B.C. hip and knee surgery proposal ‘looks promising’: Health ministry; gov’t releases information previously denied to Saskatchewan NDP

Hill-Fisher emails released Feb. 17, 2010

Additional facts have emerged surrounding the B.C. government’s controversial proposal last year to charge the Saskatchewan government a “premium” for providing hip and knee joint replacement surgeries to Saskatchewan patients.

A senior health ministry official said last summer that the proposal put forward by the B.C. Government looked “promising” and that a funding request to cabinet was being prepared.

“The initial response is it looks promising although as you know I am not in a position to make any commitments yet as we have not taken the full proposal to gov’t for funding approval,” said Duncan Fisher, special advisor to the deputy health minister, in an August 19, 2009, email to B.C. assistant deputy health minister Wendy Hill. “I will keep you informed as that process unfolds.”

Hill replied later that day asking Fisher if he needed “a more fulsome costing analysis” for his purposes and when would he “be going to gov’t” on the item.

“I will need to connect with the health authority we have suggested to confirm the costing model including feasibility and need a window to do this work,” she said.

Fisher responded on August 20, 2009, stating: “Don’t need anything more at this point. Our proposal will be requesting a lump sum for [out of province] assistance so rates can be finalized later. We hope to be before gov’t by mid Sept.”

However, Fisher’s plan seemed to hit an unexplained snag.

On September 11, 2009, Fisher responded to a request by Hill the day before for an update on when Saskatchewan health officials would be taking their proposal to government and when they’d be in a position to move forward in discussions.

“We were supposed to go to Treasury Board next week but our appearance has been cancelled. A new date has yet to be scheduled but it would appear it will not be until October. I will keep you posted,” Fisher wrote.

This appears to be the last email that Fisher sent to Hill. So if he’s kept her in the loop since then it must be by some other means.

In his email to Hill on August 19, Fisher also inquired about the post operative stay for Saskatchewan hip and knee patients.

“The proposal speaks to an inpatient stay of 3-4 days. The question is will these patients be ready to fly home in 3 days. Our experience suggests they might not be ready (i.e. no 90 degree bend in leg for an airplane seat, ability to sit up for that long particularly if stopover in Calgary) is there any non acute step down capacity to keep these folks a few days longer to allow them to be better prepared for travel?”

It turns out that health officials in B.C. had already thought about this.

“I anticipated the need for this for the reasons you mentioned,” Hill replied.

“The need for additional convalescent care beyond the 3 or 4 day [average length of stay] that would be included in the procedure rate would be over and above, and based on the IPR agreement. Hope this makes sense. If we need to chat further, we can set up another T/C.”

Saskatchewan Health has described the discussions as very preliminary. But obviously they were pleased with what they were hearing, so much so that a proposal and funding request was being readied for the treasury board. What we don’t know is whether or not that plan made it to cabinet and what the outcome was.

The health ministry released the August 19-20 emails between Fisher and Hill in their entirety on February 17, 2010, in response to a freedom of information (FOI) request made by a private citizen January 14, 2010.

Oddly, some of the information disclosed in the emails was previously denied to the Saskatchewan NDP when it made a similar FOI request in November 2009. It would be interesting to know why the ministry did that.

The B.C. government made its proposal on August 10, 2009.

The idea apparently first arose at the June 2009 Western Premiers’ Conference in Dawson City, Yukon.

According to the StarPhoenix, Premier Brad Wall said he initiated a discussion with Premier Gordon Campbell about Saskatchewan’s long waiting lists and B.C.’s capacity to do joint replacements. [Sask. not interested in paying premium for surgeries: Wall (StarPhoenix, November 3, 2009)]

Saskatchewan health officials followed-up on the conversation with inquiries to their counterparts in B.C.

On November 3, 2009, Saskatchewan Party Health Minister Don McMorris told reporters that two phone calls were initiated by a Saskatchewan health bureaucrat with B.C. officials. [B.C., Sask. at odds over surgery costs files (StarPhoenix, November 4, 2009)]

Duncan Fisher told StarPhoenix reporter James Wood on October 29, 2009, that, “The call to B.C. was simply a request on our part to see if they had the capacity to help us out if we needed the help.” [Group to examine wait times (StarPhoenix, October 30, 2009)]

Neither McMorris nor Fisher revealed the dates of the phone calls.

The earliest email between Fisher and Hill appears to have been August 10, 2009, when Hill sent an attachment containing the two-page proposal entitled Proposed Out-of-Province Joint Replacement Program: British Columbia and Saskatchewan, that outlines the potential treatment of 440 provincial patients by the Vancouver Coastal Health Authority.

The body of the email was blacked out by the province as well as portions of two sections of the proposal called “service description” and “proposed funding model.”

The controversy started in the B.C. legislature on October 28, 2009, during question period when NDP health critic Adrian Dix accused the right-wing Campbell government of cancelling thousands of elective surgeries while offering hip and knee operations to patients from Saskatchewan and other provinces.

