The head of a Vancouver-based company that organizes surgery in the United States for Canadian patients says it is providing a needed service to supplement the shortcomings of the Canadian medical system.

Richard Baker, president of Timely Medical Alternatives Inc., says U.S. surgeons who have operated on Canadian patients he has referred for orthopedic surgery have told him the condition of the joints of Canadian patients is shocking.

“The deterioration is severe compared to what they see in their normal practice with Americans,” says Baker.

Ninety-five per cent of Baker’s clients require hip or knee surgery, classed as “elective” in British Columbia.

Photo courtesy of Timely Medical Alternatives Inc.
Timely Medical Alternatives president Richard Baker receives referrals from doctors, although the BCMA is disappointed with his company organizing surgery in the U.S. for Canadians.

“This seems to be the one area in the Canadian medical system where we are failing to provide adequate care,” says Baker, who adds patients currently have to wait up to three years for those two types of surgeries.

Provincial health statistics indicate that as of December 31, there were 2,866 patients on the waiting list for hip-replacement surgery and 4,734 waiting for knee replacements. Median wait times are calculated from the time the procedure is formally booked in the hospital until it is actually carried out.

The government estimates wait times at 29.7 weeks for knees and 21.1 weeks for hips, though British Columbia Medical Association (BCMA) president Dr. John Turner says those times don’t include the amount of time it takes to see a specialist in the first place. He estimates the total waiting time as being closer to a year.

Turner says an additional $20 million announced by the government on March 6 to help reduce waitlists will make very little difference to long waiting times. However, he adds, “it’s at least an acknowledgement that the government realizes there’s a problem with waiting lists and they have to do something about it.”

The government said the additional $20 million is available as a result of a number of savings outlined in the February 17 provincial budget, as part of the third-quarter results for 2003-04.

It is earmarked for various medical procedures, services and surgeries, including more than 400 additional hip and knee surgeries.

Baker’s assessment of the need for timely orthopedic surgery was underscored by a recent Ipsos-Reid poll conducted on behalf of the Canadian Medical Association. The poll reported last month that 67 per cent of Canadians say they or a family member waited longer than was reasonable for access to health-care services. The poll also revealed half of those who waited reported that they had to cope with worsening conditions and/or increased anxiety.

“If somebody in my own family needed surgery on a hip or knee, I wouldn’t wait for two or three years before getting them down there,” says Baker.

“I’ve had patients in wheelchairs, on morphine, who are addicted to morphine, and yet it’s still considered elective. That’s ridiculous.”

Baker says when people wait so long and their condition deteriorates, it has an impact on the length of time they take to recover from the operation.

“Our position is that anybody using our services is not jumping the queue, they are leaving the queue, and in fact, leaving the country,” says Baker.

He adds the number of people leaving the system in Canada is limited because not everyone can afford the cost. A hip or knee replacement costs approximately $20,000 to $25,000 (US), with a 30-per-cent discount if both hips or knees are done at the same time.

“We live in a good situation here in Canada. If you need medical care, if you wait long enough you will get that care at no cost to you. On other hand, if you are desperate, you do have an option,” says Baker.

His firm receives referrals from clinics and doctors who are only too happy to help their patients get quick treatment. For example, Baker says, he helped one man with bilateral carpal tunnel syndrome who was facing a six-month wait just to get a consultation. He called Baker at 10 o’clock one morning and at 4:30 that afternoon he was in surgery. “His own general practitioner was dumbfounded, flabbergasted that he could get help that quickly,” Baker says.

False Creek Surgical Centre, a private clinic in Vancouver that isn’t permitted by law to do any surgery requiring more than an overnight stay, also refers patients who require hip or knee replacements or cardiac surgery requiring longer hospital stays.

“At least we can help in some way,” says Dr. Mark Godley, the clinic’s medical director, predicting they will be referring many more patients as the waiting lists grow and the “system collapses.”

Baker says he has received some rude e-mails suggesting he is promoting a two-tier health system. But he argues Canada already has a multi-tier system because immediate care is available to the Royal Canadian Mounted Police and clients of the Insurance Corp. of British Columbia (ICBC) or Workmen’s Compensation, as well as “clients” of the Department of Corrections – prisoners.

He adds even if the medical system officially became a two-tier system, it would take a long time to clear up the backlog of people waiting for orthopedic surgery, a number he estimates stands at about 17,000.

Baker primarily sends patients to three medical providers in the U.S., with most referrals going to St. Joseph Hospital in Bellingham.

He says the major benefit to using that hospital is that in the unlikely event a patient experienced complications, such as a heart attack during surgery, it is only 25 minutes to the emergency ward at Peace Arch Hospital in White Rock, just across the Canadian border.

“In Bellingham they are very conscious of the Canadian system and their first thought is to get the person stabilized, call an ambulance and get them back to Canada,” says Baker, adding that there aren’t a lot of conditions that couldn’t be stabilized for the 25 minutes it would take to transfer the patient.

Baker, whose background includes a commerce degree from the University of British Columbia, 12 years in advertising and a two-year stint as a stock broker with Merrill Lynch, formed Timely Medical last November.

He says he consults with his wife Lori, a registered nurse and clinical educator, and daughter Ashley, who is enrolled in the master’s program in human kinetics at the University of British Columbia, if there are medical terms he doesn’t understand.

Besides orthopedic patients, Baker says he has referred a cardiac patient to Bellingham and is currently making arrangements for gastric bypass surgery (used for weight loss) for two people.

Baker adds he has primarily been targeting B.C. patients for his service, and hasn’t had much response from patients outside the province.

Although patients can go to a hospital in the U.S. on their own, Baker says they save money by going through him because he has been able to negotiate discounts with U.S. hospitals and doctors.

He passes on the discount to his clients after taking a percentage for his services, though he declines to say how much.

He adds another benefit to his service is that he has a commitment from the hospitals he uses for priority in terms of timing.

Baker says the average Canadian’s perception of the American health-care system as being money- grabbing, greedy and solely profit-oriented is badly skewed.

He notes his experience has been that of excellent facilities and attentive staff, and Canadian patients generally return from surgery there raving about their treatment.

BCMA’s Turner says the association isn’t really enthusiastic about patients using the services of companies such as Timely Medical.

“The thing I have some difficulty with is who is the broker, how does he organize his business, how well does he know the physicians in Bellingham, and what is his percentage take on the deal?” Turner asks.

“We would much rather see them have their surgery done here and money put into the system so we can provide the service,” Turner adds.

“It’s really an indictment of the sort of service we can provide that they’re having to go south of the border.”

Baker says he will continue in his efforts to help patients get the medical care they need, in a timely manner.

“Something will have to be done. What that will be – wiser heads than mine are working on that,” he says. “In the meantime I’m helping as many people as I can.”