Kingston hospitals respond to allegations about cataract surgery partnership

Photo by Michael Amesse.

In the days following the release of a report that leveled scathing allegations over a partnership between Kingston-based hospitals and a local eye care clinic, representatives of the local hospitals have had time to reflect on the purported findings of the report.

That time of reflection has allowed Dr. David Pichora, President and CEO of Kingston Health Sciences Centre (KHSC), to formulate a concise response.

“We fundamentally disagree with the findings of the report,” Pichora said plainly in an interview on Tuesday, Feb. 20, 2024.

The report in question is A Clear-Eyed Analysis of Cataract Surgery Privatization,’ authored by the Kingston Health Coalition and published on Thursday, Feb. 15, 2024. That report claimed to have examined the partnership between KHSC (which oversees the operations of a number of Kingston’s hospitals, including Kingston General Hospital and Hotel Dieu Hospital) and Focus Medical Ancillary (which oversees the operations of Focus Eye Centre here in Kingston). KHSC and Focus Eye Centre announced their partnership in February 2022 as a means of cutting wait times and increasing accessibility for cataract surgeries. The partnership allows some of the patients currently on the wait list for cataract surgeries to have those procedures performed at Focus Eye Centre, rather than at KHSC’s Hotel Dieu Hospital.

According to the Kingston Health Coalition, their organization used various documents obtained through “multiple” Freedom of Information (FOI) requests, as well as searches of the databases kept by Independent Health Facilities, Out of Hospital Premises, and Community Health Services Centres. The aim of the study was to “better understand the public interest implications of this ‘integrated’ privatization approach.” The Coalition said their study found that cataract surgeries performed as part of the partnership between KHSC and Focus Eye Centre have cost the public health-care system 56 per cent more than if the surgeries were conducted by KHSC alone.

Representatives from Kingston Health Sciences Centre (KHSC) are seeing the report with the clarity they hope their cataract surgery patients are now experiencing — and it is clear to the local health-care organization that parts of the report are seriously misleading, Pichora claimed.

“First of all, I have no idea where they get some of their interpretation of the numbers from,” he said, reiterating that KHSC “fundamentally disagrees” with many of the assertions in the report and “believes that it gives a very biased overview of our partnership with Focus Eye [Centre].”

“It’s missing significant pieces of information. They don’t really know what Focus Eye’s operating costs are, and they have no idea what the hospitals’ operating costs are… They’re making assumptions about that, things that they have no knowledge of. And so… the conclusions are inaccurate.”

Pichora questioned the Coalition’s motives for the study and subsequent report and how those motives shaped the results.

“They had an end in mind and did FOIs so that they could then write the conclusions. They wanted to write [those conclusions] and lean on the FOI for some degree of support,” he said, insisting the Coalition doesn’t have a full picture of how KHSC and its hospitals operate, nor of how Focus Medical Ancillary and its clinics, including Focus Eye Centre, operate. The Coalition doesn’t have information on the operating budgets for those organizations either, Pichora pointed out.

“There’s a lot of stuff that they simply don’t know, and don’t understand, and don’t have any sort of contextual understanding of,” he said.

“[The report] sows mistrust in the hospital and in the health-care system, which I think is inappropriate.”

Pichora went on to say there is a difference between provincially funded partnerships like the one between Focus Eye Centre and KHSC, and fully privatized health-care options. In fact, without the partnership offering cataract surgeries to patients through KHSC, he emphasized, those patients on the waiting list would be faced with a far more stark decision: remain on the list waiting for surgery, or have it performed privately at their own expense. And the wait list for cataract surgeries is not getting any shorter, Pichora pointed out, stating that unlike some backlogs which can be cleared when all the patients on the wait list have been treated, the wait list for cataract surgeries continues to grow alongside Ontario’s aging population.

“Focus have been very good partners,” Pichora said, noting that the current state of health care in Ontario is not easy for any health-care organizations or professionals to deal with.

“They have stepped up and wanted to do this, been willing to do it in partnership with us, as opposed to trying to create an opportunity to do something in parallel to the health-care system… something that might compete with the hospital.”

Further, Pichora pointed out, the surgeries at Focus Eye Centre are being performed by KHSC’s surgeons, so patients have the peace of mind of knowing they’re still being treated by the same doctors they would be if being treated at the hospitals. Additionally, the surgeries come with the same price tag regardless of which facility they are performed at — a price tag that is covered by the province, he said.

“They’re not competing with the hospital; we’re working together… The cases that they do are a portion of our allocated funded volume from the government… They’re getting the same service there as they would at the hospital. It’s the same surgeons doing it. And the provincial price is, I think, something like $505, to the hospital or to Focus.”

Those funds, Pichora noted, do not cover any overhead costs that might be related to the surgeries or the daily operations of Focus Eye Centre, which include things like pharmacy administration and running a sterilization facility on site. And as operating room space is at a premium for KHSC hospitals, having cataract surgeries performed off site allows for more surgeries to take place than could otherwise — while also allowing other surgical procedures to take place in KHSC operating room space, he explained.

But what the report overlooked entirely, Pichora emphasized, is the exact objective of the partnership between the two entities in the first place: timely and accessible patient care.

“In terms of thinking about what matters to patients in the community of value for the health-care dollar, there’s no evidence of that in their report,” he said.

