A Calgary knee surgeon says queue-jumping occurs all the time because Alberta's health care is so broken that people with connections will naturally do whatever they can to get timely help.
Dr. Nicholas Mohtadi told a preferential access inquiry Thursday that he and a "majority" of surgeons are pressured by friends and colleagues for fast-track examinations that then allow patients to immediately get on wait lists for surgery.
Mohtadi testified that doctors see those patients, but always outside office hours so that no one who is on the regular list gets bumped.
"Isn't this circumventing the wait time that ordinary patients like myself would have to undergo?" commission head John Vertes asked Mohtadi.
"Yes, absolutely," the Calgary surgeon replied.
Mohtadi said he and other doctors often debate the ethics of fast-track consultations.
"It's a very frustrating process," he said.
"(But) because of (wait-list bottlenecks) this is always going to occur. People are going to try and get in and see people like me any way they can."
He suggested it's unfair to force doctors to turn their backs on people they know personally or professionally because the system doesn't function properly between 9 a.m. and 5 p.m.
"The appropriate response is that that patient should be able to demand as an Albertan a standard of care that is acceptable to anybody in this room," Mohtadi told lead commission counsel Michele Hollins.
"As a taxpayer, it's not acceptable that you have to pick up the phone and use influence to get through the system.
"We should have standards (of care) that we agree upon that will allow us to solve some of these problems."
Mohtadi said MRIs are one example of uneven standards. Some doctors, he said, refuse to see a patient for a knee injury without an MRI being done first, even though the test may not be necessary for an accurate diagnosis.
The result, he said, is patients waiting longer for care and needlessly gumming up wait lists.
He said consequences for patients can be profound. A ruptured knee tendon, for example, needs to be operated on within a matter of weeks at the most or the joint will develop arthritis "and be damaged irreparably for life."
Mohtadi told the inquiry he is not interested in a solution that would prevent doctors from seeing people not on the regular wait list. He said he has opened a clinic in Calgary focusing on knee repairs for athletes and other patients as one way to clear up wait-list bottlenecks.
Mohtadi was the second doctor to testify at the inquiry about treating patients outside regular hours.
Last month, Raj Sherman — leader of Alberta's Liberals and an emergency room doctor — told Hollins that he would treat fellow politicians in his legislature office for minor ailments such as rashes.
That led Hollins to challenge Sherman, a sharp critic of government queue-jumping, of being culpable of similar out-of-bounds behaviour. Sherman called it "professional courtesy."
Sherman later told reporters he didn't mind the grilling but said the inquiry had a double standard, asking hard questions or soft ones depending on the witness.
On Thursday, Hollins did not rigorously challenge Mohtadi when he told her about seeing favoured patients out of turn.
And when Mohtadi, in response to Vertes's questions, later admitted he considered his actions queue-jumping, Hollins was again on her feet, but only to tell the inquiry she was finished.
"Those are all my questions," she said.
Former health executive Neil Wilkinson weighs in
Also Thursday, the chairman of Edmonton's former Capital Health region told the inquiry that he was not aware of any VIP patients getting better or faster care.
"This wasn't part of our culture," testified Neil Wilkinson, who now works as Alberta's ethics commissioner.
Wilkinson was chairman of the region until the board — along with eight other boards — were folded into the current Alberta Health Services superboard in 2008.
He also testified he wasn't aware that former Capital Region CEO Sheila Weatherill was directing her staff to have doctors and nurses keep tabs and report back on the care being given to so-called VIP patients.
Hollins asked Wilkinson if those calls, which both Weatherill and her staff have testified took place, would have been acceptable to Wilkinson and the board.
Wilkinson deflected answering, dismissing the issue as "hypothetical." He suggested if the calls took place it's nitpicking.
"(I know) you've got a job to do," he told Hollins. "(But) there was so much going on in the health-care system.
"People worked 18 hours a day. Board members were studying material they had been given long into the night.
"People were giving their all for this system."
Health minister testifies
Alberta's health minister also spoke Thursday at the inquiry, but he was not able to shed much light on any queue-jumping in the health-care system.
There was discussion of the controversial memo from Stephen Duckett, the former head of Alberta Health Services.
Duckett said there were what he called "go-to" people that MLAs could call to arrange special access.
Fred Horne was asked by the inquiry commissioner if anyone in government wanted to investigate that claim when it became public in 2011.
"Not to my knowledge," he said "I certainly wasn't in a position where I would initiate something like that as the parliamentary assistant."
The inquiry has heard of a handful of incidents of special access but no real names have been attached.
When asked if there's value in having this inquiry, Horne said it's not up to him.
"The fact of the matter is the government made the decision to hold the inquiry, established the terms of reference," he said. "It's an independent process and it's proceeding and so we'll await the commissioner's final report."
A report of the inquiry's findings must be submitted to Speaker Gene Zwozdesky no later than April 30.
Testimony is set to continue Friday at the $10-million inquiry, which was called by Alberta Premier Alison Redford but operates independently of her government.
The inquiry is still expecting to hear how members of the Calgary Flames and their families came to get access H1N1 flu shots when other Albertans had to wait in long lines.