When Mr Stanley tracked down Dr Livingstone on the shores of Lake Tanganyika he greeted the doctor with the now famous phrase “Dr Livingstone, I presume?” Dr Livingstone replied “Yes, I feel thankful that I am here to welcome you”. Dr Livingstone was thankful but very ill; still he refused to leave Africa until he found the source of the Nile. Unfortunately he died before achieving his goal.
Henry Morton Stanley meets David Livingstone in Ujiji, 1871. (Photo credit: Wikipedia)
As I plowed through the transcripts of the Preferential Access (Queue Jumping) Inquiry, I was struck by the testimony of two intrepid physicians—Drs Love and Boswell—who like Dr Livingstone refused to give up their search for justice until they’d reached their goal. Unlike the unfortunate Dr Livingston, Drs Love and Boswell were successful.
Note to reader: from this point forward you’re going to meet a lot of doctors…stay with me.
Dr Love is a gastroenterologist and site chief at Foothills Medical Centre. He sees patients at the University of Calgary Medical Centre and the Forzani & MacPhail Colon Cancer Screening Centre (CCSC).
Dr Boswell is a general practitioner who performs pre-assessments at CCSC. She’s married to Dr Love.
In 2010 Dr Love heard rumours that patients from the Helios clinic, a private facility providing concierge medical service to well heeled patients, were being treated differently than the 14,000 people on the CCSC waiting list (2454)*
He was troubled that a patient rated “moderate priority” had been booked for a colonoscopy four days after referral. The usual wait time for a “moderate priority” case is 10 months. Other than her file being tagged “as per Dr Bridges” (2444), there was nothing to indicate an urgent priority, other than perhaps a referral letter from her Helios physician, Dr Caine, that indicated a relationship between him and Dr Bridges (remember Dr Bridges, he figures prominently in this story) and the fact that the patient was leaving for her winter home in Mexico in two weeks (2463).
Dr Love paid a visit to the Helios clinic and was treated to a tour by Dr Caine, who described Helios as a “reward for the philanthropic community of the University of Calgary”. Dr Love’s reaction: “it’s not really charity if you get a reward” (2450). He tightened CCSC procedures and asked Ms Barbara Kathol, an executive at Foothills Hospital, to speak to Dr Rostom, the medical director and boss of CCSC.
The Kathol/Rostom conversation had an impact and the rumours of queue jumping died down…only to resurface in 2011. This time the concern was raised by Dr Love’s wife, Dr Boswell, who noticed that the Helios patients were moving through the queue more quickly than the rest. After investigating she learned that the Helios charts were colour coded and booked through a special booking clerk (Olga).
Dr Boswell raised her concerns at a meeting with Dr Rostom, CCSC boss, and his colleague Dr Hilsden. They “kind of looked at each other and Dr Rostom said ‘This is not a hill we want to die on’”(2485).
At that point the intrepid Dr Boswell took matters into her own hands. She called the Helios clinic from her home phone and asked how to get a patient into the clinic. She was “grilled” by the receptionist and was so “spooked” that she hung up (2487).
Drs Love and Boswell took their concerns to Dr Swain, the head of gastroenterology at the University of Calgary and Foothills Hospital. Dr Swain is a quirky fellow who describes himself as a “clinical scientist…80 percent of my time, I spend with mice” (2385)
While the practice of flagging a Helios file had subsided, there was still a major problem at CCSC. It appeared that Dr Bridges (remember him, the “as per Dr Bridges” note on the file of the patient going to Mexico?) was booking patients on to his own list. This gave Dr Bridges an opportunity to accelerate his own Helios patients at the expense of CCSC patients.
Dr Swain took the concern to Ms Kathol (she’s the executive that Dr Love sought out originally—clearly a woman with ethics and courage). Ms Kathol took the matter up with Dr Rostom, the CCSC boss, who issued a strongly worded memo warning against this practice.
So why didn’t anyone confront Dr Bridges directly? Dr Swain sums it up in a nutshell: Dr Bridges is a very powerful man and one of the most significant people in the Faculty of Medicine (2397).
He’s the head negotiator for the alternate funding plan (AFP) between the University, the government and Alberta Health Services—AFP pays the salaries of all of the academic physicians (2398).
He has friends in high places and is a director of CCSC with a voice in who gets reaccredited each year. The loss of accredition would result in a “significant financial loss” to doctors who would no longer be allowed to perform colonoscopies at CCSC (2399).
And as if that wasn’t enough, Dr Bridges was Dr Rostom’s first boss at CCSC. Their friendship dates back to their medical school days.
So in the words of Dr Swain, you’d need a lot of self-confidence to complain to Dr Bridges about Dr Bridges.
Aren’t we lucky that Drs Love and Boswell have the courage to “die on this hill” by fighting the Helios expedited list and testifying about it at the Inquiry instead of staying silent? It’s the only way we’ll ever get to the front of the line.
* All references are to page numbers from the Preferential Access Transcript.
Susan on the Soapbox 
Wow, I’m going to need a playbook for this blog. Terrible thought “selective waiting lists”. Approximately 29 years ago when I gave birth to a son, I shared a room with 2 other mothers. Between the three of us we had 2 boys and 1 girl and circumcising our boys was considered cosmetic surgery. With nothing better to talk about we compared notes and it turn out I paid $25.00 more to circumcise my son. I asked my doctor why the difference in prices and the answer I got was “I have an ex-wife and her doctor is single.” Twenty-nine years later and we still have the haves and the have nots.
Rose Marie, what’s really shocking about your story is that your doctor made no effort to disguise his rationale which boiled down to “I need the money and you can’t do anything about it”. There’s something wrong with a fee structure that allows doctors to play around like that. There’s something even more wrong with a health care system that pushes a poorer and sicker patient out of the way so that a richer and healthier patient can stay on schedule for a trip to Mexico.
