Ottawa Hospital opens operating rooms to private corporation, amid questions about new partnership

A move by Ottawa’s largest hospital to allow a surgeon-run corporation to use its operating rooms is fuelling concerns about how the provincial government plans to grow the private footprint in publicly-funded health-care.

Last weekend, The Ottawa Hospital (TOH) began allowing a private corporation run by eight Ottawa physicians to perform orthopedic surgeries in vacant operating rooms at its Riverside Campus.

The corporation, Academic Orthopedic Surgical Associates of Ottawa Inc. (AOAO), will perform surgeries at the hospital on Saturdays — a day TOH’s operating rooms typically sit empty — with the goal of reducing the backlog of joint replacement surgeries and long wait times, according to the Ministry of Health. The hospital says all procedures are covered by OHIP.

But the arrangement with Academic Orthopedic Surgical Associates, which TOH calls a “partnership,” has nurses’ unions and health-care experts questioning why a private corporation is being allowed to use publicly-funded operating rooms instead of the hospital extending its own operating hours.

The new partnership was not widely publicized by the province or by the hospital itself and details about how the arrangement will work have so far been scarce.

Registered Nurses at the Riverside Campus are being offered a flat rate of $750 per day to work with Academic Orthopedic Surgical Associates on Saturdays, while Registered Practical Nurses are being offered $550 per day, with clerical staff receiving $600 per day, according to an employee at the hospital who spoke to the Star on the condition of anonymity out of concern for repercussions.

TOH spokesperson Rebecca Abelson said the hospital would not comment on these payment details “as that is out of our purview.”

Both the Ontario Nurses Association, which represents RNs at the Ottawa Hospital, and CUPE, which represents RPNs at the hospital, told the Star these payments are approximately double what an average RN or RPN would make on a regular 8 hour shift working for the hospital.

This discrepancy in pay is feeding concerns that private entities will use higher wages to lure away staff nurses at a time when hospitals are already struggling with staffing shortages, particularly for those with specialized skills.

Health system experts and union leaders are calling for greater transparency from individual hospitals and the province as private-public arrangements are rolled out in a bid to reduce surgical wait lists that ballooned during the pandemic.

“Who is staffing these ORs? What is The Ottawa Hospital going to do with this added revenue? Will they use it to run their public ORs longer?” said Dr. David Gomez, a general surgeon at St. Michael’s Hospital, part of Unity Health Toronto, and whose research focuses on surgical wait times.

“This could be a useful public-private partnership but there is still so much up in the air. The bigger question is: Why is this (partnership) coming from an independent hospital, rather than from a planned central provincial strategy in which we utilize public resources in an organized and targeted way?”

In response to questions from the Star, TOH spokesperson Abelson said that the Ministry of Health and Ontario Health are “both aware of (the hospital’s) partnership with the AOAO.

“All of the patients receiving surgery through AOAO are TOH patients and all services are billed through OHIP, as per standard practice,” she said, noting physicians are “independent contractors who work within hospitals” and that “physicians are compensated through OHIP.”

The Star requested an interview with the hospital’s chief of staff, who referred reporters to TOH’s media relations department. No response to this request was provided by press time.

A search of Ontario’s corporation registry reveals Academic Orthopedic Surgical Associates of Ottawa Inc. was incorporated in December 2021 and is directed by eight orthopedic surgeons, most of whom have privileges at The Ottawa Hospital.

The Star reached out to the doctors for comment but did not get a response.

Premier Doug Ford and Health Minister Sylvia Jones announced earlier this year that, in an effort to cut down on surgical backlogs and wait times, thousands of surgeries and diagnostic procedures currently performed in hospitals will be moved to community surgical and diagnostic centres, which can operate on a private, for-profit basis.

The plan will start this year by adding some 14,000 cataract surgeries, representing as much as 25 per cent of Ontario’s current waitlist for this procedure, and will also include more MRI and CT scans and other surgeries. In 2024, hip and knee surgeries will also be offered in outside clinics. Ford has said that these procedures will be covered by OHIP and that patients will never need to use their credit cards when obtaining them outside of hospital settings.

According to the Ministry of Health, there were an estimated 206,000 people waiting for surgery in January.

During the pandemic, hospitals were forced to postpone scheduled surgeries — including during three provincially mandated surgical slowdowns — to redeploy staff to care for COVID patients, causing wait lists to soar. Prior to the pandemic, about 200,000 patients were waiting for a surgical procedure, according to figures from the province.

Typically, there are about 650,000 scheduled surgeries performed in Ontario hospital ORs every year.

December figures from Ontario Health show that, on average, 85 per cent of patients in Ontario who are referred to an orthopedic surgeon for a hip replacement will see their specialist within their target wait time, while on average 65 per cent get their hip replaced within their wait time target.

At TOH’s General Campus, 43 per cent of patients needing a hip replacement saw their specialist within the target wait time, while just 16 per cent got their hip replaced within the target.

Hannah Jensen, a spokesperson for Health Minister Jones, said the province was “excited” to see the Ottawa Hospital taking “innovative action” to eliminate the joint replacement surgical backlogs and reduce patient wait times.

“The Ottawa Hospital is doing its part in helping clear the region’s surgical backlog by opening up operating rooms to existing staff on the weekend when they are not in use by the hospital,” she said in an email. “We are always open to innovative ideas to address the current surgical backlog and we will continue to work collaboratively with our partners to build a more convenient, better connected public health care system.”

Rachel Muir, the Ontario Nurses’ Association bargaining unit president at The Ottawa Hospital, said her union has numerous concerns with the use of operating rooms by the Academic Orthopedic Surgical Associates, primarily around nurse and patient safety and liability.

She said she wants her members to know that if they sign up to work with the corporation on Saturdays they are no longer insured under her union’s umbrella, nor would they be covered by The Ottawa Hospital’s insurance since they are being hired as independent practitioners. In such a case, a nurse would have to purchase their own private insurance.

“I’m genuinely concerned about the nurses who are working there and the position they’re potentially putting themselves in. I’m also concerned for the patients who they’re caring for,” Muir said.

“We have so many unanswered questions…Do they have policies and procedures in place if there’s an emergency? What are those? What if a nurse is injured on the job? What’s in place for them?”

TOH spokesperson Abelson told the Star Academic Orthopedic Surgical Associates has insurance “and each physician and health care professional carry their own professional and medical insurance.”

In a statement to the Star, the Ontario Medical Association, which represents Ontario’s 43,000 practising and retired doctors as well as medical students, said it could not comment on the new partnership at The Ottawa Hospital “as we do not have the details.”

The OMA said while it supports the government’s recent move to increase the number of surgeries done in the community, a “health human resources strategy is needed to ensure (community surgical and diagnostic) centres do not take resources away from hospitals or exacerbate existing HHR challenges,” among other key considerations.