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Fraser Health has directed surgeons to reassess patients who have been waiting more than 40 weeks for surgery, in part to avoid financial penalties that kick in if waiting periods last more than 52 weeks.

Rafal Gerszak/The Globe and Mail

Fraser Health has directed surgeons to reassess patients who have been waiting more than 40 weeks for surgery, in part to avoid financial penalties that kick in if waiting periods last more than 52 weeks.

The Canadian Taxpayers Federation (CTF), which obtained and released a Fraser Health memo about the directive, says it amounts to using a loophole to avoid $2.5-million in fines. The health authority, however, says it is simply doing all it can to meet provincial standards and improve patient care.

"Like all good health-care institutions, we are worried about timely access to surgical services for our patients," Peter Blair, Fraser Health's program medical director for surgery, said Thursday. "So we are flagging patients who are coming up to 52 weeks – in other words at 40 weeks … we are asking the surgeon to reassess the patient to remind them [surgeons] that they have to get that patient done as soon as possible, so that they don't pass 52 weeks."

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The order comes as Fraser Health, which named a new president and CEO this month, is implementing the recommendations of a July review ordered last November after the health authority – the biggest and fastest-growing in the province – failed to meet its budget.

In its statement, the CTF had said it was "unclear" whether patients who were reassessed at 40 weeks would be pushed back to the beginning of the waiting list. Dr. Blair emphasized that would not happen.

"They don't start back at zero – it's important to understand that," Dr. Blair said. "What we are trying to do by sending them back is to say, 'Hey, Dr. Brown – Mrs. Smith needs to get this surgery done as soon as possible.'"

B.C. Health Minister Terry Lake also said there would be "no resetting of the clock" as a result of the directive.

"This is an initiative to connect surgeons with their patients that have been waiting for more than 40 weeks, to make sure their health hasn't deteriorated, that they still require the surgery, that they still want the surgery – some of these are elective surgeries – and it is an impetus to get the surgeons to have their patients get the surgery within those 52 weeks," Mr. Lake told reporters in Victoria. "This is proactively making sure people aren't on a waiting list too long."

David W. Jones, a general physician and the former medical director of Burnaby General Hospital, a Fraser Health facility, said surgeons are limited in what they can do to tackle waiting lists. At Burnaby General, for example, budget constraints mean that only six of 10 operating rooms are regularly used, he said.

"If Fraser Health and/or the ministry is putting it back to the surgeons to say, 'You have to manage your waiting list better – that's kind of impossible if the surgeon can't do anything about their growing waiting list because they don't get the operating room to do the work," Dr. Jones said.

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In a Nov. 4 memo released by the CTF, Dr. Blair and another Fraser Health director, Judith Hockney, said the percentage of cases on the waiting list for more than 52 weeks had dropped from around 10 per cent to about 4.5 per cent over the past year.

"However, there still remains a volume of patients whose bookings are causing financial penalty. It is imperative for the interest of all, including our patients, that we use every available strategy to avoid penalties," the memo states.

No penalties were assessed last year, the Health Ministry says.

Surgical waiting times are an issue across the country. According to the Canadian Institute for Health Information, the percentage of surgeries done within benchmark time frames last year in B.C. ranged from 65 per cent for knee replacements to 83 per cent for hip fracture repair.

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