For the record
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## Claim and counterclaim

Canadian Medical Association past president Dr. Brian Day and other owners of British Columbia private medical clinics have launched a Canadian Charter of Rights and Freedoms challenge against the provincial government’s prohibition against charging fees for essential services. Essentially, the suit asks the BC Supreme Court to apply the principles implicit within the Supreme Court of Canada’s landmark 2005 Chaoulli decision (*Chaoulli and Zeliotis* v. *A.G. Quebec et al.*) that the province of Quebec’s ban on private health insurance for medically necessary services violated provincial human rights law.

Day’s Cambie Surgeries Corporation, 4 other private firms and the Canadian Independent Medical Clinics Association argue in their writ of summons ([www.healthcoalition.ca/CIMCAwrit.pdf](http://www.healthcoalition.ca/CIMCAwrit.pdf)) that patients are entitled to expedited medical treatment at the more than 50 independent surgical facilities in BC, and that restrictions imposed by the province’s Medicare Protection Act violate the section 7 Charter right to life, liberty and security of the person, as well as the section 15 right to equality. The suit also seeks unspecified general damages.

The counterclaim from the province’s health minister, attorney-general and Medical Services Commission argues that “there is no freestanding constitutional right to health care” so the Charter is essentially inapplicable, even in cases where patients had long waits to obtain treatment ([www.healthcoalition.ca/Defence-BCgov.pdf](http://www.healthcoalition.ca/Defence-BCgov.pdf)). It also asserts that private clinics have billed patients directly for insured services in violation of the public medical plan and the Canada Health Act. The “extra billing” places the province at serious risk of financial penalties imposed by the federal government for such violations, the counter-claim states. The clinics have “intended to cause economic loss to the Province, or been wilfully blind or reckless with respect to whether such loss would occur.”

To that end, the province also sought an injunction that would allow its inspectors to enter Cambie offices and inspect records for evidence of billing for insured services. — Wayne Kondro, *CMAJ*

## Wait time reductions

Canadian hospitals have made significant strides in shortening wait times and improving patient flow, according to a report from the Association of Canadian Academic Healthcare Organizations.

Those strides have been achieved through better integrating family physicians and specialists, better disease screening, reducing emergency room visits and hospital readmissions, improving ambulance offload times, moving patients through emergency departments quicker, reducing time required to complete urgent consults, reducing paperwork, and improving patient and family participation, says the report, *“Wait” Watchers III: Order & Speed … Improving Access to Care Through Innovations in Patient Flow*, released Mar. 26.

Glenn Brimacombe, the association’s president and chief executive officer, said in an email to *CMAJ* that this demonstrates “the power of local innovations in improving timely access to care often within the existing resources of the organization.” — Roger Collier, *CMAJ*