《Want fast care? Slip an MD some cash》
'It's systemic'.
Privatization fosters black market, physician says
By CHARLIE FIDELMAN
The Gazette November 27, 2010
When their mother was diagnosed with pancreatic cancer, the twin sisters didn't hesitate for a moment: They chose the surgeon they wanted and slipped him $2,000 in cash to bump their mother to the top of the waiting list.
"We wanted to save our mother," Vivian Green said. "It was cash incentive, to buy our place ahead of everyone else."
Green and her sister, Ora Marcus, say bribes are an open secret in the medical field. They grew up with a father who was an obstetrician at the Jewish General Hospital.
"If you have money, you live, and if you don't, you die," Green said.
Critics say the practice is illegal and unethical, but several patients who contacted The Gazette say offering envelopes stuffed with thousands of dollars to surgeons has become a way to speed treatment in public hospitals.
One high-ranking physician who works with doctors at several Montreal hospitals told The Gazette that obstetricians often accept cash offered by expectant parents to ensure their doctor attends the delivery, rather than having to depend on whichever doctor is on call.
"I've learned that it's current practice. ... Everyone within these hospitals knows about it," he said of the hush-hush payments. "It's systemic, and it has been so for a long time now."
The prices?
Minimum $2,000 to guarantee that a woman's doctor will be there for the birth. "And it can go up to $10,000," he added.
For general surgery, the cost runs between $5,000 to $7,000 to jump the wait list into the operating room, he said.
For Green and Marcus, the $2,000 got their mother's operation bumped up -but not the surgeon they wanted.
Green and her mother initially offered cash to a surgeon at the Jewish General. He accepted an envelope but returned it within days, saying the operation was beyond his expertise.
Green was then referred to a doctor at the Royal Victoria Hospital.
"We wanted to have the operation done by (someone) who we know is the best," she said. She said she slid an envelope filled with $20 bills across the surgeon's desk at the second appointment to set the surgery date.
"I gave it to him discreetly and he took it -he knew what was in the envelope," she said. "He took the money and never showed up."
Another member of his surgical team removed the tumour in September. Their 80-year-old mother died this month of the cancer.
The family plans to file a formal complaint, Green said, because patients are helpless. "Payment for services should be stopped."
But patients who get what they want won't complain, she noted.
Karine Rivard, press attache to Quebec Health Minister Yves Bolduc, said that the Health Department has never heard of the practice.
"But if this is the case, then it's unacceptable," Rivard said.
After consulting Bolduc, Rivard called back: "Minister Bolduc is urging people who are aware of it to report it to
the Quebec College of Physicians."
Paul Saba, a primary care physician at Lachine Hospital, said that not only has he heard of the practice but that he, too, has been offered gifts for quicker access to care.
"People have offered me money and I've refused it," Saba said. "Today ... one patient offered me cash. People are desperate for services and they want to move things along."
The black market for care is encouraged by the privatization of services, he said. Doctors feel underpaid and the demand for medical services in the public system outstrips supply, he said.
But doctors shouldn't accept such gifts, he said.
Quebec has to find solutions within the public system to relieve the pressure on operating rooms and diagnostic procedures, "so people
don't feel like they have to put money in an envelope to get a test," he said.
"It's unacceptable, but I don't blame the patients. We need to find solutions -I don't want to see my colleagues doing this, either."
Disgusting, scandalous and indefensible, said Gaetan Barrette, head of the Quebec Association of Specialists.
"It makes me very sad," he said, adding that patients should complain to Quebec's physicians disciplinary board.
The Quebec College of Physicians said it condemns any form of kickbacks but it is not aware of any complaints about the practice.
The board's main investigator, Francois Gauthier, has not had a single complaint, said newly elected president Charles Bernard.
"It's not normal if this is happening," Bernard said.
Another patient -who sent the Jewish General a letter of complaint last year about services not rendered following payment to a doctor -said she got a "donation" certificate acknowledging her "gift" in response to her complaint.
Nicolas Steinmetz, a former executive director of the Montreal Children's Hospital, said he, too, is aware of extra payments made under the table.
"Disgusting," he said. Years ago, patients would give their doctors tokens of appreciation -a bottle of wine or a fruit basket at Christmas, he said. "In the country, it would be a chicken, but that's different -that won't buy you a Mercedes."
Michael McBane of the Health Council of Canada said the problem of greedy doctors exists everywhere, not just Quebec, but the medical profession polices itself.
"Doctors aren't going to report on themselves -the fox is guarding the chicken coop," he said.
However, illegal billing and queue jumping are clear violations of the Canada Health Act, he added.
Hospital officials at the Jewish General and the Royal Victoria hospitals have refused repeated requests for interviews. Both issued statements via email late yesterday.
"There's no preferential treatment of patients. All receive best quality care. Furthermore the JGH has a policy on conflict of interest regarding possible gifts offered to staff by patients."
The McGill University Health Centre "expects professional conduct from all staff. ... This includes avoiding potential conflict of interest with respect to offers of cash or gifts."
