Thursday, March 10, 2011

Your rights and Ontario's bariatric surgical wait times


Today's a guest post from an anonymous writer who has sadly had first hand experience of how poorly Ontario's bariatric surgical program is being run - a frightening state of affairs given that Ontario is far and away the most progressive province in Canada when it comes to bariatric surgery.

Here this writer recounts his experience in getting Ombudsman Ontario involved where according to Ontario's Ombudsman's website,

"The Ombudsman’s job is to ensure government accountability through effective oversight of the administration of government services."
Health care of course is indeed a government service and if you remember from a post a ways back, Ontario's target wait times for a Priority II general surgery (like a gastric bypass), is in fact a scant 4 weeks, and even if you want to try to make the case the bariatric surgery is "elective", 26 weeks is the wait time target.

The writer believes that perhaps if more people made Ontario's Ombudsman aware of not only the incredibly long wait times, but the bureaucratic run around often associated with bariatric surgery in Ontario (for instance when my office called Ottawa they out right refused to provide us with any information at all regarding wait times, waiting lists, appointments etc. and stated clearly it was their policy to never disclose such information to anyone), that perhaps things might improve.

Here's what he had to say:
Bariatric Surgery Wait Times and Customer Service

Long wait times and poor customer service do not need to go hand-in-hand in Ontario, but it sure feels that way. Fortunately, there is a way to dramatically increase your chances of being treated with some respect by having your calls returned and perhaps finding out where you are on the waiting list.

What you need is an influential friend. Let me introduce you to Ombudsman Ontario, and how they helped my wife, and how they might be able to help you. These are the same folks who investigated police actions at the G20 summit, and found that the Ministry of Health and Long Term Care's policy on one cancer treatment "verges on cruelty", with their communications in the matter being "blatantly misleading".

They haven't really been aware of the problems in the bariatric system because nobody has been complaining to them. It's time to start. Complaining to the Ombudsman is not an appeal, with a lot of requirements. You can phone them, email them, write them... and they respond... promptly.

Within a week of my wife's letter, they were calling to follow up and investigate. Within two days, they had contacted both Windsor and Hamilton to find out what was going on. Another two days, and there a call from Windsor with information from Hamilton about a missing test, and an expected wait time.

There was a lull and the Ombudsman's office thought they were done and everything was going well, except that it looked like Hamilton was gearing up for a repeat of the assessment done in Windsor, and not willing to set an appointment with a surgeon until after that.

My wife called the Ombudsman again to explain that it looked like this was going to be wait time upon wait time. They stepped in again.

I'll cut to today's highlight. There was a call from a representative at the Ministry of Health to make sure that my wife received the message from Hamilton Bariatric for two appointments including one next Tuesday with the surgeon because Hamilton's coordinator had not yet heard that my wife had already confirmed with booking clerk.

My wife's complaint to the Ombudsman was treated as a Customer Service issue. The Ombudsman will not make medical decisions, or dictate to either the Ministry of Health or the bariatric centers. From my perspective, what they will say to the Ministry and bariatric centers is, "This is your system. Make it work."

A large number of complaints might cause the Ombudsman to escalate their investigation to one that looks at the system itself instead of just service for a single patient. This could benefit all of the patients stacked up awaiting assessment or surgery.

If you are stuck on Ontario's wait list, then you probably have something to complain about. It could be not having calls returned, not being told when to expect an appointment, having to re-do assessments, bad wait time data, or just excessive wait time. Even if contacting the Ombudsman doesn't speed up the process, you may be pleasantly surprised at being treated with respect.
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30 comments:

  1. Anonymous8:00 am

    I read today's post with great interest as I'm on the wait list at Humber. I had my orientation session on Monday, March 7th and the next day I was called by the clinic to book the next series of appointments.

    Yes, the wait lists are long. And yes, there is often times misplaced info that can hold up the surgery. But I did find something to be very interesting during my orientation session - most of the people scheduled didnt show up. Of those who did show up, only a handful knew about the procedure and what they need to do to become successful. A lot of people opted not to have surgery when they found out they had to give up smoking, drinking and junk food.

