Patients wait in pain as a surgeon fights to get paid — all in a battle over health-care dollars

Christine Kaschuba first noticed a strange bend in her spine as a teenager. 

For years, it seemed manageable: she played sports, ran marathons and had three children. But slowly and steadily, her back deformity worsened. Her spine's C-shaped curve, a hallmark of severe scoliosis, is now roughly 70 degrees.

The pain is unrelenting. It ripples from Kaschuba's back to her lopsided hips, sometimes shooting down her legs, all while her lungs struggle to take in full, deep breaths. Most nights, she says, the ache is so all-consuming she just wants to close her eyes and not wake up.

For the last few years, the 44-year-old Whitby, Ont., resident has been waiting for a risky, complicated spine-straightening surgery with one of the few Ontario surgeons capable of handling the most challenging scoliosis cases.

But in January, that Toronto surgeon told her — for reasons she didn't fully understand — that he was no longer offering the procedure to correct her curve. 

In a moment of desperation a few months later, Kaschuba drafted an email to the patient relations team at Toronto Western Hospital, one of two downtown facilities where her doctor has privileges, begging to know why her long-awaited procedure was no longer happening. 

"I don't understand how things changed from me being on a wait list at your hospital to now not having this surgery at all," she wrote in April. "As a patient, I deserve answers."

The answer, she found out, was that the physician was no longer doing this kind of complex surgery. And the reasons why, CBC has learned, are tied to a years-long, behind-the-scenes battle between her surgeon and the province over delayed payments and rising pressure to tackle backlogs of other, more common procedures.

Kaschuba's case provides a window into the inner workings of Canada's complex health-care system. Money, staff and operating room time are all finite resources, government funding is funnelled into different buckets and both hospitals and surgeons have to make tough decisions about which patients to prioritize — and which to deny.

WATCH | Why an Ontario surgeon is hitting pause on his toughest operations:

The physician at the centre of this protracted conflict is Dr. Stephen Lewis, a highly specialized orthopedic surgeon.

A typical day's work for Lewis usually lasts 12 hours. Much of it is spent inside a hospital operating room, carefully cutting open someone's back, exposing their spine, removing sections of bone from multiple vertebrae, then realigning the spinal columns to correct painful, complex deformities — all while ensuring these high-risk procedures don't lead to paralysis or death.

As Lewis told CBC News in a sit-down interview, the surgeries themselves aren't the only challenging part of the job.

For years, he says there's been a growing push for hospitals to prioritize more common procedures, leaving little money or operating room time for complex work. Meanwhile, Lewis has also been locked in discussions with the province about getting properly paid for these kinds of complicated surgeries, which long made up the bulk of his practice.