Breast cancer surgery backlog: Women going to private Montreal clinic


Personal clinics are usually not legally allowed to supply providers lined by the Canada Well being Act. However there’s a loophole.

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By the point Lisa met with a breast most cancers specialist final fall to debate surgical procedure, frustration and panic had been setting in.

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The Ottawa girl had found a lump on her breast greater than six weeks earlier. With no household physician, she navigated the well being system largely on her personal earlier than a biopsy confirmed she had an invasive type of most cancers. It was nonetheless at an early stage, however had unfold to her lymph nodes.

She wished it out as rapidly as attainable earlier than the most cancers unfold additional. However when she met with a surgeon at The Ottawa Hospital in late October she was instructed the surgeon solely had one date in December and he or she would not going get in to surgical procedure till January as a result of there was so little working room time accessible to breast most cancers surgeons.

She heard from others that these surgical procedure dates are generally pushed again additional. She knew she couldn’t wait that lengthy.

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Lisa, who’s now retired from the Canadian army, skilled abuse throughout her profession there which contributed to her psychological well being struggles. This newspaper has agreed to not use her actual identify to guard her privateness.

“There was no manner I used to be going to make it by way of the winter and Christmas. I’ve psychological well being points already. I knew I’d go downhill actually quick,” she stated.

The next week, she contacted VM-Med Montreal Breast Heart, which describes itself as the most important personal breast centre in Canada. Lisa had completed her homework, together with talking with one other Ottawa girl who lately had surgical procedure on the Montreal clinic. Lisa went for a seek the advice of a couple of days later, paid a deposit, and was in surgical procedure 10 days after that.

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Lisa is one in all a rising variety of Ottawa breast most cancers sufferers who’re turning to non-public surgical procedure as a result of the wait within the public system is so lengthy. Sufferers, assist employees and the Montreal clinic itself have confirmed the development. A spokesperson for the clinic stated they’ve seen a rise in sufferers coming from Ottawa since final fall. Sufferers who’ve gone to Montreal for surgical procedure share their experiences with others in breast most cancers assist teams. Some sufferers are utilizing a major chunk of their financial savings to take action.

Lisa paid about $50,000 for surgical procedure. That included a double mastectomy, breast reconstruction, sentinel lymph node removing and follow-up. It’s a determine she doesn’t share with many individuals. “Most peoples’ chins would drop to the ground,” she stated. A double mastectomy prices about $15,000 on the personal clinic. A lumpectomy is lower than $5,000.

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She was happy with each the pace and the standard of care she obtained and understands why different Ottawa sufferers are additionally looking for personal breast most cancers surgical procedure in Montreal.

“Phrase is getting out, clearly, as a result of the wait is unacceptable.”


Gail Kelpin will have waited six months for breast cancer surgery when it takes place later this month. The Ottawa Hospital has some of the longest waits for breast cancer surgery in Ontario.
Gail Kelpin could have waited six months for breast most cancers surgical procedure when it takes place later this month. The Ottawa Hospital has a few of the longest waits for breast most cancers surgical procedure in Ontario. Photograph by Jean Levac /POSTMEDIA

As backlogs have grown in current months, pissed off surgeons have begun mentioning personal surgical procedure as an possibility, sufferers say.

The mere suggestion from her surgeon shocked Christine MacMillan.

“I used to be shocked after they instructed personal,” stated MacMillan. “That is our nice Canadian well being care system?”

MacMillan, 59, was recognized with early-stage breast most cancers in October. She met with a surgeon at The Ottawa Hospital on Nov. 7 and was instructed she would have surgical procedure initially of January. That date was later bumped again to early February.

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The wait, she says, was torture.

For Ottawa’s Gail Kelpin, the wait continues.

The 55-year-old could have waited about six months when she has surgical procedure later this month — 24 weeks after assembly with a surgeon and a full 27 weeks after she was recognized with most cancers. That’s about double the goal time designated by the province. Previous to the pandemic, the anticipate breast most cancers surgical procedure at The Ottawa Hospital was between eight and 10 weeks.

Throughout that interval not one, however two, surgeons instructed she think about personal surgical procedure. One even instructed Kelpin, who travels incessantly for work, could have to go to a different nation.

“That is mistaken for therefore many causes,” stated Kelpin. Not simply due to the price of personal surgical procedure, which most individuals couldn’t afford, however she has different issues. Chief amongst them is what it means for the general public well being system.

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Below federal regulation, personal clinics are usually not legally allowed to supply providers lined by the Canada Well being Act. However there’s a loophole that enables sufferers to exit of province for personal surgical procedure. The Supreme Courtroom of Canada lately determined it will not hear an attraction from Vancouver-based doctor Dr. Brian Day who has been difficult the well being care system for years over the suitable to entry personal care when the general public system isn’t in a position to provide well timed care, which is seen by some as a victory for public well being care in Canada.

