A four-year-old Newfoundland boy who has already lost one kidney to cancer is facing a staggering 21/2-year wait for a scan on the province's only magnetic-resonance-imaging machine. The scan was requested by a geneticist who suspects Ryan Oldford, a rambunctious, blue-eyed blond, has a rare syndrome that puts him at higher risk for leukemia and cancers of the kidney and liver, according to his mother, Brenda Oldford.

"I'm always very worried whether his other kidney is okay," Mrs. Oldford, who is a nurse, said in a telephone interview from the St. John's suburb of St. Philip's. "My heart has to believe he is okay, otherwise, I would not be able to survive."

As many as 100 children in Newfoundland face 30-month waits for the high-tech scans, said Geoffrey Higgins, clinical chief of diagnostic imaging at the Health Care Corporation of St. John's. While the wait is "less than ideal," he said patients' conditions are being investigated and followed by other medical means, and that anyone needing an emergency scan gets one.

Stories such as Ryan's are fuelling public demand for MRI services and sparking a boom in the private-clinic business, mostly in B.C., Alberta, Quebec and Nova Scotia.

On 36 private scanners across the country, patients can pay to have speedy access to MRIs, computed tomography machines, positron-emission tomography machines or the combination of a CT/PET scanner.

But federal representatives, concerned over the emergence of a private pay system, are meeting in Toronto today with officials from British Columbia, Alberta and Nova Scotia. "User charges and queue-jumping at diagnostic clinics" will be discussed, Health Canada spokeswoman Catherine Saunders said.

A separate meeting with Quebec on allowing patients to pay for medically necessary scans at private clinics will take place later.

Documents from 2004 obtained by The Globe and Mail under the Access to Information Act show that Health Canada is investigating every province over suspected Canada Health Act violations. The list includes patient charges at private high-tech diagnostic clinics, private surgery clinics, specialty referral centres, bone-density scans, surgical supplies and abortion services. Six provinces have also failed to pay the home rate for hospital care when patients are out of province and require care, according to the documents, which are marked "secret."

"The Canada Health Act is something we take very seriously," Ms. Saunders of Health Canada said in a telephone interview from Ottawa. "There is a concern that people are being charged for medically necessary services."

The huge growth in private clinics began with the opening of a private MRI scanner in Laval, Que., in 1992. And the proliferation of private scanners appears to have Ottawa particularly troubled.

At the Ville Marie PET/CT Centre in Montreal, for example, patients can pay $2,500 and bypass months-long waits at hospitals.

"Most of our patients have indications of cancer. The key for us is to stage it at the earliest possible moment so the treatment can start soon," Steve Stein, Ville Marie's director of operations, said. "It does the CT and the PET at the same time, giving doctors the best possible look."

Quebec Health Ministry spokeswoman Dominique Breton said patients have a choice.

"We have all these services in the public system, but if some people don't want to wait and they want to pay, that's their personal choice," Ms. Breton said in a telephone interview from Quebec City.

Normand Laberge, chief executive officer of the Canadian Association of Radiologists, said politicians need to ask themselves why these clinics are drawing paying patients. "It's because the public system is not doing its job," Mr. Laberge said.

Former federal health commissioner Roy Romanow said the Canada Health Act has "fallen into an almost benign neglect in some ways."

In a telephone interview from Saskatoon, he said these latest documents outlining the Canada Health Act investigations are "another piece of evidence that is a little unsettling because it seems to indicate that these [Canada Health Act] issues are not clarified, and not clarified in accordance with the law."

Colleen Flood, a University of Toronto law professor on sabbatical in New Zealand, said in an e-mail that the federal government is "very nervous (unduly nervous) about enforcing its vision of health care on the provinces."

That's because it is not always clear when the act has been breached. Health care is often thought of as a provincial responsibility and some cases (such as user fees for abortions) are "inherently dangerous political issues," she wrote.

But Ms. Saunders said that some provinces are penalized. Last year, $126,775 was deducted from British Columbia's transfer payments because it failed to submit a report to the federal government on extra billing and user fees in 2001-02. Health Canada estimated the amount of charges and deducted it from transfer payments, according to the same documents.

At issue is the definition of what constitutes a medically necessary service. As it stands now, a private patient payment for a medically necessary service would be seen as a violation of the Canada Health Act.

British Columbia is seeking clarification over what is medically necessary, according to Carol Carman, executive director of communications for B.C.'s Ministry of Health Services.

Albert Schumacher, president of the Canadian Medical Association, said: "We need the list of what is going to be publicly funded and what is medically necessary."

One particularly busy private clinic is False Creek Surgical Centre in Vancouver, where about 3,000 private operations are performed each year. One of its owners, Mark Godley, said patients can pay for operations so long as it is a "lifestyle choice" and, therefore, not medically necessary. In other words, if patients can safely wait for the publicly funded procedure but choose not to, then they can pay to have it done at his clinic.

"People are not prepared to wait any more," Dr. Godley said in a telephone interview from Vancouver. "People are calling us out of desperation; they need care and they're not getting it."

As for Ryan Oldford, his mother isn't planning to take him to a private clinic for an MRI just yet. She is hoping that he, and other children in the queue, will be able to have their MRIs soon. But, she added, "I'm not ruling it out. I don't know that I can wait 2½ years."

John Ottenheimer, Health and Community Services Minister for Newfoundland and Labrador, said in a telephone interview that he has not entertained the idea of sending patients out of province to private clinics as a way to whittle down the waiting list. He said the province will be getting another MRI in Corner Brook in a couple of weeks and he is hoping to get a third some time later.