No. S-090663 Vancouver Registry IN THE SUPREME COURT OF BRITISH COLUMBIA BETWEEN: CAMBIE SURGERIES CORPORATION, CHRIS CHIAVATTI, MANDY MARTENS, KRYSTIANA CORRADO, WALID KHALFALLAH by his litigation guardian DEBBIE WAITKUS, and SPECIALIST REFERRAL CLINIC (VANCOUVER) INC. PLAINTIFFS AND: ATTORNEY GENERAL OF BRITISH COLUMBIA DEFENDANT AND: DR. DUNCAN ETCHES, DR. ROBERT WOOLLARD, GLYN TOWNSON, THOMAS McGREGOR, BRITISH COLUMBIA FRIENDS OF MEDICARE SOCIETY, CANADIAN DOCTORS FOR MEDICARE, MARIËL SCHOOFF, JOYCE HAMER, MYRNA ALLISON, and the BRITISH COLUMBIA ANESTHESIOLOGISTS’ SOCIETY INTERVENORS AND: ATTORNEY GENERAL OF CANADA PURSUANT TO THE CONSTITUTIONAL QUESTION ACT DEFENDANT’S CLOSING SUBMISSIONS Jonathan Penner and Jacqueline Hughes Peter A. Gall, Q.C. and Robert Grant, Q.C. For the Defendant For the Plaintiffs Ministry of Attorney General Gall Legge Grant Zwack Legal Services Branch 1000 – 1199 West Hastings Street, 1001 Douglas Street Vancouver, BC V6E 3T5 Victoria BC V8W 2C5 Telephone: 250-952-0122 Telephone: 604-669-0011 Facsimile: 250-356-9154 Facsimile: 604-669-5101 Ken Manning Joseph J. Arvay, Q.C. For the Attorney General of Canada For the Coalition Intervenors Department of Justice, Vancouver 1512 - 808 Nelson Street 900 – 840 Howe Street Box 12149 Nelson Square Vancouver BC V6Z 2S9 Vancouver BC V6Z 2H2 Telephone: 604-696-9828 Telephone: 604-666-6731 Facsimile: 888-575-3281 Facsimile: 604-666-1585 Derek Knoeckel and James Gould Dr. Roland Orfaly For the Patient Intervenors For Intervenor “BCAS” HHBG LAWYERS – Vancouver BRITISH COLUMBIA 1918 – 1030 West Georgia Street ANESTHESIOLOGISTS’ SOCIETY Vancouver BC V6E 2Y3 350- 555 Sixth Street New Westminster BC V3L 5H1 Telephone: 604-696-0556 Telephone: 604-553-0040 Facsimile: 604-6380614 TABLE OF CONTENTS PART 1 - OVERVIEW 1 1.1 FUNDAMENTAL PROBLEMS WITH THE PLAINTIFFS’ CLAIM ....................................................... 2 1.2 THE LEGISLATIVE SCHEME .................................................................................................... 3 1.3 THE BRITISH COLUMBIA HEALTH CARE SYSTEM ..................................................................... 4 1.4 PRIVATE HEALTH CARE IN BRITISH COLUMBIA ....................................................................... 6 1.5 THE PATIENT PLAINTIFFS’ EXPERIENCES ............................................................................... 6 1.6 THE EXPERT EVIDENCE ......................................................................................................... 7 1.7 THE LEGAL ARGUMENT ......................................................................................................... 8 PART 2 - FUNDAMENTAL PROBLEMS WITH THE PLAINTIFFS’ CLAIM 11 2.1 THE PLAINTIFFS DO NOT HAVE PUBLIC INTEREST STANDING ............................................... 11 2.2 THIS IS NOT A “SYSTEMIC” CLAIM ....................................................................................... 17 2.3 DETRIMENTAL IMPACT ON TRIAL FAIRNESS .......................................................................... 23 2.4 THE PLAINTIFFS’ GENERAL APPROACH TO THE EVIDENCE IS PROBLEMATIC .......................... 28 2.4.1 PROPER APPROACH TO THE EVIDENCE ................................................................... 29 2.4.1.1 The Usual Rules of Evidence Apply to Constitutional Claims ...................... 30 2.4.1.2 Admissibility for One Purpose Is Not Admissibility for All Purposes .......... 32 2.4.1.3 Permissible Use of Hearsay Evidence ............................................................ 33 2.4.1.3.1 Medical Records ...................................................................................... 34 2.4.1.3.2 Hansard ................................................................................................... 37 2.4.1.4 Limitations of lay witness evidence ............................................................... 38 2.4.1.4.1 Compendious Statement of Fact Exception Does Not Permit Opinion from Lay Physician Witnesses.......................................................................... 39 2.4.1.5 Expert Evidence: Use and Weight .................................................................. 42 2.5.1.5.1 Gatekeeper Obligation Ongoing: Expert Must Stay Within Proper Scope ........................................................................................... 43 2.4.1.5.2 Common Book Documents not Admissible for Truth of Opinions .......... 44 2.4.1.6 Exhibits for Identification ............................................................................... 45 2.4.2 PLAINTIFFS’ IMPERMISSIBLE USE OF EVIDENCE AND RELIANCE ON NON-PLAINTIFF PATIENTS ................................................................................................................ 