    Putting people through the system who have no intention of changing their lifestyles is a waste of time IMHO. I'm not blaming the patients. Some are going to the sessions blind. They have no idea what this process really entails.

    Referring doctors should be given an information package to give to patients before they send in a referral. The patients can then decide based on that info if it's something they want to persue.

    I researched the surgery for 5 years before asking for a referral and I'm making the changes I need to make to be a successful candidate.

    That said, I'm glad that there's an option to take if there's a lengthier than normal delay in the process.

    PS. I wanted to give a shout out to Deena at HRRH for great customer service :) She's treated me great during this process. I hope my other encounters with the HRRH team will be the same.

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  2. Anonymous8:27 am

    Reposted this to Obesity help website. There are lots of folks there who have waited over a year. This lying govt has de-listed Duodenal Switch surgery, make people wait and jump through hoops that are nothing short of mal-practice. They make them meet with social workers and other non necessary govt hacks. Why? Since when did (OR SHOULD) a social worker have any say in one's own private health matters?

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  3. This comment has been removed by the author.

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  4. Anonymous9:23 am

    I am in Ottawa.

    I had my first appointment with Dr Dent 2 years ago. He told me I was not eligible for Weight loss surgery but to book an appointment in 6 months. I have been going every 6 months. Last time when I went in October he finally booked added me to the list for surgery, but said that the wait would be 2 years. I am only being considered for RNY although I think DS would be better for my situation. My BMI is shy of 40 and has been for 5 years.

    If any other weight loss system showed the efficacy of WLS I would do that in a heartbeat. But honestly most Weight Loss systems have a distinct lack of studies showing their effectiveness. I don't want to yo-yo any more.

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  5. Anonymous9:57 am

    I waited more than a year from my referral just to my very first appointment. I wish I'd thought about the Ombudsmen back then.

    Great post!

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  6. Anonymous1:52 pm

    @Anonymous(I am in Ottawa)

    Start pushing now for a date, or where you are on the wait list. These are the kinds of things the Ombudsman are likely to feel you should be entitled to.

    Also, personal opinion, if you just went on the registry then you are probably looking at 3-4 years. It's my understanding that the wait list in Ottawa is even longer than elsewhere.

    @Anonymous(Reposted this...)
    The U.S. Centers of Excellence have similar hoops, but they line them up and make it possible to get through to surgery in 6 months. As for "lying govt"... I can't argue with that.

    @Anonymous(I read today's...)
    There are people working in this system that are doing a great job subject to the constraints they face. My anger is pointed squarely at OHIP.

    Let's see... you can get Out Of Country Approval if the delay in
    Ontario will jeopardize your health... but OHIP requires that you be assessed by an Ontario specialist... but the delay in getting to them is so long that it's the reason you want OOC in the first place...

    Catch-22. Joseph Heller would love this one.

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  7. Anonymous8:09 pm

    This is elective surgery. You can pay for it yourself, in some other country.

    You should be ashamed of yourself, Dr. Freedhoff, and someone should make a complaint about you to the Ontario College.

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  8. Anonymous10:31 am

    Yes this is elective surgery but so are things like hip and knee replacements! Should people be paying for those?? And BTW I am paying for it, all Canadians have been paying for their health care in their taxes for their entire lives. We don't have free health care here by a longshot. We may not have to pay out of pocket but it's taken off each and every paycheque before we even see the money. This surgery has been proven to save health care dollars in the long run because it helps people get rid of long term illnesses like diabetes and high blood pressure. The poster who says that we should pay for it ourselves is IGNORANT AND UNINFORMED.

    I have been on the waiting list for an entire year now. My referral was lost and I just had to accept that. I only found out that I wasn't in the system when I called the Ministry of Health and Long Term care 5 months after hearing nothing. The hospital doesn't answer the phone and their answering machine says, "don't leave a message unless you already have an appointment because we won't call you back." My family doctor sent in the wrong forms and instead of the hospital letting him know, they tossed my referral without saying a word. It's a frustrating process but it's what we've been conditioned to believe is acceptable. I hope they change it for future patients because the system now is deplorable.

