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Why Wait? Small Town Operating Rooms Are Empty
Bulkley Valley offers a waiting list cure: Bring surgeons to rural hospitals where operating rooms stand idle.
Ask almost anyone in the province and they can tell you a horror story related to waiting for health care.
Kamloops resident Ken Alexander was beside himself after waiting four months for a return call from the local knee specialist's office.
Finally the secretary called, offered an initial appointment in six months and the possibility of an operation in two and a half years.
In the meantime his knee kept getting worse.
"The amount of damage that I could have done to myself hobbling around," he recalls.
After another call to his family doctor, Alexander was asked whether he would be willing to see a specialist in Vernon.
An hour and a half drive seemed a small price to pay. Within days Alexander had an appointment.
The Vernon specialist agreed action needed to be taken on the knee and suggested an operation. Would Alexander mind if the surgery took place in Salmon Arm?
The attention focused on the First Minister's conference on health care made it clear the health care system has a number of problems.
Waiting lists are a significant part of those problems, but why are people waiting?
"It depends on who you see," says Alexander.
Alternative to going private?
Right now there is no general list for surgeries. Each hospital and each doctor in the province has their own lineups and no one seems to have a clear idea of how to make it work.
Even before the minister's meeting, the B.C. government had announced $25.7 million to be spent on reducing wait lists for heart, hip and knee surgeries.
Health Minister Colin Hansen, who wasn't available to be interviewed for this article, has suggested that using private surgical facilities may be an option for reducing wait lists.
Debra McPherson of the BC Nurses Union doesn't agree. She says the provincial health care system has the capacity, we just aren't using it.
According to her office, the Vancouver Island Health Authority recently spent $200,000 to contract out approximately 100 operations in Victoria, even though three of the 14 operating rooms at Victoria General Hospital have never been used.
Every fifth Friday the hospital closes all but three of its operating rooms to save money, she says.
Union staff are busy canvassing health care facilities in B.C. to determine how many have had their operating rooms closed or reduced, hoping to prove to the premier there is capacity out there.
"We just need to fund it," says McPherson.
Empty operating rooms abound
Empty operating rooms are easy to find in small towns across the province, but not because there are no surgical patients there -- those patients are simply tacked onto lists at larger urban hospitals.
"There are no wait lists for the operating rooms in Smithers like there is in the Lower Mainland. But there are no doctors," says Sandy Estby, Charge Nurse at the Bulkley Valley District Hospital.
The hospital was built to accommodate 70 beds and six operating rooms at a time when the population projections in the area were far different than they are today. Now it is difficult to recruit a full-time general surgeon, because two weeks a month coverage is usually enough to fulfill the community's needs.
Bulkley Valley's experiment
Fearing further cuts to their operating room, staff at the Bulkley Valley District Hospital have been working to come up with a unique solution for the community.
Recruiting specialists, such as an orthopaedic surgeon or an ear, nose and throat doctor to a town of 5,000 sounds like an unheard of luxury, but that's what they've done.
With several operating room nurses and two anesthetists living in the community, the hospital is well-served to provide day surgeries to area residents. Rather than finding one doctor to live in Smithers, a rotating schedule of specialists is now in place.
The town is now serviced by a general surgeon, a gynecologist, a urologist, and more.
Not perfect
Dr. Marius Pienaar, a gynacolgist from Prince Rupert who spends a week in Smithers every three months, admits the system is far from ideal.
"You are working there away from home without your own instruments and with a different team. It is difficult to do follow-up, you've got to hand over patients to someone else. . . But we do it successfully."
The alternative, being no service to the community, with residents traveling to urban centres for all manner of health care, is also far from ideal.
"It keeps us all employed and give us a diversified service close to home. It works for everybody. Doctors, staff, patients," says Estby.
Although there has long been a program to help pay the transportation costs of visiting surgeons to northern regions, Estby says they've had to lobby hard to keep the services available to people in the Bulkley Valley.
Looking for solutions
Mike Old of the Health Employees Union wonders why these innovations aren't more of a priority.
"Why doesn't the government spend more time focusing on innovative ways to strengthen the public system instead of opting to throw public dollars into for-profit, investor-backed clinics?"
He points to the Fraser Health Authority's decision to contract out MRI services to private companies and wonders whether they looked at all the options.
"Could they put on an extra shift to process more MRI procedures. Are they talking to other health authorities to share resources and reduce the MRI waits?"
Old admits that one can't underplay the complexity of running a health care system. For example, issues around supplying staff to keep operating rooms open need to be addressed.
How to use money injection?
McPherson sees the influx of $5.4 billion into the B.C. health care system as a good step toward addressing this.
"There are areas we have shortages, but putting it out to the private sector doesn't make it any better because we only have one body of nurses or doctors and they are either working in the private clinics or the public places," says McPherson.
"But most of the time they are working in the private places because there is no operating room time in the public places."
For now the vision at the Bulkley Valley District Hospital remains part of a solution for providing care to people in the North, but eventually bringing people in from larger centers is not being ruled out.
If Alexander's case is any example, it seems as if some people are already doing that.
Heather Ramsey is journalist based in Queen Charlotte City.
