Evidence of meeting #8 for Health in the 39th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was women.
Conservative
The Chair Conservative Rob Merrifield
Because of the complexity of the technology, Dr. Brown, do you have anything to add to that? If you do, just raise your hand or something and I'll get you to answer.
Plastic, Reconstructive and Cosmetic Surgeon and Associate Professor, Department of Surgery, University of Toronto
Yes, I would like to make a few comments.
I think one of the outstanding features of the expert advisory panel was its diversity of membership. You could ask Dr. Chidwick or me to comment specifically about the panel's recommendations as they relate to fatigue testing, rupture rates, toxicology, etc. Dr. Chidwick mentioned immunology in one of the points that she raised. The beauty of our panel is that we had experts from each of these different areas who helped us, as a group, to put together a response to the questions put forth to us by Health Canada.
I do not put myself out as a biomaterials expert or an expert in immunology. I was part of the consultation process to put together this report. There was certainly debate about what safety is and when enough information is enough, and it's reasonable to request further information that is helpful and useful. The question becomes a determination of when there is enough information for a person to make a reasonable, informed decision based on the risks laid out in front of them.
Conservative
Liberal
Bonnie Brown Liberal Oakville, ON
No. I don't want to hear any more about that. I want to ask Sylvie Stachenko--
Assistant Deputy Minister, Health Products and Food Branch, Department of Health
No, I can leave it. That's fine.
Liberal
Bonnie Brown Liberal Oakville, ON
Sylvie Stachenko, thankfully, brought forward a summary of the epidemiological study that we have been trying to get to this committee for about the last three years.
Looking at your notes, you said that the suicide rates for silicone gel breast implant patients were about the same as for all plastic surgery patients, but even so, greater than for the general population. What about the cancer rates? The cancer rates in silicone gel breast implant patients were the same as for regular plastic surgery patients, but were they greater than those of the general population? No?
Deputy Chief Public Health Officer, Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada
No. The answer is no.
Deputy Chief Public Health Officer, Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada
It was mortality.
Liberal
Deputy Chief Public Health Officer, Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada
By suicide. Correct.
Bloc
Nicole Demers Bloc Laval, QC
Thank you, Mr. Chairman.
I will address my first questions to Mr. Brown.
Can you hear me?
Plastic, Reconstructive and Cosmetic Surgeon and Associate Professor, Department of Surgery, University of Toronto
Yes, I can, thank you.
Bloc
Nicole Demers Bloc Laval, QC
I can see that I'll have to pose my questions in English.
I also have some letters from some of your patients. They are not so encouraging, though. One of them tells us that before she could get a meeting with you in order to get her breast implants extracted there was a nine-month wait, and then after that it would take 12 more months to get them extracted because you have too much work doing implants and reconstruction.
The same person tells us that if she was ready to pay $4,800 to get ahead of the list of patients covered by the Ontario health insurance program, you would be ready to operate on her before the other patients, who were covered by the Ontario health insurance program. On top of that, she had to give you an $800 deposit, which was not refundable if she decided not to have the operation with you.
Can you explain why you have such a practice with people who are desperate to get their implants extracted?
Plastic, Reconstructive and Cosmetic Surgeon and Associate Professor, Department of Surgery, University of Toronto
Thank you, Madame Demers.
I must start by saying that you are quite incorrect in the information you have just requested of me. Those are absolutely not the facts as they exist, so let me please explain.
I see patients on a very regular basis who come to me with concerns about their breast implants, or just to have them checked because their surgeon may not presently be around--is deceased, etc. If a woman comes to me with a problem with a breast implant and she requires, through informed consent, to have something done—to replace, reposition, remove her implant, etc.—I like to operate on her immediately if it's at all possible. There is no incentive for me to have a patient wait.
In Canada, at least in Ontario at the present time, women who come to my office who have concerns with medical problems related to their implants are offered surgery under the Ontario health insurance program. It is a medically insured service. In those instances, I must provide surgery in the publicly funded hospital where I work, Women's College Hospital.
I am only provided a certain amount of operating time. Every bit of operating time that I am provided is directed at reconstructive patients, such as the patients you have described. All of the esthetic surgical work I do that is not covered by the Ministry of Health is done outside of the hospital, so as not to impact on the time I have available in the hospital.
I can only use the time that is provided to me. I have had four days removed from me for surgery during the summer because of the hospital slowdown. I have days removed from me because there are not enough nurses to staff the operating facility. I have days removed from me because there are not enough anesthetists. So I do the work I can—
Bloc
Nicole Demers Bloc Laval, QC
Excuse me, Dr. Brown. Can I tell those women that they'll get their deposits refunded to them?
Plastic, Reconstructive and Cosmetic Surgeon and Associate Professor, Department of Surgery, University of Toronto
Excuse me. I will finish my remarks.
Bloc
Nicole Demers Bloc Laval, QC
No, I'm sorry, you have a very short time and that was not my question. My question was, do you charge those women $4,800 to pass ahead of the others? That was my question.
Plastic, Reconstructive and Cosmetic Surgeon and Associate Professor, Department of Surgery, University of Toronto
The answer is a very clear no. Patients who come to see me—
Plastic, Reconstructive and Cosmetic Surgeon and Associate Professor, Department of Surgery, University of Toronto
I will now complete my answer.
Patients who come to see me with a concern that is medically related, where there is a medical problem, are only offered service in the publicly funded hospital, without a penny being charged to them by my office.
If a patient comes to my office because she has implants that have been in through her choice for many years, there is no medical indication for their removal, and she wishes to have them removed, that is her choice. That is not a medical indication. That is something that is not an insured service in our province, and patients are charged a fee that is appropriate for that type of procedure.
Thank you.