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Panel on Patient Perspectives
John Saunders, Paula Brook and Jandi Fraser
Now we've heard from a lot of lawyers today and yesterday and some of them with the capacity to think and some with the capacity to not think. We have got one left on the front row a non-thinker, Mr. Storrow.
We are now going to here from the patient panel, this is unique and it has never been done in any other conference to my knowledge, not that there has ever been a conference like this before. But I would like to introduce the moderator. The moderator is John Saunders who is a lawyer but unlike any of the other lawyers here, he is a tax lawyer. He is a very good tax lawyer. I can tell you that personally because he got us a refund of $100,000 from Revenue Canada last year. That's a pretty good tax lawyer by my standards. Although John specializes in tax law he is actually an expert in two areas one of them is the reason he's here, well actually two of them is the reason he's here other than tax law. He is an expert in the health care system. He knows a lot about the law of health care in this country. Almost as much as Dr. Jacques Chaoulli knows about the law. But the other thing is he's a real expert in is hip replacement. There are only about 5% of orthopaedic surgeons who know more about hip replacements than John Saunders and you will find out why. When I say that his knowledge includes US and European health care he might inform you of why that is. But he does have some connections in health care. He is a former member of the Hospital Medical Ethics Committee. And his wife is a physician also. So he's got some insider knowledge. John thank you for coming and moderating this session. John Saunders.
Moderator: John Saunders
So this session is called a panel on patient perspectives and this is I suppose you would call it the human interest portion of this and the reason that we were chosen, the three of us to speak here is each of us is a hip replacement patient. To my right I have Paula Brook. Paula is a journalist for the Vancouver Sun. She went from running marathons to being unable to walk until she got a hip resurfacing in 2003. Now she's very active including skiing and cycling. She also tells me that she does salsa dancing. However, despite my encouragement she has unfortunately declined to perform a demonstration of that. Maybe a little applause and we can encourage her later on.
The woman to my left is Jandi Fraser. She had a hip resurfacing operation in 2002. She's a great example of just how wonderful this medical technology is. She went from not being able to walk to winning the Canadian National Doubles Tennis Championship for players over 45. She is also a highly ranked singles tennis player as well.
So the Supreme Court of Canada case involved a patient who wanted to get a hip replacement and was put on a waiting list. Now I don't think it is any coincidence that this was the case that made it to the Supreme Court of Canada because what we are talking about on the one hand is a tremendously successful medical procedure. Perhaps the most successful, arguably the most successful medical procedure that really takes people from being cripples and I don't use that word lightly to playing golf and skiing and winning tennis championships. Nevertheless, this is one of the medical procedures with the longest wait lists. So you have got to ask yourself why would that be? In the real world if you invent a better mousetrap, think flat screen TV, production goes up, price goes down, and availability increases. But in the public monopoly health care system that doesn't seem to be the case.
Again, the reason for this is I think many people, physicians here will be the exception, orthopaedic surgeons will be the exception but people in the health care industry a lot of them don't actually talk to the patients. I know in my particular case, I had a situation where I spoke with someone who worked for a hip prosthesis company making these things, custom hip prosthesis and he told me that he had been working there for about 10 years and I was only the second actual patient he had ever spoken with. So with that introduction, the first speaker here will be Jandi and I am sure you will be very interested in her story.
Speaker: Jandi Fraser
Thank you. By way of background I am 58 years old and prior to the deterioration of my hip 4 years ago, I had always enjoyed good health, was physically active and participated in competitive seniors tennis. I underwent a hip resurfacing operation in June 2002, at the Birmingham Nuffield Hospital in England. It's now over 3 years since my operation, which was successful and has allowed me to return to a full and active life.
I have been asked to tell you about the events that lead up to my surgery. Having been here to the last two days what I am about to tell you is my story is not news. It reflects many of the comments that I've heard over the last two days.
It began with the struggle that I went through to find out what was really wrong with my hip. It took 14 months and was emotionally charged with both high hopes and great disappointments. It began in February 2001, when I first experienced pain in my left hip joint. My GP prescribed taking Advil. In June, I went back to my GP as the pain persisted and I had developed a limp. An x-ray was taken which lead to the diagnosis of osteoarthritis. I was advised to see a physiotherapist, take anti-inflammatory drugs and to continue to maintain as active a lifestyle as possible. All of which I did with no significant relief of the pain.
