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Women sue over delays in treatment for breast cancer
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     Quebec

    A class action lawsuit is being launched against 12 Quebec hospitals on behalf of 10 000 patients who waited more than eight weeks for radiotherapy after being diagnosed with breast cancer. The suit, the first of its kind, could entail damages as great as $C50m (£21m; $US37m; 31m) and have repercussions in provinces across Canada.

    The suit was initiated by Anahit Cilinger, a Montreal woman of Turkish origin, who after waiting three months in vain for radiotherapy under Canada's public healthcare system, received it in Istanbul at a cost of $US10 000. Her daughter arranged for the therapy within 24 hours.

    Canadian provinces, and Quebec in particular, have had problems providing prompt radiotherapy for some years. By 2000, several provinces were forced to send more than 800 patients to the United States for treatment as a result of shortages of healthcare staff and long waiting times. The board of Canada's major cancer treatment centre—Princess Margaret Hospital in Toronto—considered a proposal by staff to ask patients to sign waivers stating they were aware of the risks involved in joining long waiting lists (BMJ 2000;320: 203/a). The proposal was never carried through. Instead, the hospital sent those waiting a letter telling them their options. They could either continue to wait for treatment at the Princess Margaret or could opt to be sent elsewhere in Ontario or to the United States.

    In 1999, Quebec had about 1200 patients waiting for radiotherapy, some for as long as five months (BMJ 1999;318: 1507/a). Dr Carolyn Freeman, director of radiation oncology at McGill University health centre, then approved of sending patients to the United States as part of a short term solution, but said that long term planning was essential.

    The next year Quebec imported five radiation technicians from Paris and recruited several radiation oncologists (BMJ 2000;320: 826/a). By that time, Quebec had spent $C6.5m sending patients to the United States for radiation therapy.

    The Fraser Institute, which conducts an annual survey of hospital waiting lists, says that in 2003 Quebec had the second longest waiting time (10 weeks) for radiation for breast cancer in Canada. Quebec's Superior Court has ruled that 8-12 weeks is the maximum delay that is medically acceptable.

    Canada's new prime minister, Paul Martin, has made finding solutions to the federal healthcare plan a top priority since he succeeded Jean Chrétien on 12 December 2003.(David Spurgeon)