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But many medical tourists are returning home with potentially catastrophic complications, including anastomotic leakages, where intestinal contents leak through surgical staples into the abdominal cavity, increasing the risk of life-threatening sepsis. "It's almost like your stomach ruptures," says Dr. Shahzeer Karmali, an associate professor of surgery at the University of Alberta and one of the authors of the newly published paper.

Complications can be a nightmare to manage and repair "because we don't really know what they've had done," Karmali says. "There's no real operative report; we don't know exactly what happened elsewhere. It's hard for us to figure out what was done, and how to fix it." One woman in her 20s who underwent surgery in Mexico had to have her "essentially her entire stomach," as well as part of her esophagus, removed, he says. She will need to be fed through a feeding tube for the rest of her life. Despite increased funding in Ontario and other jurisdictions, wait lists average five years across Canada. Only one per cent of eligible patients are offered access to surgery. "Consequently,

many patients turn to medical tourism despite potentially severe complications," the Alberta researchers write in the Canadian Journal of Surgery. Earlier work by the same group estimated a complication rate of 42 to 56 per cent for out-of-country weight loss surgery. In Canada, unplanned readmission to hospital within 30 days of bariatric surgery was 6.3 per cent in 2012-2013, according to the Canadian Institute for Health Information. Karmali says Canadians living with obesity are being shortchanged because of lingering stigma and bias. "The stigma is that these people just eat too much and don't exercise enough and they can fix themselves," he said.

"The reality is, it's a significant problem and when people become severely obese it is very hard to 'fix.'" Surgery not only improves weight and overall life expectancy, it helps reduce the drain on the health-care system and economy. A Senate committee report released this month pegged the cost of obesity at upwards of $7.1 billion a year in health care and lost productivity. The committee made 21 recommendations to combat obesity, from overhauling Canada's food guide to banning food advertising to children. But it was silent on reducing wait times for bariatric surgery. Karmali and colleagues surveyed Alberta general surgeons to estimate the cost of revision surgery, ICU stays and other interventions to treat complications in "BMTs" - bariatric medical tourists.

In all, 25 doctors responded to the survey. Together they treated 59 out-of-country surgery patients in 2012-13. Complications included slipped bands, leaking, abscesses and blood clots. The estimated average cost per medical tourist was just under $10,000 - an "extremely conservative estimate" that doesn't include total hospital stay, blood work, nursing care and other costs. By comparison, the average cost of bariatric surgery performed in Alberta public hospitals was just under $14,000. "Alberta does not seem to save much money by limiting the annual volume of bariatric surgeries," the authors write. Studies suggest bariatric surgery accounts for a growing proportion of Canadian medical tourism, with Mexico one of the most popular destinations. According to Statistics Canada, one in four adults in Canada - more than six million people - are obese. skirkey@postmedia.com

The announcement comes as the provincial government prepares to defend itself in a lawsuit filed by Brian Day, an orthopedic surgeon, co-owner of the Cambie Surgery Centre and 2016 presidential candidate for Doctors of B.C. Day contends in his suit that patients should have the constitutional right to pay for care in private clinics if waits in the public system are too long.

"I think this is a good initiative. I think it's, in a way, brave of the government to do this when it's involved in a lawsuit," said Day. He said the province's announcement did not put it in an awkward position going into the court case, given that "contracting out has been going on for years," but it showed that the public sector is stressed to the point that it cannot handle the workload. "Obviously I support what the government's doing here, but I think there's a touch of hypocrisy going on when they're involved in a lawsuit where they claim that wait lists are not the fault of the hospitals or themselves but the fault of the doctors," Day said. "There are two wait lists.

There are the patients waiting for surgery. Then there are the surgeons waiting to be able to do the surgery. ... The surgeons are waiting because they can't get operating time." Day's lawsuit is expected to last seven months and is tentatively scheduled in the B.C. Supreme Court at the end of the year. Under current laws, private clinics are not supposed to collect money from patients if the treatment is an insured service in the public system. Lake said B.C. remains fully against a two-tier health system, but the government has used private clinics in the past and considers many of its physicians to be private health care contractors.

B.C. is turning to private clinics to help ease a massive backlog of surgeries, even as it prepares to fight a court battle against private medicine. Health Minister Terry Lake announced $10 million on Monday to push through common surgical procedures - orthopedics, hernias, cataracts, gall bladder, plastic surgery, and ear, nose and throat procedures - for those waiting more than 40 weeks. The extra money will be used to conduct up to 1,000 new surgeries, some of which will be done in private clinics when there are no available operating rooms in public hospitals.

