Robert Barron and Scott Stanfield
There is a great deal of variation in the waiting times for surgical procedures faced by patients across Vancouver Island.
Depending on the procedure, available space and the number of specialists in the hospital where it is to be performed, patients from the Island can wait just a few weeks to more than a year. And different procedures can happen faster, or slower, depending upon which community your surgery is scheduled.
For example, according to the latest statistics from Island Health, most people waiting for hip replacement surgery at St. Joseph’s General Hospital in Comox can wait up to 51.2 weeks.
It’s even worse down-Island. Most patients waiting for the same surgery at Nanaimo Regional General Hospital can expect to wait up to 63 weeks from the original referral from their doctor.
On the other hand, wait times for a breast mastectomy at NRGH can be up to just four weeks, while it’s up to eight weeks at St. Joseph’s.
The Fraser Institute’s 2014 edition of Waiting Your Turn, which catalogues waiting times for medical procedures across the country, indicates that the waiting times are getting longer everywhere.
According to the report, specialist physicians surveyed across the 10 provinces and 12 specialties reported an average waiting time of 18.2 weeks between referral from a general practitioner to the medical procedure.
This wait time is 96 per cent higher than in 1993 when it was just 9.3 weeks.
“We monitor very closely that 52-mark (hip replacement) threshold,” said St. Joe’s acting CEO Eric Macdonald, noting the difference between average and maximum wait times. “Last year we completed 99 per cent of our elective surgeries in less than the 52 weeks.”
The average wait across all of St. Joe’s different procedures is about 13.5 weeks.
“When you think about elective surgery, and time to prepare, that’s not so bad,” Macdonald said, noting one to two per cent of elective patients will go over 52 weeks for various reasons.
The Health Ministry has set ‘clinical benchmarks’ for improvement. For instance, cataracts would ideally be done within 16 weeks. And in a perfect world, joint replacements would be done within 26 weeks.
“Last year we were able to meet those targets 64 per cent of the time,” Macdonald said. “This year, so far we’re meeting them 70 per cent of the time. So it’s improving.”
Macdonald said staff members have worked hard within a constrained acute care system with a limited number of available beds.
“There have been very few and far between surgical cancellations.”
Macdonald notes the potential presented by a new regional hospital that will contain six ORs.
“Island Health is dedicated to improving surgical access,” said Dr. Dermot Kelly, executive director for Geography 1 (Comox Valley north). “What we’re really focused on right now when we start looking at the geographies is aligning with community-based health care.”
Another priority is a focus on surgical access and improvement to wait times.
“What we’re looking at with these new hospitals (in Courtenay and Campbell River) is an opportunity to be able to look at the operational planning – the clinical transformation that’s going to help improve access to acute care for all the patients in our communities.”
Island Health does not yet have the specificity because it’s going through the operational planning.
“That will come over the next few months that we’ll really understand what are the services we need in order to be able to meet some of these benchmarks,” Kelly said.
“It’s not just associated with surgical. We’re focused on all patients and access to acute care, and then also what does it look like even from a length of stay within the acute care setting.”
A component he feels is valuable is the focus on patient-centred care at the new hospitals.
“And that really does focus on, not only for all Islanders, but how do we do that for the elderly as well as for our First Nations?” Kelly said.
In B.C., the average wait from referral by a general practitioner to treatment was 21.1 weeks in 2014, up dramatically from 10.4 weeks in 1993.
Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences: “Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish,” the report states.
“In certain instances, they can also result in poorer medical outcomes, transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities.”
The provincial government announced in June that it will pump $10 million into the province’s health care system to help some of the patients languishing on surgery wait lists get treatment sooner.
Health Minister Terry Lake said at the time that people who have already been waiting more than 10 months will be given priority when the funding kicks in.
But Lake said the one-time funding is only designed as a short-term solution to B.C.’s long wait lists.
He said his ministry has tasked the Provincial Surgery Executive Committee with coming up with a long-term plan to deal with the issue.
Alison Dormuth, director of surgical services for Island Health, acknowledged that the waiting lists are getting longer for many surgeries and other medical procedures on the Island, despite the small cash infusion from the government this summer.
She said there are different demands for surgical services on Vancouver Island, but much of the increased demand is connected with the growing population of seniors who are moving here.
“There’s no doubt that medical conditions related to aging, like the need for orthopedic joint replacements and cataract operations, continue to grow,” Dormuth said.
“There’s not a lot health authorities can do to provide more specialists to help deal with the wait lists.
“It’s really up to the Ministry of Health to address this issue by working with medical schools to try to fill these demands, among other initiatives.”
Dormuth said there are a number of ongoing advances in medical technology that are helping to deal with some of the wait lists.
She said, for example, that cataract surgery used to take more than an hour and the patient would be required to spend several days in hospital.
“Now the procedure takes 20 minutes and most patients are sent home on the same day,” Dormuth said.
“That has certainly helped lessen the wait time for those surgeries.”
As for patients being transferred to other hospitals that have shorter wait times for their required procedures, Dormuth said special referrals can be made by a patient’s family doctor.
She said those referrals are often related to the seriousness of the medical condition and the availability of other hospitals and specialists to do the procedure sooner.
But, Dormuth said, priority is always placed on those whose conditions are considered life-threatening.
“In a lot of cases, it’s up to the individual patients who know their own conditions best to encourage their family doctors to explore other options,” she said.
Valerie Wilson, a spokeswoman for Island Health, said simpler medical procedures, like X-rays and blood samples, are usually done the same day in the community where they are required.
She said they are usually done either at the local hospitals or at private labs and centres that Island Health contracts work out to.
How the wait lists of Vancouver Island communities compare
Estimated maximum wait times for various surgical procedures in hospitals where they are available on Vancouver Island:
• St. Joseph’s General Hospital (51.2 weeks)
• Greater Victoria’s hospitals (58.1 weeks)
• Cowichan District Regional Hospital (59.9 weeks)
• Campbell River & District Regional Hospital (61.4 weeks)
• Nanaimo Regional General Hospital (62.9 weeks)
• St. Joseph’s General Hospital (56.8 weeks)
• Greater Victoria hospitals (58.9 weeks.)
• Cowichan District Regional Hospital. (60.1 weeks)
• NRGH (64 weeks.)
• Campbell River & District Regional Hospital (72.8 weeks)
• Cowichan District Regional Hospital (14.6 weeks)
• St. Joseph’s General Hospital (30.7 weeks)
• Greater Victoria hospitals (40 weeks)
• NRGH (43.7 weeks)
• Campbell River & District Regional Hospital (3.1 weeks)
• West Coast General Hospital (3.4 weeks)
• NRGH (four weeks)
• Cowichan District Regional Hospital (4.1 weeks)
• Greater Victoria hospitals (7.4 weeks)
• St. Joseph’s General Hospital (eight weeks)
Kidney stone removal
• NRGH (three weeks)
• Cowichan District Regional Hospital (3.8 weeks)
• West Coast General Hospital (8.6 weeks)
• St. Joseph’s General Hospital (10.7 weeks)
• Greater Victoria hospitals. (12.2 weeks)