A look inside New Brunswick's first private cataract surgery clinic
Surgeon says ‘this is the way of the future’ — but wants tougher rules against ‘corporate’ care
Gemma Firlotte says New Brunswick's experiment with private surgical clinics suits her just fine.
The 71-year-old Nigadoo resident was sitting in the waiting area of a Bathurst ophthalmology clinic last week, tape over one eye, waiting for her turn in the operating room.
That's right: Firlotte was about to undergo cataract surgery in a clinic, not a hospital, something not allowed under provincial law until last fall.
The retired hospital worker said she was getting the operation much faster than if it had been at the Chaleur Regional Hospital, where she used to work.
"People were always complaining and had to wait too long, and I find here I haven't waited very long," she said.
From diagnosis to her appointment, "it was about three weeks. And the surgery is today."
The clinic, and the legislation that the Higgs government passed last fall to allow it to operate, has sparked a political debate about how much private health care New Brunswick should tolerate.
Green Party leader David Coon asked in the legislature last November why the Progressive Conservatives were opening the door to "corporate-owned surgical centres."
But given the staff shortages and long wait times in the province's hospitals, Health Minister Bruce Fitch said, "it would be naive for us to not to at least consider some of the alternatives to what has been occurring in the last little bit."
The clinic is owned by Dr. Robert Javidi, an ophthalmologist who has practised in the city for 20 years.
The basics of the arrangement are no different than those of a family doctor's office, which is also a private corporation: the doctor provides a service and bills Medicare for it.
Javidi's been doing consultations in his clinic for years, but until last fall, he had to send patients to the hospital so he could perform cataract surgery.
That took up valuable operating room time and space that might have been used for other procedures.
The province and the Vitalité Health Network say they have put safeguards in place to avoid the risks of more private care.
"For the patient there's no difference," said Dr. Natalie Banville, Vitalité's vice-president of medical affairs. "The patient doesn't pay. Dr. Javidi is paid by the government, so for the patient there is nothing different."
The health authority still controls the wait-list and determines which patients get priority. No one is allowed to pay out of pocket to jump the line.
And Javidi and any other surgeons who perform surgeries at the clinic must have hospital privileges and must commit to being available for emergency calls there.
"It is actually privately delivered public care, and it's not corporate," Javidi said in an interview in the OR.
"So if it's physician-owned … and operated, I'm pretty sure it will be a very good success story."
Javidi and other ophthalmologists first pitched the concept a decade ago.
But he wasn't willing to take the financial risk of equipping the clinic with a surgical suite because there was no certainty the province would approve it.
Then, when COVID-19 put a severe crunch on hospital capacity, the ophthalmologists proposed it again.
Vitalité was on board, but "there wasn't at the time much of an appetite from the government side," Javidi said.
"It was like something that they've never done before, and they weren't really quite familiar with it at the time."
Still, he decided to gamble, building the operating room based on his belief the government would say yes.
"I was convinced that this is the way of the future. It was one of those good gambles. I kind of came to the conclusion that there is no other way. … And I don't think it's going to change in the near future."
The growing wait-time crisis finally got the government to "yes" and surgeries began at the clinic last fall.
Before the change, 1,551 patients were on the wait list for cataract surgery in the Chaleur hospital's coverage area, said Banville.
All of them have now had their operations, and there were 476 new patients on the wait list as of last week.
During the same period, the number of people who'd been waiting for at least a year dropped from 306 to 72.
And 123 other surgeries have been done that could not have been done if cataract operations were still taking up capacity at the Chaleur OR.
Surgery takes about 10 minutes
Gemma Firlotte remained awake during her operation, which took about 10 minutes.
Javidi delicately sliced out her eye's natural lens, made opaque by the cataract, a cloudy area that is common with age.
"It's like if you're looking at the world through a very dirty window," he said.
Next he slid an artificial lens into place.
The whole process was visible in, well, eye-popping detail on a large monitor in the OR.
As soon as it was over, Firlotte was sitting up.
After a brief post-op with a licensed practical nurse, who told her she should be able to see normally and even drive in about 24 hours, she was on her way.
"I have nothing but good things to say about it," she said. "The service is good. It didn't hurt me at all. It's a good job. A job well done."
This scene will soon be repeating itself around the province.
On Monday, Horizon Health will officially announce a similar agreement on cataract surgeries with a clinic in Miramichi.
Javidi has heard that Fredericton will be next, with Moncton, Saint John and Edmundston likely to follow.
"This was supposed to be a two-year pilot project and we're not even — we're just past six months into the pilot and we're already opening other places," he said.
He also expects other simple surgeries to eventually be done in clinics.
"It wouldn't be a surprise to see that, with time, we are also taking out things that don't need to be in hospitals, and we're really keeping the hospitals for all the interventions that are necessary to be done in the hospital," he said.
But Javidi also said the Higgs government should take additional steps to toughen the law to avoid exactly the kind of "corporate-owned surgical centres" that David Coon and others worry about.
"We're trying to prevent that," he said. "The law is there now to be able to have entities like this. But we haven't still defined exactly how and with whom we're going to work.
"We want to keep all these entities as physician-owned facilities, meaning that the same people who are actually working in a community would own such a facility and they would be the ones that are operating it."
Otherwise, the concerns about out-of-province corporations focusing on profits at the expense of quality care could be legitimate, he said.
"Those warnings are real and we are working with the government to see if it is possible for us to keep it this way," he said.
"I think for the benefit of both health authorities, patients and doctors and everyone involved, it's better if it's kept this way."
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