Private clinics would harm 'ordinary' people using public system in B.C., says government lawyer

A legal challenge by the owner of a private clinic providing scheduled surgery for affluent patients should be denied because it is based on a flawed constitutional argument, a lawyer for the B.C. government says.

Jonathan Penner said Tuesday that Dr. Brian Day's bid to have the province strike down provisions of the Medicare Protection Act prohibiting double billing amounts to an "unlawful business model."

Penner told B.C. Supreme Court Justice John Steeves that Day's legal team has called the province's position shocking, adding that's based on a disregard for patients who can't afford private care at clinics, such as the Cambie Surgery Centre, opened by Day in 1996.

"In my submission, what truly is shocking, is this complete and utter disregard for the situation of anyone who is not in a position to come up with the funds to pay them to provide rapid surgical services," he said.

"They seek the privileged, those few privileged British Columbians, who require scheduled surgery and have the resources to pay for private care,'' Penner said, adding "ordinary" people would have less access to care under a two-tier system Day has proposed.

'Could invite American-style insurers'

The frail and elderly, patients with complex conditions, and those with severe mental illness and/or substance-use issues would be particularly disadvantaged because regulating a public-private system that could invite American-style insurers would come at a high cost and take money away from public health care, he said.

Wait lists for patients requiring palliative care as well as emergency and urgent services would also increase under such a system because doctors, anesthesiologists and nurses would be lured to clinics allowing them to earn money in both the public and private systems, he said.

Penner suggested physicians should no longer be enrolled in the Medical Services Plan if they choose to work in for-profit clinics.

Patients' Charter rights violated: Day

Day, an orthopedic surgeon, has hinged his decade-long legal battle on arguments around patients having a right to pay for services if wait times in the public system are too long.

He has maintained that four plaintiff patients have been deprived of life, liberty and security under the Charter of Rights and Freedoms after suffering harms from waiting for surgery in the public system before they sought care at his clinic.

Penner called that argument "political theatre" and said Day's legal team has failed to identify whether any harms the patients may have endured were related to wait times in the public system.

When Day opened his clinic, he said surgeons who worked in hospitals were not getting enough operating-room time and profit was not his motive.

Health Minister Adrian Dix announced in 2018 that the government would begin to fine doctors $10,000 for a first offence if they charged patients for publicly available services and that the "don't ask, don't tell" approach that allowed private-clinic surgeries and diagnostic tests to continue would no longer be permitted.

Day won an injunction from the B.C. Supreme Court that ordered the government not to enforce that section of the act until his constitutional challenge is dealt with.