Our Equality Based Healthcare

[cybercoma]

This is an article in Tuesday's Windsor Star that I thought I'd transcribe for you guys because it's worth reading.

ICU has it all -- except doctors

City's last 2 intensive care MDs set to leave

By Brian Cross

Star Staff Reporter

To care for the "sickest of the sick," Hotel-Dieu Grace Hospital's $9-million intesive care unit has everything -- except specialists to work in it.

A 20-bed ICU opened less than three years ago should have no fewer than five doctors specializing in keeping critically ill patients alive. But today there are only two, and both are leaving the city in the coming months, the hospital's chief of staff Dr. Arther Kidd said Monday.

Their jobs will be filled by doctors parachuted in from places like London and Toronto for one-week stints, until the hospital can find permanent replacements.

"It does make things more difficult because you like to have, in any organization, you like to have consistency with your staff," said Kidd.  But he said the use of fill-in docotrs is nothing new -- the hospital has not had a full complement of ICU specialists for several years.

"we've never missed having coverage yet, and we don't want to and we don't expect to," said Kidd.

Last year when the ICU's long time director Dr. John Muscadere announced he was leaving for a similar job in Kingston, he blamed an oppressive workload of 90 to 100 hours a week on call.

And the situation hasn't improved for the intensive care specilists who remain, said Kidd.  WHen on-call for a week, doctors must be available 24 hours a day, seven days a week.  That usually averages out to 16 hour days, said Kidd.

"You know those motor vehicle accidents you hear about?  Those patients end up in the intensive care unit, often in the middle of the night."

The unit -- three times the size of the ICU it replaced -- takes in 1,500 patients annually who need to be watched, treated and intensely monitored, following major surgery trauma, respiratory failure, overwhelming infection and complications from operations.  The nurse-to-patient ratio is one-to-one or one-to-two.  In regular units in the hospital, the ratio is between one-to-six and one-to-nine.

Dr. Partha Datta, who took over as director when Muscadere left, is leaving in the late summer or early fall because his wife is making a career move to another community.

The second, Dr. Giulio DiDiodato, is moving at the end of this month to a city where there is already an established base of fiver or six specialists to share the laod in the hospital ICU, said Kidd.

It's going to be very difficult to recruit new specialists when you have no in-house pool of intensive care specialists to join, he said.

Newly trained doctors are used to working in  teaching hospitals where there are eight intensivists covering an ICU, "We get down to this small number and we become intimidating to new recruits."

The hospital has beent rying to address this problem by negotiating an alternative payment program with the Health Ministry, whereby the specialists will be compensated over and above their standard OHIP billings for their heavy workload and added administrative duties.  Those negotiations were held up until recently, when the Ontario Medical Association ratified a new contract.

Now, the OMA and ministry are working together to prioritize all the outstanding alternative payment program requests, ministry spokesman Dan Strasbourg said Monday.

"We are aware of the situation at Hotel-Dieu Grace and we are working on it."

Recognizing it may take some time for this alternative payment program to be approved, the hospital is shifting resources to provide more resources to the ICU in the meantime, said Kidd.  One saving grace is the presence of nurse-practitioner Mary Cunningham, who can help provide consistency that might otherwise be lacking.  She can do some of the jobs typically done by a doctor, such as assessing patients when they're admitted, discharging patients, ordering certain drugs and doing some procedures such as putting an intervenous line into a patient's wrist.

"It's got an element of a nursing role and an element of a medical role," said Cunningham.

"Because the intensivist has so many patients to take care of, if he can only deal with the real serious issues, I can take care of the less serious issues."

Thoughts, opinions, comments?

[August1991]

That story is a classic example of misallocation of resources. The Ste-Justine Hospital in Montreal has had an emergency entrance under construction for over two years now. (Think what that means. They allocated insufficient funds for the work and are waiting for future budgets to complete it. As they say, a substantially finished bridge is an unfinished bridge.)

Hospital administrators now spend enormous amounts of time managing queues and priority lists leaving little time to think ahead. (Backlog management is a frustrating waste of resources.)

The personal offices (in square meters) of Soviet managers were typically larger than their apartments. My measure of a third-world country is the number of construction cranes hovering over unfinished buildings.

I have sympathy for hospital administrators because they have so little freedom to manoeuvre and too many of their decisions are subject to arbitrary changes. Those decisions are often wrong anyway because the administrators never really see the whole picture.

Profits are good because they clarify the situation and concentrate minds.

