X-ray van man ban

>> Quebec government won't let doctor make house calls

by CRAIG SEGAL

The right person might have a shot at a deal on a white '97 Chevy van with just 40,000 kilometres now parked in Dr. Jacques Chaouilli's Town of Mount Royal driveway. The 49-year-old French doctor plunked down his cash for the van four years ago, loaded it up with a portable x-ray machine, darkroom, siren, portable electrocardiograph machine and intravenous equipment and painted Emergency Medicine 24 Hours in big red letters.

But the van has yet to respond to any emergency. "My plan is to give medical care to the homebound. Here people pay the ambulance to go to hospitals. It clogs the waiting rooms and it's expensive. I learned that it would be cheaper to go to their homes with the van than have them inconvenienced and taking the ambulance to the hospital. My plan was to go to their homes where I'd do the job and the patient would be better off."

With the ageing of the population and its subsequent increase in homebound patients, the time for home x-ray service has come, he says. Choualli notes a precedent: locally based SOS Dentist, run by a Dr. William Dery, also does home x-rays.

American studies indicate that home visits can save money for the health-care system. A 1995 cost report performed by the Center for Health Policy Studies indicates that an x-ray performed by a portable x-ray provider cost $87 (U.S.), whereas taking the same patient by ambulance cost $420 (U.S.). A home x-ray pilot project launched in New York State in 1998 has since been renewed three times, Chaouilli points out.

The 15-year local medical veteran, who went on a hunger strike in 1996 to protest the privatization of some medical services, says he wanted the x-rays to be paid for by Medicare. But the province refused outright. Chaouilli fought the province in court but lost a decision in January 1998. He lost again on appeal in March 1999. In March 2000, the Supreme Court ruled that they would refuse to hear his case.

Chaouilli, who represented himself in court, says that the province argued that home x-rays constitute a cancer risk--a charge he rejects, asserting that modern x-rays release only small amounts of radiation. The cancer threat is so minimal, he says, that in many U.S. states portable x-ray services don't even need licenses--they simply have to register with the state.

Now Chaouilli is willing to lend his van for free to anybody who can convince their provincial government to set up a pilot project to allow for at-home x-ray and medical services. "In the U.S. they found out that the practice is cost-effective for the Medicare. It's not a question of luxury, it's a question of it saving money," says Chaouilli. "They are not smart enough (in Quebec). There's something wrong in the mentality of those provincial authorities, they don't follow rational thought. They have an ideological standpoint that's very rigid. There's no ground for rational discussion based on evidence."

Although the project has cost Chaouilli "tens of thousands," he urges people not to feel sorry for him. "I work at two clinics. I make my money. The pity is for the patients who don't get the service."