As mentioned last week, Health Edition will stop publishing at the end of this year, on December 20. I have made the difficult decision to retire, and I would like to acknowledge the many kind emails I have received this past week. It has been my immense privilege to bring you the news on Canadian health care since 1996. Together, we have been on a fascinating journey of discovery about changes to the fabulous treasure that is Canadian health care.
John Pye, Publisher and Editor
Emergency department issues were a hot topic in three provinces this past week, coming on the heels of a warning in a recent position paper from the Canadian Association of Emergency Physicians (CAEP) that ED overcrowding is worsening and constitutes a “public health crisis.”
In Newfoundland and Labrador Tuesday, the St. John’s Telegram reported that hospitals in the city are falling short of their wait-time targets for 75 per cent of Level 3 ED patients. The situation is even worse (23 per cent) for Level 4 patients.
Questioned about this in the legislature Wednesday, Health Minister Susan Sullivan said the government has already made progress with its ED wait-time strategy. In fact, in response to a related question last Thursday, she said the government has acted on seven of the 11 needed action steps cited in the CAEP position paper.
Ms. Sullivan said that despite a 16 per cent increase in traffic, the time to initial physician assessment has decreased by 17 per cent and the total length of stay is down 11 per cent. She also said the number of patients who leave without being seen by a physician has decreased by 35 per cent.
In the Manitoba legislature Tuesday, Progressive Conservative Health Critic Cameron Friesen cited data from a freedom of information request that show 10 per cent of people who go to Winnipeg EDs leave before seeing a doctor. He said 28,000 “simply got up and walked out,” 5,000 more than the year before.
Over the past number of months, the Opposition in Manitoba has also criticized the government for patient off-load times at EDs and rotating ED closures at some rural hospitals.
Emergency department issues, while prevalent in many parts of the country, are a particular concern in Regina right now. As of this Thursday, one of the two EDs in the city is closed during the evening and overnight hours.
From 7:30 p.m. to 8:00 a.m., the Pasqua Hospital ED is closed, and a paramedic team is assessing patients who turn up at the ED and referring those who truly need emergency care to the General Hospital, about 10 minutes away. Others are being sent to a primary care centre across the street from the Pasqua which has agreed to stay open until midnight.
The problem is a shortage of resuscitation-capable physicians. The Regina Qu’Appelle health region needs 30 of these doctors to staff the two city EDs, but has only 20 despite aggressive recruiting efforts.
It is estimated that the General could end up seeing around 30 additional patients a night, and this has raised questions about how it will be able to cope. Tracy Zambory, the president of the nurses’ union, says the southern part of the province cannot function with only one ED in Regina.
“You can’t do it,” she told the Regina Leader-Post this week. “Patient safety is going to be put at risk and we can’t have that.”
Health Minister Dustin Duncan has blamed the situation on a global shortage of highly-trained emergency physicians, although the NDP Opposition says the government has been ignoring the looming issue for years.
In the legislature Wednesday, Mr. Duncan suggested that the situation may improve when a new contract is signed with physicians. He said the government hopes this will put the province in a competitive place with other provinces across Western Canada and “help fill some of the gaps in terms of coverage.” HE
The Centre hospitalier de l'Université de Montréal (CHUM), one of the largest hospitals in Canada with a staff of 12,000, is facing supervision after a damning report this week from Quebec Acting Auditor General Michel Samson.
Mr. Samson said government guidelines for executive pay were flaunted by the hospital, as were guidelines for filling senior management positions and awarding contracts.
Health Minister Réjean Hébert has given the board of the hospital until next Wednesday to detail measures of how it will remedy the situation. This includes what it intends to do with its director general, Christian Paire, whose contract is up for renewal.
The auditor general said Mr. Paire had received $70,000 more in pay since 2010 than is specified by Treasury Board rules. He also received $80,000 as a teaching salary from the Université de Montréal, also contrary to the rules. The extra pay bumped up his salary to $430,000 a year which is what he wanted to leave his former job at a French hospital and take the CHUM position in 2009.
Mr. Paire’s pay situation is not news. In fact, he is suing the university for stopping his $80,000 pay in 2011 because he is not teaching.
The Auditor General also found several deficiencies with regard to remuneration of executives including the “systematic allocation” of maximum salary scales. He calculated that non-compliance with the established rules amounted to an overpayment of $750,000. This does not include issues he found with the reimbursement of expenses incurred by some executives. As well, he said almost two thirds of professional service contracts awarded had not been open to public tender.
The health minister has said he may fire the board and replace it with a supervisor, or appoint an overseer to monitor board activities, if he is not satisfied with its response next week. HE
Governments must make a greater effort to collaborate to improve health care for First Nations, Inuit and Métis seniors, the Health Council of Canada says in a report released Thursday.
These seniors often do not receive the same level of health care as non-Aboriginal Canadians because of poor communication, collaboration, and disputes between governments about who is responsible for the care of Aboriginal people.
