CALGARY - A high-ranking Calgary doctor at the centre of queue-jumping allegations conceded Monday he booked his patients outside the normal routine, but said he didn't realize that would move them to the front of the line.
Dr. Ron Bridges told Alberta's preferential access inquiry Monday that he was not clear on the rules for booking patients into the publicly funded Colon Cancer Screening Centre, which he founded in 2008.
Bridges, a gastroenterologist, said he booked referrals through senior managers at the centre rather than faxing the referrals through the booking clerks, as per normal procedure, because he didn't know the booking clerks.
"In five years you've never taken the time to find out who the booking clerks are at the clinic that you founded?" asked inquiry lawyer Michele Hollins.
"I don't know who the booking clerks are, no," said Bridges.
Bridges is an associate dean of medicine at the University of Calgary and the inquiry has already heard he holds considerable stature in the medical community.
But he said he didn't realize that by sending his patient-screening requests through senior brass, those patients were then getting fast-track treatment.
"I'm just trying to help people get into the system," said Bridges.
But why not simply tell those patients to follow the rules, asked Hollins.
"What prevents (those patients) from going to their family doctor like anybody else has to, faxing in a referral, and waiting the appropriate time?" asked Hollins.
"Many people don't have family doctors," replied Bridges.
"What are all of the other people supposed to do? Can anyone without a family physician call you up?" asked Hollins.
"If they phone me I will try and help them access the system."
Clerks at the colon cancer clinic, better known as the CCSC, have testified that from 2008 to 2012, at the direction of senior management, they slotted in Bridges' low-risk patients for colon cancer screening within weeks while the normal wait for everyone else was three years.
CCSC assistant manager Olga Koch has testified she booked the fast-track slots for Bridges even though he didn't have any authority out of her respect for him and his title.
Bridges acknowledged that, in a 2011 email to Koch, he directed her to book his low-risk patients "in the coming months" while the wait list as he understood it at the time for those patients was well over a year.
But he testified that at time, the CCSC was short patients and was looking to fill slots. He also said that when he asked his patients be seen within months, he didn't realize that they would be.
"Certainly it was not my expectation that the average-risk people would be seen in the course of a few weeks or months," said Bridges.
"But that is exactly what you say (in the email)," said Hollins. "Please arrange for these colonoscopies in the coming months. That was clearly your expectation."
"That was a poor choice of words," allowed Bridges. "My expectation was not that they be seen in the next two or three months at all."
"A poor choice of words that we've seen repeatedly in these emails," said Hollins.
Clerks and doctors have testified that many of the patients moved to the head of the line at the CCSC were from the Helios Wellness Centre. Helios is a private clinic that dispenses yoga, exercise, and diet advice to patients for $10,000 a year.
Both Helios and the CCSC rent space from the University of Calgary at the Foothills Medical Centre.
Helios founder Dr. Chen Fong has testified Helios is non-profit and donates $200,000 or more per year to the University of Calgary's faculty of medicine to fund scholarships and other projects.
Helios staff have already testified that they bypassed the normal booking procedures to go through Bridges. But they said it was done to get their patient names into what they labelled a dysfunctional CCSC database — not to get preferential access to cancer tests.
But Bridges testified he was not aware that Helios patients were being sent to the front on the line. He also said he wasn't aware that staff at the publicly funded clinic had a special file for private Helios patients.
— By Dean Bennett in Edmonton
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Jan. 22, 2008: Colon Cancer Screening Centre, or CCSC, officially opens at the Foothills Medical Centre as a joint initiative of University of Calgary and Calgary Health Region. It is Canada's first free-standing colon cancer screening clinic designed to assume 30 per cent of the colon-cancer tests in the region to take pressure off hospitals. CCSC medical director Dr. Alaa Rostom is hired by clinic founder and University of Calgary associate dean Dr. Ron Bridges. Rostom testified in order to change colon cancer testing from individual patient lists to one common queue at CCSC, doctors are allowed to fill half their slots with their own patients during the transition.
