Private Clinics Not The Magic Solution
By Michele Landsberg
Toronto Star
September 22, 2002
PREMIER ERNIE EVES had better hope that Tinkerbell does sit on his bed post - to borrow a phrase he used last week to mock environmentalists - if he ever hops up on the bed of an MRI or CT scan machine in one of those private clinics he's pushing.
Ernie is going to need a little fairy dust to protect him, because nobody else will.
His health minister, Tony Clement, has called for 20 private, for-profit MRI clinics and five CT clinics - for fast, fast, fast relief before the Romanow commission on medicare can report later this fall and possibly prevent further erosion of our public health care system. The intent of Tony Clement's reckless rush to privatize seems to be to establish "facts on the ground," as West Bank settlers used to say.
How safe are those clinics? How necessary are they? Will they reduce waiting lists? Is there no other way to get the public diagnostic services we need so desperately?
CT scans - magnificent diagnostic tools, when properly used - emit radiation. Radiation is not harmless. In fact, the American College of Radiology does not endorse whole-body scans for "the worried well." Even more alarmingly, whole-body CT scans expose a patient to the equivalent of 400 to 500 chest x-rays, according to physicist Thomas Shope Jr. of the U.S. Food and Drug Administration's office of science and technology, quoted last year in The Washington Post.
A private owner of CT clinics, however, said the number was "absolute nonsense."
Who do you believe, the physicist or the business owner? Even if it's only twice or three times the amount of radiation, it seems scary to me to hawk these services like used cars or package tours.
I'd like to think that someone a little more qualified than Tinkerbell is supervising the whole procedure. What chilly comfort, then, to know that the oversight for private diagnostic imaging clinics will fall to the College of Physicians and Surgeons of Ontario.
You remember them. They're the ones who, The Star has revealed, did nothing for 11 years after they were warned that Dr. Ronald Wilson and his technologist were putting dirty EEG needles in patients' scalps at their diagnostic clinic. Hundreds of patients were infected with potentially deadly hepatitis B, while the college dozed. Even now that the horrifying facts are known, and Wilson was found guilty of incompetence and is awaiting his punishment, he and his employee are still running a sleep clinic.
I wonder if the current CT scenario will play out like the tainted blood scandal. Will thousands of sick people be suing the Ontario government 20 years from now for wilful negligence?
It's not as though we're taking risks in order to save public dollars. According to the Ontario Health Coalition's recent report, the private clinics in Alberta cost 21 to 25 per cent more than the public facilities, and did not shorten waiting lists.
Most people in favour of the clinics imagine that, in a crisis, they'd love to be able to fork over $800 and get a very quick diagnosis. But under the rules of medicare, you can pay privately for these scans only if they're not medically required. In an urgent medical crisis, you'd go to the head of the public waiting list and would not pay anything.
In the U.S., private companies haul their CT machines around the country, setting up shop in church parking lots (they pay the pastor with two free CT scan coupons) and touting themselves as the Wal-Mart of medical care. One physician who succumbed to the lure of a quickie scan had his sad tale retold in The New York Times last spring. The scan revealed suspicious masses and nodules; more and higher-risk scans were done, and then more tests. The doctor finally insisted on painful, invasive surgery, with a two-month recovery time, only to learn that the so-called masses were innocuous scars from childhood illness. Whole-body CT scans, the doctor concluded, were "prescriptions for panic."
But, you may argue, the public system is bankrupt and can't buy the desperately needed machines.
Wrong. The federal government gave the provinces $1 billion over the last two years specifically to buy diagnostic machinery. Ontario, alone of all the provinces, stole a huge whack of that money, $60 million, and gave it to private, for-profit companies. That money could have bought more than enough machinery for all the hospitals with waiting lists. Instead, private owners like Extendicare, Leisureworld, DiagnostiCare and Central Park Lodge "lucked out," in the words of one of their staff.
But wait, there's more. At least two towns, Kenora and Oakville, have raised the money, through public campaigns, to buy MRI or CT scan machines for their local hospitals. Their offers are languishing unanswered on Tony Clement's desk.
The private sector knows no bounds in its hunger for public money. DiagnostiCare, an Alberta-based company which says it owns 120 private clinics in Ontario, last year demanded from three small towns in eastern Ontario that they provide public subsidies to increase the clinics' profit margin to 23 per cent, or the clinics would have to close. They got $12 million from Tony Clement - and closed the clinics anyway, according to the Canadian Association of Radiologists.
There's an agenda here that has nothing to do with public health, waiting lists or strengthening medicare. The agenda is to privatize now, and fast, and without scruples. It's the government's very own going-out-of-business sale.
Neither the Canadian Association of Radiologists nor their Ontario counterparts have been consulted about this massive shift of care into the private sector. Both have publicly and strenuously objected to Tony Clement. He has not bothered to reply to them.
On the other hand, the Tories are thick as thieves (it's just a metaphor) with private sector lobbyists - at least three of whom have left the corporate medical world to join the government staff.
There's another threat: the continent-wide shortage of radiologists. Private clinics poach their radiologists from public hospitals, luring them with rich "signing bonuses." In cities like Calgary, Vancouver or Halifax, the impact of this raiding has been to impair or actually kill some public hospitals' capacity to offer diagnostic imaging. This is privatization by stealth.
"It's a speeding train with no conductor," said Normand Laberge of the Canadian Association of Radiologists. "The only thing that can happen is a derailment."
Tony Clement, on the other hand, blandly assures us, without offering a shred of evidence, that the private clinics will end waiting lists and offer universal access.
Clap if you believe in fairies.
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