Questions swirl around joint surgery 'partnership' at The Ottawa Hospital
Private group performing hip, knee operations at Riverside campus on Saturdays
An enigmatic partnership between The Ottawa Hospital (TOH) and a private entity run by a group of surgeons to perform hip and knee replacements at the Riverside campus on weekends is causing concern among advocates who worry it represents a further step toward privatization of Ontario's health-care system.
CBC News first learned of the arrangement between Ottawa's largest hospital and Academic Orthopedic Surgical Associates of Ottawa Inc. (AOAO) in mid-January. A search of the Ontario Business Registry shows AOAO was incorporated on Dec. 15, 2021, and includes eight surgeons with links to TOH.
The further we get into it, the more questions we have that aren't answered.- Rachel Muir, Ontario Nurses' Association
According to an email sent to the personal addresses of several TOH employees in January, AOAO was seeking surgical support staff to help with "a pilot project to help address the backlog of total joint replacement cases," beginning Feb. 25.
The email, which came from the personal address of another hospital employee, noted the project, "although supported by, is not part of TOH," and said interested employees would be paid a per diem rate by AOAO.
When CBC first inquired about the arrangement on Jan. 16, TOH responded three days later with a 17-word statement: "Talks are underway to expand the capacity for orthopedic surgery as part of our integrated regional plan."
Pressed for further information, the hospital confirmed on Jan. 27 that it and its department of orthopedic surgery were "working with AOAO to help increase access to surgical care for our patients," and said details were still in the works.
On Feb. 16, the hospital announced publicly that it's "working with [AOAO] to increase capacity for orthopedic procedures, such as hip and knee replacements."
10 surgeries performed Saturday
The announcement confirmed the surgeries would take place at the Riverside campus on Saturdays, starting nine days later on Feb. 25, in operating rooms that were "previously unused on weekends."
On Wednesday, TOH confirmed that 10 joint surgeries were performed on Saturday.
TOH also confirmed Wednesday that "all of the patients receiving surgery through AOAO are TOH patients and all services are billed through OHIP, as per standard practice."
It's not entirely clear how those patients are chosen, nor is it clear how AOAO is paying TOH for the use of the hospital's operating rooms, equipment and other supplies. Repeated calls and emails to the physician listed on the business registry as AOAO's chair have gone unanswered.
CBC News has learned that registered nurses who agree to work on Saturdays are being offered $750 for a 10-hour shift, approximately double what they'd be paid for a regular eight-hour shift at the hospital. Registered practical nurses are being offered $550 a day to work for AOAO, while clerical staff are being offered $600.
CBC News has also learned those employees are responsible for their own insurance coverage while working outside the normal hospital structure.
Unanswered questions
Rachel Muir, a registered nurse and the Ontario Nurses' Association (ONA) bargaining unit president at TOH, said the ONA first became aware of the partnership between the hospital and AOAO in mid-February, and only learned the surgeries were going ahead at the Riverside the day before they occurred.
Muir said she's particularly concerned for nurses who have agreed to take on the extra shifts, because certain safeguards that are in place at the hospital during the week could be absent on weekends.
"So if there's an emergency, what's going to happen?" Muir asked. "We don't know what policies and protocols and procedures are in place. Are they using the TOH ones, or have they created their own?"
Muir said that lack of clarity is typical of the general secrecy surrounding the project.
"The further we get into it, the more questions we have that aren't answered," she said.
The registered practical nurses and clerical staff who have volunteered to work at the Riverside on Saturdays are represented by different unions.
A 'step toward privatization'
The decision to allow a private entity to operate out of a publicly funded hospital, and to recruit staff from the limited existing supply of health-care workers, is causing concern among some advocates who aren't buying the argument that the only alternative is to let the facilities sit empty.
"We have a premier in this province who's told us many times now that our existing hospitals have no capacity to deal with the wait-lists," Ed Cashman, co-chair of the Ottawa Health Coalition, told Radio-Canada during a small demonstration outside the Riverside on Saturday morning.
"Well, this is an example right here in Ottawa that simply by looking around you can find empty operating rooms. They could have done that with existing facilities and existing people."
Doug Angus, professor emeritus at the University of Ottawa's Telfer School of Management and an expert in public health policy, has similar questions.
"If the capacity could be used at the Riverside campus of The Ottawa Hospital on weekends, then why doesn't that happen just as a matter of routine from the hospital itself, within the existing OHIP arrangement?" he asked.
"Why don't we make better use of the existing facilities that we currently have in the hospitals?"
Angus is also concerned that by recruiting hospital staff and offering relatively generous compensation, partnerships such as the one between TOH and AOAO risk further diminishing the available supply of experienced health-care workers.
Muir, whose organization represents 68,000 health-care professionals in the province, shares those concerns.
"You're hiring them away from the public institutions to work in a private institution at a higher rate," she said. "Why not pay the nurses who are already there? Why not use what you already have instead of taking this step toward privatization?"
Province applauds 'innovative' partnership
In January, Ontario Premier Doug Ford and Health Minister Sylvia Jones announced a plan to expand the number and range of medical procedures performed in privately run clinics as the province deals with a surgical backlog made worse by the COVID-19 pandemic.
The expansion is planned in three phases, beginning with cataract surgeries. Hip and knee surgeries will be offered in 2024.
CBC News first contacted the Ministry of Health on Jan. 26 to inquire about the partnership between TOH and AOAO, but after initially acknowledging the request, the ministry did not respond to numerous calls and emails.
An access to information request submitted by CBC last month turned up no records regarding the partnership, according to the ministry.
In an email on Wednesday, a spokesperson for Jones told CBC: "We are excited to see our partners, like the Ottawa Hospital, taking innovative action to eliminate the joint replacement surgical backlog and reduce patient wait times so more Ontarians can receive the care they need, closer to home.
"The Ottawa Hospital is doing its part in helping clear the region's surgical backlog by opening up operating rooms to existing staff on the weekend when they are not in use by the hospital."
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