Unethical, Immoral, not Illegal?

"If you have money, you live; and if you don't, you die."

That's the kind of matter-of-fact statement reflecting the hard life realities in impoverished countries of the world where medical treatment can be obtained but not by the vast mass of the population, only those who represent the elite, the entitled, the moneyed class. And of course health-tourists who travel to countries like India where they can obtain expert surgical procedures not recognized in Canada.

Thank heavens, we live in Canada. Where universal access to timely and state-of-the-art medical intervention is not only possible, but a matter of life. Life defeating death. We are indeed fortunate. Of course there's been a creeping incidence of private, for-profit interventions that we mostly decry; clinics and medical specialists who've opted out of our universal health care system.

But the universality of Canada's public health care system is an enviable one. Particularly when it works. And often enough it does. Occasionally it slips up and people are left untreated on the brink of expiration, cautioned to be patient and simply await their turn, and then there occasions a tragedy and that patient no longer needs to wait for his/her turn.

Now, we learn of another, odious practise recently revealed that appears to be common in Quebec. Where skilled surgeons supplement their comfortable incomes (which they claim, as people are wont to do, that those incomes do not reflect the value they give to their communities) display an unwonted venality. Accepting thick envelopes padded with thousands of dollars to expedite individuals to the top of the waiting list.

Alternately, agreeing to perform the surgery themselves rather than delegate it to an inferior-skilled practitioner or a junior surgical professional.

"I've learned that it's current practise ... everyone within these hospitals knows about it. It's systemic, and it's been so for a long time now."

This is a narrative through the mouth of a high-ranking physician with experience at a number of Montreal-area hospitals, explaining that obstetricians regularly deign to accept cash from families anxious to ensure that it is the contracted obstetrician who will show up at the hospital for the delivery, not whichever doctor happens to be on call at the hospital at the time.

"We wanted to have the operation done by (someone) who we know is the best. I gave it to him discreetly and he took it. He knew what was in the envelope. He took the money and never showed up."

That was one plan that went awry, when the surgeon quietly took possession of the cash-stuffed envelope and somehow a member of his surgical team managed to conduct the surgery, not he. A formal complaint is in the planning stages. Who will they complain to, the surgeon who forbore to act on his part of this sleazy bargain?

The hospital, which will deny that such a practise exists? The province which underfunds its health system, even as it continues to extend its grasp of another province's equalization hand-outs? This blackest of black markets is representative of another type of two-tier system we hardly imagined exists in Canada.

It helps immeasurably to know that the head of the Quebec Association of Specialists considers the phenomenon to be "disgusting, scandalous and indefensible", and that "It makes me very sad". All is not lost thank our lucky stars; the Quebec College of Physicians condemns any form of kickbacks.

Of course they deny knowledge of any complaints about the practise.