A Health Ministry official said the "cost of doing procedures in a private surgical facility is generally comparable to what it would have cost to do them in a public health care facility" but could not offer a specific comparison. There were almost 72,000 adults waiting for surgery in B.C. at the end of April. Approximately 90 per cent of patients receive surgeries within 33 weeks, according to a government website.

The reality is we're still struggling with wait times despite a huge increase in the number of surgeries that we are performing each and every year," said Lake. NDP critic Judy Darcy chastised the government for turning to private clinics when underfunding has left some hospital surgical rooms empty. The government estimates 82 per cent of its 295 operating rooms are fully operational, with the rest unused due to financial or staffing shortages.

"It's a very small Band-Aid on a very big problem," said Darcy. "It's yet another short-term fix that shifts services to private clinics rather than addressing the serious problems in the public system." If the province properly funded the public operating rooms it could help retain staff and have a better long-term impact on waiting times than short-term contracts with the private sector, she said.

Darcy also accused government of "talking out of both sides of its mouth" by relying on public surgical suites to knock down waiting times while at the same time fighting against them in court. Lake said the $10 million will also be used to "optimize the booking system" for surgeries, which could mean sending a patient to a hospital outside their home city if it has extra capacity in an operating room.

He also suggested B.C. could move to a "first available surgeon model" where patients are referred to whoever can conduct the surgery quickest rather than to a preferred surgeon. The government will announce further ways it intends to increase surgical capacity later this year. rshaw@vancouversun.com mrobinson@vancouversun.com

Dr. Brendon Carr (president and CEO of Island Health) when asked at the Island Health Board meeting here in June stated that there will be a premium in cost for the surgeries at the private clinic. We know private, for profit, health care is more expensive. He said they have the information and would provide it, but when I wrote and asked what the difference in cost for the taxpayers between surgeries in public or private, for profit, operating rooms, Mr. Peters declined to answer the question.

It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private surgery clinic Re: Deal with private contractor could reduce surgery wait times - J.R. Rardon. The above noted article was in the Aug. 26, Campbell River Mirror. Reading the headline I have to ask "but at what cost?"

I pointed out to Dr. Carr that we have a shortage of doctors in Canada and he agreed. He said it would be the same doctors doing the surgeries in the private, for profit, surgery clinics. I asked how they can usurp our doctors into the private system without straining our public system more. He just said they will be watching it. That doesn't bode well for our public operating rooms. I fear that our provincial government is seriously undermining our position in defending the Dr. Brian Day court case on behalf of all British Columbians. At the very least it looks like a huge conflict of interest when they are seeking to contract an enormous number of surgeries to private clinics.

Our provincial and federal governments seem determined to starve the public health care system in favour of private, for profit, health care. They have let the surgery wait lists increase substantially. Our federal government refused to renegotiate the Canada Health Accord and brought in a new funding formula. They are telling us they are "increasing"  funding of the transfer payments to the provinces by three per cent, tied to the cost of living. Currently they are paying six per cent annually so this actually is a massive cut to the provinces for public health care in the amount of $36 billion over the next 10 years. With the federal government's cuts to health care funding, the share of federal CHT cash payments in provincial-territorial health spending will decrease substantially from 20.4 per cent in 2010-11 to less than 12 per cent over the next 25 years. This, according to the Parliamentary Budget Office, will bring the level of federal cash support for health care to historical lows. National Medicare was implemented across Canada by provinces and territories on the understanding that the federal government would contribute roughly 50 percent of the spending on Medicare.

Canadians are vehemently opposed to private health care whether it is using our public tax dollars or not. Canadians should not have to suffer and wait a long time for surgery. Funds would be far better invested in the public health care system which is being starved by our governments. It is very difficult for Canadians to see our medicare in serious jeopardy. The Canadian Medical Assoc., Canadian Doctors for Medicare, Canadian Health Coalition, Council of Canadians, B.C. Health Coalition, HEU, CUPE, Citizens for Quality Health Care and many others are united to protect, strengthen and expand our public health care. Please check out their websites and get more information. Please vote in the next two elections and vote for health care for the benefit of all Canadians. Lois Jarvis Citizens for Quality Health Care Campbell River

As a policy under the workers' compensation insurance system, expedited fees were effective in reducing wait time to surgery. While a difference of only two weeks may not improve longer-term clinical outcomes post-surgery, it represents a reduction in the total disability duration (i.e., pain, suffering, quality of life) for the injured worker and increases the worker's likelihood of successfully returning to work; the reduced disability duration also represents a cost saving to the workers' compensation system for time-loss benefits and to employers who pay compensation premiums based on the frequency and duration of their claims experience.