I decided at this point to look for some solutions myself. Over the next several months I underwent two different types of chiropractic therapy, two types of acupuncture therapy, massage therapy as well as going to a physiotherapist. While all of these practitioners were very encouraging, their efforts were to no avail. In the fall, I went for another assessment with my GP who once again maintained that I had osteoarthritis. She told me to take anti-inflammatory medication and to just get on with my life. Although I followed my doctor's advice, my hip continued to deteriorate to the point that I developed a severe limp and could no longer remain active.
In December, I changed doctors. My new GP was encouraging. He gave me several kinds of stronger anti-inflammatory medication to try and assured me that I would be back living an active life in no time. In January, when the medication had failed to help in any way he referred me to an arthritis specialist who again maintained that I had osteoarthritis and that I should be able to live a relatively normal, active life with proper medication. Determined to explore every possible solution I once again decided to take the responsibility of my own health care and paid to have an MRI test which was taken in March. The MRI results indicated that while I may have some changes of osteoarthritis the head of my femur was highly suspicious of avascular necrosis. My doctor advised that I needed to start using crutches immediately in case my bone collapsed. Needless to say I was devastated. However, the good news was that the MRI test triggered a referral that would put me on a wait list to see an orthopaedic surgeon.
In April, due to the fact that I was now on crutches and the serious implications of the MRI test, I had a consultation with an orthopaedic surgeon. I arrived with my husband who was tightly clutching my new $900 MRI test and while the course of the events leading up to this appointment had taken over a year it took only minutes for the orthopaedic surgeon to dismiss my MRI test as unnecessary, note one crestfallen husband, and look at my x-rays and diagnose that I had a congenital hip problem, an abnormal acetabular as well as inflammation in the top of my femur caused by bone rubbing on bone and the fact that it had rotated nearly out of its socket.
The second party of my story is the road from diagnosis to surgery. As I was already fully weight bearing on crutches I was put on the urgent list for surgery with the expectation I could receive hip replacement operation at the end of 2002. A waiting list of six to eight months that could be even longer as I might be bumped at any time by patients with more urgent problems.
I came away from this appointment very relieved that I did not have avascular necrosis but the stress that I had to wait so long for surgery and relief from pain. I was also concerned about the general deterioration of my health and the long term affects of being on crutches as I was now starting to suffer from pain in my neck and shoulders and was watching my left leg shrivel.
When I was advised that it was medically unacceptable for someone my age to be on crutches for another 6 to 8 months I took this advice to heart. I once again searched for solutions. I sought advice from friends; acquaintances, doctors, lawyers, no politicians and eventually resorted to search in the Internet. I researched the Birmingham Hip Resurfacing procedure and consulted my orthopaedic surgeon about this option. I was told I was not an appropriate candidate for this surgical procedure and that he was not an advocate of metal on metal hip resurfacing. However, at the end of May I sent my x-rays to England with a friend and I received correspondence from the leading surgeon at the Nuffield Hospital in Birmingham stating that I was a suitable candidate for hip resurfacing and an operation date had been set aside for me in just 2 weeks time. My head was spinning. Clearly, I had a very important decision to make. I am a list person so I began to write down all the pros and cons – should I go – should I wait. One of the deciding factors was a comment made by a friend, a prominent surgeon. I recall when my husband was consulting with him he suddenly interrupted the conversation, looked him in the eye and said – just tell me what would you do if it was your wife. He didn't hesitate and he said – I would take her wherever necessary to have the surgery done as soon as possible.
So on that note it took the window of opportunity and on June 16th I travelled to the UK and was admitted to the Birmingham Nuffield Hospital for a left dysplasia hip resurfacing operation. I have to say it was scary to be so far from home, family and friends and to have an operation that was not yet performed in Canada and had no long term statistics to back it up. I have been told that hip resurfacing operation was much less intrusive than a total hip replacement and was supposed to be the operation of choice for active patients with the promise of a more fuller lifestyle than one could expect with a traditional hip replacement surgery. I believed.