The Health Council says that little attention has been paid to date to the health care needs of Aboriginal seniors in either research or public policy. Yet in comparison to the larger Canadian population, a significantly higher proportion of Aboriginal seniors live on low incomes and in poor health, with multiple chronic conditions and disabilities.
Many are in poorer physical and mental health due to the disruption to their way of life caused by colonization, particularly the intergenerational impacts and trauma of the residential school experience. These health needs are magnified by poverty, poor housing, racism, language barriers, and cultural differences.
“Aboriginal seniors have more complex health needs than other Canadian seniors, but they often don’t receive the same level of care,” Catherine Cook, a councillor with the Health Council of Canada who is Métis, said in a news release. Home care is one example of this, and Dr. Cook said some provinces have inadvertently caused more pressure for on-reserve home care programs by creating policies that send people home earlier from the hospital.
A link to the report, Canada’s most vulnerable: Improving health care for First Nations, Inuit, and Métis seniors, can be found at www.healthcouncilcanada.ca. HE
Pharmacies cannot sell their own generic prescription drugs, the Supreme Court of Canada ruled last Friday. Shoppers Drug Mart and Katz Group, owners of Rexall and PharmaPlus, had taken the Ontario government to court over this policy instituted as part of massive drug reforms in 2010. “If pharmacies were permitted to create their own affiliated manufacturers whom they controlled, they would be directly involved in setting the formulary prices and have strong incentives to keep those prices high,” the Court said in a unanimous decision. (Toronto Star, Nov. 23)
Ontario is expanding the use of electronic health records in 80 community-based clinics, benefiting some 500,000 patients. Forty-five of Ontario's 90 Association of Ontario Health Centre member clinics, including Community Health Centres, Nurse-Practitioner-Led Clinics and Aboriginal Health Access Centres, have already added electronic health records into their practice. News release at http://news.ontario.ca/mohltc/en/2013/11/ontario-expanding-electronic-health-records-to-more-patients.html
A number of Quebec health regions have adopted the OACIS electronic health record system without inviting proposals from other vendors, La Presse reports. OACIS is a hospital-based system first developed by McGill and subsequently sold to an e-health company that was eventually bought by Telus. La Presse says that since 2009, five health regions have picked up the system through a “replication clause” in the original contract with the Montreal health region. Such a clause would not be permitted today, the newspaper says. (La Presse, Nov. 25)
The federal government should establish a collaborative aging and seniors care commission, the Canadian Nurses Association says. This commission would promote the health and well-being of Canadians as they age, enhance chronic disease prevention and management, and increase system capacity around frailty and vulnerability. It would be modelled after the Mental Health Commission of Canada. (News release at www.cna-aiic.ca/en/news-room/news-releases/2013/canadas-nurses-push-parliament-for-new-seniors-commission)
Poverty rates among seniors rose in Canada between 2007 and 2010, the OECD says in a report this week. This is despite these rates falling in many other countries over the same period, and the Canadian Medical Association says this underlines the country’s need for a national seniors’ care strategy. (News release at www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Media_Release/2013/OECD-Seniors-Report_en.pdf)
Ontario needs to hire more nurses if it wants to make good on its plan to transform the health system, the Registered Nurses Association of Ontario says. It says employment opportunities for nurses in the province have dwindled. According to its calculations, 12.9 per cent of newly graduated RNs were unemployed in 2012 and another 4.2 per cent were working outside the field and looking for a nursing job. (News release at http://rnao.ca/news/media-releases/2013/11/25/hiring-more-rns-crucial-if-government-wants-deliver-its-action-plan-h)
Fraser Health in British Columbia spent $43.3 million on overtime last year, $5 million more than the year before, an audit of the region’s books has found. The audit was ordered by the government after the region failed to balance its budget three years in a row. The auditors have recommended a limit be placed on the amount of overtime an employee can work. (Vancouver Province, Nov. 28)
All 12 physician assistants graduating this year in Manitoba have accepted positions within the province. The program was started in 2008 and 46 PAs in total have graduated from the Physician Assistant Education Program. More than 87 per cent of graduates continue to provide care in Manitoba. (News release at http://news.gov.mb.ca/news/index.html?archive=2013-11-01&item=19710)
Prince Edward Island’s recent investment announcement in mental health and addictions services is being criticized for promising a 10-bed transition unit that actually takes 10 beds from an existing rehab program. Health Minister Doug Currie admits that the beds are being “reprofiled” but said the beds at the rehab unit were not being used. (Charlottetown Guardian, Nov. 26)
As of September 30, 80 per cent of Saskatchewan patients received their surgery within three months and 92 per cent within six months. Regina Qu’Appelle Health Region lags the others at 69 per cent but has had 12 straight months of improved surgical wait times, and a 39 per cent drop in the number of people waiting more than three months. (News release)
Alberta is now handling 95 per cent of ambulance calls through three dispatch centres as it moves to a consolidated provincewide service, a process begun in 2009 when there were 35 centres in operation. Health Minister Fred Horne says more work is needed to ensure ambulances are not tied up in interfacillty transfers for routine care such as driving a patient from one hospital to another for a diagnostic test. (Edmonton Journal, Nov. 27)
The Windsor Star (Nov. 28) comments on the recent approval by the boards of the city’s two existing hospitals – Windsor Regional and Hotel-Dieu Grace – of preliminary plans to build a single, state-of-the-art hospital.