the provision of surgeries "after hours" or within private clinics may result in a redistribution of finite resources (e.g., surgeons, surgeon time, surgical staff) from one insurance provider to another, favouring those associated with higher fees, thus creating inequities. An evaluation of the effect of workers' compensation policies on inequity in the provincial healthcare system was not part of this study and warrants future investigation.

the time leading up to surgery may be confounded by co-morbidities and that individuals with complications may be directed to the public system

A difference of approximately two weeks in surgery wait time associated with the expedited fee policy may have meaningful clinical and quality-of-life implications for injured workers, in addition to being cost-effective policy for workers' compensation insurance systems, but did not affect the return-to-work time post-surgery as part of total disability duration. Minimal (and not statistically significant) differences in disability duration were observed for surgeries performed in private clinics versus public hospitals.

"It has been so undertreated (in the public system) that there's no way you can bring it into the 21st century without some expenditure," Dooner says. He suggests de-insuring older treatments such as sclerotherapy - the injection of saline fluid into veins to make them shrivel away - and putting that money into surgery.

At the root of the issue is the idea that varicose veins are a strictly cosmetic problem, says Dr. David Liu, an interventional radiologist at Vancouver General Hospital who also works in a private clinic with vascular surgeon Dr. Joel Gagnon. "Venous disease is really a redheaded stepchild of diseases because we're only starting to understand it now ... and the funding structures are based on antiquated concepts," Liu says.

Varicose veins can result in more serious leg damage if left untreated. The range of options and their prices can make it overwhelming for patients to choose, Liu says. Even worse are so-called vein clinics that aren't overseen by doctors using ultrasound imaging, where patients get superficial laser treatments, missing the underlying problem. Susanne Ziltener of Vancouver has experienced both traditional vein-stripping surgery and one of the new treatments, a medical glue approved last year for use in Canada. Liu and Gagnon were the first to use it in Western Canada. The 66-year-old waited about three years for the publicly-funded surgery and then paid $4,000 to have the other leg treated privately.

Ziltener says neither was particularly painful although she was dreading the surgery, based on the experience of her mother who had the same operation. The biggest difference in her experience was having to wear a compression bandage 24 hours a day for about a week following surgery, something not required after the less-invasive treatment. The choices are vast enough that B.C.'s Ministry of Health has created an online guide to walk people through their choices. In an emailed statement, ministry of health's Laura Heinze said officials reviewed alternatives to surgery this year and decided not to fund them because they are more expensive than surgery and results are similar.

Regarding waiting lists, the government added $10 million to the health system in June to reduce the number of people waiting more than 40 weeks for surgery, including surgery on varicose veins, she said. eellis@vancouversun.com Varicose veins The common condition is viewed as a cosmetic nuisance by most, but can lead to painful leg ulcers if severe cases are left untreated. What are varicose veins?

Bulging, painful veins typically in the lower leg, occur when valves inside them stop working properly and are no longer able to push blood upward to the heart. This causes it to flow backward and pool in the veins, pushing them into tortured shapes. The extra blood also makes legs feel heavy. What causes varicose veins? Family History Aging Pregnancy Being over weight Standing or sitting too long

Who gets them? At least 15 percent of Canadian adult have varicose vein although some estimates are much higher. What are the treatments? In all cases, the aim of treatment is to remove or disable damaged veins so healthier ones will take over the task of pushing blood upward. Surgery usually called vein stripping, entails making cuts in the skin above, below and in the middle of the vein to be removed, which is then pulled out. It is done under a general or spinal anesthetic.

Sclerotherapy is the injection of a saline solution directly into the vein where it irritates the lining of the blood vessel and causes its walls to stick together. It needs no anesthetic. Minimally Invasive technique are grouped under the heading of endogenous ablation, which is the destruction of veins from the inside using a tiny probe inserted through a cut in the skin which is then guided by ultrasound imaging. It can employ laser or radio frequency to heat and essentially cauterize the vein; a fluid or foam that causes the vein to collapse; or medical glue which sticks the walls of the vein together. It may require local anesthetic around the incision.

While private facilities like the Cambie Surgery Centre and the Centric Health Surgical Centre (formerly False Creek Surgical Centre) consider themselves hospitals, the college makes a distinction and Oetter said private facilities are inspected and accredited for one-night stays only. "We think of them as private facilities, not hospitals. When you think of hospitals, you think of 24-hour staff, security guards, meals and so on," she said.

Cambie has five operating rooms plus a dental procedure suite and seven private post-op recovery rooms. He said whether the facility is a hospital or not is really a matter of semantics. "Think about all the tiny community hospitals around B.C. and you can see that we are far more advanced and closest to the best hospital in B.C. Our staff are all the best you can get." Day said Cambie has been inspected and approved not only by the college but by the national body that audits and accredits hospitals - Accreditation Canada. Such accreditation isn't mandatory, but college approval is required.

