Skip to comments.Critically ill [Canadian] patients rushed to U.S. for care
Posted on 01/20/2008 10:34:27 AM PST by John Jorsett
More than 150 critically ill Canadians many with life-threatening cerebral hemorrhages have been rushed to the United States since the spring of 2006 because they could not obtain intensive-care beds here.
Before patients with bleeding in or outside the brain have been whisked through U.S. operating-room doors, some have languished for as long as eight hours in Canadian emergency wards while health-care workers scrambled to locate care.
The waits, in some instances, have had devastating consequences.
There have been very serious health-care problems that have arisen in neurosurgical patients because of the lack of ability to attain timely transport to expert neurosurgical centres in Ontario, said R. Loch Macdonald, chief of the division of neurosurgery at St. Michael's Hospital in Toronto. Those problems, he said, include brain injury or brain damage that could have been prevented by earlier treatment.
Ontario has the worst problem, though it is not alone.
British Columbia has sent four patients with spine injuries to Washington State hospitals for care from May to September, 2007, though the recruitment of more staff and opening of new beds have helped alleviate the problem. Saskatchewan has sent patients to neighbouring provinces such as Alberta, which is working at maximum capacity for specialized neurosurgical services.
But nowhere is the problem of accessing neurosurgery more severe in this country than in Ontario. Since April of 2006, 157 people have been sent to Michigan and New York State hospitals for care. That includes the 62 patients sent so far in fiscal 2007-2008, according to David Jensen, spokesman for the Ontario Health Ministry.
When asked if any patients transported to the United States had died, Mr. Jensen said the ministry does not specifically record the outcomes of health services provided out of country.
Patients being sent to U.S. hospitals are in the midst of acute medical emergencies, including head injuries, broken necks and hemorrhagic strokes, such as a brain aneurysm that has ruptured.
Unlike other cases where patients have been sent to the U.S. for care such as radiotherapy for cancer patients this is the first time doctors have categorically equated delays in obtaining treatment with poorer patient outcomes.
Tim Rutledge, former chief of emergency medicine at North York General Hospital, said physicians are spending many hours trying to find neurosurgical services.
When someone starts to bleed in their head, you don't have a lot of time. You have to take these patients stat, said Dr. Rutledge, who was asked to represent the concerns of Ontario emergency-room physicians before a provincial panel studying access to neurosurgical services. Not only is waiting traumatic for patients and families, he said, but it's immensely stressful for emergency personnel to watch a patient deteriorate before their eyes while they try to access care. Deterioration, he said, comes in the form of loss of limb function, seizures and comas.
Despite the urgency of these cases, patients encounter barriers to accessing care at every turn. The problems include: limited access to teleradiology; limited operating-room time; too few intensive-care beds; a short supply of neurosurgically trained intensive-care nurses to staff them, and too few neurosurgeons.
In some cases, neurosurgeons are available to operate, but with intensive-care beds full, there simply is nowhere to put them afterward.
Even the method of funding neurosurgical services is an enormous disincentive. Neurosurgery is funded out of fixed, global hospital budgets and is viewed as a financial drain. Orthopedic surgeons, by comparison, are seen as money makers: The more operations they do, the more their hospitals are reimbursed.
Tom Chan, chief of emergency at Scarborough Hospital, said the process is frustrating for emergency-room doctors, who are the first to see these patients. Typically, the patients come in having had a seizure or complaining of severe headaches, numbness, confusion, or vomiting.
My hospital is 20 minutes from the best neurosurgery in the country if not the world and we can't get to it, said Dr. Chan, who described the situation as crazy.
When Alan Hudson, head of Ontario's waiting-time strategy, heard about the problem, he immediately struck a panel to study it. The solution to fix this is within sight, said Dr. Hudson, a former neurosurgeon and hospital president. What it requires is some organization.
To that end, the Ontario government in November provided an additional $4.1-million to Toronto's University Health Network, to do 100 more neurosurgical cases by October, 2008.
Catherine Zahn, executive vice-president, clinical programs and practice at the University Health Network, said the additional government funding is having an impact, though she conceded the pace is not sustainable as more neurosurgeons are needed. She stressed that the government and her institution are working together to address the problem.
And yet, governments were warned of a shortage of neurosurgical services five years ago. In August, 2003, a report co-authored by Chris Wallace, head of the division of neurosurgery at Toronto Western Hospital, said that increasingly, the resources are not available to handle neurosurgical emergencies.
At that time, in fiscal 2003-2004, fewer than five patients were sent to U.S. hospitals for care. One year later, 10 patients were sent. That number doubled in 2005-2006, according to Ontario Health Ministry figures.
Dr. Wallace's report mentioned four main areas of concern and made eight recommendations to improve access to neurosurgery and to plan for the unplanned.
It has started to reach capacities that are not tolerable and that's what has caused the groundswell and the concern, Dr. Wallace said in an interview. He described the situation of travelling to the U.S. for care as intolerable for the critically ill.
Two more reports on the difficulties of accessing neurosurgical services followed. An October, 2003, report by Charles Wright found there was a significant shortage of neurosurgeons in some centres. Two years later, a report by the Institute for Clinical Evaluative Sciences said demands were being met by very few surgeons with high workloads, which is not sustainable.
Now, a fourth report, authored by James Rutka, appointed by the provincial government to head the neurosurgery expert panel, has listed about 20 recommendations to solve the problem.
The report by Dr. Rutka, chairman of the division of neurosurgery at the University of Toronto, was provided to government in late December. It recommends a two-phased approach: allocating additional neurosurgical services to one hospital to address emergency out-of-country transfers immediately, and increasing capacity in more centres in Ontario.
