Montreal reporter finds that envelopes of cash improve access to care

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Montreal Gazette‘s Charlie Fidelman has uncovered a shadowy pay-for-care system in that city’s public hospitals which promises patients quicker access to preferred doctors in exchange for envelopes of cash.

dollarsPhoto by coaxeus via Flickr

In his first story, Fidelman revealed a remarkably detailed fee system.

Minimum $2,000 to guarantee that a woman’s doctor will be there for the birth. “And it can go up to $10,000,” he added.

For general surgery, the cost runs between $5,000 to $7,000 to jump the wait list into the operating room, he said.

For Green and Marcus [sisters featured earlier in the story], the $2,000 got their mother’s operation bumped up – but not the surgeon they wanted.

“People have offered me money and I’ve refused it,” (Primary care physician Paul Saba) said. “Today … one patient offered me cash. People are desperate for services and they want to move things along.”

Fidelman’s story prompted an investigation by the Quebec College of Surgeons, which he also covered. Then the province’s top health minister followed suit.

All this attention prompted a fresh wave of cash-for-care allegations, which Fidelman chronicled in another follow-up story. One example in particular seemed to point to systemic issues.

Another patient undergoing a medically necessary breast reduction at Santa Cabrini Hospital in October, said she was told not to forget to slip $100 under the pillow – for the anesthesiologist. She had already paid her surgeon $900 for “administrative fees.”

“The nurses were asking me: ‘Where did you put the cash?’ like they’d asked if I had eaten that morning or taken medication.”

In the end, the official response seems to boil down to the request that more members of the public start blowing whistles, despite the fact that they cannot make anonymous complaints.

Round two?

Now that he was wise to the informal economy behind the patient side of Montreal health care, Fidelman began to wonder about billing and fraud.

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