About 50,000 people pay for their procedures themselves each year in private facilities. Renee Hourigan, spokeswoman for Centric, declined to comment. Dr. Brian Day, owner of the Cambie Surgery Centre, said it would be easy to accommodate patients for longer periods and to meet any new requirements. "We're not going to hire a chef, but we already provide snacks and meals to patients. We give them menus and they choose what they want and the food is delivered."

There are nearly 80,000 adults and children waiting for surgery in B.C. hospitals and median waiting times have not changed in several years despite reforms. According to the policy paper, 90 per cent of elective surgery patients got their surgery within 40 weeks in 2013/14, while the rest waited longer. In 2013/14, 5,503 publicly funded operations were performed in private facilities, down from the 7,839 cases performed in private clinics the year before. Another 541,886 scheduled (elective) operations were done in B.C. public hospitals. There are about a dozen private surgery centres in B.C. offering a range of operations, general anesthetics and overnight stays.

About 700 B.C. surgeons have privileges to work at private surgery centres. Under B.C. law, any facility where surgeons work must be inspected and accredited by the college to ensure high standards of care and patient safety. Sarah Plank, a spokeswoman for the Health Ministry, said the government is analyzing what kind of cases might be suitable for funded private surgery centres. The process is in the early stages so a timeline of up to two years is "not unreasonable," she said.

Frequent door openings can disrupt the positive-pressure airflow system in the OR, "possibly introducing more bacteria into the OR and potentially contributing to contamination of the wound," Bédard and his co-authors write in the Canadian Journal of Surgery. The "bacterial count" in an OR is directly proportional to the number of people in the room, and the more people in the room, the more traffic flowing in and out. "As a surgeon, infection is your worst complication," Bédard said in an email interview. "It is clear that bacteria are brought into the operating room by the OR personnel and can potentially cause surgical wound infections. The best way to monitor traffic is to count door openings."

Some people had valid reasons for leaving the OR - to retrieve an instrument or joint component, for example. But others left to "chat with a friend" in the hallway, ask questions not related to the case or to get personal items, Bédard said. Entering an OR should be viewed as "a privilege and not a right," he said. "Before entering any OR, OR personnel should ask themselves this question: Is my presence really beneficial to the patient?" While the study focused on joint replacements, Bédard believes the findings likely apply to other surgeries as well.

A leading infectious-disease specialist said the volume of surgery traffic startled him. More than 200,000 Canadians get infected in a healthcare institution each year, and surgical site infections account for about a third of all hospitalacquired infections.

"The misery - because I see a lot of these patients - is significant," said Dr. Dick Zoutman, a professor at Queen's University in Kingston and chief of staff at Quinte Health Care in Belleville, Ont. Hip and knee replacements are among the most frequently performed operations in Canada, accounting for more than 104,800 surgeries combined in 2012-13, says the Canadian Institute for Health Information. According to the Quebec researchers, "Infection following total joint arthroplasty remains a disastrous complication for both the patient and surgeon." The cost to treat an infected prosthetic joint can reach $60,000.

"Once the bacteria are in contact with metal, it is very difficult, if not impossible to eradicate with antibiotics alone," Bédard said. Infections require repeat surgeries and, sometimes, temporary removal of the prosthesis in order to sterilize the knee. While the individual risk of infection is low - about one to two per cent - "one per cent times thousands of surgeries per year is not insignificant," Zoutman said.

Patients are frequently given antibiotics before surgeries and airflow systems push air away from the surgical wound to help prevent infections. But, like Pigpen in the Peanuts comic strip, humans "slough off " millions of cells from the skin's surface, Zoutman said. "The staff are gowned and gloved. But the patient is there, giving off their skin cells as we yank and pull and do the surgery ... we all know from the Pigpen theory of infectious diseases, the more people in the room, the greater the risk."

Meanwhile on the East Coast, Nova Scotia posted the worst numbers for joint-replacement surgeries. The province has high obesity rates and an older population, which increase demand for these procedures. But so do several other provinces that performed better. "Nova Scotia, particularly on joint replacements, has historically had a difficult time getting all of the patients done within a timely fashion," Morris says. The battle to improve wait times for key surgeries began in 2004, with provinces setting targets for hip and knee replacements, hip-fracture repairs, cataract surgeries and radiation therapy. The goal is to ensure that 90 per cent of patients wait no longer than 48 hours for a hip-fracture repair, 182 days for the joint-replacement procedures, 112 days for cataract surgery and 28 days for radiation. The 2014 national numbers reveal that 98 per cent of people received radiation therapy within the benchmarked time. For the other procedures, the national averages ranged from 79 per cent (cataract surgeries) to 84 per cent (hip-fracture repairs). For the first time, CIHI was able to compare surgical wait times in Canada with those of several similar countries, including Britain, Finland, Australia and New Zealand.

