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A persistent mystery: Why do Alberta patients still face long waits for lung surgery?

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Dr. Ciaran McNamee

Scotland Yard Detective: "Is there any other point to which you would wish to draw my attention?"

Sherlock Holmes: "To the curious incident of the dog in the night-time."

Detective: "The dog did nothing in the night-time."

Holmes: "That was the curious incident."

There was something eerily familiar about the Edmonton Journal's report Tuesday, "Alberta lung cancer patients are typically waiting twice as long as other Canadians for surgery, a distressing trend the provincial health authority says it is struggling to understand."

But what was it? There was no hint of it in the story, which was published on April 1 although it was evidently not meant as a joke.

The story was based on a report by the respected Canadian Institute of Health Information, known throughout the medical field by its acronym, CIHI, which is inevitably pronounced Ky-High. The CIHI study compared wait times across Canada for a variety of medical operations, putting Alberta close to the national average for many.

But Alberta was "dead last" in the Journal's unfortunate turn of phrase when it came to lung surgery, with patients last year undergoing the procedure within 85 days. The Canadian average was 49 days; Ontario's was 36 and B.C.'s 32, CIHI said.

"It's a real challenging issue," the Journal quoted Alberta Health Services Chief Medical Officer Verna Yiu as saying. The Journal’s reporter intoned: "Yiu did not have a definitive explanation for the delays in Alberta."

Well, does anyone in Alberta remember retired judge John Z. Vertes' Health Services Preferential Access Inquiry? Professional journalists are forgiven if they have forgotten. After all, since the summer of 2013 there's been a lot of water under the bridge behind the Legislature that crosses the North Saskatchewan River to the University of Alberta Hospital.

Nevertheless, the report contains a hint of something that might be related to the mystery that is stumping Dr. Yiu -- or, rather, its absence, rather like the Dog that Didn't Bark, contains the hint. Let me explain:

The inquiry, created back in the days when Premier Dave Hancock  was still loyally toiling in the cabinet of Alison Redford's already troubled government, seems to have been ginned up in response to the premier’s leadership-contest promise of a real judicial inquiry into accusations of line-jumping and bullying in the health care system

Apparently an inquiry by a retired judge reporting to Health Minister Fred Horne was deemed good enough for most voters, and the whole $10-million affair now seems to have drained quietly down the Memory Hole.

After months of testimony, the commissioner reached the conclusion there was no basis for the startling allegations of routine line jumping that contributed to the brouhaha that sparked the inquiry -- claims made in public principally by Alberta Liberal Leader Dr. Raj Sherman and former AHS CEO Dr. Stephen Duckett.

The final report of the inquiry all but called Sherman a liar -- or, as I wrote at the time, at the very least a deluded fantasist.

But at this late juncture, the April 1 CIHI report suggests a glimmer of vindication for Sherman.

Why was it that the inquiry failed to call a witness who was at the centre of one of the most spectacular allegations of medical queue jumping in recent decades? To wit: that lung surgeons were being denied operating room time and resources because other kinds of surgeons had political access to the people who ran the health care system in the late 1990s?

That accusation was made by Dr. Ciaran McNamee, once the head of thoracic surgery at the U of A Hospital, who had sued the former Capital Health Region.

In his lawsuit, McNamee claimed he’d been improperly hounded out of his surgical practice for complaining publicly about his patients' long waits for surgery. He also claimed Capital Health Region officials had improperly questioned his competence and even his sanity.

Indeed, according to the CBC at the time, one allegation in McNamee's lawsuit was "that his budget for lung surgery had been all, or in part, effectively taken over by other surgeons at the hospital."

But despite the fact that this was one of the incidents that led to calls for a real judicial inquiry into bullying and intimidation of medical professionals in the Alberta health care system, Vertes' inquiry declined to call McNamee as a witness because, as a spokesperson said at the time, "it was decided his information was 'dated' and would provide little useful information about queue-jumping that may be occurring now." (Emphasis added.)

McNamee -- who by then was practicing medicine in a little U.S. backwater called Boston and teaching at a provincial school known as Harvard University -- had made it very clear he was "willing to co-operate, in any form or fashion" with the inquiry.

His allegations became public at about the same time as Sherman's assertions in the Legislature that 250 people had died, many from lung cancer, while on a 1,200-name surgical waiting list in the 1990s.

Unfortunately for those who would have liked to cast a light on what was going on in Alberta's health care system back in that decade, the lawsuit was settled out of court in 2001 and McNamee was bound by a convenient non-disclosure agreement -- unless he was subpoenaed to testify.

In a contemporary blog post by Calgary-Mountain View MLA David Swann, which has since disappeared from the Internet, the former party leader accused the inquiry of "deliberate avoidance of the most dramatic allegations of queue jumping."

"Many of (McNamee's) lung patients were 'bumped,' allegedly by other surgeons given preferential access, resulting, allegedly, in preventable deaths among his patients," alleged Swann, who like Sherman is a physician.

Of course, much has changed in Alberta health care since the late 1990s. Most importantly, Capital Health and nine other health regions no longer exist -- they have all been rolled into Alberta Health Services. Most of the key players have been shuffled around, and some of the most important ones have changed, been fired, quit or retired.

But as this week's CIHI report has made clear, serious, life-threatening problems persist in how lung surgeries are provided in Alberta.

Could it be that the problems in the Capital Health Region pointed to by McNamee, Sherman and Swann were real, and have never been resolved?

Could it be that the same kind of politics that McNamee pointed to in his now settled lawsuit are still being played within Alberta Health Services?

Could it be that like so much else done by the Redford-Hancock Government, the Health Services Preferential Access Inquiry was a half-baked promise at best that no one intended to keep and that, by accident or design, didn't achieve very much?

Perhaps this curious coincidence is something Yiu should look into.

This post also appears on David Climenhaga's blog, Alberta Diary.

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