After Ladora Schwab of the small Vancouver Island community of Cedar suffered a heart attack last September, doctors told her the muscle in her heart wall and her aortic valve were both damaged, and that her mitral valve was also leaking. Nevertheless, Schwab, then 63, was given a pacemaker and sent home to take her place in line for further testing. After seven months of waiting, she died this spring.

The B.C. Ministry of Health's 1997 "Waiting List Report" concedes, "In virtually every healthcare system around the world, whether public or private, waiting lists for non-emergency treatment are a reality." But, the report continues, "A patient who needs emergency surgery does not go on a waiting list. Emergency surgery or treatment takes place immediately."

Increasingly, that reassurance—printed in boldface type—is false. From one corner of B.C. to another, families like the Schwabs are seeing their loved ones suffer while waiting, not just for routine surgery, but for procedures considered far more critical. In the worst of the cases patients are dying before cash-strapped hospitals and overbooked doctors can find surgery time for them.

The "wait-list" problem hits more than just patients and medical staff. It has become one of the key issues around which the debate on the future of medicare is building. Equal medical treatment for all is one thing, say critics of the state-run system, but equal suffering for all is an entirely different matter. For now, the focus may be on the level of pay for remote northern doctors or on last week's Hospital Employees' Union (HEU) strike (see story, page 13 of printed edition), but the basic issue is—and will always be—quality of care. And if a one-tier system continues to deliver such poor care to British Columbians, the pressure for change will become uncontrollable.

Schwab died of internal hemorrhaging March 4, the day after her family celebrated her 64th birthday. She was scheduled to travel to Victoria March 17 for an angiogram, a pre-surgery test that measures blockages. A combination of the heart attack and multiple blood transfusions had left her swollen with excess fluid and struggling to breathe. "It was a terrible thing to have to watch her go like that," says her husband, Ralph. "She couldn't do anything for at least three months." Schwab's internist, Dr. Niels Schwartz, told Mr. Schwab that he could not say if an operation would have saved the life of his wife. "But," says Mr. Schwab, "he did say the weeks of waiting increased the risk of her dying."

According to an April report by the Canadian Medical Association, B.C. has the second worst physician-to-patient ratio in Canada, and even obvious emergencies frequently get postponed, often with disastrous results. Last October 30 Philip Georgiou of Kelowna, 61, went to the emergency room of Kelowna General Hospital complaining of discomfort in his chest. An angiogram revealed severe arterial blockages, as well as a floating blood clot. Doctors in Kelowna decided he needed immediate surgery; they wanted to fly him to St. Paul's Hospital in Vancouver.

However, no beds were available and Georgiou was forced to wait until November 5 before going to St. Paul's. "He was scheduled for surgery on November 6," reports his wife Gwen. "But the next day he was bumped for someone more 'urgent.' 'It'll be tomorrow,' they said." Tomorrow stretched into another day, and then another. "The whole time my husband was becoming increasingly nervous and agitated," Mrs. Georgiou recalls. On November 11 she learned by phone that her husband had suffered cardiac arrest and was undergoing emergency surgery. By the time she arrived at the hospital he was dead. "We still don't know whether he died in bed or during surgery," says his wife.

An inquest into Georgiou's death was delayed when the first coroner fell ill; a second coroner assigned to the case has yet to look into it. However, a health ministry investigation decided his death was not due to the waiting period. "But the cardiologist in Kelowna said he needed surgery within 24 hours," Mrs. Georgiou points out.

The 1997 government report defends waiting lists: "As long as waiting times are reasonable, waiting lists play a valuable role in helping priorize cases based on urgency and in ensuring that our health system doesn't have more capacity than it needs or taxpayers can afford." Besides, the report adds, it is a "myth" that "waiting times are longer in B.C. than in the rest of Canada."

Two months ago the B.C. Medical Association (BCMA) countered the government's report with a study of its own. Based primarily on statistics compiled by the Fraser Institute, the report found that not only are wait times much longer than the government says, they are also increasing each year. For example, the BCMA report says the median wait (the point where half the patients have a shorter wait and the other half have a longer wait) for cataract removal is 14 weeks, compared to the government-stated median of 7.3 weeks.

Furthermore, the BCMA accused Victoria of disregarding major portions of what constitutes ordinary wait time in order to achieve overly optimistic results. "The minister's report inappropriately ignores the wait from GP visit to specialist consultation, as well as the wait for diagnostic testing," the BCMA report states.

