Why Wait? Small Town Operating Rooms Are Empty

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.