According to CBC News, B.C. Health Minister Kevin Falcon “scoffed” at the accusation.

“If we do this properly, we would have the ability to charge a premium,” Falcon said.

“So we cover not only our costs, but use the additional dollars to allow British Columbians to get through the system quicker, faster and better.” [B.C. plans to import surgery patients (CBC News, October 28, 2009)]

From that moment forward the Saskatchewan Party government was in damage control mode. Premier Brad Wall and Health Minister Don McMorris confirmed the discussions but denied that the idea of a “premium” was ever discussed.

In early November 2009 Wall told the StarPhoenix: “If right away other jurisdictions want to talk about that, clearly, that’s not on. We didn’t talk about premiums when I mentioned it to the premiers, we just simply talked about capacity.

“There’s reciprocal health agreements that exist today between the provinces.

“There are no premiums charged for those. So it’s interesting that B.C. would be saying that. That’s certainly not been part of the intent here.” [Memo to Sask.: Don't expect freebies (StarPhoenix, November 5, 2009)]

It’s difficult to accept Wall at his word when on so many occasions in the past he has misled, flip-flopped or outright broken a promise. Essential services legislation, TILMA, and equalization are but three examples.

It should be noted that in the throne speech on October 21, 2009, the Wall government promised that in four years no surgical waiting time will be longer than three months.

The StarPhoenix reported Wall as saying the health-care system will remain a single-payer, publicly funded medicare system but all options will be considered to cut into the wait times. [Gov’t focuses on health care (StarPhoenix, October 22, 2009)]

McMorris said the same thing on October 29, 2009, when he appointed a working group to develop a wait time reduction plan that is expected to be in place by April 2010. According to StarPhoenix reporter James Wood, McMorris said all options are on the table. [Private clinic interested in Sask. (StarPhoenix, October 31, 2009)]

On January 11, 2010, the Saskatchewan NDP held a news conference to release documents it obtained through the FOI request it made in November 2009. One of those records was the redacted two-page proposal that Saskatchewan received from B.C.

However, the StarPhoenix had access to an uncensored copy of the proposal and said it shows B.C. had suggested that “an administrative and capital overhead” be put on each case as a “discrete business unit will be established to manage this work.”

In an interview with reporter James Wood, Saskatchewan’s deputy minister of health, Dan Florizone, acknowledged that could amount to the “premium” referred to by B.C., but Saskatchewan never identified it in that way.

The lesson here is that a premium does not need to be called a premium to be one.

NDP Leader Dwain Lingenfelter said at the news conference the censored documents show the Saskatchewan Party government has not been telling the truth about the issue.

He noted B.C.’s Falcon has spoken consistently of a premium since the issue became public in October. An e-mail exchange obtained by the NDP shows Saskatchewan health official Fisher describing the first media report published in B.C. on the issue, which mentions a premium, as “essentially true.”

“They spent months working on a premium surgery scheme that now sits in limbo and then, when pressed, they denied doing so. What we have here is a government that does not know what it’s doing,” said Lingenfelter. [Document details Sask., B.C. surgeries fees (StarPhoenix, January 12, 2010)]

McMorris told the StarPhoenix that he spoke with his B.C. counterpart, Kevin Falcon, on November 4, 2009. Apparently the issue of a premium was discussed but the subsequent news article is not clear on whether McMorris told Falcon that Saskatchewan had no interest or intention of paying one. [Sask., B.C. stitch up rift (StarPhoenix, November 7, 2009)]

Falcon is sticking to his story that the question of a premium was there from the beginning. He made that clear in the B.C. legislature on November 24, 2009, and even suggested that the Wall government was still considering the controversial proposal: “The reason why we wanted to make sure that there was a premium reflected in us doing it was because, obviously, we’re not interested in doing it just for the sake of doing it. We’ve got British Columbians who also require those services and want to have those services. So we would only do it on the basis that a premium is paid such that we can use those dollars to get British Columbians through the system faster.

“That was the nature of the discussion. I’m not sure where Saskatchewan is on that. I understand their position. No doubt, they’re receiving their share of political feedback on that, and I imagine that they’ll have to decide whether that’s the appropriate way.

“The last time I had the discussion with their Minister of Health, he advised that they were still examining the B.C. option, private clinics and them undertaking the equivalent kind of massive investments, presumably, that we’ve made here in British Columbia.”

The story does not appear to end here. According to an October 29, 2009, email obtained by the Saskatchewan NDP, Duncan Fisher told the health ministry’s executive director of communications, Marg Moran McQuinn, that B.C. has been put “on hold pending budget decisions and to see whether we need their help.”

Saskatchewan Finance Minister Rod Gantefoer will present the 2010 budget on March 24, 2010. This is when we might see if Brad Wall keeps his word or not.

Hill-Fisher emails released to Sask. NDP Jan. 4, 2010