Extra-billing fines delayed as doctors, ministry agree to 1-month extension

B.C.'s ministry of health is extending, until the end of June, the time before fines and other penalties are levied on doctors who are still providing for-pay services.

The province says extra-billing practices in B.C. have cost the province $32-million in lost federal health-care transfer payments that are withheld by Ottawa, because some doctors and clinics continue to charge for medical care privately.

In November, B.C. Supreme Court Madame Justice Janet Winteringham set a deadline of June 1 for the provisions and penalties of B.C.'s new health-care act to kick in.

She stopped the province from immediately enacting the new provisions of the Medicare Protection Act, because of an ongoing constitutional challenge, as well as concerns around the impact penalizing doctors might have on patients.

This weekend, both the province and the doctors involved in challenging the law agreed to extend the deadline by a month.

"The Province and Plaintiffs have agreed to a brief extension of a more limited form of the injunction, limited to the Bill 92 enforcement provisions that were introduced last October, to the end of June," said the ministry in an emailed statement.

The province has long said it would move to recover some $15.9 million in fines incurred under the Canada Health Act for extra billing by private surgical clinics.

In October 2018, the ministry introduced Bill 92 to do just that. It also required B.C. doctors — who were providing services at private clinics that had contracts with health authorities — to sign what some doctors describe as "compliance letters."

They were told to sign to confirm that they understood the law relating to extra billing and would not engage in for-pay medical practices at those private clinics.

But about 100 doctors challenged those letters in B.C. Supreme Court as a violation of their rights.

A May 30 ruling on the challenge stipulated the doctors would have to file a new legal application if they planned to keep challenging the letters. The legal team for Cambie Surgeries Corp. says it's reviewing its next move.

Province wants us to run out of money

Cambie Surgeries Corporation's Dr. Brian Day, who spearheaded the challenges, said he doubts it will happen.

He says the main focus is the constitutional challenge of the provincial legislation which doesn't allow for a mix of private-public medical care options he believes would cut wait-times and better serve patients. He says a side action over the letters would just cost too much time and money.

"One of the strategies of the government is to make us run out of money," Day told CBC.

It's unclear what will happen after the 30-day extension ends.

Provincial officials say they are reviewing a B.C. Supreme Court ruling handed down last week to determine next steps.

B.C. officials say extra billing is resulting in a loss of federal health transfer dollars that could reduce wait-times for patients  by increasing surgery hours.

The province says federal funding to B.C. was reduced in 2018 by $16-million because some practitioners and clinics were extra billing patients.

This year, B.C. says it lost a further $16-million in health transfer payments — money, it says, could be used to improve public health care.

Health Minister Adrian Dix has said a crackdown is needed to prevent clinics that have ignored the rules for decades.

The constitutional challenge case is expected to wrap up this fall with a decision probably not until 2020. Some predict that the judge may keep extending the order until that trial is over.

In Winteringham's 74-page decision last November, the B.C. Supreme Court justice said that tough penalties on doctors would force clinic closures and cut limited services, causing more delays in a system already beset with long line-ups for surgery.

In the meantime, Day complains the province is moving to pull public contracts from surgeries and surgeons who are refusing to comply with the new act, and he says that's making waits even longer for patients looking for these specialized surgeons' services.