Where will the poor Canadians go if Hillary wins?
Many of these poor souls, near dead to begin with, probably didn’t survive being transported 100 miles to the US.
But at least they had a chance.
At least they were not left to die like dogs in the street in the medical hellhole of Canada.
And speaking of hell, these is a special place in aforementioned nether region for the truly despicable, dishonest Michael Moore and the US demcrat party leadership propagandizing for Canada’s nightmarish plan.
Buffalo, NY is one of America’s great decaying cities. They really should take advantage of things like then however they can. Perhaps Buffalo can be rebuilt by Canadians who want out.
Not a bad idea.
Many new businesses sprang up in Buffalo when we had the socialist Ontario leader Bob Rae - he sent Canadian small business owners south of the border faster than our high dollar sends shoppers.
It is interesting in light of this that the Democrats are so focused on some form of nationalize health care.
Well spoken. If you want proof that the left intends to grossly underfund healthcare think Medicaid and the Indian Health Service.
Recently, I have been adding examples like this to the wikipedia article on Caandian health care. So I just added a quote from this article.
Here are the things that I added over the past few weeks. The quote from your article appears at the very end:
Health care in Canada
A March 2, 2004 article in the Canadian Medical Association Journal stated, "Saskatchewan is under fire for having the longest waiting time in the country for a diagnostic MRI a whopping 22 months." 
A February 28, 2006 article in The New York Times quoted Dr. Brian Day as saying, "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years." In a 2007 episode of ABC News 20/20, host John Stossel cited numerous examples of Canadians who had difficulty accessing health care.
Medical professional shortage
According to a 2007 article, the Canadian medical profession is suffering from a brain drain. The article states, "One in nine trained-in-Canada doctors is practising medicine in the United States... If Canadian-educated doctors who were born in the U.S. are excluded, the number is one in 12." 
Restrictions on privately funded health care
In a June 13, 2005 editorial, the Wall St. Journal wrote, "Canada is the only nation other than Cuba and North Korea that bans private health insurance," ... the editorial provides an example to illustrate its point: "When George Zeliotis of Quebec was told in 1997 that he would have to wait a year for a replacement for his painful, arthritic hip, he did what every Canadian who's been put on a waiting list does: He got mad. He got even madder when he learned it was against the law to pay for a replacement privately." 
In 2006, a Canadian court threatened to shut down one private clinic because it was planning to start accepting private payments from patients. According to The New York Times, although privately funded clinics are illegal in Canada, many clinics are opening anyway, because patients don't like the long waiting lists in the government system. 
In a 2007 interview on ABC News, Professor Regina Herzlinger of Harvard Business School said, "Many clinics all across Canada are illegal for-profit... They know they can't get the health care they need from the legal system, so they're complicit in creating an illegal system that'll give them what they need." 
Canadians visiting the U.S. to receive health care
According to a September 14, 2007, article from CTV News, Canadian Liberal MP Belinda Stronach went to the United States for breast cancer surgery in June 2007. According to the article, Stronach's spokesperson Greg MacEachern said that the United States was the best place to have this type of surgery done. The article also says that Stronach paid for the surgery out of her own pocket. Prior to this incident, Stronach had stated in an interview that she was against two-tiered health care.
When Robert Bouressa, the Premier of Quebec needed cancer treatment, he went to the U.S. to get it.
In 2007 it was reported that Canada sends scores of pregnant women to the U.S. to give birth. In 2007 a woman from Calgary who was pregnant with quadruplets was sent to Great Falls, Montana to give birth. An article on this incident states, "There was no room at any other Canadian neonatal intensive care unit."
Champion figure skater Audrey Williams needed a hip replacement. Even though she waited two years and suffered in terrible pain, she still did not get the surgery, because the waiting list was so long. So she went to the U.S. and spent her own money to get the surgery.
A January 19, 2008 in The Globe And Mail states, "More than 150 critically ill Canadians many with life-threatening cerebral hemorrhages have been rushed to the United States since the spring of 2006 because they could not obtain intensive-care beds here. Before patients with bleeding in or outside the brain have been whisked through U.S. operating-room doors, some have languished for as long as eight hours in Canadian emergency wards while health-care workers scrambled to locate care." 
I hope we are not helping to subsidize those patients with US tax dollars or worse, with higher domestic rates as we do to subsidize their cheap meds.
Where will the poor Canadians go if Hillary wins?
forget the canucks....where will the US taxpaying public go???
They will die like dogs in the streets. Hillary and the crooked democrat politicians will be cared for in luxurious style, while you are kicked out of the ER, covered in blood.
YEP, exactly what YOU said. When we lived in Vancouver, BC there was a big hullabaloo over the local politicians being able to get in to see doctors, but not the everyday guy....why? Well...you figure it out....
Excellent work. Next time I get into an online argument about the merits of the Canadian system, I’ll be sure to arm myself with info from your Wikipedia collection.
I have not the slightest doubt about this. I would LOVE to have documentation, but I read Canadian "newspapers" enough to know how they are engaged in a colossal cover-up of socialist misbehavior.
The key point of failure for the US healthcare system is the rapidly increasing cost of any type of medical procedure. Competition of services is the only way that we will drive them down, and it simply isn’t happening.
This is work for the ailing Michigan economy.
I’m sure the Canada must pay to going rate.
A socialist country like Canada wouldn’t stiff the US hospital, would they?
How about facing the real problem head on: Deny all medical services (except for life-saving measures) to everyone in this country illegally.