Lastly, I am going to tell you about what I learned about our health care system. You have to be willing to push for answers, to seek as many opinions as possible and explore all opportunities. You have to be willing to do research on your own, search for solutions and take responsibility for managing your own health care. You have to be prepared for long wait lists and long waits. You have to be prepared to use your resources. It took me over a year to find out what was wrong with my hip and along the way I paid for services and used personal connections to speed up the process. I simply couldn't predict how long it would take others who may not have the same resources or the same initiative. The cost of my surgery, excluding travelling expenses was approximately $25,000. When I applied for reimbursement the Medical Services Plan denied my request as I did not meet the criteria for out of country medical treatment. The disappointment I experienced wasn't about the money but about their conviction that it was appropriate for me to be on crutches and waiting listed for a hip replacement surgery that could have been over 8 months away. I felt with assistance that this was the correct and proper course of action, that my right to lead a full and active life at risk.
I conclude by saying that I firmly believe that the hip resurfacing operation that I had done in England was the right option for me. I don't take good health care – good health for granted and I am grateful each day that I can move freely without pain and participate in the activities that I enjoy. Thank you.
Moderator: John Saunders
Thank you Jandi. I might just insert one comment here as a tax lawyer. Jandi said that the operation cost her $25,000 – a couple weeks ago I was reading something in the Globe and Mail. In the same article it talked about a woman who had gone to the United States and paid $40,000 to get a hip replacement. It also talked about another patient who got a hip replacement in the province of Quebec in a private clinic for $12,000. My immediate reaction to that as a tax lawyer was - there is something wrong with this picture because the person who paid $40,000 to go down to the US didn't pay $40,000. They paid about $30,000. The government of Canada paid the rest in a form of a tax credit. So ball-park $9,000 to $10,000 of that $40,000 amount that was out of the country and into the United States was paid for by the government of Canada. That was about $3,000 less that the Government of Canada would have paid had they simply funded the $12,000 operation in the province of Quebec. But of course if you fund the operation in the province of Quebec, people get paid in Quebec and when people get paid they have to pay income taxes themselves. So there is a certain recycling of money there. I think you have to be very careful when you look at some of the numbers.
Anyway our next speaker is Paula Brook and she will tell you about her experience.
Speaker: Paula Brook
Thank you very much John. I just wanted to – I am 53. I am a Canadian and I am a very successful user of both tiers of Canada's current health care system as we all are. I think it's no coincidence – John was talking about the – there was no coincidence that it was a hip case that set off a lot of the issues around this conference. It's no coincidence that we are all relatively young for hip patients. We are different from what the traditional hip surgery patient has been in terms of our profile. We're active, we're assertive and we're not going to take really bad news lying down. I think that is why we're here telling you our stories. You're going to hear a lot more stories and Canada is going to be hearing a lot more stories like ours and things eventually will change as a result.
Before I get into my story I should tell you I have done a lot of research in this area. Enough research to know that the two tiers that are already successfully operating under the radar of Canada's health care system are really not two financial tiers as most of the public knows. They are tiers in those who have versus those who do not have the information. They need to make decisions about their own health care. I am a journalist. I know a lot about information and about gathering it. The more I gather the more appalled really and scandalized I am by the amount of information that is not available to those people who need it. And the fact that you still have to work extremely hard to get straight information to make your decisions and to end up on the lucky side of the kinds of procedures that the three of us have had. Most people are no better off today than their parents or older aunts or uncles or more typical arthritis patients were 50 years ago.
My case is very similar to Jandi's. The difference is I had my surgery here at Vancouver General Hospital and I paid $3,000 for the device that I have in my right hip. That's a bit of an anomaly right there. I believe there is some kind of loophole that I still don't understand that the fact I was charged for my metal on metal hip is not a violation of the Canada Health Act. But I stand before you a happy recipient. It was the culmination of about 3 years of very hard work and networking connections, the kinds of things it takes to become a successful user of the second tier of Canada's Health Care System. Not being covered by Worker's Compensation for example and/or not being perhaps a wife of a doctor or other well placed person in the medical system I had to scramble as I do often as a journalist just to get the information to figure out how I was going to place myself into the hands of the right doctor and get what I needed. I can't pretend not to be proud of the fact that I did accomplish that in Canada and spent my little bit of money here in Canada. I was prepared to spend a lot more in Europe before I figured out how to do it here in Canada. My goal would be to see everybody have those kinds of choices and to be able to make informed choices and get their hands on information that is really available to everybody and not just people who spend years researching this to uncover the hidden bits that really make the difference.
