Surgeries at for-profit orthopedic clinic already impacting hospital staffing, some insiders say

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The Ontario NDP is asking the province to investigate allegations that cancer patients waiting for surgery are being bumped by clients of the for-profit clinic operating at the Riverside campus of The Ottawa Hospital.

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“This for-profit clinic has been offering nurses double the wages they normally earn, and now our public ORs do not have the staff capacity to help cancer patients waiting for surgery,” Ottawa Centre MPP Joel Harden said Tuesday during Question Period at the Ontario Legislature.

“That is what I am being told by hospital staff who fear repercussions for speaking publicly.”

This newspaper has spoken with a source inside the hospital, who said an upcoming plan to address backlogged cancer surgeries at The Ottawa Hospital was curtailed because of concerns that nurses would not be available to manage patients. The source, who has direct knowledge of the issue, asked to remain anonymous because of fears of reprisal from hospital management.

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The Ottawa Hospital denies that the orthopedic clinic is negatively affecting staffing at the hospital. In the Legislature, Health Minister Sylvia Jones sidestepped the NDP’s question but said the government’s Bill 60 will address all surgical backlogs by allowing more private and standalone clinics to open in the province.

File photo: Ontario Premier Doug Ford and Minister of Health Sylvia Jones. January 20, 2023
File photo: Ontario Premier Doug Ford and Minister of Health Sylvia Jones. January 20, 2023 Photo by Mike Hensen /POSTMEDIA

According to the source and to other information seen by this newspaper, an oncology surgery blitz planned for this spring at The Ottawa Hospital was trimmed from four days to three days because of concerns about finding nurses to work in the recovery room on Saturday. It is unclear whether any of those patients were moved to other surgical slots.

Saturday is the day the private group called the Academic Orthopaedic Surgical Associates of Ottawa (AOAO) rents operating room space at the hospital’s Riverside campus to perform hip and knee replacement surgeries — an initiative aimed at reducing long waits for joint surgery that has been applauded by provincial officials. The surgeries began on Feb. 25 and have taken place each Saturday since then.

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AOAO is paying registered nurses $750 a day and registered practical nurses $550 a day for a 10-hour shift, which represents a significant premium over their regular pay.

The source said the decision to reduce the oncology blitz from four days to three is evidence that the private oncology clinic is already squeezing the public system.

“We are not able to provide the service we want for oncology patients because nurses are working in a higher paid environment,” said the unnamed source. “My view is that this is confirming the concerns that we are limited in terms of the service we can provide in the public system because nurses are obviously being poached by this private clinic.”

Read more: As some Ottawa cancer patients wait longer than the provincial average for surgery, calls for transparency of orthopedic clinic grow

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The hospital denies the orthopaedic surgery clinic has had any negative impact on cancer or other surgeries, something it is monitoring as part of its agreement with AOAO.

“We continue to perform all planned surgical oncology cases and the AOAO weekend activity does not have an impact on our plans to continue increasing oncology surgery and all other surgical activity,” said hospital spokesperson Rebecca Abelson. “There is a commitment to not impact the hospital’s human resources.”

Beyond monitoring, some staff members are asking what safeguards are in place to prevent staff poaching, given the fact that the hospital already has more than 500 vacancies for nurses.

Insiders also say the hospital is being tight-lipped about the private clinic. One medical professional, speaking to this newspaper on the condition of anonymity, said he only learned about it from a newspaper article. Others say they have received limited answers to their questions, according to information seen by this newspaper.

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A second physician, also speaking on background, was highly supportive of the orthopaedic clinic, saying it is already proving more efficient than the hospital itself and might have lessons for many specialties. A crucial difference, he said, is that outcome-based work, where you work until a certain numbers of surgeries are completed, for example, is more efficient than shift-based work.

But he conceded it will likely have a negative impact on hospital human resources, at least in the short term.

“Is this going to make things worse before it makes things better? Oh yes, 100 per cent. You have a fixed pie of human resources. The nurses might be working Monday to Friday and adding Saturdays for now, but eventually, they will stop working Thursday and Friday and that will have to be backfilled.”

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Some health professionals are worried the hospital’s pre-admission clinic will be overwhelmed by the AOAO patients, according to details seen by this newspaper.

All surgical patients must go through the hospital’s pre-admission clinic, where nurses and other medical specialists, including anesthesiologists, take information and might do blood and other tests to prepare patients for surgery.

Questions are being raised by some insiders about whether the clinic has the capacity to absorb an additional 10 patients a week without the risk of further delaying surgeries, according to information seen by this newspaper.

“These patients are taking up spaces in the clinic and that is preventing other patients from accessing the clinic,” said the source.

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The hospital, in its statement, said the pre-admission clinic is not understaffed and is able to manage the additional 10 AOAO cases “without any impact to the clinic or other activity.” It also said all costs are accounted for as part of its agreement with AOAO.

“The rental agreement includes all services and associated costs provided by TOH. These costs plus charges from AOAO are all accounted for as part of the agreement and the costs are well within the funding envelope.”

Prior to the AOAO agreement, it was not uncommon for staff shortages to impact some surgical services, including urgent surgeries on weekends.  Among other things, some staff have said it is now more difficult to call in casual or part-time nurses. The General campus emergency department has one of the longest wait times in the province.

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A key question being raised by some is whether the orthopedic program will ultimately give some surgical patients an advantage at the expense of others.

Few details of the agreement between the hospital and AOAO have been made public. AOAO says it is supplying its own instruments and equipment but it is unknown how much rent it is paying for the operating space.

The hospital says the patients are Ottawa Hospital patients on wait lists whose surgeries are covered by OHIP and are fully funded by the province. The hospital has described the use of previously idle operating rooms on Saturdays as a cost recovery initiative. Without it, the hospital says, it didn’t have enough staff to do the number of hip and knee surgeries the province has agreed to pay for. The agreement with AOAO helps close the gap.

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The doctors behind the private corporation say the new model of care will help relieve the surgical backlog as well as their patients’ distress and pain.

The initiative has drawn attention across the province at a time when the Ontario government wants to see more innovation in the way health services are delivered — including from more private, for-profit clinics.

The NDP’s question in Question Period Tuesday came just days before Bill 60, a bill to reduce surgical backlogs by allowing more private clinics to open and perform surgeries, is expected to pass.


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