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Earnest Canuck (not verified)
7 years ago
My mother died of an aggressive lung cancer at Bulkley Valley District Hospital in May. She had been diagnosed just five months earlier and, apart from a couple of trips to oncology/testing centres in Kelowna and Prince George, received most of her care there. It was top-notch, compassionate, even heroic care from the get-go to the end.// This points up a discordance in the great Canadian health-care debate, I think. I've been puzzled by the rhetoric around waiting lists, funding and private delivery for, oh, fifteen years... because I've been told for *at least* that long that the whole system is on the verge of collapse, standards are Third-Worldish, it's unsustainable, etc. God knows I'm no expert on this arcane subject, but it just directly contradicts my lived experience. No one in my extended family has for decades received anything less than a superb standard of medical attention when required (mind you, we're the sort who try not to require it too often. Remember when *massages* were covered by MSP? Jesus).// But Ramsey's article leads me to think we might just have been perversely lucky to live in the North. I can see there might be a Catch-22 situation under public health, whereby when you plan for small towns you pretty much always overestimate the demand -- whereas in the metropolises, the simple nature of crowds might mean demand always outstrips supply. I think of my mum maybe dying amid the bedlam at St. Paul's hospital in Van -- receiving centre for the ill and broken masses of the Downtown East Side -- and I kinda shudder.// Could it be so simple? Is rural Canada actually a *better* place to get sick? I hate to use the phrase, but... this question needs more study. Let's just make it *quick* study, right?
allan (not verified)
7 years ago
This certainly sounds like something to consider. It will ensure the money stays within the public system, helping its viability through better efficiencies of infrastructure and, of course, shortening waiting lists.
shirin (not verified)
7 years ago
More money coming into the health system is good only if there is a solid plan and direction on how best to invest it. Being on the research end of the spectrum and working side by side with the primary care givers, I have to confess that funds leak through beaurocratic waste like a dripping faucet. Wait lists exist for the more common ailments (growing with an aging population) - such as hip/knee surgery, scans, and basic operations for removal of tumours - which are often more than minor inconveniences. But the fact remains the specialist is drawn to private clinics because of 1) the great money and 2) convenience of location and willing to pay clientelle. And who can blame them? The public system needs a hauling over and more accountability of how patients are treated and the system charged - do you ever figure out how the dentist comes at the sum billed to you insurer and the MSP? The podiatrist files a ingrown nail and charges $85 for a first visit? It is pleasant, but health care is a very lucrative business - and the Provincial Liberals profit as long as they aren't paying for your inflated costs. There really needs to be a standardization of the entire system - with an interconnected waiting list system for all of BC so the patient in waiting has the option of fast-tracking if there is an opening in a remote area. This way the wait lists at crowded centres would shorten and doctors and supporting staff would be more willing to take up practice if a guaranteed steady stream of patients is waiting in que.
outsider (not verified)
7 years ago
The solution to waiting lists is quite simple: more surgery time for the specialists, and more surgical recovery beds on the wards. The issues are more money, and more nurses (that should please the nurses union!). My b-in-law is an orthapedic surgeon in BC who only has 5 hours of elective surgery time available to him each week. I don't know how many patients he can work on in that time (depends on the complexity of each case, I presume), but it probably doesn't put much of a dent in his 2 year + waiting list. Ironically, if you are an accident victim or a patient already in the system for other or related conditions, you will receive either immediate surgical care or you move to the top of the waiting list - it is the "elective" patient, with degenerative conditions or quality of life issues who doesn't seem to get any care or respect by the health care system as it is currently designed.
Bernard (not verified)
7 years ago
The mayor of Lytton, Chris O'Connor suggested this a few years ago to Interior Health. Interior Health(along with the northern equivilant) are not interested in cost effective practices, but in centralizing services. In the case of the North, everything in PG, in the south everything in Kelowna.
emuman (not verified)
7 years ago
the governement allow only so many knee replacement, not the matter of there are OR avaable or not!.
tsanh (not verified)
7 years ago
There are beds that have been closed along with operating room time that isn't being used for the simple reason that they were closed by the liberal govt. I'm pretty sure that this largesse is really only replacing a portion of the system that already previously existed.Staffing is the biggest problem.Our hospital has already increased its joint replacement surgery but not one extra job has been created. We are constantly understaffed having to rely on the casual pool to increasingly fill in labour gaps.McJobs in health care...obviously no real commitment here.This so called govt is far from wanting joe public to think that there are beds in their own (and owned) hospitals...they prefer to tout the private clinic crapola and hope that all the great unwashed will buy their bullshit.Where would these private clinics get their staff?There a finite number of us nurses and if we go to work privately who will nurse the public?What would probably happen is that some clinics would cream off the surgical part and dump the patient back into the system for the rest. Thanks for the article and the ideas.Innovative thinking like this will work for the good of all communities not just the liberal favoured few.
RickW (not verified)
7 years ago
"You are working there away from home without your own instruments and with a different team. It is difficult to do follow-up, you've got to hand over patients to someone else. . . But we do it successfully." Perhaps a full-fledged "flying squad" is the answer. O/R's could be maintained in a state of readiness, but a whole team, working with each other constantly, would come in to preform operations.
JDC (not verified)
7 years ago
Dont kid yourself...big city hospitals are housing empty and underused operating rooms..THATS what is creating your wait lists..we had units closed at our hospital all summer long..more rooms down this fall? where is all our health care money going ?? This " crisis " is being created so that the govt can bring in more for profit care to " save us " . Dont wonder or question it..Its already happening. Youre being lied to every single day.