Healthcare not a profesional operation

BY WENDY ELLIOTT

Kings County Register

Pat Patterson says asking questions about waiting lists is a “one-sided conversation,” he says.

“They generally don’t reply.”

He’d rather be working than plaguing elected representatives, but he hasn’t had the option.

A 10-year-old injury sidelined the Wolfville resident last November: osteoarthritis. When he couldn’t walk upstairs, he saw orthopedic surgeon Dr. Bill Beveridge, who presented him with an 18-month wait for a hip replacement.

“He was honest and up front,” says Patterson; however, the option of going elsewhere was not presented.

Patterson did not want to be sidelined or take narcotic painkillers for an extended period of time “due to the lack of surgical capability.”

A construction manager who has worked all over the planet, he was soon on the internet researching medical tourism. Surgery was possible privately in Montreal, Vancouver and Alberta; but it would cost something like $25,000.

Patterson began looking farther afield. He settled on Panama, where he had the choice of two modern hospitals. The cost: $13,000.

He and his wife flew south in February. He spent four days in hospital. His private room “had a flat screen TV and a cot for my wife. It was like a hotel room, and the attention was excellent.”

They stayed a month while he had physiotherapy with a McGill-trained staff member, then they flew home - where he was astounded to learn the wait time for his other hip had increased to 24 months.

Back he went to Panama in June for an operation on his other hip.

Now at the end of August, Patterson is looking at returning to work soon. While he recuperates , he writes letters to the editor about the state of our healthcare. He bemoans paying taxes for decades without needing healthcare and then, when in extreme pain, discovering a remedy was not available for two years.

“If we managed construction projects like they manage healthcare, we would be fired,” he says. “We need to pay more for our politicians - then we’d get more professionalism.”

To add insult to injury, when faced with $100-an-hour private physio last March at his local healthcare centre, patterson was told, “if you have enough money to go to Panama, then you have enough money to pay for private physio.”

Patterson is convinced doctors need to be allowed to do their job.

“Having a qualified, capable surgeon and operating room team is no use if the team is budgeted,” says Patterson. “The people who are being made to suffer need to speak up - and loudly.”



Wait times anything but ‘simple math’ - surgeon

Dr. Bill Beveridge says wait times in the western region of Nova Scotia are crazy.

"There's a federal guideline, and Nova Scotia is not even close - and nothing is being done.

“It’s terribly frustrating every day. People are in terrible pain and we can improve them, but I have to say, ‘I’m sorry, it’ll be two years’.”

He says his secretary hears from patients daily, many in tears. Beveridge doesn’t believe in queue jumping, but he knows Halifax doctors who allow it.

Beveridge began his practice in New Glasgow 18 years ago and he got a day-and-a-half operating time each week. Today, as one of five orthopaedic specialists in Kentville, he is allowed a day-and-a-quarter: time for just two hip joints.

Some times he has to check at noon whether a bed will exist for the patient he’s scheduled to operate on that afternoon.

“The nurse managers have bed meetings almost every day. They micro-manage.

“It’s complex, but the biggest problem is not enough nurses and beds. If you don’t have the staff and beds, operations can’t be done safely.”

Recent renovations at the hospital are not increasing bed numbers, and long-term beds occupied by seniors limit capacity. Beveridge knows the province has committed to fund new nursing home beds, “but when are we supposed to get some?”

Since Kentville surgeons cover all of Western Nova Scotia, Beveridge said the five operating rooms can be busy places. He notes the provincial health department has indicated nine per cent of necessary hip replacements take place within 60 days. In the Capital Health District, the figure increases to 13 per cent.

“I don’t believe their numbers,” says Beveridge, who keeps his own waiting list. The names on his list are not shared.

Two surgeons from Kentville do travel to Bridgewater and three go to Yarmouth for day surgery. Beveridge has young children and isn’t willing to spend long hours traveling without pay. The Worker’s Compensation Board routinely sends people to Moncton for orthopedic operations.

Beveridge could easily double the number of operations he conducts a week.

“It’s a question of balance. In my office, I see 20 patients a week and, if five of them need joint replacements, I can do two.

“It’s simple math.”

An average of one hip fracture per day comes into the hospital, bumping scheduled replacements.

The other frustrating aspect for local physicians is the Code Blue status at Valley Regional.

“We’ve been full for two or three years. When emerg gets full, it spills over into psych beds. That’s (the hospital) full 97 or 98 per cent of the time. It’s a crisis when there are no beds.

“There doesn’t seem to be an end in sight…”



Managing the lists

In April, the Wait Time Alliance (WTA) of Canada Report Card gave Nova Scotia an ‘F’for orthopedic operation wait times.

WTA co-chairman Dr. Lorne Bellan said governments need to improve the collection and reporting of comparable data.

This year’s report shows no change from the 2007 report card in terms of grades for reduction in wait times nationally. Overall, bypass surgery and cancer had the strongest grades; knee replacement received the poorest.

In July, the province said it is looking for a consultant to carry out an $8 million, two-year project to reduce wait times for both surgery and diagnostic imaging, involving new computer software for family doctors to help them decide what tests are needed. The project should begin in October and conclude in the spring of 2010.

Kyle Buott with the Nova Scotia Citizens' Health Care Network, says the government is continuing its push to outsourcing.

“We, of course, have concerns they will privatize the delivery of these services as a result of this study and will monitor who receives the contract but, in general, these new software programs have been very successful in other regions.”

Of course, says Buott, all the research they need is already done in other areas.

Dr. Michael Rachlis, in his 2004 book Prescription for Excellence, says, “some of Canada's best-known researchers in the area of waiting lists recently concluded, ‘The current Canadian 'non-system' of physician-controlled lists make it impossible for managers to manage and actually 'puts patients last’.”