2009: Samantha Mallyon joins CCSC as a booking clerk. Mallyon testified she was soon directed to take all patient files coming from the private Helios Wellness Centre and book them within week or two, while regular patients waited three years or more. She testified CCSC administrator Darlene Pontifex directed her to do it and came by her desk once a week to make sure Helios patients were indeed fast-tracked.
April 2009: All Alberta health regions are folded into one superboard titled Alberta Health Services under new president Stephen Duckett. Duckett issues a memo a month later to health leaders saying that he had heard queue-jumping was going on and would not be tolerated. Around this time Alberta Health Services begins the process to take full control of CCSC.
Early 2010: Patients from the Helios Wellness Centre are being systematically seen much sooner than the normal three-year waiting period for routine tests, according to the testimony of Dr. Valerie Boswell, a general physician hired to pre-screen patients at CCSC. Boswell said she made a phone call to Helios to learn more, but was berated by the person at the other end of the line, who demanded to know why she wanted the information.
March 2010: Boswell brings up concerns about Helios patients jumping the queue to Rostom, Pontifex, CCSC research director Dr. Robert Hilsden, nurse Heather Stubley and Pontifex assistant Olga Koch. Boswell testified she got a frosty reception and no response. She wrote "Yikes" on her meeting notes.
Nov. 1, 2010: Dr. Jonathan Love — site chief for gastroenterology at Foothills Hospital — checks a patient for a colon cancer on expedited basis on referral from Helios doctor Doug Caine and Bridges. The patient was marked urgent but Love testified case appeared routine. Love visited Caine at Helios clinic. Caine gives him a tour and, according to Love, told him the clinic was set up to reward deep-pocket donors at the University of Calgary. Love said he raised the issue of possible queue-jumping involving Bridges and Helios at subsequent meetings of gastronintestinal doctors from Foothills and CCSC, including Rostom, but nothing was done. Rostom testified he doesn't remember such comments. Around the same time, CCSC policy is changed to forbid doctors from booking their own patients because CCSC is moving to one common patient queue.
December 2010: Two boxes of wine with a bow are delivered to CCSC from Helios. Rostom testified he ordered the wine sent back, but didn't explore the issue further. Rostom denied testimony from Barb Kathol, an executive director at the Foothills Hospital who works with the CCSC, that he didn't send the wine back until she ordered him to do so two months later.
Early 2011: David Beninger begins working as booking clerk at CCSC. He testified he saw Helios patients being fast-tracked, with many of them tied to Bridges. He testified he mentioned it to Boswell and was told the practice was supposed to have stopped. He told her it was still happening. Dr. Mark Swain, the head of gastroenterology for the Calgary region but with no authority over CCSC, is told by Love and Boswell about possible queue-jumping involving Bridges' patients.
Alison Redford 2012
Oct. 2, 2011: Alison Redford voted Alberta PC party leader and premier after campaigning on promise to hold a public inquiry into health system problems including queue-jumping.
November 2011: Boswell has second meeting with Rostom, Pontifex, and Hilsden over queue jumping involving Helios. She testified Rostom told her: "This is not a hill we want to die on."
Early 2012: Love asks CCSC clerks if queue-jumping is going on. He testified they replied: "Sure it's going on. Like, duh."
Feb. 28, 2012: Health Minister Fred Horne announces he has asked Health Quality Council to strike an independent panel to examine any queue-jumping in Alberta's health system.
March 16, 2012: After Swain tells Kathol she needs to again look into queue-jumping allegations, Kathol phones Rostom to advise him a second time of concerns that Bridges is directly booking patients at CCSC. This time, Rostom tells her he'll look into it, but testified that he didn't because he didn't have the time or resources.
March 19, 2012: Instead, Rostom sends out an email warning to senior staff reminding them that queue jumping in endoscopy procedures is not allowed. This catches the attention of his boss Dr. Francois Belanger, the head of the Calgary medical zone.
March 21, 2012: Belanger talks to Rostom. He said Rostom confirmed to him there had been charts flagged with him, but told him it was largely the result of organizational confusion and had been fixed. Belanger let the matter drop.
All parties agree any queue-jumping stopped after this point.