The Canadian figures were among the best for waits for joint replacement and cataract surgeries, Morris notes. But that picture might not be as favourable if the time being measured included how long it takes for Canadian patients to see a specialist after their family doctor decides they need one of these five procedures. The wait-time clock starts ticking from the time a specialist orders the surgery. Critics have long argued that starting the clock from the visit to the family doctor would give a more realistic picture of the state of care in Canada. Morris says that is the next frontier in the campaign to reduce surgical wait times. "We know, overall, that Canadians wait much longer than people in other countries on average to see a specialist," she says. "So it's probably an area where there is opportunity to apply some of the same principles in terms of streamlining the steps and getting people in quickly."

The procedures are publicly funded and patients come from Island Health's standard wait lists. The B.C. NDP said Island Health's call for contracts entrenches stop-gap measures in which the use of private clinics to reduce wait times drains funding, doctors and nurses from the public to the private system. On Vancouver Island, there are 1,265 people waiting (for an average of 39 weeks) for all types of colonoscopies, including screening colonoscopies, at Victoria General and Royal Jubilee hospitals. There are 352 people facing an average wait time of 26 weeks for hip replacements, and 566 people facing an average wait time of 28.7 weeks for knee replacements.

There are 404 people waiting for a hernia repair (an average wait time of 22.4 weeks) and 445 people waiting for varicose veins to be treated (an average wait time of 99.2 weeks). Canadian Institute for Health Information executive Kathleen Morris said working through a list of people who had waited longer than the recommended limit might have temporarily made wait times look worse than they typically are. "The question, I guess, is if the strategy is successful and it's a one-time strategy, you'll have one year with funny results and then things will kind of - hopefully - go back to a better spot," said Morris, the institute's director of health-system analysis and emerging issues. Meanwhile on the East Coast, Nova Scotia posted the worst numbers for joint replacement surgeries. The province has high obesity rates and an older population, which increase demand for these procedures.

But so do several other provinces that performed better. "Nova Scotia, particularly on joint replacements, has historically had a difficult time getting all of the patients done within a timely fashion," Morris said. The battle to improve wait times for key surgeries began in 2004, with provinces setting targets for hip and knee replacements, hip-fracture repairs, cataract surgeries and radiation therapy. The goal is to ensure that 90 per cent of patients wait no longer than 48 hours for a hipfracture repair, 182 days for joint-replacement procedures, 112 days for cataract surgery and 28 days for radiation.

They allocated billions of dollars for five kinds of procedures, all disproportionately afflicting seniors who, after all, vote in elections more than young people and use the health-care system more. The procedures were: hip and knee replacements, hip-fracture repairs, cataracts, and radiation. More than a decade and billions of dollars later, how are we doing? What did all that money and effort produce? In a nutshell: middling results. Initial data were released in 2006. From then until 2015, some improvements occurred, according to a recent report (www.cihi.ca») from the Canadian Institute for Health Information (CIHI). Between 2011 and 2015, wait times shrank for some procedures in some provinces, but increased for other procedures elsewhere.

One challenge is obvious: the population is aging. Ergo: more need for cataracts, more falls causing hip fractures, more joints giving out, more youthful athletic injuries becoming painful in later years. Aging puts governments on a treadmill. More money and improved allocation of medical resources result in more procedures but demand keeps growing. For example, between 2011 and 2015, 25 per cent more hip-replacement operations were done, but the number of patients being treated within "benchmark" time frames actually fell.

What are these benchmark time frames? Governments establish them to measure progress or lack thereof, based on what medical experts think are appropriate times to wait before procedures are undertaken. The benchmarks are rather generous and can be irritating to patients in pain. They are also somewhat misleading. The hip and knee benchmarks are six months. That period measures only the time between when surgery is recommended and the surgery occurs. It does not measure what is often the most aggravating part of the health-care system: getting an appointment with a specialist who might then recommend surgery.

Combine the two waiting times - see a specialist, have surgery - and Canada's record looks less than average compared with other advanced industrialized countries. One challenge plaguing the Canadian system for joint-replacement surgeries is the endemic fight for operating time in hospitals. Orthopedic surgeries have to be slotted into ORs, which are needed for emergencies, life-threatening problems, very complicated surgeries for cancer or neurological procedures. Orthopedic surgeries, except for hip fractures that have to be repaired swiftly, can wait, and wait.

