The decision to not look further into the Forzani and MacPhail Colon Cancer Screening Centre came weeks after the province’s Feb. 28, 2012 announcement of the Health Services Preferential Access Inquiry looking into medical system queue-jumping.
In March 2012, AHS Calgary zone medical director Dr. Francois Belanger followed up on an e-mail the colon cancer screening centre’s head sent out to local endoscopists, addressing “concerns over endoscopy queue-jumping.”
“I was reassured at that time, if there were any irregularities in the process, it had been fixed and we had a clear policy moving forward,” Belanger said of his inquiries into the clinic, testifying before retired Justice John Vertes, the inquiry’s commissioner.
Asked why he didn’t pursue questions around “direct booking” practices of one clinic doctor, Belanger added that there was “no hard evidence or any evidence in writing that would be enough for me to engage or initiate or trigger a review under the (medical staff) bylaws,” Belanger added.
On Tuesday, three clerks at the Forzani centre testified about systematic queue-jumping at the publicly-funded cancer screening centre, in which select patients were bumped to the top of the list for colonoscopies within months, while regular Albertans waited as long as three years.
They testified that many of the preferred patients were referred from the Helios Wellness Centre — a private clinic in the same building in which patients pay annual memberships of up to $10,000 each — and that their superiors told them to give those cases “urgent” priority, regardless of medical need.
On Wednesday, the medical director of the colon cancer screening clinic, Dr. Alaa Rostom, said clinic staffers were not told to give preferential treatment to favoured patients.
“It’s inappropriate for clerks to change priority based on anything other than actual priority of the patient,” he said.
Inquiry lead counsel Michele Hollins asked Rostom, a gastroenterologist, why he wrote the March 19, 2012 letter to Calgary endoscopists reminding them of the centre’s policy on “endoscopist initiated ‘queue-jumping.’ ”
Rostom said the email stemmed from a phone call from a Foothills Medical Centre executive who said “she’d been hearing rumours that Dr. (Ron) Bridges was directly booking patients at the colon cancer screening centre and whether I knew anything about that,” Rostom testified. “I said, ‘No, absolutely not, I didn’t know about that.’ ”
Bridges couldn’t be reached by the Herald Wednesday. He is scheduled to testify at the inquiry Friday.
“I had to trust what she was saying. She was saying there was rumours of queue-jumping. I thought if this was happening we needed to address it immediately,” Rostom said.
“I didn’t care whether it was happening or not, my point was to get it out there to indicate it’s not acceptable.”
He said he didn’t have resources to investigate and decided writing the note was the best way to address general concerns.
Rostom said he struggled with how to craft the email, which also discussed other booking issues, considering he was going off conjecture.
The e-mail included the centre’s policy on direct booking, which states, in part, that endoscopists’ private patients referred for treatment must be sent to triage to determine their place in the queue, not a booking clerk.
AHS’s Belanger was one of the senior superboard staff who got the e-mail.
The note was surprising and warranted a closer look, he said, including several conversations with gastroenterologist section heads.
“The picture I was getting is there was a suspicion, I was being told people were suspicious that certain charts were being flagged and ended up on one physician’s list, which had a private booking clerk, and some of those charts were originating from the Helios clinic,” said Belanger.
After speaking with Rostom, Belanger said he was satisfied that any irregular booking practices had been stopped months earlier and that there were no grounds to launch a formal probe. Under AHS medical staff bylaws, there must be documented evidence before a physician review can be launched, Belanger noted.
The Calgary zone chief discussed the situation with AHS chief executive Dr. Chris Eagle and chief medical officer Dr. David Megran, and they decided not to pursue the issue further.
The Forzani and MacPhail Colon Cancer Screening Centre, which opened in 2008 with a 14,000-patient backlog, was meant to take some of the burden off the city’s hospitals by taking on their load of routine colonoscopy tests. Today, the clinic is still swamped, receiving 150 referrals a day for its 96 daily spots and performing up to 20,000 procedures a year.
Rostom noted that in the early days of the centre, some doctors newly recruited to the clinic were allowed to slot in patients from their own practices’ referral list. The patients were expected to be triaged, and it was deemed a “fair compromise” easing the physicians through the transition to the new centre, said Rostom.
That practice ended in 2010 when the colorectal facility was in a transition period as it came under the direction of AHS instead of the University of Calgary, he said.
Original Article
Source: calgary herald
Author: Jamie Komarnicki
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