Notley upset that important health services for women ‘deemed unnecessary’ in AHS review

Alberta now has 661 confirmed cases of COVID-19, according to an update released on Sunday, March 29, 2020. THE CANADIAN PRESS/AP, Molly Riley

The official Opposition leader is firing back at the province’s United Conservative government after its review of Alberta Health Services suggests some procedures, including tubal ligation and breast reduction, have “limited clinical value.”

On page 79 of the AHS review, where the panel looked at improving operating room efficiency, procedures of limited clinical value are defined as procedures where the evidence of clinical effectiveness is deemed to be weak or absent. Many times, alternative therapeutic approaches exist that reduce the risk of patient harm and promote more efficient use of OR (operating room) capacity.”

The report listed the top 10 procedures that were deemed of limited clinical value (and the number of procedures of each that were done in 2018/2019):

  • Abdominal hernias for adults (8,658)
  • Benign skin lesions (6,827)
  • Carpal tunnel syndrome (5,845)
  • Haemorrhoids surgery (2,835)
  • Adenoidectomy in conjunction with tonsillectomy (1,633)
  • Tonsillectomy in adults and children (1,106)
  • Trigger finger (1,106)
  • Sterilization for women (1,095)
  • Rhinosinusitis (1,033)
  • Breast reduction for women (1,011)

“What we’re talking about there is delisting of carpal tunnel surgery, potentially trigger finger surgery, tubal ligation, breast reductions,” NDP Leader Rachel Notley said on Thursday. “All those things are — tubal ligation, obviously — but the other ones are mostly women that require that type of treatment. So it’s very distressing to see those kinds of services that matter a great deal to women suddenly being deemed unnecessary.”

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She also noticed vasectomies were not on that list.

“I’m not quite sure why it is women’s birth control [that] is somehow unnecessary but men’s birth control carries on,” Notley said.

“At the same time, we’re telling women that if they do get pregnant they have to leave their community to deliver their baby, quite possibly, because we’re looking at reducing maternity services in rural communities. It’s kind of ironic.”

READ MORE: Alberta Health Services review aimed at finding savings, improving performance

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On Monday, Health Minister Tyler Shandro released the 220-page Ernst & Young report, which will serve as the blueprint for upcoming structural changes to Alberta Health Services.

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Alberta is spending $20.6 billion on health this year, equivalent to more than 40 per cent of the operating budget — higher per capita than almost all other provinces — but with outcomes that the government says put the province in the middle of the pack.

The $2-million report was ordered by Shandro last summer to find efficiencies while not compromising care.

The report made 57 recommendations, including changes to work rules and pay for doctors and nurses, expanded use of private clinics, and further outsourcing of support services such as laundry, linen, food service and housekeeping.

READ MORE: Alberta Health Services review aimed at finding savings, improving performance

The report also said that close to half of the 83 hospitals in smaller regional areas could be reconfigured to get better value for money while making sure remote residents still get timely care.

Shandro rejected the recommendations to close down five regional hospitals and shutter one of Edmonton’s two adult trauma centres.

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On Wednesday, the health minister questioned Notley’s concerns about losing services important to women and her use of the term “delisting.”

“I don’t think that’s medical professionals saying that; I think that’s her (Notley) saying it. I think she knows very well what delisting means. I think she knows that she’s using that word incorrectly,” Shandro said.

“Look, there’s a list — there’s a suggestion — that we work with the Choose Wisely program, and make sure that when there is a referral for surgery, that it’s done considering appropriateness. And working with medical professionals to be able to develop guidelines about when — and when not — something is appropriate.

“I’m minister of health; I’m not here to micro-manage which procedures are done at which locations, that’s why we have the experts at AHS to do that. I look forward to them being able to take that recommendation and working with patients and working with professionals to develop those guidelines.”

Notley stands by her statement.

“They’re talking about how these are very possibly not services that are necessary. So if they stop performing them, then what that likely means is that if people need those services, they’ll have to get them privately, and that’s a form of delisting.

“We’re very concerned that this report, as a whole, is going to significantly undermine the quality of health care that all Albertans receive — women, seniors and all Albertans.”

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The report estimated that if the government follows through on the recommended changes, it would result in a maximum of $1.9 billion in total savings per year. Shandro said that figure can vary depending on how recommendations are implemented, but any savings will be reinvested in the system.

Shandro said Alberta Health Services, the $15.4-billion delivery arm of the health system, will act on the other recommendations and provide an implementation plan by May 13.

— With files from Dean Bennett, Canadian Press

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