My medical story is very much like Jandi's. I was a runner, I was very active, healthy person and still am. I was – because I had a similar situation with my hip I have a congenital acetabular dysplasia in the hip, which causes early arthritis. Had I known that I would not have been running marathons but we don't always know things? Hindsight is easy. It took me about two years from the time I was diagnosed in 2002, until 2004, early 2004, to understand that to figure out how – I waited basically two years to find out how long I was going to have to wait for surgery. It took me a tremendously long time to find out the doctor that I should see and to see that doctor and to get on his waiting list which was at that point another year or two long because this was one of the doctors that I felt had some of the new technology that I was interested in. So I was looking at – I had spent two years in a lot of discomfort and pain, seeking out every kind of therapy, massage, physio, exercise therapy, taking anti-inflammatories full-time, trashing my stomach lining. Probably setting myself up to be a stroke and heart patient because of what I was taking. We now know this is definitely not good for us, it was Vioxx for over two years full-time and I was becoming a very heavy user of the health care system costing the tax payers a lot of money, costing my extended health plan a lot of money, in order to save I guess the certain other – the surgery side of the health care system a lot of money by not just operating on me and getting me well again.
I found out at the same time while I was undergoing all these different treatments, none of which were really working, I was doing a lot of research, writing about it in the paper and it put me in touch with a lot of people with very similar stories, some of whom I discovered were going away, going to the States, to Europe, Australia, even India, taking it in their own hands and having these surgeries as Jandi did. So I contacted one of the doctors and by the way these were not wealthy people for the most part and I am in touch with hundreds of people, I wrote a very long series in the Sun and it proved to be the most popular series of the entire year in terms of the Sun reader feedback. Hundreds and hundreds of emails to me because of the kind of desperation among people that need to get information and the difficulty of getting the information. Anyway being connected with so many people, many who had already done a lot of research, I discovered that people were second mortgaging their homes, they were selling their cars. They were not wealthy people but they were taking their lives in their hands to get the care they knew they needed, timely care and ignoring, in many cases, or simply working around what their doctors were telling them about what they actually needed. I decided to do the same thing.
I felt that I had contacted a doctor in Belgium who did this resurfacing procedure? A very young, with it, bright, orthopaedic surgeon who I was seeing in Vancouver who I really liked and trusted had told me I would be a lunatic to get this operation. This was about 2 years ago. He said no one wants that amount of metal in their body, it's not done, he really strongly advised me not to do it. It took me a while to get the courage to tell him that I was going to do it anyway and I felt that he was wrong. It's very hard for a patient to take that on, to tell a surgeon that they do not believe that he is right. He looked at me like I was crazy and there were times when I really thought I was. But I was in touch with many people around the world who were looking at things differently and I thought this was really worth a try. I would end up waiting another 2 or 3 years in Canada getting sicker and older to become a better candidate to get total hip surgery and I would be lucky to get that metal on metal total hip in Canada after that point, never mind a resurfacing hip which was what I felt I needed.
So I made an appointment. I sent my x-rays to Belgium, Dr. Smidt and the next day he answered my email. The next day he answered it personally and I didn't even know what to think. I thought maybe I hadn't woken up and I was still dreaming. I had digitized my x-rays and sent them to him. He looked at them and determined I was a good candidate for the surgery and he could fit me in within two weeks. So I was ready to go. I was going to sell my motorcycle, I hadn't ridden it for two years anyway, I couldn't get my leg up over it and I thought it would be the best $15,000 I had ever spent. It would have been but a lucky thing happened and this is another thing about our two tiered system. I really believe there are the lucky ones and the not lucky ones. There are the informed ones and the not informed ones. Fortunately, for me a call came in from a buddy of my husband's who was a motor cycling buddy, a surgeon, a lot of surgeons ride motorcycles, go figure, he said I should not go. He knew another surgeon who is going to start doing these procedures here in Vancouver, I could probably get high up on the list because they don't have a lot of guinea pigs and if I was willing to put my case in the hands of an excellent surgeon who is starting to do these operations I could probably have the operation very quickly and actually it transpired that I did. I went to see the surgeon. I was fast tracked, I queue jumped and bought myself a bit of hardware and had the operation in Canada. The end result is I'm as healthy – I feel I am as healthy as I have ever been in my life. I had the right operation at the right time because I was informed and I was lucky and I just wish that it didn't have to be that way. Everybody should have that kind of medical care.
So that is the end of my story. Thank you.