The Star says the project “is linked to the quality and level of health care the community can expect in the future.” It cites the recent issue of thoracic cancer surgeries being moved from Windsor to London because it does not do a sufficient number of the procedures, and notes that the CEO of Windsor Regional expects there to be other examples of this in the future “if the region doesn't update a health-care delivery system that’s anchored in old hospitals.”
But the Star says that aside from providing better health care, a new 560-bed hospital “has the potential to become a medical hub and an engine for economic development.” The approval of the Local Health Integration Network is first needed, and then a funding decision from the government. It is expected that it could take another seven to 10 years before construction begins.
The Toronto Star (Nov. 21) comments on the position paper of the Canadian Association of Emergency Physicians calling for the national reporting of emergency department wait times. The Star says this makes “eminent sense” and would produce data helpful to researchers “investigating ways to enhance the system’s performance.” While the Star says some progress has been made in reducing ED wait times, especially in Ontario, it’s not enough. “When Canada’s emergency physicians warn of looming crisis, governments – at every level – need to pay attention. Beyond that, they need to act.”
In a letter-to-the-editor of the Star (Nov. 25), Dr. Calvin Gutkin, the former executive director of the College of Family Physicians of Canada, responds to the editorial making the point that the problem of long ED waits has been repeatedly identified for decades – patients taking up needed hospital beds for admitted ED patients because they are in queue for a continuing care placement. “The only thing less acceptable than how long it takes for some patients to receive care in the [ED] is how long it has taken for our system to address the root cause of this crisis,” he writes.
The Edmonton Journal (Nov. 20) reacts to Alberta’s decision to proclaim the Alberta Health Act this coming January and create a health advocate’s position. The Journal says that while it is important to help patients navigate the health system (one of the responsibilities of the health advocate), “Creating a web of advocacy is no substitute for making an entire system that is patient-focused.” It suggests the government’s goal “should be to put the advocate out of business because the health system works so well.”
A Speech from the Throne opened a new session of the Nova Scotia legislature Thursday and outlined the agenda of the new Liberal government of Premier Stephen McNeil. It said one of the government’s priorities will be to realign health care “to place the needs of patients, families, and individuals first.” This includes one of the major commitments made by the Liberals in the September 2013 election — to reduce the number of district health authorities from ten to two.
“This transformative process will not happen overnight, nor will it occur without the valuable input of all those involved in our healthcare system – administrators, frontline workers, patients, volunteers, advocates and communities will have their voices heard,” the Speech said.
It also alluded to the Liberals’ other health-care promises, namely to improve chronic disease management programs, providing up to $120,000 in tuition relief to 25 new doctors a year for four years, in exchange for a five-year commitment to practice in underserviced communities, and appointing an expert Physician Recruitment and Retention Action Team “so that Nova Scotia is able to competitively recruit new doctors and keep the ones we have.”
The Speech further said that the government has already begun work “evaluating, updating, and implementing the Continuing Care Strategy to ensure that it meets our long-term needs, both at home and in facilities where our senior population is cared for.”
In the Ontario legislature Wednesday Health Minister Deb Matthews was asked about a human rights challenge launched that day by the Association of Ontario Midwives. They say they have been paid 52 per cent of what their work is worth based on what the government is paying other community-based health care workers. Ms. Matthews said the government values the work of midwives and increased their compensation by 25 per cent in 2005 and two per cent a year between 2006 and 2011. “I confess I do not understand why the midwives are going this route, but I am very, very proud of our record, and I will defend our record.”
Over the weekend, the Alberta Progressive Conservative Party annual meeting passed a resolution calling for the reinstatement of health premiums which were abolished by the government of former PC Premier Ed Stelmach in 2009. Questioned about the development in the legislature Monday, Health Minister Fred Horne said flatly, “We will not be introducing health care premiums.” He later told the Edmonton Journal that the government is not seeking to increase revenue for the health system. “What we’re looking to do is get better value for the dollars we are spending.”
In the New Brunswick legislature Wednesday, the government was again pressed by the Opposition to declare when it would make good on its promise to institute a new prescription drug plan and a separate plan to cover New Brunswickers from catastrophic drug costs. Health Minister Ted Flemming said it would be done in this session, the fourth and last of the government’s mandate. Premier David Alward had promised in the 2010 election to have the plan in place within a year, and Mr. Flemming told reporters outside the legislature that this was “an optimistic line” in the party platform.