administrative issues were to blame, not misuse of the system, Wright said. As a result, the WRHA is focusing on the report’s recommendations, not looking more closely at the names on the auditor general’s list.
In his weekly note to WRHA staff sent Tuesday, Sussman denied seeking preferential treatment and announced an internal investigation into the leak, calling it a "troubling and serious breach of (the Personal Health Information Act)."
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"I want to be very clear — I did not seek preferential treatment, nor was told I was receiving it," Sussman wrote. "I did not believe I was receiving preferential treatment. None of the other senior leaders identified asked for or were told they were receiving preferential care either."
Sussman took issue with the auditor general’s use of the word "preferential" given the lack of conclusive evidence of any wrongdoing. He re-iterated the WRHA’s position it does not "condone preferred access to diagnostic or any health-care services for anything other than medical reasons." The WRHA is in agreement with the auditor general recommendations concerning wait lists and centralized policies, he said.
"We recognize the need to reinforce the use of priority codes to ensure those waiting for scans are prioritized according to clinical need," Sussman said in his note. "We recently issued a directive re-emphasizing the importance of assigning priority levels to patients requiring an MRI exam to ensure booking is based on clinical criteria and that there is no preferential treatment for patients."
The auditor general recommended the province and the regional health authorities standardize and strengthen processes around booking, cancellations and wait lists, as well as ensure intake clerks know clearly what is expected of them. But, Ricard notes, some aspects of standardization will be tricky to finesse.
"If they tried to fill (an empty slot), couldn’t fill it and there’s someone in the building that’s there, then it seems better for that slot to be filled than unfilled," Ricard said. "It’s a difficult thing, for sure."
MRI options, wait times
In early February, the B.C. government announced it was funding four new MRI machines in keeping with its 2015 MRI strategy, which was geared toward addressing long wait lists and an increasing demand for the scan. Over the last 10 years, the province has increased its MRI capacity by more than 175 per cent. It introduced 16 machines, bringing the current total to 25. Correspondingly, the number of public MRIs has jumped from around 67,000 in 2004 and 2005 to more than 151,000 in 2015 and 2016. There are also a number of private medical clinics that offer MRIs for a fee across the province. One such facility advertises the scans starting at $825.
According to the most recent government statistics available, 90 per cent of people in Saskatchewan who needed an MRI between November 2016 and January 2017 had their scan within 194 days. The province’s patients have two options: they’re able to join the public wait list, or they’re able to pay for a private MRI. If they choose to pay for a private MRI, the licensed facility they use is obligated to provide a second MRI “of similar complexity” for free to another person on the public waitlist.
The government has rules for how private facilities pick someone off the public wait list. They start with the first person on the list and give them two options in the next two weeks to come for an MRI. If that doesn’t work for the person’s schedule, the facility then goes to the second person on the list. Once the free MRI has been done, the facility is obligated to inform the local health region within a week in order to make sure the public list is kept current.
In Quebec, there are nearly 70,000 people waiting for an MRI, per the government’s February figures. Of those people, 54 per cent have been in the queue for less than three months. The government’s goal is to reduce the wait so people spend a maximum of three months on the list, and it’s using room and equipment optimization as well as extended facility hours to try to do that. In keeping with that goal, the government announced in November it was going to spend $4.5 million to facilitate 46,500 MRI scans.
In Nova Scotia, the wait time for an MRI varies depending on which hospital it’s happening at. The range is anywhere from 61 days at the Cape Breton Regional Hospital in Sydney to 466 days at the QEII Heath Sciences Centre in Halifax. At QEII, the wait time is 233 days for a heart scan and 490 days for a brain scan. People also have access to private MRIs, but if a person doesn’t have accepted third-party insurance, the scan could cost hundreds of dollars.