Speaker: John Saunders
I think one thing that Paula said rang true with me and that is the number of people that she saw before she actually got what was needed. I think that personally in my opinion, that's an insidious result of some long wait lists. If you need a hip replacement it's like you have a bald tire. If you imagine a bald tire on the car, you can replace the shocks, you can clean the upholstery, you can paint the car and you can replace the engine but at the end of the day you still have a bald tire and what you need is a new tire. If you need a hip replacement and there is a 1 to 2 year wait list to get it are you going to do nothing in the interim? No you're not. You're going to make the predictable round of various other health care professionals and you're going to be advised to wait and you're going to be given some physiotherapy and you're going to be given some anti-inflammatories etc, etc., etc., but you still have got the bald tire and what you really need is a new tire.
So I believe there is a certain amount of waste in the health care system that is generated which is really collateral damage to the wait lists that we have in this area. I can only speak for this area. It's the only area of health care that I have experience with and I don't have experience with any other area of health care but as you will see in a second I have had a tremendous amount of experience in this particular area.
Let me start out by saying when I was asked to speak here I was a little bit conflicted because I have personally benefited immensely from publicly funded health care. I have two artificial hips. They're magnificent. They work very well. In fact, after I go skiing or play a game of tennis or do some of the other athletic activities that I do I often find that the only part of my body that doesn't hurt is my hips which leads to me to think that perhaps I should have taken the full body replacement option, just ticked all the boxes and gotten it over with. But I had a lot of problems along the way. I am sort of the poster child for everything that can go wrong with hip replacement that hardly ever does and in the end things ended up alright because I have had 20 operations on these hips. Every single one of them funded through public health care dollars. So I will be quite honest with you. Private health care scares me. The problem is that government monopoly health care scares me more and I think that probably as a general rule that's the situation that many hip replacement patients at least find themselves in.
So I am going to talk about four things here. The first thing I am going to do is to put on my lawyers hat for a second and talk about the Supreme Court of Canada decision. Then I would like to talk about hip replacements generally. Then my particular experience and some of the things I think are obvious priorities.
The Supreme Court of Canada decision in the Zeliotis-Chaoulli case has received some criticism and some criticism in dissenting judgements of the Supreme Court and the criticism that lawyers tend to, those lawyers who do criticize, it tend to level at it is they will say that the role of an activist court such as the Supreme Court of Canada shouldn't retry the case and shouldn't revisit the facts and they're saying that the Supreme Court essentially ignored the findings of fact by the trial court judge and they ought not to have done that. Well I think those people who levelled those criticisms haven't actually gone back and read some of the transcripts from the trial decisions in Quebec because if you read the transcripts from some of the testimony given and you read the trial judges decision you kind of wonder if she in fact, had gone back and reviewed the transcripts. Especially the cross-examination of some of the witnesses. We have a court case here which – we had two lawyers from a small firm in Montreal, capable guys but they were basically up against the State. If you look at some of the testimony at trial, I am going to read you just a little section here from the cross examination of one of the governments expert witnesses and as I read this keep in mind that this actually did happen. This is taking from the transcripts.
So this is the cross-examination of that expert.
Question: In this section of your report your answering the question – would private health care cause a reduction in public system waiting lists and you were referring, in your testimony this morning, to a recent in depth investigative report in Britain and you quoted the conclusion from that report. Now that report was a written report.
Question: And you read that report?
Question: And I suppose in the in-depth investigative nature it must have been a long report?
Answer: Um, I just noticed that the reference I made here is to a summary of it, which was printed, in the British Medical Journal.
Question: So what you're saying is the document referred to in your report was not in fact the report referred to but a summary of the report.
Answer: Yes. And I am trying to remember. Did I actually look up the report on the Internet or not. It's over a year ago.
Question: So is it possible you didn't read this report?
Answer: Its possible I didn't read the full report, yes.
Question: How is it possible that this report is in fact not a written report? Is it possible that it refers to a television documentary?
Answer: Ah yes; now I remember. Yes indeed, that's why it's called an Investigative Report.
Question: OK so I take it you wish to change your testimony with respect to the fact that this in fact refers to a written document that you read.
Question: That was in error. So now I am going to show you another document called "Embarrassing Greed" it was published in the British Medical Journal. Is this another document that you are referring to in your report.
Answer: Oh yes it is.
Question: So isn't it true that this is not a report at all but a letter to the British Medical Journal that someone wrote after seeing the show on television if that's the case? So in your report when you state that the report concludes its in fact the letter to the editor that concluded that. Isn't that right?
