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Letter from BCOA to the BC Health Minister – March 16, 2022

16 March 22

Honourable Adrian Dix, British Columbia Minister of Health

Victoria B.C.

Communicating a Realistic Picture of Orthopaedic Healthcare in B.C.

Dear Honourable Minister,

This letter is to formally request an urgent meeting or call with you to discuss the state of orthopaedic surgery in our province.

I have been approached by CTV for comment on the situation with orthopaedic healthcare in B.C. and have an interview scheduled with them for Monday March 21.

I reach out not only as the incoming President of the British Columbia Orthopaedic Association representing over 170 Orthopaedic Surgeons in the Province, but also as a practicing physician with first-hand experience of the situation we are experiencing and supported by reliable accounts from many trusted colleagues. The BCOA advocates for the tens of thousands of orthopaedic patients across our province who are waiting for their time on our surgical waitlists to be up.

Managing health care through this pandemic has been no small feat. I commend the steps that have been taken over the past two and a half years to keep British Columbians safe, and to keep health care moving forward.

I also want to thank you for your advocacy for our patients in the past.

As we enter this now new world of “recovery,” a whole new set of challenges are upon us as a province. We would like to work with you, the ministry, the hospitals and the regions to ensure steady, appropriate access to care for Orthopaedic patients across the province for the future.

The reason for this letter and our request for a meeting is also to communicate serious concerns on behalf of our association regarding comments made recently, about having caught up with 100% of postponed operations from the early pandemic. This in no way re”ects the experience for most orthopaedic patients or surgeons in the province. In fact, we continue to struggle with access to operating rooms, have not caught up, and continue to see wait lists grow. We are bringing this to your attention urgently as we nervously see these trends continuing with detrimental impact to our patients’ mobility and mental health.

In Prince George, one surgeon whose waitlist averaged 80-90 patients for the 5 years leading up to the pandemic, has seen his waitlist almost TRIPLE, currently with a waitlist of 271
patients. If he was given 1extraOR per week, it would take him an entire year to bring his list back to pre-pandemic levels.
In Kelowna there are currently over 1200 patients on the Orthopaedic surgical waitlist,over halfof them have exceeded their benchmark, many of those have now waited over 52 weeks.

In Kamloops, since the beginning of the pandemic, Orthopaedics has lost 1,803 hours of operating time. On average an orthopaedic case takes around 2 hours, that is 900 patients who have lost their chance in the operating room.
At St. Paul’s Hospital, just this week it was announced an ongoing 40% reduction in surgeries for the next 4 months, due to sta#ng shortages as a fallout of the pandemic.

Unfortunately, orthopaedic surgery is often labeled as “elective,” which implies these surgical procedures are non-urgent. As such, orthopaedics has been hit by closures at a disproportionately high rate compared to all other surgical specialties. In Kelowna, since April of 2021, orthopaedics has lost 79 OR days, the next highest level of cancelations for another specialty is 48. These trends are seen across the province; according to the Fraser Institute report, orthopaedic wait times until surgery grew by 64% from 2020 to 2021, while Neurosurgery, Gynaecology, Ophthalmology, Otolaryngology, and General Surgery all showed a net REDUCTION in wait times (ranging 6 to 34% reduction).

The reality is, Orthopaedic surgeries are life-transforming.
The patient stories that have consistently!ltered in across this pandemic, as our waitlists continue to grow, are!lled with tales of uncontrollable pain, loss of mobility, loss of independence, ultimately leading to depression, short and long-term disability, job loss, and an increasing prevalence of narcotic dependence.

Orthopaedic procedures have a high success rate and are e$ective at helping patients restore their mobility and function.Appropriate timely treatment allows people to ‘get their lives back’ faster so they can get back to work earlier to contribute to their own welfare and the economic welfare of the Province.

Patients have been waiting for months, sometimes years, for any indication that their pain and su$ering will end. Many have seen these recent (operations back to normal)announcements as a promise. Since this announcement our phones have been ringing o$the hook, with patients inquiring when their surgical date will be, as they saw on TV, or read online, the excellent news of the (apparent) surgical renewal and success. The reality is patients have had their expectations unrealistically raised at the same time as access to orthopaedic operating resources have been cut, again.

For orthopaedic surgeons, the shock and response to the announcement of “nearly 100% of postponed surgeries completed” – has been staggering.

On the day of the announcement, I personally received six phone calls, 12 emails, and over 30 text messages from surgeons across the province, from multiple hospitals, in every health
authority, stating their astonishment and disbelief, with the statements that were made about surgeries being back on track. It has heaped pressure on an already pressured and frustrated professional body – reinforcing perceptions of orthopaedics as the ‘low hanging fruit’ for cuts and cancellations.

It is imperative for the orthopaedic surgeons we represent to have faith in the leadership we ultimately work for. It is important too, that patients have a realistic perception of the challenges we continue to face together and realistic expectations as to the waiting times they are likely to encounter.

We share a common goal of wanting to deliver an exemplary orthopaedic healthcare service to orthopaedic patients in B.C. The challenges also present opportunities to change and I look forward with hope and optimism that we can create plans together for a true recovery for orthopaedic patients in this province.

I look forward to the opportunity to discuss this with you at your earliest convenience.

Sincerely yours,

Cassandra Lane Dielwart MD. FRCSC
President-Elect British Columbia Orthopaedic Association