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Health-care line-jumping a fact of life, Alberta inquiry told

Dr. Nicholas Mohtadi, an Orthopaedic Surgeon and Director of the Sport Medicine Centre at the University of Calgary talks to patient Tori Orosz about her knee on Wed., Dec. 7, 2011. The Acute Knee Injury Clinic pilot project (funded by Alberta Health Services and run through the University of Calgary's Kinesiology Department) has come up with an innovative, cost-effective approach to treating acute knee injuries that is improving access and reducing wait times for patients.

Chris Bolin/The Globe and Mail

A knee surgeon says queue-jumping occurs all the time because Alberta's health care is so broken that people with connections will naturally do whatever they can to get timely help.

Nicholas Mohtadi told a preferential access inquiry Thursday that he and a "majority" of surgeons are pressed by friends and colleagues for fast-track examinations that then allow patients to immediately get on waiting lists for surgery.

Dr. Mohtadi testified that doctors see those patients, but always outside office hours so that no one who is on the regular list gets bumped.

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"Isn't this circumventing the wait time that ordinary patients like myself would have to undergo?" commission head John Vertes asked Dr. Mohtadi.

"Yes, absolutely," the Calgary surgeon replied.

Dr. Mohtadi said he and other doctors often debate the ethics of fast-track consultations.

"It's a very frustrating process," he said.

"[But] because of [wait-list bottlenecks] this is always going to occur.

"People are going to try and get in and see people like me any way they can."

He suggested it's unfair to force doctors to turn their backs on people they know personally or professionally because the system doesn't function properly between 9 a.m. and 5 p.m.

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"The appropriate response is that that patient should be able to demand as an Albertan a standard of care that is acceptable to anybody in this room," Dr. Mohtadi told lead commission counsel Michele Hollins.

"As a taxpayer, it's not acceptable that you have to pick up the phone and use influence to get through the system.

"We should have standards [of care] that we agree upon that will allow us to solve some of these problems."

Dr. Mohtadi said MRIs are one example of uneven standards. Some doctors, he said, refuse to see a patient for a knee injury without an MRI being done first, even though the test may not be necessary for an accurate diagnosis.

The result, he said, is patients waiting longer for care and needlessly gumming up waiting lists.

He said consequences for patients can be profound. A ruptured knee tendon, for example, needs to be operated on within a matter of weeks at the most or the joint will develop arthritis "and be damaged irreparably for life."

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Dr. Mohtadi told the inquiry he is not interested in a solution that would prevent doctors from seeing people not on the regular waiting list. He said he has opened a clinic in Calgary focusing on knee repairs for athletes and other patients as one way to clear up waiting-list bottlenecks.

Dr. Mohtadi was the second doctor to testify at the inquiry about treating patients outside regular hours.

Last month, Raj Sherman – leader of Alberta's Liberals and an emergency room doctor – told Ms. Hollins that he would treat fellow politicians in his legislature office for minor ailments such as rashes.

That led Ms. Hollins to challenge Dr. Sherman, a sharp critic of government queue-jumping, of being culpable of similar out-of-bounds behaviour. Dr. Sherman called it "professional courtesy."

Dr. Sherman later told reporters he didn't mind the grilling but said the inquiry had a double standard, asking hard questions or soft ones depending on the witness.

On Thursday, Ms. Hollins did not rigorously challenge Dr. Mohtadi when he told her about seeing favoured patients out of turn.

And when Dr. Mohtadi – in response to Mr. Vertes's questions – later admitted he considered his actions queue-jumping, Ms. Hollins was again on her feet, but only to tell the inquiry she was finished.

"Those are all my questions," she said.

Also Thursday, the chairman of Edmonton's former Capital Health region told the inquiry during he was not aware of any VIP patients getting better or faster care.

"This wasn't part of our culture," testified Neil Wilkinson, who now works as Alberta's ethics commissioner.

Mr. Wilkinson was chairman of the region until the board – along with eight other boards – were folded into the current Alberta Health Services Superboard in 2008.

He also testified he wasn't aware that former Capital Region CEO Sheila Weatherill was directing her staff to have doctors and nurses keep tabs and report back on the care being given to so-called VIP patients.

Ms. Hollins asked Mr. Wilkinson whether those calls – which both Ms. Weatherill and her staff have testified took place – would have been acceptable to Mr. Wilkinson and the board.

Mr. Wilkinson deflected answering, dismissing the issue as "hypothetical." He suggested if the calls took place, it's nitpicking.

"[I know] you've got a job to do," he told Ms. Hollins. "[But] there was so much going on in the health-care system.

"People worked 18 hours a day. Board members were studying material they had been given long into the night.

"People were giving their all for this system."

Testimony is set to continue Friday at the $10-million inquiry, which was called by Alberta Premier Alison Redford but operates independently of her government.

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