Doctors working on a patient in an operating room.
Doctors working on a patient in an operating room. Credit: engin akyurt / Unsplash Credit: engin akyurt / Unsplash

I bet you didn’t know the United Conservative Party (UCP) government plans to let private medical corporations operating their own facilities perform surgeries even if the person delivering the anesthesia is not a physician specializing in anesthesiology.

Alberta political blogger and corporate and regulatory lawyer Susan Wright mentioned this interesting tidbit in passing Sunday in an eye-popping post on her Susan on the Soapbox blog, wherein she deconstructed Health Minister Jason Copping’s lame responses to Opposition Health Critic David Shepherd’s not-so-hard questions about the government’s surgery privatization contracts. 

One of Shepherd’s questions, which Copping failed to answer in a meaningful way in the Legislature, was: “Will surgeries in AHS publicly funded hospitals be postponed because AHS is redeploying anesthesiologists to for-profit chartered surgical facilities?”

Shepherd asked the question because the Alberta Health Services (AHS) contract with Calgary-based Canadian Surgery Solutions Ltd. signed January 3 guarantees the private operator a minimum number of surgeries per year. It also makes it easy for the company to pull out of the deal and leave the health care system in even more of a shambles than it is now. (From a contract negotiation point of view, that was plain dumb!)

Accusing Copping of being “less than forthright” when he claimed a contract wasn’t the same thing as a guarantee, Wright explained, “If AHS doesn’t have enough spare anesthesiologists floating around, it would have to pull some out of the AHS public hospitals and put them into the CSF operating rooms so it would not be in breach of its ‘volume floor’ contractual obligation.”

Given the shortage of anesthesiologists and other health professionals in Alberta, Wright pointed out, this could easily result in postponements and cancellations of surgeries in public hospitals, wreaking more havoc in an already strained system. 

So this development brings us into outright Yikes! territory. 

Meanwhile, Wright wrote, the contracts with Canadian Surgery Solutions and Alberta Surgical Group – Heritage Valley Ltd. also “appear to allow surgeries to proceed even if the physician administering the IV sedation is not an anesthesiologist as long as there are two staff members certified in Advanced Cardiac Life Support present in the surgical suite.”

There’s a bit of a back story to the idea of not requiring a qualified anesthesiologist to be in every operating room, which is being tried in some public facilities elsewhere in Canada. 

In an AHS press release in April last year – which was written as if it were a newspaper feature story – AHS said it was introducing a new pilot program called the “Anesthesia Care Team” (ACT) model at facilities in Edmonton and Calgary.

In the event, AHS told me Wednesday, ACTs were piloted at two private eye surgery facilities in Calgary and at the pubic Royal Alexandra Hospital’s ophthalmology clinic in Edmonton.

This approach, the 2022 news release said, “aims to reduce surgical wait times by drawing more upon the skills and expertise of respiratory therapists.”

“The premise of the pilot is simple,” the story burbled. “By having a qualified respiratory therapist II perform certain tasks traditionally performed by an anesthesiologist, it allows the anesthesiologist to extend care to more patients and increase access to safe and timely surgeries for more Albertans.”

Is this a good idea? 

Well, that’s hard for me to say, being a medical layperson and all. 

The AHS story is not much help in this regard because, as mentioned, it’s a news release, and therefore contains not a word of what journalists used to call “balance” – that is, an educated voice or two that could add a word of caution or raise an outright alarm if that were warranted. 

Obviously, someone thought it was a worthwhile question last year because a CTV story at the time included an answer of sorts from an AHS spokesperson.

“Following completion of this pilot project, for cataract surgery, various stakeholders will review the outcomes,” CTV quoted Kerry Williamson of AHS saying. The story said the changes would be tested until the end of March 2023, “with ongoing evaluation and opportunities for feedback.”

Well, here we are, less than a week before the scheduled end of the pilots and AHS has already signed a contract to permit a private corporation to use a non-anesthesiologist to do an anesthesiologist’s work.

And not with an eye surgery clinic for removing cataracts, but with a company doing orthopedic surgery. 

Cataract surgery nowadays is a pretty straightforward procedure – I speak from the perspective of someone who has undergone this procedure, not that of an ophthalmologist. The anesthetic part mostly seems to involve eyedrops and the anti-anxiety medication Ativan.

Bone surgery? Perhaps not so much. But don’t ask me. 

And remember, a physician specializing in anesthesiology is responsible for more than just mitigating a patient’s pain and distress during surgery, but also for monitoring and maintaining the patient’s vital functions before, during and after the operation. In other words, keeping them alive! 

The way the pilots were supposed to work, AHS said last year, was that “an anesthesiologist can oversee two or three surgeries with the support of one RT II providing anesthesia service in each room. This differs from the current structure, in which an RT II would support an anesthesiologist by providing anesthesia service during procedures only.”

Will the same situation with a qualified anesthesiologist in the room across the hall exist in all private mini-hospitals run by a for-profit corporations that are “chartered” by the government?

Does what makes sense for ophthalmology make sense for bone surgery? 

Will it be permitted in more complicated surgeries requiring more prolonged pain mitigation?

At the moment, the answers to these questions are unknown. 

NOTE: AHS Communications helpfully answered my question about where the ACT pilots took place, but did not respond to my request for a copy of the assessment report for the pilot projects. DJC

David J. Climenhaga

David J. Climenhaga

David Climenhaga is a journalist and trade union communicator who has worked in senior writing and editing positions with the Globe and Mail and the Calgary Herald. He left journalism after the strike...