Answer: Well this is not a letter to the editor. This must have been a commissioned editorial I suspect. I am not sure.
Question: You're not sure? Now when you refer to a report on page 15 issued in Australia, "Cutting Edge" did you read that report?
(He's getting a little cautious now)
Answer: Well let me consult the reference I used.
(Again it's an article in the British Medical Journal reporting on the report.)
Question: You didn't read that report either?
Question: But don't you think before submitting your report to this court you might have read the report you're referring to?
Answer: Well I referred to the report and the reference is to the summary.
Question: It's not a summary. It's an editorial.
Question: You didn't think it was relevant to read the actual reports?
Answer: Well I felt there was enough information in the editorials to meet my needs in this situation.
Question: And this report in Australia is actually a one pager in the British Medical Journal likewise.
Now if you're a Supreme Court of Canada judge and you're reading this what do you want to do? You probably want to go out and get coffee. Why am I wasting my time on this? So I think that that has perhaps – that kind of logic has perhaps characterized this debate.
Anyway, this is supposed to be the sort of personal interest section. So let me talk about hip replacements and I will tell you a little bit about my medical history.
Again I want to refer to the Supreme Court of Canada decision and the trial decision. One of the experts of the trial said this ...
"Well with hip surgery we know that the prosthesis, that is the replacement hips only last for a certain amount of time so if we do too many too soon then there would be an enormous problem and hips getting badly in trouble later on because they don't last forever."
So that's kind of funny to me. You know when I read that I thought this is a fantastic operation. As I said before it takes people from being crippled to being able to play tennis at a competitive level. When you read that quote it almost sounds like we're creating a problem here. We can't possibly do these things we're just going to run into a lot of trouble later. Well there is a little problem with that and the problem is, it's not correct. It wasn't correct then, it hasn't been correct for a long time. If you read the medical literature on hip replacements there are lots of studies with 15 year follow-ups that showed 95-100% survival and in fact, there was a report recently published on hips done in 76 to 78 with a 25% year follow-up. There were about 2.3% that were revised because of loosening and there were another 7 or 9% that were radiologically looked like they were in trouble. But if you're looking at somebody who is 50 or 60 years old and you are telling them – well you should wait as long as possible for this. Well why he do that with 30 year old technology he's going to say – you want me to wait when the chances that I get this now are 2-3% in the next 25 years something's going to go south with it.
So I think that this is a problem with the system and I think that this in my experience is a little bit insidious and it permeates the system and I think that part of this is because if you go to an orthopaedic surgeon and say – well what do you think, this hip is really bothering me. I can't walk, I can't sleep and if you have a manual labour job you're not working and should I get it done. Well do you think that if you're a surgeon who has got a year and a half of patients that you've got to burn through before he can tough the next one that you're going to say – maybe you're bias is going to be a little bit – well maybe you're not quite ready yet. Well you might say that for a number of reasons. Maybe the person isn't quite ready but if you can't touch them for a year and a half I think you are going to have to have a psychological bias to say that. I think that does happen in the system. I think the measurement of waiting lists whether people are on a wait list for 6 months or 8 months whatever it is, whatever estimate that comes up I believe is going to be a gross underestimate of the real wait list because the real waiting list is how long it takes to get you on the waiting list. Nobody in this country gets their hip cut out and replaced unless they're very, very, very disabled. So we're not talking about an operation. You know it's almost being, I think, in the public perception a victim of its own success. The joint replacements are almost becoming too big for this and I think there are people in the public who think well this is just a bunch of yuppies trying to shave a couple strokes off their golf game. Nothing could be further from the truth.
This is described as an elective procedure. Well an elective procedure I guess technically speaking is one if you don't get it you're not going to die but I think you have to ask yourself how long should somebody reasonably wait for a surgical procedure with a superb track record, really the cure is on the shelf, when while you're waiting you're basically not walking around a shopping mall. This is a serious situation.
As I said before in the real world outside a monopoly system if you build a better mousetrap, if you had anything that was this effective and worked this well and was able to transform somebody's life as well what you would see is you would see an increase in supply and a drop in the price. We haven't seen that. So you have to ask yourself why do we have one of the most successful medical procedures having the longest wait lists? Go figure. It doesn't make sense.