Susan no real surprise to me. These are just the first steps of two tiered health care system and as you can see it works just fine. What is it about humans that cannot exist without being corrupt and predatorial. It is also fascinating how many levels in that medical department. How many people does it take to manage a few doctors doing colonoscopies? While reading your post I had to write down who was the boss of the next boss
Carlos, you’re right, there were so many doctors involved in this story it was hard to keep track, but all it took was two doctors and three clerks to blow the lid off of Helios. All of them showed remarkable courage by coming forward and testifying. Can you imagine what would have come out if this had been an inquiry into physician intimidation? Mind boggling.
Susan I agree and I am glad that at least people that have some power in our society take the lead. For most of us showing this kind of courage has way more consequences and we do not have the income to pay for them.
I really think that way more of this is happening and as far as doctor intimidation, if they did go there it would have been a tsunami.
This government is on the ropes and about to do what Klein did when in desperate position – cuts left and right and nothing else. I still think she will not survive the 4 years. If she does the PCs will be dead next election finally. It is hard to believe what they have done with our finances. I could not watch her more than a couple of minutes. She has the body language of a frozen seal. Nothing but spin.
I attended that Friday hearing and encourage others to attend when the hearing resumes in Calgary on Feb. 19th. Credit needs to be given also to the three clerks who testified early in the week. For a while, a suggestion was floated that it could have been a rogue clerk who fast tracked the private clinic patients to the front of the line. This view has since been laid to rest. If I recall, Dr Swain was a scientist on the Heritage committee for a number of years before the govt pulled the plug on funding. He lead of the the morning with his testimony and that set the tone for Ms Kathol, Dr. Love and Dr. Boswell later in the day. All displayed a remarkable courage along with professional ethics and integrity. These hearings may have started in a benign manner, but they have certainly taken a different direction.
It will be very interesting to hear Dr Bridges’ testimony. No doubt he’ll be represented by a top tier law firms and well prepared for whatever comes at him. On the point of lawyers, one wonders whether the class action lawyers are poring over the transcripts to see if there’s enough here to launch a class action law suit on behalf of the patients who had a a higher priority but were bumped by Helios clients with a lower priority. As you said Ted, this inquiry has gone in a dramatically different direction than anyone imagined at the outset.
Hi Susan,
I have been trying to keep up with your fine reviews of the inquiry.
It is very interesting to have you make stories of them for us and I could almost believe this was all a fictional tale except that I know it is true.
In Alberta, doctors have always been regulated by the hospital boards in their communities before we got these mega-boards. The small community hospital boards had the power to remove hospital privileges from their employees and so the politics of keeping your hospital privileges was confined to local communities.
But now?
I think the AHS board –the super-Borg board created by the Alberta Government has all the doctors in the province by their balls and I have to say that I am surprised that any doctors had the guts to say squeak in this inquiry.
I mean just one flick of the pen and these yappy doctors could lose their hospital privileges.
Or be forced to flee the country.
I’m not sure if these doctors are just plain foolish and don’t know that their careers might get derailed by their blabbing or if they are extremely ethical people who don’t give a darn if their careers stagnate and their incomes shrink (remember Dr. Fanning? She had to work abroad after yakking too much about T.B. patients).
I hope to look at the inquiry transcripts in their full bloom soon.
Thanks so much for giving us these cheering details (that some people in Alberta aren’t entirely cowed in medicine by the Borg Board of AHS).
Julie, The doctors who testified were, for lack of a better term, subpoenaed. That means that they were compelled to be there to answer questions. They displayed remarkable courage and ethics in providing information based on what they experienced. In my view, they are to be applauded for that. Nevertheless, I would imagine that potential risks to their careers may have been top of mind given that they would be returning to the location where these incident have been alleged to have happened.
I agree Ted. It will be interesting to compare the frank and open testimony of the doctors with Dr Bridges’ testimony. I have a feeling that Dr Bridges will not be anywhere as candid as Drs Love and Boswell.
Julie, I too had that “this has got to be fiction” feeling when I read the transcripts. There were so many weird bits that I couldn’t get them all into the blog. Dr Boswell (the wife) said that after she had the unsettling experience of being grilled by the staff at Helios she looked them up on the web. She said it was a great website. A few days later when she tried to show it to her husband, Dr Love, the site had been taken down. It was “under construction” and hasn’t been seen since. The newspapers have tried to reach senior management at Helios but the response is consistently “no comment”. Everyone is working very hard to stay under the radar but it’s too late now. I’m really looking forward to Dr Bridges’ testimony on Feb 19th. Could be very interesting.
Just read the infomercial last night by our illustrous premier and also some comments about it. What a gong show. We are all paying the price of a democratic system that does not work along with organized irresponsibility of the highest level. For 41 years they have been playing the fiddle and now what? It is the BITUMEN BUBBLE. Like an asteroid that came from nowhere and no one knew about it.
Now the solution – cuts left and right without any intelligent plan as usual. This is I believe the fourth time I have seen this in Alberta. These are then the same people that point the finger to people like Chief Spencer and ask what she did with her 90 million dollars budget. It is to say the least a shame.
The problem is that we are so addicted to incompetence we do not realize anymore what is quality management. We are now in the consulting spinning era. Make up artists to make them look good and lies to complement it. These politicians and experts have done to politics what MacDonalds has done to Gourmet Food.
Journalists are happy now. Something more news worthy than the inquiry that they have avoided like the plague.
So the world goes until we all have to face the real hidden reality.
Thanks Carlos. I caught the Premier’s “Bitumen Bubble” speech as well. It was bizarre. I’ll be blogging about it this weekend. Stay tuned.
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