Red Deer surgeons call on province to lift cap on joint replacements

Doctors in Red Deer say their patients face unnecessarily long waits and are suffering needlessly because of a cap on funding for hip and knee replacements.

“Patients are so frustrated and dismayed by wait times here in central [Alberta],” said Red Deer orthopedic surgeon Dr. Keith Wolstenholme, whose patients wait an average of two years from the time they are referred to the time they get their joint replacements.

“That’s just too long.”

According to Wolstenholme, the long wait list is driven, in large part, by a limit on the number of joint replacements that are  publicly funded in the province of Alberta. There is no cap on other orthopedic surgeries.

“It’s not fair and its not equal access to care,” he said. “What we end up having is essentially discrimination based on diagnoses. So patients with hip and knee arthritis have a longer wait list than patients with other orthopedic complaints.”

That disadvantage is aggravated, he says, by an uneven distribution of dollars, with Red Deer getting less per capita funding for these procedures than Calgary and Edmonton.

Dr. Keith Wolstenholme says patients waiting for hip and knee replacements wait much longer than those needing other orthopedic surgeries because of the funding cap. (Jennifer Lee/CBC)

According to the Alberta Bone and Joint Health Institute, during the 2017-2018 year, 678 non-emergency hip and knee replacements were performed at Red Deer Regional Hospital, which serves roughly half a million central Albertans. Calgary hospitals performed 3,821 and Edmonton hospitals completed 3,582.

Cap based on ‘need and capacity’

In a response emailed to CBC News, an Alberta Health spokesperson said 194 additional hip and knee surgeries for south and central Alberta were funded through the 2018 provincial budget. The spokesperson did not say how many of those went to Red Deer.

While the larger pool of funding comes from the provincial health department, the number of joint replacements each zone is allowed to perform annually is set out by Alberta Health Services (AHS).

“Volumes are based on need and capacity,” said the Alberta Health spokesperson in the emailed statement.

“Capacity is determined by available resources, including staffing, OR [operating room] space and equipment. AHS prioritizes surgeries provincially based on need, ensuring the ability to address and decrease wait times for all procedures including hips and knees.”

That explanation doesn’t sit well with those on the front lines.

“We don’t understand why the cap is there,” said Dr. Bryce Henderson, an orthopedic surgeon in Red Deer who regularly sees patients struggling with severe pain as they wait.

“People who have paid taxes their entire lives no longer seem to have coverage for the health services that they’ve already paid for,” he said. “They’re angry. They’re frustrated.”

Out of desperation, Henderson says, patients often go to Calgary or Edmonton, where they can get the surgery more quickly.

Or they go out of province — even out of the country — in search of relief.

Dr. Bryce Henderson, a Red Deer orthopedic surgeon, says he’s had patients go as far away as Mexico to get their hip or knee replacements because the waits in Red Deer are so long. (Jennifer Lee/CBC)

‘I was done. I was finished’

Bradley McEwen knows what it’s like to wait for months on end: unable to work and housebound. Intense pain left the Red Deer man struggling both physically and mentally.

“[It] was to the point where I couldn’t get up the stairs. I couldn’t walk. I couldn’t sit. I couldn’t lay. I couldn’t do anything. I was done, I was finished,” he said.

McEwen gave up waiting for his hip replacement when a family member offered to pay roughly $20,000 so he could have his surgery done at a private clinic in Laval, Que.

“And I walked away — no pain. As soon as they do the surgery, the pain stops.”

Bradley McEwen says he was unable to sleep, work or walk up and down stairs prior to getting his hip replaced at a private clinic in Quebec. The pain was so intense it was impacting his mental health. (Jennifer Lee/CBC)

Five months later, McEwen can now shovel his walk and navigate stairs with no trouble. And he’s adamant other patients shouldn’t be forced to wait.

“There shouldn’t be a cap. I mean, people are walking around in pain, critical pain, and they’ve paid their taxes for years now — and there’s a cap? ‘Oh no, you can’t have yours done now because we’ve done too many this year?'”

Calls for change

To put an end to the frustration, the Red Deer surgeons are calling on health officials to immediately increase the number of joint replacements funded in central Alberta.

“Pain, suffering and illness shouldn’t be worth any more or any less in Fort McMurray, Red Deer, Calgary or Medicine Hat. It should all be the same,” said Henderson.

According Wolstenholme, doctors could perform up to 200 more joint replacements a year in Red Deer — at no extra cost — with the operating rooms, beds and staff already in place.

Those operating rooms are not sitting idle just because Red Deer has hit its quota for hip and knee replacements. The doctors say — because other surgeries are not capped — patients with different orthopedic problems are getting earlier access to OR time than they would otherwise get.

“All we’re asking as surgeons is the ability to control our own wait lists,” said Wolstenholme. 

“We should be able to prioritize our patients. We should be able to at least offer them equal access. But right now we can’t. We know that the patients that need hip and knee replacements have to wait longer because of the cap.”