“I think the other thing that’s really buried… deep in their report is the fundamental reason for doing all of this in the first place,” Pichora continued. “The government wanted to improve access to care… You know, people love to complain about waiting lists… [but] when you go to do anything about it, they complain about that too, which is what the Coalition is doing.”

Pichora then turned his attention to a recommendation the Coalition made in their report: that local hospitals simply extend their hours and have the nurses, doctors, and other health-care professionals needed to perform more surgeries work on evenings and weekends.

“Well, remember, there’s a staffing shortage… Nurses are something that we really struggled to find. It’s one of the areas where we’ve had to engage agency support,” he said frankly.

It should be noted that, on the same day the Kingston Health Coalition released its report on the cataract surgery partnership, KHSC released information on steps it’s taken to address the nursing shortage and the new hires that have resulted.

“And so, to think that our staff are suddenly going to volunteer to work extended amounts of overtime or weekends is an assumption that may not pan out. And we’d be paying them overtime, so that would suddenly escalate our cost dramatically,” Pichora noted.

“And so getting these cases done within regular hours is a huge cost advantage, as well as [being congruous] as far as keeping staff happy and ensuring patients receive timely care [are concerned].”

Pichora also drew attention to a fact that seemed to be overlooked in Kingston Health Coalition’s report entirely: “Through Focus, we have been able to provide cataract surgery to 2,946 patients who would otherwise still be on the waiting list,” he said.

Finally, Pichora addressed the possible “conflict of interest” the Coalition pointed to between KHSC, Queen’s University, and Focus Eye Centre. The three entities have a number of crossover employees, including Dr. Davin Johnson, who is the Medical Director at Focus Eye Centre and also an associate professor at Queen’s.

“If somebody wants me to apologize for that, I guess I won’t,” Pichora said with a laugh.

“We are a tertiary academic hospital, so when it comes to training health-care workers of the future — whether we’re talking about physiotherapists or nurses or technicians or physicians — we’re Queen’s main training site, and we have a similar relationship with St. Lawrence College and many other institutions. It’s not just Kingston-based institutions by any means,” he said.

“And then on the research side of it, we have a very strong research partnership with Queen’s, absolutely. That’s… that’s what we want!”

Pichora concluded, “there are no conflicts of interest here.”

“KHSC is not a shareholder in Focus Eye… and we’re not making any profits off this [partnership],” he said, noting that Focus Eye Centre and/or Focus Medical Ancillary similarly do not have representation on the KHSC Board of Directors or on any management teams at the hospitals or Queen’s University.

“This is a straight purchase service agreement. And we have many, many, many of those with lots of different people, including, by the way, our physicians.”

11 thoughts on “Kingston hospitals respond to allegations about cataract surgery partnership

  • For millions of Canadians without a Family Doctor and those waiting years to see specialists the health system is broken. All the reports I’ve seen do little to solve the major problem.

  • I am glad and appreciate that Dr Pichora provided this factual response. Too often the critics of our institutions, or certain advocacy groups pressing for change do not have the public interest in mind but are pursuing an agenda based on personal beliefs divorced from the public good.

    • Hi Cristian, unfortunately, Dr. Pichora’s comments are significantly misleading on a central issue in the privatization of cataract surgeries, how they are funded, and incorrect in the options he says that patients face. The Health Coalition has responded to his reported statements and that response can be found at keepourhospitalspublic.ca.

  • The good Dr. laughs. His position is clear……aquila non capit muscas

  • As Benjamin Disraeli is supposed to have said “There are three kinds of lies: lies, damned lies, and statistics.”

  • As a recent cataract surgery patient at Focus Eye Centre, the efficiency, good humor and skilled care experienced was striking. The relationship between KHSC and Focus Eye Centre and the staff concerned was clear. The number of daily surgeries performed obviously relieved pressure on KHSC operating room space.
    I fully concur with Dr. Pichora’s response.

  • Dr Pichora’s response needs to be published in the Whig Standard as a response to the health coalition’ s statements

  • Dr. Pichora claims that the report produced by the Kingston Health Coalition is “biased”. Of course it is, as one of the aims of the Kingston Health Coalition is to maintain a system where medical treatment is performed in publicly owned facilities. Many of the things Dr. Pichoar says are correct but his argument misses a major point. The reason the provincial government encourages hospitals to enter into agreements such as the one between KHSC and Focus Eye Centre is that it allows the government to push costs off into the future. If the government wanted the hospital to increase the number of cataract surgeries it would need to provide funding for additional facilities. This would involve adding to the provincial budget which either means additional debt or increased taxes. With the partnership in place the owners (investors) in the Focus Eye Centre take on the initial costs of establishing the clinic. But this does not eliminate the cost to the government and taxpayer. Obviously the payments flowing to Focus Eye Centre cover the costs of the surgery including the costs of constructing and equipping the facility. Over time the full costs of the new surgical centre have been payed but now the owners are the investors in the centre and not the public. Now the government has the choice of continuing to fund surgeries at Focus Eye Centre at enhanced financial returns to the investors or address the initial issue again and provide KHSC with the fund to expand surgical facilities.

    • Hi Donna, there are significant issues with Dr. Pichora’s reported comments on the Quality Based Procedures funding, the core funding for cataract surgeries, and the option he outlines for patients is incorrect. The Health Coalition has responded to these concerns in a post at keepourhospitalspublic.ca.

    • Hi Geoffrey, thank you for your comments identifying the trade off that the provincial government and the hospital need to make.

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