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ER for hire: X-rays $50, casts set for $70
By Cori Howard
Globe and Mail
Novemeber 27, 2006
By Michael McCarthy
VANCOUVER - The Urgent Care Centre doesn't look like it will be ready to open its doors next Friday. The new storefront clinic is currently an active construction zone complete with ladders, drywall and wires hanging from the ceiling. Still, Mark Godley, founder of what he says is the country's first genuinely private emergency clinic, insists everything is on schedule.
By the following week, he says, the cavernous empty rooms will be filled with treatment chairs, beds and state-of-the-art diagnostic equipment for MRIs, CT scans, ultrasounds and digital X-rays, as well as a hand-held lab that can assess blood in 10 minutes at bedside.
There are private clinics across the country that have been offering those kinds of services for years. What is new with Dr. Godley's clinic is that it's dedicated entirely to treating minor emergencies like broken bones, lacerations, back injuries, abdominal pain and a severe flu that could be pneumonia. And it's intended to take a load off beleaguered public emergency rooms, one of which is mere blocks away.
"They've been overcrowded for years, mostly because of a lack of beds," he said. "But people need service and we're a place to offload services from the public system and, for patients, increase their access to care."
Dr. Godley has hired 24 emergency doctors, all of whom will continue to work in the public system. But unlike at some private clinics in the country, they won't bill the public system for their work at the Urgent Care Centre. The UCC will be open from 8 a.m. to midnight, seven days a week. There will be a facility fee of $195, plus the extras -- X-rays for $50, blood tests for $70, casting a broken bone for $70. Starting on Dec. 1, Dr. Godley will be advertising on TV, on Smart cars painted with the UCC logo and by knocking on the doors of family physicians.
The centre won't be taking ambulances. If patients come in with a life-threatening illness, the centre will have the surgeons and the operating room stabilize them before transferring them to a hospital. They will provide intravenous antibiotics; they can defibrillate someone with severe bleeding. Their only other limitation: Patients can't stay longer than 24 hours.
Dr. Godley, an anesthesiologist originally from South Africa, is the founder of two other private clinics: Vancouver's False Creek Surgical Centre (just upstairs from the new UCC) and Winnipeg's Maples Surgical Centre, both offering multi-specialty surgery, including plastic, knee and back.
All his clinics operate in a legal grey zone, but he says there's nothing illegal. "We believe we're on the right side of the law," he says. "That individuals are entitled to look after themselves and if you choose to come here for prompt medical attention instead of waiting eight hours, you deserve the choice."
His position may be supported by the 2005 Supreme Court of Canada decision that gave private clinics new legitimacy. Known as the Chaoulli case, after the Montreal doctor who took it to court, the ruling says, in essence, that if governments cannot provide timely access to health care, they cannot prevent citizens from obtaining it on their own.
More ambiguous is the letter of the law. The Canada Health Act says you can't charge for a medically necessary service. But each province interprets the act differently, and private interests have been quick to exploit loopholes in federal and provincial legislation.
When a private clinic similar to the UCC opened in Montreal two years ago, Quebec's Health and Social Services Minister, Philippe Couillard, dismissed it as "legal -- but no solution for the health-care system." MD-Plus also performs minor emergency procedures and bills itself as a private emergency clinic. But its focus is on family-doctor consultations; just 30 per cent of its cases are emergencies. Ujjal Dosanjh, then federal health minister, also looked into whether MD-Plus violated the Canada Health Act, but no action was taken.
Some health experts say that worrying about legality is asking the wrong question. Senator Michael Kirby, who chaired the Senate committee on the federal role of health care, has said the controversy overlooks the pressures that led to the clinics' creation.
Last spring, for instance, a group of emergency doctors at Vancouver General -- just up the street from the UCC -- issued an unprecedented declaration of non-confidence by handing out a letter to patients questioning the department's ability to provide "safe, timely and appropriate" emergency care.
In the November issue of the Canadian Journal of Emergency Medicine, one of those doctors writes that despite their drastic action, the emergency department still looks the same: "gridlocked with admitted patients while the front hallway is full of new patients receiving undignified, unsafe care by frustrated EPs, nurses and paramedics. And once again my group is seriously considering taking strong action."
The UCC medical director, Gordon Bird, has been an emergency doctor for eight years. He says it's clear that the deterioration of the public system is part of the reason why it has been so easy to hire doctors at the private clinic.
"The public system is full of great doctors all trying to do their job well, but there are limitations in resources that can interfere with delivering the best care. Here is a new paradigm. It's a risk-free environment that's innovative, efficient and we can provide great care for our patients."
But whether the UCC will help to ease the backlog in the public system is yet to be seen. Most research to date shows that minor emergencies are not the cause of overcrowding. Rather, the true cause of emergency overcrowding is a growing and aging population that has diminishing access to a shrinking pool of acute-care beds.
"This may help people who don't want to wait in line," says Les Vertesi, a veteran emergency doctor and author of the book Broken Promises. "But it won't help the emergency departments with their real loads. What we need help with is with really sick people, with ambulance patients and patients they can't take. We already have good access to diagnostics like MRIs and lab tests. The problem is moving patients away from the emergency department to a different part of the hospital to free up beds for the people coming in."
Still, Dr. Godley believes the state of patient care will drive people his way. And his ambitions don't stop there. He wants to give Vancouver a facility on the model of the famed Mayo Clinics in the United States. Yet he also hopes to work harmoniously with the public system -- no small feat when it's not even harmonious inside the public system.
"This is the kind of place that doctors and governments can embrace as a risk-free pilot project," Dr. Godley says. "We see this as a win-win for ourselves, for doctors and for the people of British Columbia."
Reprinted from the Globe and Mail, November 27, 2006.
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