Two years ago, a Commission of Inquiry in Alberta was called to explore improper preferential treatment in the healthcare system. It was a result of a public outcry after members of the Calgary Flames hockey team and their families were vaccinated for the H1N1 virus ahead of the general public during a declared pandemic. Other allegations of preferential treatment were made as well. The commission was formed with the mandate to consider, “whether improper preferential access to publicly funded health services [was] occurring; and if there [was] evidence of improper preferential access to publicly funded health services occurring, [it was to] make recommendations to prevent improper access in the future.” Volume 1: Inquiry Report of the Health Services Preferential Access Inquiry was published in August 2013.
The vaccination of the Calgary Flames team was investigated by the College of Physicians and Surgeons and Albert Health Services before the inquiry. The college found that the doctor in charge of the clinic that vaccinated the hockey players and their families, decision was “an error in judgement, not professional misconduct. As a result, the Investigation Chairman has directed that this complaint be closed. The public reaction to this incident, as well as the complaint, has served as very useful feedback to [the doctor involved] regarding the ethics of seeking preferred services for an elite group of individuals in a publicly funded health care system.” On the other hand, Alberta Health Services fired the administrators involved in setting up this special clinic. The Commission of Inquiry found that this was indeed improper preferential access and a clear rule should be put in place to avoid such incidents because they undermine the public’s confidence in a publicly funded system.
The inquiry looked at several other cases where there might be a question of preferential access. It found that where a physician deemed a case to be especially urgent and the patient was allowed to jump the queue once that diagnosis was made, then this could not be considered a case of improper preferential access. Even if the patient had special access to the doctor because of personal or professional relationships, once the urgency of the case was established, then there could be adequate medical justification for jumping the queue. The inquiry recognized that there was no way to stop the practice of “courtesy calls” where doctors see patients outside regular hours as a courtesy to their colleagues. As a result it looks like there is really no way of eliminating some level of preferential treatment of first class patients. But the inquiry concluded these patients should not be allowed to jump the queue without clear medical need. It also found that this small group did not significantly affect the care of the rest of us.
The question of third class patients was not investigated by the inquiry. The commissioner declared that the inquiry was limited to looking at whether there were people who were “getting access that is superior to the norm.” It did not look at cases where people were getting access that is markedly inferior to the norm. However it did note that the groups listed below were receiving inferior access:
- Rural populations;
- Individuals without family doctors, particularly individuals with complex medical issues;
- Individuals with addictions and/or mental health issues;
- The poor;
- The elderly;
- Individuals whose first language is not English;
- Those with hearing or vision loss or mobility issues; and
- First Nations communities
These are the third class patients. So it looks like even today in Alberta, and probably across Canada, we have the same three classes of patients in our publicly funded system. What do you think we should do about it? Are there others who should be added to the list of third class patients?