Here's a telling irony. A surplus of orthopedic surgeons now exists in some parts of Canada. There's not a surplus of surgeons versus demand for their services but rather versus the OR time they are allocated. In other words, more surgeries could be done because surgeons are available but operating-room time is not. The result is that some young surgeons are going to the United States or working part-time. Trying to fit surgeons and patients into hospital OR allocations on a timely basis is made more difficult by the straitjacket of the Canadian system or at least the view, bordering on secular theology in some quarters, that everything must be done in a public hospital rather than in private clinics operating under funding arrangements with the state.

Saskatchewan has used this method - private delivery of publicly funded and regulated services - which partly explains why that province finishes first in the CIHI report for timeliness of procedures. Quebec also used this system, until the Liberal government, led by a neurological surgeon (current Premier Philippe Couillard), ended the experiment.

If the results are so-so in recent years for the five procedures identified in 2004, CIHI numbers suggest backsliding for diagnostic imaging. For six provinces that provided data, waiting times for MRIs increased "significantly" as they did for CT scans. Waiting times for cancer surgeries have remained stable.

Dryly and accurately, CIHI repeats what everyone who thinks about the future of health care knows: "With a growing and aging population in Canada ... demand for priority procedures will likely continue to increase."

Cripps is fully booked with eye surgeries until November and has "100 eyes" on a waiting list. "It's only going to get worse," he said. Three years ago the eye surgeon was performing about 900 cataract surgeries and 1,000 laser surgeries a year, but with cutbacks to what the health system will fund, he now only does approximately 320 at the most.

According to Cripps, the health system is making it impossible for an eye surgeon to survive in the region. "You can't begin to understand the stress on me and my wife (Arienne, his office manager)," he said. "We've never seen it this bad in all my years in medicine."

CATHERINE CULLEN (REPORTER): The Cambie Surgery Centre is taking on the province of British Columbia in court next week, trying to overturn two provincial regulations. One bans private health insurance from medically-necessary surgeries. Advocates of private healthcare says it's too expensive for most people if there's no insurance. The other regulation forces doctors to choose between working in the public or private system rather than letting them to split their schedule. And now Justin Trudeau's government has been accepted as an intervener in the case. CBC News has obtained the expert report federal lawyers will use. It cites numerous studies to paint a bleak picture of a Canada with more private health care, arguing "society as a whole would be worse off." Resources like highly- skilled doctors would be siphoned from the public system. Even bankruptcies if people buy health insurance they can't afford as sometimes happens in the United States. Day says that he wants to see a European-style system with a public/private mix. DR. BRIAN DAY (CAMBIE SURGERY CENTRE):

To me it's a very simple question and that is: if the government promises health care, fails to deliver it, do they have the right under the constitution to stop you or your loved ones from extricating yourself from the pain and suffering that then ensues? CATHERINE CULLEN (REPORTER): The federal government says it's concerned about anything that would create a barrier to quality healthcare. JANE PHILPOTT (MINISTER OF HEALTH): It goes completely against the principles of the Canada Health Act which include accessibility and universality and we're committed to upholding those. CATHERINE CULLEN (REPORTER):

Now, the Supreme Court has already ruled on a similar case about private insurance, specifically in Québec, and in that case private healthcare won. People on both sides of the debate say that this new case could have some very important consequences for the whole country and that it could also wind up in front of the Supreme Court. Catherine Cullen, CBC News, Ottawa. © 2016 CBC. All Rights Reserved.

The health authority isn’t releasing a cost estimate for the new contract. In the last three years, the three-day-a week contract cost taxpayers between $1.1 and $1.4 million each year.

Beth spent a week in one facility before the band, which had literally fallen apart inside her abdomen, was surgically removed, all costs picked up by the provincial medicare system.

Patients show up complaining of serious complications, unpleasant side effects or just the inability to shed pounds after an investment that can top $16,000 — and limited help from the company that originally treated them.

An Edmonton program has estimated the cost to taxpayers of treating patients who had gastric bands implanted by for-profit clinics in Canada and out of country at millions of dollars, and suspects it has seen only the “tip of the iceberg.”

“I think it’s a crisis, to be honest. It may explode at some point when all these people have ongoing issues,” said Daniel Birch, an Edmonton surgeon. “It’s a tremendous cost to the patient and to the system, with no sustainable quality-of-life change.”

Patients typically indicate they received little support from their clinics, which seem anxious to recruit patients but less eager to provide crucial care after the operation, said David Urbach, surgical director of the Toronto Western Hospital’s bariatric unit.

“They privatize the profit and they socialize the losses,” he charged. “All the risk is borne by the public system.”