That conclusion is one with which Dave Garneau agrees. An athletic 22-year-old, Mr. Garneau's troubles began last December with a severe pain in his lower abdomen that eventually became a hernia half the size of a tennis ball. After suffering through the holidays, Mr. Garneau went to a doctor in early January. The GP referred him to a surgeon in the same building; however, he had to wait until February to see the surgeon. Finally, the surgeon simply confirmed the GP's diagnosis and referred him to yet another surgeon who could not see him until March.

By the time Mr. Garneau saw the second surgeon he was in too much pain to sit at his computer at work for a full day. Furthermore, even though the doctor described his hernia as "potentially dangerous," Mr. Garneau was told he had to wait until August or September for his operation. At that point his pain was sometimes so severe he felt he would black out.

By late March Mr. Garneau was investigating the possibility of travelling to Seattle and paying for an operation. Then his parents called from their home in Quebec and told him their family doctor had assured them a surgeon could see their son immediately. "I arrived in Montreal by air at 3:30 a.m.," he reports. "At 8:30 a.m. I saw the surgeon and the next day I had the operation." The Hotel Dieu de Levis hospital in Quebec will bill the B.C. healthcare system for the work. "I'm scared to live [in B.C.] now," he says. "I'm afraid if I'm in trouble again, I'll be screwed again."

Mr. Garneau is not alone in reaching that conclusion. Chilliwack resident Henry Bolt, 65, was diagnosed with angina in April 1997. He was too weak to take a stress test, but his angiogram was postponed until October anyway. "I could not walk two house lengths without pain," Mr. Bolt reports. Eventually, "The test found one of my arteries completely blocked."

With his condition now listed as "critical," Mr. Bolt's surgery took place the following week. Since his surgery he has "been like a new man." Nevertheless, he remains mad that "half a year of my life was wasted" waiting for his operation.

When Kamloops resident Roy Salter, 65, failed to get timely treatment, it was his wife, Yvonne, who got angry. Mr. Salter has suffered from angina since 1991. Initially, his doctor treated the condition with medication, but when Mr. Salter's condition worsened last summer he was referred to an internist. An angiogram in October revealled he needed six bypasses. He was advised there would be a three- to six-month wait.

When Mrs. Salter learned in March that Dr. Howard Ling, the Vancouver heart specialist who was scheduled to perform the surgery, had taken the entire month off, she sent a letter to Health Minister Penny Priddy. There were 98 similar surgeries waiting for Dr. Ling, she noted, and with his being permitted to perform only four heart operations a week, it appeared her husband would be waiting at least a year for surgery. "The simple fact is that my husband without treatment may very likely not last that long!" Mrs. Salter wrote. "He is frustrated, losing hope and shows signs of deepening depression as he is convinced that he will not live to undergo the surgery."

Mrs. Salter informed the minister that her husband had instructed her to sue the government if he died before his surgery. At first it appeared that her threat had brought results. A letter from the ministry informed Mr. Salter that he had been scheduled for surgery June 8, 1998. But, "When I phoned Dr. Ling to confirm the new date," says Mrs. Salter, "his office had not heard of it." As of last week, Mr. Salter was still waiting for his operation.

A more successful tactic was employed by Penticton resident Vern Ginther, 63, who finally got his bypass surgery after a 10-week wait. Mr. Ginther checked into hospital with extreme angina three times. Twice he was declared stabilized and sent home. On his third trip to the hospital this past January, however, Mr. Ginther refused to go home. He was flown to Vancouver January 8 and was operated on within days. "On my first trip to the hospital I didn't know to fight the system," he says. "But by my second trip I was beginning to figure it out."

Then there is 71-year-old Hector McNeil, who has waited since May 1997 for surgery on a leaky heart valve. He is supposed to have his operation July 14, but he fears last week's HEU strike could delay it further. Mr. McNeil says doctors have been watching his bad valve since childhood; only in the past year was surgery considered necessary. "I wish I had my operation 10 years ago," he says now. "The wait would have been much shorter."

Jim Riley, who had his first open heart surgery 30 years ago, agrees; three weeks passed between his first examination and his operation. This time he was diagnosed in January as needing "emergency" bypass surgery. He is still waiting.

Senior citizens often think they are being singled out for long waiting periods, but Terrace resident Robyn Montgomery tells a different story. In January 1995, when she was 15, Robyn suffered an attack of Superventricular Tachycardia (SVT), an abnormally accelerated heartbeat that can be fatal. Ms. Montgomery was flown to B.C. Children's Hospital in Vancouver where her illness was confirmed and she was put on a waiting list for surgery.

