Sleep doctors resign from Manitoba's backlog task force, saying proposal was 'completely ignored'

Two sleep specialists have resigned from Manitoba's pandemic backlog task force over concerns with how the group is handling the waiting list of people in need of help for sleep disorders.

The doctors said Tuesday there's been no commitment from the province to add the resources needed at the Misericordia Health Centre's Sleep Disorder Centre to address the backlog of people waiting for help.

The task forceformed in late 2021 totackle the backlog of surgeries, tests and diagnostic procedures that built up during the COVID-19 pandemic announced in February ithad struck a deal with the private company Cerebra to provide up to 1,000 sleep diagnostic tests.

But the doctors who resigned said that plan was made without considering a proposal they submitted themselves last year, which included adding staff and equipment, oversight of outsourced private testing, and ensuring care is in place for patients beyond getting a diagnosis.

"To this day, our proposal has been completely ignored," said respirologist Dr. Eleni Giannouli, the sleep disorder centre's medical director.

Giannouli said there are about 6,600 patients waiting for sleep disorder treatment in Manitoba.

Dr. Nancy Porhownik, co-section head of respirology in the University of Manitoba's department of medicine, resigned from her clinical advisor role on the task force alongside Giannouli on April 6.

"It became apparent over time that decisions were made about sleep services in Manitoba without including us as content experts and without including other sleep medicine content experts," Porhownik said.

"Staying part of the task force really implied that we were participating in these discussions. And we weren't."

As of March 28, the doctors' proposal was under review, according to a timeline dated April 14 and signed by task force leaders Drs. David Matear and Peter MacDonald that was provided to CBC.

'Queue jumping' concerns

Giannouli and Porhownik estimated their proposalwhich included diagnostics as well as interpretation of testing, care and followupcould completely eliminate the wait-list in three years.

"We stand behind it as a comprehensive plan, and we have significant concerns about the care of Manitobans with disorders of sleep who have testing but no plan for care," Porhownik said.

The Misericordia lab currently does about 430 sleep studies a month but gets 600 referrals in the same period, Giannouli said. With proper equipment, it would be able to handle about 120 every week 70 in the lab and 50through at-home sleep apnea studies.

Misericordia's sleep centre, which opened in 2008 and is the largest sleep centre in Canada, has 10 in-patient beds, a Winnipeg Regional Health Authority spokesperson said in an email.

The doctors questioned how the lab would suddenly be able to handle a jump in patients who did sleep studies through a private company, something Giannouli said led to perceptions Cerebra patients were jumping the line and ethical dilemmas for doctors.

"We don't have the capacity to increase our spots. And if we're going to prioritize them as there has been the pressure [to do], then that allows patients to do queue jumping, and that means we will have other patients who wait," she said.

Zahra Moussavi, a University of Manitoba professor whose research includes detecting sleep apnea, said Manitoba's long waiting list for sleep disorder care is a "major health issue" because sleep disorders can have so many other effects.

Sleep apnea, for example a condition where a person stops breathing while asleep is associated with conditions including cardiovascular disease, she said.

Whilemore diagnoses are needed,it's also "crucially important" to make sure those people then get the treatment they need, Moussavi said.

"Let's say that you diagnose somebody with sleep apnea. If you don't treat it, so what?" she said.

"You are not reducing the risk factor for the patient to develop other cardiovascular issues and so on. So treatment and diagnosis should go hand in hand."

Only 158 of 1K studies done

While the Cerebra agreement could have covered up to 1,000 tests, company president Patrick Crampton said only 237 referrals came in and 158 sleep studies were done from the end of January to the end of March, when the agreement expired.

Because the company wasn't responsible for treatment after diagnosis, Crampton said he couldn't say whether any of those patients are still waiting for treatment. He said there was "fantastic" feedback from patients who used Cerebra's services, most of whom had been waiting for one to two years.

A provincial spokesperson said in a statement that the task force estimates as many as 24,000 patients in Manitoba could be waiting for sleep studies.

However, "due to the limited access to the provincial sleep study wait list, the flow of patients" to Cerebrawas "compromised," which meant"negligible impact on the number of patients waiting for assessment," according to thestatement.

During question period on Tuesday, Opposition NDP Leader Wab Kinew accused the province of "putting politics ahead of patients" in its sleep disorder task force work by ignoring the doctors' proposal due in part to minimal private sector involvement, quoting information on the timeline signed by task force leaders.

In response, Premier Heather Stefanson pointed to the government's increased health-care spending and thanked the task force for its work.

"They are contracting out some of those services. That gets patients the health care that they need sooner. It's not taking an ideological approach," she said.