46 2.4.2.1 Monica Forster – Gallbladder Surgery ........................................................... 47 2.4.2.2 Barbara Collin – Post-Cancer Breast Reconstruction .................................... 50 2.4.2.3 Grant Pearson – Bariatric Surgery .................................................................. 52 2.4.2.4 Michelle Graham – Sinus Surgery ................................................................. 56 2.4.2.5 Marshall Van de Kamp – Knee Surgery ......................................................... 59 2.4.2.6 Denise Tessier – Knee Surgery ...................................................................... 60 2.4.3 UNSUBSTANTIATED ASSERTIONS OF GENERALIZED PSYCHOLOGICAL HARM ......... 61 2.4.4 UNSUBSTANTIATED ASSERTIONS OF HARMS OF WAITING FOR CANCER DIAGNOSIS AND SURGERY ........................................................................................................ 63 2.5 PECUNIARY INTEREST OF PLAINTIFFS’ WITNESSES REDUCES WEIGHT OF THEIR EVIDENCE ... 66 2.5.1 PHYSICIAN WITNESSES ........................................................................................... 67 2.5.2 THE CORPORATE PLAINTIFFS’ COMPENSATION OF THE PATIENT PLAINTIFFS ......... 77 2.5.3 PLAINTIFFS’ EXPERT WITNESSES’ LACK OF INDEPENDENCE .................................. 78 2.5.3.1 Dr. Day’s Involvement with Expert Witnesses .............................................. 78 2.6 DR. DAY’S EVIDENCE OUGHT TO BE GIVEN LITTLE WEIGHT (IF ANY) ................................... 79 2.6.1 PERSONAL STAKE IN OUTCOME OF LITIGATION...................................................... 80 2.6.2 INCONSISTENT EVIDENCE & REVISIONIST HISTORY ............................................... 80 2.6.3 FAILURE TO PRODUCE DOCUMENTS ....................................................................... 84 2.6.4 ACTIVE MISREPRESENTATIONS .............................................................................. 89 2.6.5 REFUSAL TO ADMIT CLEAR FACTS; EVASION ......................................................... 90 2.7 SPR DATA AND ANECDOTAL EVIDENCE DOES NOT PROVE THE PLAINTIFFS’ CLAIM .............. 92 PART 3 – FACTS 94 3.1 LEGISLATIVE SCHEME .......................................................................................................... 94 3.1.1 OVERVIEW .............................................................................................................. 94 3.1.2 THE IMPUGNED PROVISIONS ................................................................................... 94 3.1.3 THE STATUTORY CONTEXT .................................................................................... 98 3.1.4 THE HISTORICAL CONTEXT .................................................................................. 105 3.1.4.1 Overview ...................................................................................................... 105 3.1.4.2 The Medical Grant Act ................................................................................. 106 3.1.4.3 The Medical Services Act ............................................................................. 108 3.1.4.4 Early Evolution: 1968 to 1992 ..................................................................... 112 3.1.4.5 The Medical and Health Care Services Act and Medicare Protection Act .. 116 3.1.4.5.1 Private Insurance Provision .................................................................. 117 3.1.4.5.2 Extra Billing and Charge Liability Provisions ...................................... 118 3.1.4.5.3 Oversight Provisions ............................................................................. 123 3.1.4.5.4 Penalty Provisions ................................................................................. 124 3.1.4.5.5 Offence Provisions................................................................................. 125 3.1.4.5.6 Voluntary Unenrollment ........................................................................ 125 3.1.4.5.7 Predetermined Coverage ....................................................................... 126 3.1.5 SUMMARY ............................................................................................................ 128 3.2 THE BRITISH COLUMBIA HEALTH CARE SYSTEM ................................................................. 128 3.2.1 OVERVIEW ............................................................................................................ 129 3.2.2 MINISTRY OF HEALTH .......................................................................................... 129 3.2.2.1 Funding ......................................................................................................... 130 3.2.2.2 Canada Health Transfer ...............................................................................