BC Court Case: Brian Day’s Credibility Problem

Does Brian Day admit that the Cambie clinic charge patients more than the province allows? Does he admit paying doctors more than the province allows? The answer to both those questions is yes and no because in day two of Brian Day’s testimony in his case against public health care, Brian Day gave a completely different answer than he did the day before.

It is against the law to charge citizens of British Columbia more than the set fee for medically necessary services. In BC doctors are paid on a fee for service basis. That is, they are paid an amount set by the province, by the province, for each insured service delivered. It is against the law to charge BC patients more than the provincial fee, in fact it is against the law to charge patients directly. This ensures that all procedures are delivered on an equal footing. In some clinical practises physician fee for service billings are pooled and the physician draws a salary. This is where it gets murky with the Cambie clinic.

On Monday under cross examination, Brian Day said yes to the question “That the amount that Cambie will charge for the surgeon is typically three, four or five times more than MSP would pay the surgeon for the same surgery; is that fair?” And, in support of that admission, Cambie offered that the doctors providing service in his clinic deserve more pay because they are working evenings and weekends after putting in a long week in the public system. “They’re coming out during their down time from the public system where some of them are working 80 hours a week and they’re coming working on what would be for an ordinary person an overtime basis.  And quite honestly they deserve to be paid more.”

Yet on day 2 of his testimony the picture was quite different. When questioning got tough on issues related to how doctors are paid, he denied that they get paid any more at Cambie Surgeries Centre than they are paid in the public system. At the same time, he went on to elaborate on how he does not know how or how much they are paid. In fact, he went as far to say that as CEO of the Cambie Corp when it comes to physician pay “it’s not an interest of mine.”

And if that weren’t enough, after saying several times that he had no knowledge of how doctors are paid or what amounts, the province produced his affidavit in which he swears it is true that he is the best qualified and most knowledgeable to testify in this case on the matter of payment.  Day also stated repeatedly under oath that there are no records of doctors’ pay, no contract between Cambie and the physicians who have surgical privileges there, and no accounting of their fees in the Cambie books beyond regular payments under a category entitled “paediatric consultation”.

The day’s questioning ended with the subject of conflict of interest. The provincial lawyer pointed out that according to the College of Physician and Surgeons standards of practise, it is a conflict of interest for a doctor to be paid a commission, or extra pay for any procedure as it would create an incentive to provide that procedure. That is clearly the case when patients are asked to pay more for speedier service. Day, while admitting on the one hand that physicians deserve to be paid more at his clinic then denying it, stated that there is not conflict in his opinion when doctors are paid more at his clinic to provide speedier service.

While this case is not about whether or not Cambie Surgeries Corp has broken the law with its billing practises, it is about whether or not the law is valid in its protection of patients and the public health care system. And, it is important to remember that Brian Day launched the case after patients complained to the province for being charged additional fees and the province notified the Cambie clinic that it would be audited. His credibility is directly on point to the question of whether or not he can speak to the suffering of patients in a public system, or whether this is simply a ploy to eliminate the barriers he faces in charging higher fees.

The prohibition on extra-billing and private insurance is in place to conform with the Canada Health Act and similar provisions exist in all provinces. If Brian Day is successful it could affect how health care is delivered all across Canada. That is why the Canadian Health Coalition is watching this case closely and getting the word out. Privatizers such as Brian Day have a credibility problem. We remain proud of our health care system where care is provided based on need, not on the ability to pay.

Brian Day’s testimony continues today.

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