“It’s very naïve to think that a simple surgical procedure will fix a complex behavioural and genetic and societal problem,” said Teodor Grantcharov, a surgeon at Toronto’s St. Michael’s Hospital.

“It isn’t just the public system that’s dealing with the complications,” the specialist said. “They [other clinics] are my nemesis, too.”

The problem, in fact, may not be the procedure itself. Surgeons in public hospitals say many private clinics seem to skimp on the crucial preparation and after-care needed to make any bariatric procedure work. The actual operation makes it harder to over-eat, but major diet, lifestyle and psychological adjustments are also needed.

Yet the mere fact that patients are paying to undergo surgery at private clinics with uncertain success rates highlights another problem: backlogs in the public system that can force obese patients to wait years for an operation, said Dr. Birch.

In contrast, her only prep before the band was implanted was to meet with a clinic sales consultant. Afterward, she had brief visits so the device could be adjusted, a revision surgery and one appointment with a nutritionist whom she said was barely qualified.

A paper published in May by his team estimated the cost to the system of treating 62 patients who had problems after private weight-loss operations in other provinces or countries was $1.8 million.

In Toronto, Dr. Grantcharov said about 10% of the 80-100 bariatric surgeries he does every year are to take out failed bands, the majority implanted at private clinics in Canada.

Ontario did boost its spending on the field in 2009, and Toronto’s Dr. Urbach maintains wait lists are now a thing of the past. Dr. Birch in Alberta is unconvinced, arguing Ontario has “not even touched” the true backlog of patients who need the operation.

In B.C., the College of Physicians and Surgeons has tried instead to bolster the standards of the for-profit clinics. It took the rare step of imposing rules for private weight-loss surgery, requiring that they be offered only as part of a comprehensive weight-loss plan, and that clinics report long-term outcomes.

It was also looking for a private clinic to provide up to 4,000 colonoscopies on the south Island and up to 3,000 in the central Island each year over the same period, to a maximum of 35,000. The preferred lease site for the Victoria clinic is believed to be the five-storey professional office building in the new $100-million Eagle Creek Village.

It is also exploring ways to allow stays of up to three days as part of a long-term strategy to manage wait-lists in the province. Overnight stays would require changes to the Hospital Act. Peters said overnight stays won't be part of this contract. "There is a desire provincially to look at that as a future stage, but that is not part of this initial contract with the preferred proponent." Island Health began awarding contracts for day surgeries to private clinics in 2004.

"That does narrow it down to a few locations," he said. The proponent has confirmed the site would be ready to meet Island Health's timelines, Peters said. The B.C. Health Ministry, as outlined in a document called Future Directions for Surgical Services in B.C., is moving toward shifting appropriate publicly funded day surgeries to private clinics.

The site, at Helmcken Road and Watkiss Way near Victoria General Hospital in View Royal, is being developed by Vancouverbased Omicron. Jessica Ng, Omicron's development manager, confirmed it's in negotiations with the Surgical Centres to lease out 15,000 square feet on the third floor of the professional office space. "Hopefully, they choose us as a preferred location," Ng said. The preferred site must meet the requirements of the College of Physicians and Surgeons of B.C. and be near a hospital for the convenience of patients, staff and doctors, Peters said.

The NDP has said Island Health's call for contracts is an entrenchment of stop-gap measures where use of private clinics to reduce wait times drains funding, doctors and nurses from the public to the private system. "It's a worrisome trend," NDP critic Judy Darcy said when the plan to contract out was announced. She called the contract a short-term fix and just the tip of the iceberg in the move toward long-term privatization.

Peters said contracting out day procedures to private clinics saves Island Health millions in capital costs, reduces wait times for day surgeries, and opens up hospital operating room time for more complex surgeries. "This is not the privatization of health-care services," Peters said. "This is a benefit overall to not only those people waiting for surgery but it's a cost-effective way of delivering health care so we can invest in other areas." Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. ceharnett@timescolonist.com

Patients suffering in pain on wait lists for surgery have once again been denied their Charter right to access health care outside of the government's cruel, inefficient, and unaccountable monopoly. In 2005, the Supreme Court of Canada famously declared in Chaoulli vs. Quebec that "access to a waiting list is not access to health care." But last week, the Alberta Court of Appeal refused to apply and follow the Chaoulli precedent, citing a lack of evidence in the case of Darcy Allen vs. Alberta.

until September 2010 - a date later pushed back to June 2011. No longer able to work to support himself and his family, unable to perform ordinary day-to-day tasks, and experiencing pain so severe that not even the strongest drugs were effective, he spent $77,000 of his own money on surgery in Montana. Dr. Allen's surgery immediately and significantly reduced his pain, and started his slow journey back to better health. Apart from paying out of pocket, Dr. Allen's only other option was to suffer two years of extreme pain, waiting for the Alberta government's monopoly system to provide necessary surgery.