So I am supposed to tell you about my particular situation and I want to add, I want to say in the beginning and make this very clear; I am just one patient. I realize as much as anybody that this is just anecdotal. My situation is very, very, very unusual. I get a person a month calling me about hip replacements because I do play tennis and I ski and I do all these things and the first thing that I tell them is well listen. I have had a lot of operations because a lot of things went wrong with me. But it's not going to happen to you. So the take home message that I want you to take from this conversation is that this is really a truly wonderful, surgical procedure. Now if you've got a guy who is sitting here saying – I have had 20 operations but I am telling you, you should jump on that operating room table and have it at the first available opportunity. Then that really is a bit of a testimony to just how wonderful a procedure this is.
So I will give you a brief medical history for the physicians in the crowd. I had adolescent Legg-Perthes, which is a disease where the blood supply to your femoral head gets compromised. So I ended up with flattened femoral heads instead of round ones and I had something else called osteoarthritis dissecans, which means I had a little joint mouse underneath the cartilage. So I was sort of headed for trouble sometime; when was a little bit of the luck of the draw. I was fine until I was 30. I was active and lived in Ontario and played sports and all those things and at 30 the wheels figuratively started to fall off and I found myself not being able to do much that was very active and having to use a cane. At that time, this would have been about 1980, people were reluctant to put hip replacements in someone my age. I think they were actually a little bit more pessimistic than they needed to be even then. So I had a bunch of operations to try and prevent me from having a hip replacement. They took the ball off and rotated it and bolted it back on. I quite literally then cut and drilled and sawed and stitched and glued and stapled, you don't want to forget stapled at numerous times. Someone at one point suggested it might be a bit of an idea to put some zippers in there. It would save a lot of time for the next time but I sort of resisted that.
So eventually at age 37 I had hip replacements and unfortunately, this is something which is very thankfully very rare, happened to me and they became infected. Probably both in the operating room but maybe one seeded the other. Nobody really knows. Infections are sometimes a little hard to diagnose. So they weren't diagnosed. They sort of took a couple sockets out and put new sockets in. That didn't work very well. An infection sort of eats away at the bones and they're not going to stick in there very long. So at that point the infection was finally diagnosed and the treatment for that wasn't quite as good as it is today. So I found myself in a lot of trouble. Possibly starring down the gun barrels of a wheel chair because these infections are quite hard to get rid of. The reason being bugs can live. You have an artificial surface and bugs can live on that and you can drink antibiotics and since the surface is not vascularized you can't get the bug juice to the bugs.
So anyway what am I going to do? I asked my surgeon, a Canadian surgeon – what am I going to do? He said, - well you know I haven't had a lot of success. I have had some but not a real high rate, you're a young guy, there's a guy in London, Ontario who has been working with antibiotic bone grafts, maybe you had better go look him up. So I did that. Except there was a little bit of a problem. He wasn't in London, Ontario any more he was in Phoenix, Arizona. So I went and saw him in Arizona and I can tell you out of all the people I have met in my life, and this goes for a lot of orthopaedic surgeons, I am a tax lawyer, I work with wealthy people, I work with corporations. I meet a lot of very smart people. I meet a lot of hardball players, people who have been very successful, people who have a lot of money. They work hard and they're pretty bright. But this guy in particular really stood out. He was an individual who basically sort of floated six inches off the ground. Just raw brilliance and enthusiasm. He had left the Canadian system. Why did he leave the Canadian system? He didn't go for the money. He went because he couldn't get enough operating room time. He did surgery on what he referred to quite affectionately as "train wrecks" like myself and he often needed sort of custom prosthesis etc., etc., etc., and he wasn't getting it and so he sort of went to where he could apply his particular trade, he thought in any event, to the best of his advantage.
So I went down there and I went through a bunch of operations and when I got in the operating room I kind of noticed something that was a little strange. First of all, I had a former Canadian surgeon, secondly I had a former Canadian anaesthetist and thirdly I had a former Canadian nurse. I mean it was like Hockey Night in Canada down there and I am wondering what the heck is going on. So all this worked out and I was very fortunate because the Medical Services Plan of British Columbia paid for all this. I can say some bad things about the US Health Care system, there are some awful things happening in the US Health Care system in terms of billing etc., etc., but you know if you ask me and you say –you were very lucky. They approved for you to go down there. They sort of said, well you're a bit of a mess here we better send you down there and get you fixed up. How can you possibly be in favour of any kind of private medical care? Well the reason is I am not naïve. I know I was, very, very, very lucky. I was lucky in particular because there was a Canadian orthopaedic surgeon in Vancouver who I had never met before that just went to bat for me. That doesn't always happen. I was lucky because a particular individual in the Medical Services Plan Out of Province Claims Department looked at my file and made a decision one way or the other but it could have gone the other way easily. I was lucky because the infection was eradicated because this particular individual had a very, very high rate of success in this and I think that success rate is probably duplicated in Vancouver now. But I was lucky for a whole number of reasons because I was sitting there poised as someone who was ready to fall through the cracks I think in the Canadian health care system.