[cybercoma]

That story is a classic example of misallocation of resources.  The Ste-Justine Hospital in Montreal has had an emergency entrance under construction for over two years now.  (Think what that means.  They allocated insufficient funds for the work and are waiting for future budgets to complete it.  As they say, a substantially finished bridge is an unfinished bridge.)

Hospital administrators now spend enormous amounts of time managing queues and priority lists leaving little time to think ahead.  (Backlog management is a  frustrating waste of resources.)

The personal offices (in square meters) of Soviet managers were typically larger than their apartments.  My measure of a third-world country is the number of construction cranes hovering over unfinished buildings.

I have sympathy for hospital administrators because they have so little freedom to manoeuvre and too many of their decisions are subject to arbitrary changes.  Those decisions are often wrong anyway because the administrators never really see the whole picture.

Profits are good because they clarify the situation and concentrate minds.

<{POST_SNAPBACK}>

You must be talking about doctors as resources, not necessarily financial resource. The money is there for the intensivists here in Windsor, the problem is none of them want to work here for the same amount of money as they'd make in another hospital that already has 7 on staff.

People in Windsor have a longer wait than someone in, say, Toronto, how is this not queue jumping?

And recently they were talking about how inmates, government and military all receive private healthcare. Meanwhile, everyday citizens are forced to wait in line suffering.

That's equality right there.

[August1991]

You must be talking about doctors as resources, not necessarily financial resource. The money is there for the intensivists here in Windsor, the problem is none of them want to work here for the same amount of money as they'd make in another hospital that already has 7 on staff.

Yes, I meant a specialist. I can see that the nurses in the ICU are getting a crash course in the distinction between a real asset and a financial asset. More broadly, why doesn't the hospital have the right to raise salaries to attract a specialist? And even more broadly, why can't the hospital make decisions about what are priorities and where to spend money - including decisions about salaries?

And recently they were talking about how inmates, government and military all receive private healthcare. Meanwhile, everyday citizens are forced to wait in line suffering.

That's a point that is truly astonishing. Karla Homolka gets better health care and waits less than my old neighbour across the street in Montreal. How long does Karla Homolka have to wait for a pap smear appointment?

Is that a Willie Horton ad?

[cybercoma]

Yes, I meant a specialist.  I can see that the nurses in the ICU are getting a crash course in the distinction between a real asset and a financial asset.  More broadly, why doesn't the hospital have the right to raise salaries to attract a specialist?  And even more broadly, why can't the hospital make decisions about what are priorities and where to spend money - including decisions about salaries?

I'm not sure about the allocation of salaries to these doctors, but it would appear that an intensivist in Windsor should make the same rate as an intensivist in Kitchener, etc. That is unless the government decides there are special circumstances here which require them to be paid more.

I'm not positive but that's what it sounds like from the article.

That's a point that is truly astonishing.  Karla Homolka gets better health care and waits less than my old neighbour across the street in Montreal.  How long does Karla Homolka have to wait for a pap smear appointment?

Is that a Willie Horton ad?

<{POST_SNAPBACK}>

Our federal prison system is a joke. Prisoners are treated better than welfare recipients. It's almost surprising that people on welfare don't commit serious crimes so they can live out their lives in Club Fed.

[Guest eureka]

Healthcare for inmates and the military is not private but it is a federal responsibility. One contribution to healthcare that the feds do not get credit for in the numbers game.

That the care is better should create a little motion in the brain cells of those who want private care.

[cybercoma]

Healthcare for inmates and the military is not private but it is a federal responsibility. One contribution to healthcare that the feds do not get credit for in the numbers game.

That the care is better should create a little motion in the brain cells of those who want private care.

<{POST_SNAPBACK}>

It's not private? Really?

Have you not been watching the news over the last couple days?

[August1991]

Healthcare for inmates and the military is not private but it is a federal responsibility. One contribution to healthcare that the feds do not get credit for in the numbers game.

That the care is better should create a little motion in the brain cells of those who want private care.

<{POST_SNAPBACK}>

eureka, I think rather that if the feds can provide better health care for inmates than provinces can for citizens, it just shows that if you have access to the bank accounts of 30 million people, it's not hard to provide health services to a hundred thousand or so people.

If the term "fiscal imbalance" has any meaning, it means that the federal government's spending priorities are wrong - or at least differ from the priorities of the provincial governments. Karla Homolka's health care is only one example.

[Guest eureka]

No, August, it means that the Constitutional responsibility of the federal government for inmates, the military and marine hospitals, is more faithfully discharged than the Provincial responsibility for the rest.

Money was never a stumbling block: the determination of the Provinces to be seen as providing care while the feds were seen as taxing Canadians to death, was the stumbling block.