Called back to Vancouver in May 1995, Ms. Montgomery was told the night before surgery that the procedure, called an ablation, could damage her heart and force her to depend on a pacemaker the rest of her life. Surprised, the teenager balked. But talks with her family doctor in Terrace allayed her fears and in January 1997 she booked an appointment to get the ablation. A date was set for August.

However, when Ms. Montgomery arrived the physician acted as though she had never heard of the impending surgery and declared she would never do an ablation after only one attack. Robyn's mother points out that two years earlier the same surgeon had backed away from doing an ablation only because Robyn would not accept a pacemaker. Robyn was sent home again, only to suffer a second SVT attack last October. Now 19, she suffers from high blood pressure brought on by anxiety and has no idea when she will get another chance for the operation that will prevent a potentially life-threatening attack.

Even where the situation is not a matter of life or death, a long wait can wreak havoc. Carol Carter, 59, who works as an office assistant for the Ministry of Finance in Victoria, suffers from progressive hearing loss and needs a magnetic resonance imaging (MRI) scan to determine how her treatment should proceed. Two weeks ago Ms. Carter was told it would be February 12, 1999, before she could get the scan. "I was flabbergasted," she says. "It's frustrating when I'm already having difficulty communicating at work."

Illnesses and injuries more serious than hearing loss are part of the MRI logjam. "Orthopedic patients in Victoria are now cancelling knee MRIs and instead are regressing to invasive and far more expensive diagnostic arthroscopy," Dr. Robert Koopmans, clinical section head for regional MRIs, said recently. "Suspected multiple sclerosis patients are having to wait a year for scans and patients having complex gynecological malignancies are often not getting the MRI scans they require for proper diagnosis and treatment."

B.C. medical care appears to have deteriorated to the point that not even emergency room service can be counted on. In March Ghelabhai Solanki, 81, fell and broke his leg. Mr. Solanki lives in Burnaby, but dispatchers sent his ambulance to Lions Gate Hospital in North Vancouver because both Burnaby Hospital and Royal Columbian Hospital in New Westminster already had ambulances waiting with patients. However, LGH emergency physician Dr. Donald Warner sent Mr. Solanki back to Burnaby without examining him, administering pain medication or talking to his family. When the old man arrived back in Burnaby he had to wait two days, in traction and on morphine, for surgery on his leg. Kalpna Solanki reports her father will not get a knee replacement until next year.

No one from the Health Ministry would discuss waiting lists with B.C. Report, but Health Minister Penny Priddy told reporters last month that lengthy lists are a problem and committed $16 million to add more services to treat cancer, cardiac ailments and kidney dialysis. Following the lead from last year's report, she also placed some blame on doctors for not doing enough to manage waiting lists.

However, Dr. Bill McArthur, senior fellow in health policy for the Fraser Institute, contends that Canadian healthcare is facing a crisis that cannot be solved by better management or cash infusions. Costs will rise primarily because the proportion of the population over 65 will soon double, from 13% of the total today, to an estimated 25% by 2025. Already unable to meet the demand for health services, governments will be forced, says Dr. McArthur, to find ways to introduce consumer accountability into healthcare, as well as free up more money.

To accomplish the former, Dr. McArthur recommends using medical savings accounts (MSAs), a kind of RRSP for healthcare. Each year the government would deposit funds into each citizen's account. People would then use the money to purchase healthcare services. At the end of the year the money left over could be rolled into an RRSP, withdrawn, or left to accumulate. If an individual is especially ill, a "catastrophic fund" would cover added costs.

Dr. McArthur also argues that Canada will eventually have to follow Europe's lead in allowing some forms of private healthcare to compete with the government system. Competition, says Dr. McArthur, will make the government system more efficient while also freeing up space for those who cannot afford anything else. "Public demand for better service will drive the change," he says. "Canada's waiting lists are longer than other countries and we are falling behind technically. People won't always accept that."

So far no politician seems ready to accept what Dr. McArthur says is inevitable. MLA Sindi Hawkins, B.C. Liberal health critic, is quick to criticize the current government for its inefficient administration and lack of clearly defined objectives. But Ms. Hawkins, a former nurse, is not prepared to consider the possibility that Canadian healthcare must face fundamental restructuring. "People tell us that universal healthcare is what distinguishes us as a nation," she says. "I can't support private facilities or MSAs. I have to take to heart what the people tell me."

—Shafer Parker Jr.

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