So in any event I came back and I kind of looked into this and I thought well one of the things that I think is a potential problem here – I had obviously gotten fixed up by a person I regarded as a superstar. Now you need you need an artificial hip. What do you need? You need an experienced orthopaedic surgeon. He needs to be a guy who works pretty hard. He needs to know what he's doing. He needs to know how to get in there. He needs to know how this reliably day after day. He needs to not be hung over from the night before. He needs to control his personal life. He needs to be cool under pressure and he needs to be basically a pretty capable individual. What you don't need is – well no. 1 you don't need a politician they're not going to help you much. You don't need a health care analyst. You don't need a social policy analysis. You need an orthopaedic surgeon basically that's what you need. You need nurses and you need a hospital and you need a lot of things. But above all that's what you need.
So I started wondering why is this asset down in the United States? Why did he leave? I started wondering – well how many people do leave. We can find this out. You can go to a website, the Canadian Orthopaedic Association and if you read that and you sort of contemplate whether you might ever need one of these little devices implanted in you I think that you'll start to get very worried. Fortunately, the thing about health care is nobody worries that much about it until they need it. But when you need it then you start worrying pretty quickly,
If you go to that website you'll find out there's a study called, "Manpower Predictions for Canadian Orthopaedic Surgeons". That's a pretty distressing little study they have there because what you'll find is that they train about 45 orthopaedic surgeons a year and the average, historically over the last decade, is that 28 leave each year. Now that is something that you have to ask yourself – why does that happen? Training to be an orthopaedic surgeon involves 5 years of just brutal, brutal, brutal hard work and why would you lose an asset like that.
In the law firm that I work in if we have a producer or if we have someone who is smart and does a lot of finance and does legal work, we keep that person happy. We make sure that that person is not disillusioned. When you look at this you sort of say – why are these people leaving? Well one of the reasons is they don't have enough operating room time. If you train for 5 years to be a surgeon you kind of think when you come out you like to operate. If you're a professional basketball player it comes in handy if you get to practice once in a while. They are only 85% occupied. That's one of the reasons that they leave. If you look at the projections in the future there are about 2.3 over 3 orthopaedic surgeons per 100,000 populations. But the demographics are going this way and the surgical population is going that way. It's going to be about 2 in the next 30 years. Meanwhile a lot of people are getting older.
So I looked at this and I sort of said – I can't solve the problems in the health care system but one part that really sticks out to me in this little area that I know a lot about and I don't know anything about any other areas is this manpower issue and how is that going to be solved. In my view, there are three things that you have to do to solve it. You have to make sure that you give these individuals the resources. You have to make sure you give them respect and probably have to pay them what they're worth. When I look at this again, this little problem, in this little area, I am reminded of a phrase and I don't know where it came from but I remember reading it a couple of years ago and this phrase was – "Canada eats its achievers". Well these are some achievers that we shouldn't be eating and I think that we should be very careful about that.
How can private health care help us? Well, I think the only way that it can help is if you're a surgeon and you're working 85% of capacity and you need some operating room space and for one reason or another public health care system can't give it to you, private system comes along and says – listen you can moonlight over here. That's a good thing for people. If you spend 5 years in a residency, the average Canadian medical resident is about one quarter of a million dollars in debt by the time they get out, you would kind of like to start working and you would kind of like to be fully employed. It would be nice if the public health care system could provide full employment for these individuals but for one reason or another and I confess I don't know why, it hasn't been able to do that. So I think that job number one in this area is to retain the people that we train at great expense and number two to fully employee the people that we have. Number three it would be nice if we could coax the people back. But you can't do that when you say to a surgeon – sorry you've got to put your feet up on your desk because you can't get an operating room. That's my two cents worth on this and I guess its time to take questions if anybody wants questions of any of the panel we would be happy to hear them.