Critics have lengthy argued that personal clinics create a two-tiered system that makes it simpler for the rich to get well timed therapy.

Kelpin didn’t wish to have personal surgical procedure. Nor did she wish to leap the queue. However she is pissed off and offended. She worries about different sufferers who’re much less possible or in a position to converse up for themselves.

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“This has been six months of making an attempt to not be pressured and making an attempt to fake it’s OK,” she stated. “That is presupposed to be one of many pre-eminent breast most cancers centres within the nation. That is the place we’re at.”


Dr. Jean Seely, a radiologist and researcher at The Ottawa Hospital, says the long waits for breast cancer surgeries could be fatal.
Dr. Jean Seely, a radiologist and researcher at The Ottawa Hospital, says the lengthy waits for breast most cancers surgical procedures could possibly be deadly. Photograph by Julie Oliver /POSTMEDIA

The Ottawa Hospital has a few of the longest waits for breast most cancers surgical procedure within the province.

Ontario’s goal wait instances for surgical procedure, after assembly with a surgeon, are 84 days for precedence 4 sufferers, 28 days for precedence three sufferers, and 14 days for precedence two sufferers. The decrease the precedence quantity, the extra superior the most cancers is and the extra rapidly sufferers have therapy.

In January 2023, solely 13 per cent of sufferers at The Ottawa Hospital’s Basic campus went from a choice to have surgical procedure, to surgical procedure inside the goal time set by the province, in response to information from Ontario Well being. Meaning they waited considerably longer than a interval deemed affordable and secure by well being officers. The provincial common is 71 per cent.

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On the hospital’s Civic campus, 21 per cent of breast most cancers sufferers had surgical procedure inside the goal time. On the Riverside campus, that quantity was 55 per cent.

At Queensway Carleton, 95 per cent of sufferers go from a choice to have surgical procedure to surgical procedure inside the goal time. At Montfort, that quantity is 50 per cent.

The Ottawa Hospital says it’s taking motion — together with creating a regional most cancers technique “to scale back general wait instances to make sure sufferers get care sooner and nearer to house,” in response to spokesperson Rebecca Abelson. The hospital has added extra working room time in April and Might and is “exploring all alternatives to broaden care capability all through the affected person’s journey.” It’s also creating a regional central consumption system for screening, prognosis and therapy that includes all regional hospitals.

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The hospital can be working with the Ministry of Well being to construct surgical capability.

It’s not simply breast most cancers sufferers who’re in lengthy queues. Wait instances for all surgical procedures have grown through the pandemic, together with a report variety of so-called “long-waiters”, in response to the province’s monetary accountability officer. Current analysis from the Canadian Institute of Well being Data discovered that waits for joint surgical procedure grew through the pandemic, as did waits for breast, bladder, colorectal, lung and prostate most cancers surgical procedures.

Surgical wait instances in Ontario are divided into two elements: The primary is the interval from referral to an preliminary appointment with a clinician. Ninety per cent of sufferers at The Ottawa Hospital’s Basic campus are seen inside the provincial goal time for the primary wait. It’s on the surgical stage that issues break right down to an extent not seen at different main hospitals across the province.

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The waits can have lethal penalties, stated Dr. Jean Seely, who heads the Breast Imaging Part at The Ottawa Hospital and is the regional breast imaging lead for the Ontario Breast Screening Program.

“That is taking a heavy toll on sufferers, affecting their well-being and bodily well being. Some sufferers have been ready since Oct. 2022 with a prognosis of breast most cancers and haven’t but been surgically handled. These delays will have an effect on vital lack of lives to breast most cancers till they’re addressed,” she stated.

Analysis revealed within the British Medical Journal in 2020 discovered that the chance of dying to breast most cancers sufferers will increase by six to eight per cent for each 4 weeks their surgical procedure is delayed. One other research revealed within the journal BMC Surgical procedure in November 2022 discovered that a delay in breast most cancers surgical procedure of greater than eight weeks was inversely related to survival for all sufferers.

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These findings are frighteningly related for sufferers at The Ottawa Hospital. “There are at the moment unprecedented wait instances for breast most cancers surgical procedure at The Ottawa Hospital,” stated Seely.

The hospital, in an announcement, acknowledged that wait instances for breast most cancers surgical procedure are rising.

“We all know this has been a really irritating time for sufferers whose surgical procedures had been rescheduled, or who’ve needed to wait longer than anticipated,” stated Abelson.


VM-Med clinic on Sherbrooke and Guy on Monday April 10, 2023.
VM-Med clinic on Sherbrooke and Man on Monday April 10, 2023. Photograph by Pierre Obendrauf /POSTMEDIA

When The Ottawa Hospital started renting its working rooms on the Riverside campus earlier this 12 months to a non-public firm to carry out hip and knee operations on Saturdays, many breast most cancers sufferers requested why their surgical procedures couldn’t even be completed exterior of normal Monday to Friday daytime hours to scale back the backlog.