Dr. Allen's experience with medical wait times is, unfortunately, not unique. While patients in France, Germany, Japan and dozens of other developed democracies count their medical wait times in days and weeks, the government health monopolies in Canadian provinces subject patients to wait times that are counted in months and years. The international evidence demonstrates that there is simply no need for government to impose a monopoly over health care in order to ensure that health services are available to all members of the public. In Chaoulli, the Supreme Court held that while government has every right to create health-care programs, it does not have the right to create a monopoly that prevents patients from accessing health care outside of that government monopoly.

Last week's Court of Appeal decision, as well as the trial decision under appeal, declared that Dr. Allen had not brought forward enough evidence to support his claim. Curiously, neither decision refers to the extensive evidence put before the court about Alberta's long wait lists, and how wait times hurt patients, even killing them in some cases. While refusing to consider - or even mention - this abundant evidence, the court declared that Darcy Allen should have introduced expert reports and expert witnesses to testify about the fact that wait lists exist, and the fact that wait lists inflict suffering - and sometimes death - on patients. The Alberta government has not disputed either of these two facts. They are the same facts on which the Supreme Court relied in Chaoulli.

Following the court's logic, Darcy Allen should have spent $77,000 out-of-pocket on his medically necessary surgery, and then an additional $200,000 to $400,000 to assert his Charter rights, by paying a panoply of experts to "prove" basic facts that have already been admitted by the Alberta government. So much for access to justice.

To respect Charter rights, governments have only two options: ensure that a monopoly system provides real access to health care (not just access to a waiting list), or allow Canadians the freedom to access health care outside of the government's system. A law that creates a government monopoly over health care, by banning private health insurance, complies with the Charter only if that monopoly does not inflict pain and suffering - and a real risk of death - on waiting patients.

Ignoring the evidence before them about Alberta's long and painful waiting lists, Alberta's courts have refused to deal with the violation of Darcy Allen's Charter rights. Hopefully the Supreme Court of Canada will not refuse to do so. National Post Calgary lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (Jccf.ca) and acts for Darcy Allen.

About 4,300 cataract operations, 1,500 dental surgeries on children over two years old, 800 knee arthroscopies, 150 ACL knee ligament repairs and 450 shoulder arthroscopies are expected to be performed at the centre each year.

The projected annual cost of the procedures is $5.3 million at the Surgical Centre. The same procedures performed at Saskatoon hospitals would cost $7.2 million.

The new facility will have seven operating theatres with state-of-the-art equipment.

patients will receive phone calls from the health region, which will check to ensure treatments meet the region's standards

The contract also includes a protocol and procedures if complications arise that require patients to be moved to hospital.

SCI has previously said it will hire about 35 staff for the Saskatoon centre. Bartsch acknowledged that poses a risk for the health region to lose some employees to it.

SCI also operates private surgical centres in Alberta and British Columbia.

The company was awarded the contract in June, to the dismay of locally operated Saskatoon Surgicentre, which has been providing some of those services since 2010.

Norm Peters, Island Health's executive director for surgical services, estimates it will take six to eight weeks to evaluate the proposals, choose one or more preferred proponents and hammer out agreements. "We're just in the start of the review stage," Peters said.

Depending on what's proposed, Island Health could be awarding one contract to a single company or two contracts to different companies on the south and central Island. B.C. Health Minister Terry Lake said the use of private clinics for publicly funded day procedures is strengthening the public system by increasing the number of more complex surgeries that can be carried out in hospitals.

Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. In 2013-14, Island Health funded 160 day surgical procedures to be performed in private clinics. That was less than the previous year when Island Health contracted out 511 publicly funded procedures for adults to private clinics and 31 for children for a total of 542.

Interior Health contracted out the most publicly funded day surgeries in 2013-14 to private facilities - 2,053 adult procedures and 173 pediatric procedures for a total of 2,226. If Island Health goes on to fund a maximum of 10,000 procedures annually over the next five years through private clinics, the health authority will lead the province in doing so.

Peters said with more day surgeries, such as varicose vein procedures, being performed by private clinics, more capacity is created in hospitals to perform hip and knee procedures, which also have long wait-lists. Edition: Final

"By increasing the number of surgeries and colonoscopies we perform outside hospital, we can free up operating rooms for more complex cases and reduce wait times for both day and inpatient surgery," said Norm Peters, executive director of surgical services and heart health at Island Health.