Doctors behind private surgical group defend 'new model of care'

The doctors behind a private corporation that's performing joint replacement surgeries at the Riverside campus of The Ottawa Hospital (TOH) on Saturdays are defending the arrangement, which some critics view asanother step toward the creeping privatization of Ontario's health-care system.

• Questions swirl around joint surgery 'partnership' at The Ottawa Hospital

As CBC News reported this week, Academic Orthopedic Surgical Associates of Ottawa Inc. (AOAO), a group led by eight Ottawa surgeons who all practise out of TOH, performed the first round of 10 surgeries at the Riverside on Feb. 25. AOAO was registered as a business in Ontario in December 2021.

As surgeons, we hear the distress, pain, and the limitations to the quality of life our patients are experiencing.- Academic Orthopedic Surgical Associates of Ottawa Inc.

CBC News first became aware of the partnership in January, but the hospital did not confirm it until Feb. 16, when it announced it was "working with [AOAO]to increase capacity for orthopedic procedures, such as hip and knee replacements" at the Riverside, where operating rooms were "previously unused on weekends."

The arrangement is "in line with the Ontario government's plan to expand surgical capacity," according to the announcement.

Advocates and experts interviewed by CBCare viewing the partnership between TOH and AOAOin a different light, however. Some are asking why, since they relyon existing medical staff and hospital facilities, the surgeries aren't being performed under the existing public health-care structure.

"Why not use what you already have instead of taking this step toward privatization?" asked Rachel Muir,a registered nurse andthe Ontario Nurses' Association's (ONA) bargaining unit president at TOH.

'The need to act is now'

According to a statement issued Thursdayevening by TOH on behalf of AOAO, the surgeons' primary motivation in introducing this "new model of care" is relieving the existing backlog in access to orthopedic procedures that has left many patients waiting too long for surgery.

"This, combined with the growth expected in the future, means we need to find new solutions to ensure patients get the care they need.As surgeons, we hear the distress, pain, and the limitations to the quality of life our patients are experiencing. The need to act is now to respond to these patient concerns," according to the statement.

"Working with The Ottawa Hospital will allow us to strengthen access, quality, and service delivery for patients requiring orthopedic care across the region."

According to the statement, AOAO is renting the operating rooms at the Riverside, but "has purchased its own equipment to perform these surgeries."

The statement does not specify how much AOAO is paying to rent the surgical space, nor what equipment itprovides. AOAO later clarified that its surgeons provide "all instruments and equipment required to perform a hip or knee replacement," but uses the hospital's existing infrastructure such as operating room lights.

Anyone undergoing surgery is a registered TOH patientand "all services are billed through OHIP, as per standard practice," according to the statement, which describes the arrangement as "a cost-recovery model."

Surgical staff including registered nurses, registered practical nurses and clerical staff who volunteer to work the 10-hour Saturday shifts are being offered a per diem by AOAO that's roughly double what they'd earn for a regular eight-hour hospital shift, however they're responsible for their own insurance, CBC News has learned.

Minister defends partnership, applauds TOH

According to AOAO, the group includes 26 orthopedic surgeons. The Ontario Business Registry lists eight surgeons as "active directors."

CBC News has made numerous attempts to contact the surgeon listed as chair of the group, and on Thursday attempted to contact the other seven directors, all of whom practise out of TOH and most of whom are also affiliated with the University of Ottawa. Until Thursday's statement, the group hadnot commented publicly.

CBC News requested an interview Friday with the hospital's president and CEO Cameron Love, but was told he's unavailable.

A spokesperson for Ontario Health Minister Sylvia Jones also turned down an interview request on Friday. On Thursday, Jones's office issued a statement laudingTOH for"taking innovative action to eliminate the joint replacement surgical backlog and reduce patient wait times so more Ontarians can receive the care they need, closer to home."

In response to an access to information request from CBC News, the ministry said last month it had no records regarding the partnership between TOH and AOAO.

At Queen's Park on Thursday, Ottawa Centre MPP Joel Harden questioned Jones about the partnership.

"Will this government get public operating rooms fully up and running for everyone?" asked Harden, who characterized the arrangement to lease the publicly funded facilitiesto a private corporation as "selling them off or renting them out."

"I can tell you, there are some innovative models that are happening in the province of Ontario that are leading to successes," Jones replied. "It is a good news story, and we will continue to invest in those innovative models."

Use existing resources, surgeon urges

Dr. David Urbach, head of the department of surgery atWomen's College Hospital in Toronto and professor of surgery and health policy, management and evaluation at theUniversity of Toronto, agrees that Ontario's capacity to provide joint replacement surgeries is insufficient to meet the current demand.

"That is why many patients are suffering in pain waiting too long for surgery," said Urbach.

However, he believesthat could be solved with proper funding and planning, and by introducing a centralized "single-entry" referral system for patients to avoid bottlenecks.

"There is no reason why additional surgeries could not be done in Ontario public hospitals," he said."There are many operating rooms in Ontario hospitals that are unused but could be used due to lack of funding and staffing, especially nurses.

"From a business and quality of care perspective, it would be a much better strategy for Ontario to maximize delivery of surgery in our existing public hospitals."

The Toronto Star, quoting a retired Ministry of Health lawyer,reported on Thursday that under Section 4 of Ontario's Public Hospitals Act,no land, building or other premises belonging toa hospital can be sold, leased or mortgaged without the minister's approval.

On Thursday, the ministry told CBC that because the operating rooms belong to TOH, and the procedures providedin them are insured hospital services, the hospital does not require the minister's approval for usessuch as the current partnership with AOAO.

Through TOH, CBC News has also asked AOAO whether it's charging a 50 per cent premium for weekend surgeries provided under OHIP as part of its "standard practice" mentioned earlier.