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“I’d have gone in at midnight,” stated MacMillan.

Wait instances for orthopedic surgical procedures in Ottawa are additionally above provincial averages, though the Saturday surgical procedures are starting to scale back that record. There are plans to ultimately do extra in a standalone personal clinic affiliated with The Ottawa Hospital.

Some critics of the orthopedic pilot mission have raised issues that it’s going to poach workers from the hospital and that may additional restrict its skill to compensate for different surgical procedures. Final month, this newspaper realized {that a} plan to compensate for backlogged most cancers surgical procedures on the hospital was trimmed again from 4 to a few days due to staffing issues on a Saturday when the orthopedic clinic was working.

Seely notes that many breast most cancers sufferers have already waited longer than they need to by the point they meet with a surgeon to debate surgical dates. Earlier than the pandemic, waits for breast biopsies at The Ottawa Hospital had been averaging three to 4 weeks. Now they common seven to eight weeks, with some folks ready so long as 12 weeks for his or her prognosis of breast most cancers, she stated.

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“That is unprecedented,” she stated.

Kelpin stated she understands why folks would foyer to maneuver up the queue or search for different choices, though she waited almost six months for her personal upcoming surgical procedure at The Ottawa Hospital — they’re scared.

“I’m simply upset that we’ve got come thus far with the system. Persons are making an attempt to determine how you can work round it, not as a result of they’re dangerous folks, however as a result of they’re determined,” she stated.

“I don’t blame the medical doctors and nurses. That is killing them too.”

Kelpin notes that Ontario has an environment friendly screening system that comes with the message that early detection saves lives, however the well being system can’t observe up rapidly.

“(It) places folks on this place of giving them data to say you’ve got most cancers and it has to return out or it might worsen sooner or later … nevertheless, they don’t have sufficient time or workers to do it in a well timed manner.”

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For Ottawa’s Julie Fantastic the choice to hunt personal therapy and surgical procedure was simple. She was recognized with early-stage breast most cancers in March 2020, simply as hospital working rooms had been shutting down for all however pressing surgical procedures due to the pandemic.

VM-Med in Montreal remained open and Fantastic was in a position to get in rapidly. There was no manner of figuring out how lengthy she would have needed to wait within the public system because the pandemic progressed.

Learn extra in regards to the loophole within the Canada Well being Act:

A loophole within the Canada Well being Act is fueling the expansion of personal drugs for sufferers from out of province

Fantastic was recognized with Stage 1 most cancers however was conscious that if she waited too lengthy, it might unfold, turning into Stage 2 and even far more superior Stage 3 most cancers, which is extra complicated to deal with and might have worse outcomes.

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“I didn’t have an possibility,” she stated. “Every part was suspended indefinitely.”

She had a collection of operations at VM-Med, beginning with a biopsy and together with two lumpectomies and a subsequent mastectomy.

Fantastic, a retired instructor who has three teenaged youngsters along with her husband, an entrepreneur, was proud of the pace at which she was handled on the personal clinic and the care that they took.

She posted a optimistic overview of her expertise, which in the end helped others resolve to additionally go to the clinic.

After the surgical procedures, Fantastic was adopted by an oncologist at Queensway Carleton Hospital.

“They didn’t appear to thoughts that I had gone personal,” Fantastic stated.

She paid tens of 1000’s of {dollars} for the surgical procedures and utilized to the Ontario authorities for reimbursement since she was unable to get well timed therapy within the province. The federal government reimbursed her about $600 for the anesthesia.

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“We’re OK, we might afford it,” Fantastic stated. “However I do really feel badly that most individuals can’t, or are usually not in a position to advocate for themselves.”

She has no regrets, calling the waits Ottawa breast most cancers sufferers at the moment are going through inhumane.

“I didn’t really feel responsible. I felt like I used to be taking myself out of the lineup,” she stated.

“It was my determination. I’m certain you might discover somebody who would say I might have waited and there could possibly be an analogous consequence. However possibly not and I didn’t wish to wait to search out out.”

Lisa, in the meantime, didn’t hesitate to go for personal surgical procedure after talking with Fantastic and doing different analysis.

However she did battle with emotions of guilt.

“I used to be actually shy to inform folks initially,” Lisa stated. “I felt like I used to be making an attempt to get particular therapy and leap the road and that I used to be extra necessary than different folks. I went by way of 1,000,000 totally different feelings.”

She has since come to phrases with it and notes that she is unburdening the system she has paid into her whole life.

However her fee for the surgical procedure got here at a excessive value. She used the cash she obtained as a part of a $900 million army sexual misconduct class-action settlement with the Canadian army.


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