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  9. Anonymous10:43 am

    @Anonymous(This is elective...)

    Stepping out of the path of an oncoming bus is elective too, but it's a darned good idea.

    Are you seriously saying you would rather pay for dialysis, coronary bypass surgery, joint replacement surgery and every other weight related consequence than pay for that same person to have bariatric surgery? Wow.

    Also, the majority of Dr. Freedhoff's posts are about preventing obesity, and about healthy choices. He's always said that surgery is the LAST choice.

    Personally, I haven't had any more luck losing the 25 pounds to get me back to my ideal weight than bariatric surgery candidates have had at losing their 125 pounds. Maybe I should just eat less. That will work.

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  10. Anonymous6:33 pm

    the wait in Nova Scotia is at least 3 years and after 3 years went by and I asked my GP if I shouldn't be hearing from the specialist soon, he looked in my file and said 'oops'. Turns out he forgot to send the referal and now I have 3 more years to wait. Sadly so much about the medical system in this province stinks! This is so frustrating considering how desperate i feel to finally agree with my GP that this was the way to go, it was his suggestion and now 3 yrs later, try as I might, I'm no smaller & feel more desperate in need of this proceedure & completely let down to know I have to wait 3 more years!

    Makes me feel like everyone in society & medical system (cause they treat you like crap at the ER too, if your fat, even if it's for a bladder infection! but that's another rant lol) is so quick to put you down but not quick to help :(

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  11. Anonymous12:03 pm

    I have been on the waiting list for a gastric bypass for over 14 months. I went to the information session last January (11 1/2 months after my initial contact with my doctor). I was told that I had to quit smoking for 3 months before I should contact them again. It has now been 3 months since I quit smoking and my calls to schedule my next appointment are not being returned. I've been told that the reason for this might be because there are no openings in the surgery schedule and that they will call me once there are openings.
    Of course, after quitting smoking, I am bigger than ever as I've gained another 20 lbs. My BMI is 50, I feel like my life is put on hold. I don't want to go shopping for clothes as I feel I could be called anytime and loose the weight. I don't want to book any holidays abroad: what if I'm called. This is terrible!!!

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  12. Anonymous8:08 am

    my propblem is getting the Doctor to fill out the referral forms as it is 10 pages long -- any suggestions?

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  13. Anonymous, if you're in Ontario, either your doctor is actively misinforming you, or your doctor is misinformed.

    While the process is certainly not without its very significant warts, the referral is both easy and straightforward.

    Your physician needs to register at www.bariatricregistry.ca and then once registered he or she needs to fill out a single page fillable PDF which then gets printed and faxed to the Ministry of Health. Aside from your demographics, the form requires only that tick boxes be checked.

    I'd say it takes at the very most 90 seconds to fill it out.

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  14. Anonymous7:52 pm

    I have been on a waiting list for over 3 years now. And going strong!

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    Replies
    1. Anonymous11:43 pm

      Omg 3years where do you live ?
      And have you been to the orientation yet ?
      Howes.marney@hotmail.com

      Delete
    2. Anonymous8:59 am

      I live in Lanark and I am suppose to have surgery in Ottawa. I went to the orientation last year in March. It's aweful. chantal_banks@hotmail.com

      Delete
  15. Anonymous10:50 pm

    What is the wait time if referral is sent in June 2012 for Humber River or Toronto Western hospitals? Anyone? Thx

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    1. My Doctor sent the referral in on May 2012. I received a letter from Toronto Western yesterday (June 5th), my orientation is at the end of August. So it looks like wait times have improved.

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  16. Anonymous11:44 pm

    if anyone is going through hamiltons gastric bypass progam I would love some info on how long I need to expect to wait betwen appontments I'v seen the internist the appontment was over at lunch time I was told the receptionest had goon to luch I waited as long as I possiibly could I had to get to my kids I thought the doctor told me to book an appontment with the surgen I'v tried calling and I am not geting any where I would love to no when at lest roughly how long I will be waiting I cant just put every thing on hold I could have goten a graet job but I did'nt take becouse I did'nt what to start a new job and then in a short time tell them oh Iam having surgery I need time off if I new roughly when then I could tell them and they could get a subtitute my doctor made me do everything you have to do to get ready for surger for a wholr yaer befor he sent in the referral not to mention all the yaer's of doctor supervised diet's befor that I am just tiered of waiting well my helth get's worse let me . ??????????

