I stopped by the hospital.
Access to a line is not the same thing as access to health 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.”
THE OBSTACLES
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.
WARNING SIGNS
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 Americans go...
Or the VA...
Homer says, “MMmmmmmmm, socialized medicine.....aaaaaaaagghh”
bump
Bookmarked.
Thanks!
I stopped by the hospital.
Access to a line is not the same thing as access to health care.
The whole tax structure of hospitals and ownership needs to be addressed. The American medical association needs to be run out of the country.
Lost my Canadian Aunt and Uncle within a year of one another. Uncle was having a simple hernia repair operation when he suffered a massive heart attack on the table...and they couldn’t save him.
Aunt had stomach cancer. By the time she finally got to the top of the list for surgery to remover her tumors, it was too late and she, too, died after they opened her up, shrugged, sewed her back up and sent her home.
Yep. I can’t WAIT for FREE health care in America. /sarcasm
2 related snippets from Germany:
-A dear friend of the family is from Germany. Her mother was visiting her in the States. The mother had been having chest pain but was being treated with medicine because seh was considered to old for surgery in Germany. American surgeons did bypass surgery.
-An acquaintance took a job working for a base in Germany as a local national employee rather than as a GS. The health insurance appealed to him. As a “local national” he is paying the German income tax of 50%. Oh, and then there is the 19% Value added tax, TV tax, church tax and on and on it goes.
bump
After we get Hillary/Canadian care we can go to Mexico for emergency health care or Cuba. Moore says Cuba has world leading health care why doesn't the Canadian government send their very sick there?
I have an uncle in Manitoba that needed heart surgery. He lived in a small town 300 miles from Winnipeg. They (the ambulance) drove to the big city and the hospital examined him. He had had a heart attack. Sent him BACK to the small city for a week, then brought him back to Winnipeg, told him he needed a three way bypass, flew in a doctor from New York for the surgery, and he gave him a five way bypass. Of course, he had been a city counsel member some years back. My uncle is VERY fortunate that he is still alive and didn’t die.
Another uncle was not so fortunate and he could only get a bed just before he died. He had only been an average joe sales man.
My mom does not believe the city counsel uncle had any special treatment. I do.
I remember clearly when in Germany, and we lived in the German community rather than the Army base, the locals speaking of those who were deemed better made comfortable than treated.
Apparently, they practice planned obsolescence rather than repair.
It is far cheaper for Canadian socialized health care to issue a death certificate than to treat a live Canadian.
But, either way ...... It's FREE!!!
That’s an unthinking emotional statement typical of the very people I suspect you despise, democrats and communists and fascists. I think you shot from the hip and are NOT a liberal but that comment sure makes you sound like one.
The bill and the actual cost are of course different, and however high they are it is a direct result of what the fascists have already done by force over a period of YEARS to the free market in this land.
Moreover, the medical system would be happy to provide 1960s level care at a very cheap price but when people demand absolutely the best care with minimal risks, care that was not even possible a few years back, then why is it any surprise that it is expensive.
What're you living in a fantasy world? Those in office...just know how to pander to illegals and Mexico. It'll NEVER happen.
There has not been a free market in the medical profession for nearly all of my life. As long as the America medical association is allowed to control the number of medical schools and students. And thus the number of doctors and to further fix the market where a start up hospital would need to provide a certificate of need to be licensed, it is a fixed market.
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