Need to get an MRI fast? Get on the cancellation lists, says auditor general

Health minister thankful for semi-private MRI clinic proposal in Niverville

You don't have be a Winnipeg Jet or politician to jump the queue for an MRI — you just need to get on a cancellation list.

That's according to Manitoba's auditor general, who found one of the most frequent ways that "people of influence" were able to get quick access to an MRI scan was by adding their names to the little-known list.

Norm Ricard said it's an avenue that many Manitobans aren't taking, and that should change.

"Queue-jumping is happening, but not just from persons of influence. It can happen to regular citizens because of their willingness and understanding of the cancellation process," Ricard told CBC News.

After an explosive leak of a document showing several athletes, politicians and medical professionals as possibly receiving preferential access to MRIs, he said their knowledge of the system is one factor that gives them a leg up.

"Those are the people who have enough savvy to know there is a cancellation list and they need to be asked to be put on it," he said.

Ricard found in his recent audit of the province's MRI system that people generally only found out about the list through word of mouth or if they phoned to complain about a long wait time. In one of his 24 recommendations in the audit released last month, he said the list needs to be advertised to everyone.

"Let everybody know," he said. "That is part of making it an equitable process."

How to get on a cancellation list

All five MRI sites in Winnipeg offer cancellation lists and to get on one, all you need to do is ask and tell them how fast you can make it to the facility on short notice.

The Winnipeg Regional Health Authority says the clinics and hospitals try to organize the list based on priority, the length of the exam for which the patient did not show, the length of the replacement exam, and whether the patient can arrive and be prepped in time.

"Time is of the essence" when it comes to filling the no-shows and cancellations, a spokeswoman for the WRHA said.

The length of the list varies from site to site. At the Pan Am Clinic, the list sits at around 400 names. Health Sciences Centre's adult MRI has 216 people on a cancellation list, and at its children's hospital there are 24 patients on the list.

At Grace Hospital, there are about 122 people on the list. The length of the cancellation list at St. Boniface was not readily available.

In Manitoba, over 70,000 MRIs are completed year, with St. Boniface doing the most scans at about 22,000 a year. 

However, the cancellation system is not without flaws. Ricard also found facilities fill cancellations with patients who were yet to be scheduled, to avoid a domino effect of having to fill a vacant spot left by a patient on the cancellation list.

Overall, Ricard estimates there are about 3,400 no-shows for MRI scan appointments each year, which helped create a vacuum that may have allowed for "persons of influence" to be given priority in filling the vacant spots. 

The WRHA says it is currently only filling about 50 per cent of those spots.

A third of 'persons of influence' got MRI within one day: audit 

A confidential report was leaked to CBC News and other media outlets last week which flagged 59 professional athletes, six politicians, eight radiologists, and senior WRHA staff as receiving "potential preferential treatment" when it came to the quick manner in which they were able to receive an MRI scan.

The document was created as part of Ricard's research for the audit released last month, but he said it was not his office that leaked the information.

It contains the names of people flagged as well as the date the scan was given, but does not say how long the patient waited.

The Winnipeg Regional Health Authority has launched an internal investigation into how the information was leaked to the media. The Manitoba Ombudsman has also initiated an investigation into the leak under the Personal Health Information Act.

The audit found while the average wait time for an MRI scan in the province was 23 weeks, 45 per cent of a compiled list of people deemed influential were scanned within a day or two weeks. One-third of those on the list received a scan within a day.

However, the high number of influential people receiving quick MRIs also highlighted a flaw with the cancellation lists, explained Ricard.

A number of influential people studied were able to move from a "to be scheduled" list to getting a scan, without ever receiving a standard priority code, he found. 

"Somehow the clerk gave them priority," he said. "There is something going on with the way the cancellation system is being managed."

Health authority ready to make changes

The WRHA says it is working to make a host of changes to improve the system, including advertising the wait list to all patients.

"It will be changed," assured Raylene McGhee, the regional program director of diagnostic imaging for the WRHA.

Ricard also highlighted the issue of duplicated MRI requests, which account for almost 20 per cent of the WRHA's no-shows. Under the current system, a doctor can order a scan at multiple facilities in hopes of getting a quicker scan and the WRHA has no way of tracking a duplication.

McGhee says centralizing the system so all requests must go through a central intake system was on their to-do list long before the audit was released. 

Meanwhile, an information technology upgrade due in the summer will likely allow the authority to track wait times for scans based on priority, another recommendation by Ricard. The system could also allow the WRHA to track how long it takes for a patient on the cancellation list to get a scan, McGhee said.

This will allow Manitobans to know how long it takes to get a scan when they are prioritized as emergent, urgent, semi-urgent and routine, rather than a global figure. 

Ricard reviewed 285 outpatient files and found the province was only meeting its regional targets 12 per cent of the time in routine cases. The target was 60 days to eight weeks.

Targets were met 24 per cent of the time in semi-urgent cases (target 14 to 16 days), 42 per cent of the time for urgent cases (target one week), and 92 per cent of the time for emergent cases (target 24 hours to three days). 

"It'll definitely be an improvement overall. We want to know if we meet those targets, not just from a non-statistical audit for an auditor general, but from actually statistical information," McGhee said.

"This has been a priority long before this audit. We want to make sure there are no gaps."