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    1. Anonymous2:01 am

      Hamilton is brutal. They tell you to attend group meetings and that they are voluntary and then force you to go after telling you that is mandatory. The group goes for three months and had I known it was mandatory I would have gone through this group a while back. Not to mention it's nothing but a support group so they can use us as guinea pigs for info. It will be more than a year and still no date. A friend at Toronto Western went in March and has his surgery in October. The social workers in Hamilton are horrible

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  17. Anonymous2:03 pm

    I had an appointment with my GP I belive almost a year ago now (I'm in Ottawa). She was going to put in a referral on my behalf to the Ottawa program. So far, I've heard nothing, (not even a call about orientation) but my dr. had told me the wait would be long. After reading these posts, I'm nervous that I may not be on any list, and I don't want to wait another year to find out I never was referred.

    So all I have to do is contact the Ministry of Health and Long Term Care and they can let me know if I'm on a wait list?

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    Replies
    1. Anonymous8:54 am

      Hi anonymous
      I sent my referral in Augest and by mid september I got my orientation date for March of 2014 I no its along way to wait but I guess thats how it is in Hamilton

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  18. Anonymous7:17 pm

    2008 or 2009 (can't remember which for sure) Original referral went to Hamilton. Feb 2010, I was told by Hamilton I was going to the the 3rd person on the list to be called to start the process. BUT, because the government came up with more money, my referral had been sent to Ottawa. My postal code put me in the Ottawa jurisdiction. End of Nov 2010 started jumping through Ottawa's hoops. Like a lot of us lost time at work and spent money on gas travelling back and forth. Aug 2011-was told by the Surgeon I needed two more tests. By now I was so frustrated I called the Patient Advocate at the Ottawa Hospital. The Advocate acts as a go between the hospital and patient. I sincerely feel only with the advocate's intervention was it agreed I was allowed to have them done closer to home. Unfortunately due to wait times for those procedures it has been another year. I recently had a conference call with the director and patient advocate where I was able to express my displeasure with the way things were handled in my case and that I wanted to be referred elsewhere. I figured if I had to start over it wouldn't be with them.

    What we did agree on was I would have 2 possibly 3 more app'ts and then the surgery before the end of 2012. This is unless the surgeon comes up with another excuse to delay it. Which by the way is NOT the same one who, in my opinion, caused the year long delay. Those tests should have been ordered at the beginning of the entire process!

    So it doesn't matter what hospital you are dealing with if you feel you are being given the runaround contact the patient advocate (each hospital should have one). Get them involved-it can't hurt. If that doesn't work go up the ladder (CEO). Your tax dollars are paying their wages - you should expect to be treated fairly or at the very least a plausible explanation as to why the delays.

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  19. Anonymous8:35 am

    I went to my orientation on Dec 13, 2011. I had 2 sets of appts with the dietician, nurse and the psychologist for approval from each and then my appt with the surgeon was in Sept 2012. I had my surgery on November 15, 2012 (1 week ago) and have lost 10 lbs this first week. I also had a couple of special circumstances that may have prolonged my wait a little bit but even with that the whole process took 11 months. Considering what you are getting out of this, and the severity of the surgery I am glad they take their time and make sure this surgery is right for you and that you are ready for it. It is a major surgery and a lifetime commitment that once done, cannot be undone. I knew this was right for me and hope everyone that is thinking of doing this is sure this is right for them as well. Good luck to all!

