Minister's MRI answers just create more questions

VICTORIA - It started to feel like a "Yes Minister" episode as Health Minister George Abbott attempted to explain just what he's doing - and not doing - about paid queue-jumping in B.C.
Reporters caught up with Abbott on his way into a Liberal caucus meeting Tuesday, looking for an update on the latest case of a public hospital selling special access for people who didn't want to wait in line.
The issue has kept Abbott off balance for almost two weeks, since NDP health critic Adrian Dix revealed that patients were paying to jump the waiting list for MRIs. A private company, Timely Medical Alternatives, cut a deal with St. Paul's Hospital in Vancouver. Pay the company up to $1,400 and you could avoid the average four-month wait for a non-urgent MRI.
Abbott first doubted the reports. But once a patient came forward and described making the payment, he denounced the practice, which violates  the Canada Health Act, provincial law and government policy. He asked his deputy minister to investigate and then offered assurances that St. Paul's was alone in violating the policy.
Until this week, when news broke that Mount St. Joseph Hospital, also in the Lower Mainland, was cutting the same deal for CT scans and other diagnostic tests.
So how come, Abbott was asked, he didn't know about this second infraction? Did the hospital or health authority not know about the provincial policy, or were they concealing the information?
No, no, said Abbott, nothing like that. But the deputy minister likely just asked the health authorities if they were selling access to MRI machines - not CT scans or other equipment. And they didn't volunteer the information.
So the deputy minister wasn't asking the right questions then?
"I think that one always builds on one's understanding of these issues and one is able to ask more, further questions that further illuminate the situation," said Abbott.
Yes, minister.
One of the themes of the British political sitcom was the usefulness of keeping the minister out of the loop about unpleasant issues. That seems much like what has happened in this case.
And it sounded much like ministry officials and the health authorities have been playing some strange game, a combination of 20 Questions and Catch Me If You Can. The deputy ministry asked if patients were paying to jump the waiting lists for MRIs. The health authority said yes, or no, without feeling it necessary to add that they were paying for speedier access to CT scans or other tests.
Which led, naturally, to another question for Abbott. How do you know that health authorities aren't also cutting deals with private companies to let people jump the queue for surgery? Is the deputy asking the health authorities that question?
"I don't believe he is pursuing the issue of surgeries at this point in time," said Abbott.  "What we do is that where issues are raised or complaints are made then we pursue,  through either the ministry or through the Medical Services Commission or through the College of Physicians and Surgeons, whether in fact the complaint exposes something being done outside of policy."
"I don't believe that either I or my deputy or his team have unfilled days to go and look for issues that we don't know exist," Abbott added.
But how would the ministry know if the Canada Health Act or its own policies were being violated? The health authority making money by selling access wouldn't raise the issue. Neither would the private broker. And most patients who could afford the prompt treatment would likely pay and keep quiet.
"Are we sure that there are no surgeries that are going on," Abbot asked himself. "I don't believe that in as large a health-care system, as we have in British Columbia that we can be 100-per-cent certain of that."
Just don't expect much of an effort to find out if the practice is happening, or how widespread it has become. Footnote: Abbott also said the Vancouver Coastal Health Authority hasn't explained why it was violating the policy, which was set out in 2002. As well as barring two-tier care, the policy requires the health authorities to check with the health ministry if there's any doubt about a planned practice or charges. The authority won't say how much it charged the private company for the service.