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    1. Anonymous1:37 pm

      Hi - may I ask which centre you were at? We're trying to help my Mom choose a centre, and it sounds like you had a smooth experience wherever you were...
      Alison

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    2. Anonymous10:04 am

      I attended my info session on 11/18/2013, in Hamilton, the Social worker was not very pleasant when I voiced a concern to her, her reply was well if you feel that way perhaps you should reconsider. I am terrified of having a endoscopy, they scare me and I honestly thought that a Social Worker might be reassuring however I have a different opinion now. I am pleased to read you post it seems that once you got to see the Surgeon you move along rather quickly! I plan to move ahead with the heartfelt support of Family that I must doing something to extend the years I have remaining on this planet!

      Delete
  20. Anonymous4:08 pm

    .. this is a continuation of the post I made earlier this morning. When I first started this entire process, I went to my family doctor and asked for a referral which she did for me right away, and then I received a letter in the mail inviting me to the orientation session in Guelph and outlining the tests that I would need to have my family doctor order for me before I had my first official appointment after the orientation. I immediately went back to my doctor and asked her to refer me for a sleep test and to write requisitions for the blood work and ultrasound and x rays that were required. I think the longest wait was for the darn sleep test. My appt for that was for a another year away so I asked them to please put me on a cancellation list. This worked like a charm because people are constantly canceling. I had a call within 2 weeks that someone cancelled and could I take their spot. Of course, I had less than a half hour to get there but I didn't care, it was a big step out of the way. I am not sure what it is like in other clinics, but in Guelph they were quite on top of things as far as making sure I knew what tests to have my doctor order and so on. The rest was up to me to make sure that it was done. When I had my visit with the surgeon, they had me buy my optifast right on the spot and also gave me my surgery date at the same time. I have hear a lot of people say that the optifast was nasty and hard to swallow, but I liked it. I was on it for 2 weeks and I alternated between vanilla and chocolate for each meal. Personally I liked it with a few ice cubes in it to make it really cold but not one time did I even consider cheating. I found it really easy and could have done it a lot longer!. I lost 8 pounds while taking the optifast. I don't know if this was good or bad, they didn't tell me. Since having my surgery a week ago, I have been strictly living off of diluted apple juice and 2 jello pops a day that my husband froze for me because I am not a big fan of jello. Believe me, I have not been hungry at all! I know I sound really gung ho but I really feel like this will give me my life back. I am 46 years old and very in love with my husband of almost 30 years, now I feel like I can easily be with him another 30!

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  21. Anonymous12:50 am

    Hello my Dr sent in my referral June 10 2013. According to the Ontario wait times website the wait is 3-4 months. You have all seemed to wait significantly longer. How long should I expect this process to take and which centre would I be dealing with I am from London Ontario. Thank you.
    andreaclove@hotmail.com

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    1. Anonymous11:05 pm

      Hi my Doctor sent my referral September 6, 2013. I have already been to the orientation session and I have all my other appointments booked for February 24, 2014. I am not sure but I imagine the surgery will be booked sometime in May or June 2014 as long as everything else works out ok. I didn't think that was too long of a wait, it just allows more time to research the procedure and what we have to look forward to.

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  22. Anonymous12:52 pm

    Thanks for your article and for your continued research, advocation and interest in helping individuals who experience difficulty controlling weight. I have been grappling with the surgery option over the past little while, since my Doctor indicated it was an option because it was covered. I am a very busy person.... married, Teacher with 3 children 7, 5, 3. I gained 85 pounds in total after the children. Have not been successful in losing it yet, because I don't have a lot of time to address this issue. Previously I have tried ( and reached some success with all) Dr. Berstein's, Nutrisystem, Slimfast, Zenical X2, Weight Watchers X3, South Beach Diet, Atkins, Low Carb and Montignac Diet....and have spent literally thousands of dollars and am only 37. I really do not want to have surgery to lose weight, (my thinking is much more exercise centric, I actually use to play varsity soccer!) But, feel as though I continue to fail at my attempts on my own, just cannot seem to find the will power, in my busy life. The thing is, since the Bariatric surgery is the ONLY option that is covered by OHIP it seems that I should perhaps be considering it. But I really do not feel that it is for me...What I would like is some choice in weight loss options that are covered by OHIP, not just the surgery.

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