Tuesday, January 22, 2008

Boost neurosurgery capacity, Ontario urged


LISA PRIEST
From Tuesday's Globe and Mail
January 22, 2008 at 4:19 AM EST
The Ontario government should take aggressive action to help stem the tide of critically ill patients with cerebral hemorrhages being rushed to American hospitals, Ontario's Progressive Conservative health critic said yesterday.
Elizabeth Witmer said the government needs a plan so patients requiring neurosurgical care are able to obtain it here - not in the United States. "There's no effort whatsoever to develop a plan of action," Ms. Witmer said of the Liberal government. "It's really quite appalling to see the increase in the number of patients from 2003-2004 to the present, who are going to the United States."
Her remarks follow a Globe and Mail story on the weekend that showed how, since April, 2006, 157 patients with broken necks, burst aneurysms and other types of bleeding in or outside of the brain have been sent to Michigan and New York State hospitals for care. Back in 2003-2004, fewer than five neurosurgical patients were sent to U.S. hospitals.
Other provinces are also struggling to meet demand. British Columbia sent four patients with spine injuries to Washington State hospitals from May, 2007, to September, 2007. The recruitment of more staff and opening of new beds in that province have since helped alleviate the problem.
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Saskatchewan has sent patients to neighbouring provinces such as Alberta, which is working at maximum capacity, for certain specialized neurosurgical services.
But nowhere is the problem worse than in Ontario. Emergency room physicians said they have watched patients deteriorate while trying to locate care for them.
Ontario Health Minister George Smitherman could not be reached for comment yesterday.
However, his press secretary, Laurel Ostfield, said the province does have a plan, one that ensures patients get the care they need and addresses neurosurgical capacity in the province.
To that end, an additional $4.1-million was provided in November to Toronto's University Health Network to handle 100 more neurosurgery cases. As well, the province commissioned a neurosurgery expert panel; it delivered its report late last month.
"We are already seeing positive results from the additional cases that have been funded at the University Health Network," Ms. Ostfield wrote in an e-mail yesterday.
The three main groups of patients sent out of the country include those with the following diagnoses: subdural hemorrhage, a collection of blood on the surface of the brain; intracerebral or intracranial hemorrhage, which is bleeding in the brain caused by the rupture of a blood vessel within the head; and subarachnoid hemorrhage, which occurs when a blood vessel just outside of the brain ruptures, causing the area of the skull surrounding the brain, the subarachnoid space, to fill with blood.
In addition to the extra stress on patients and their families, the cost to treat these patients is far higher than in Canada.
The average Ontario payment in fiscal 2006-07 to U.S. hospitals where the patient's condition was recorded solely as subarachnoid hemorrhage was $126,148, according to Health Ministry figures.
Compare that to Toronto's University Health Network, where the cost to treat a patient whose primary diagnosis is a subarachnoid hemorrhage in fiscal 2006-2007 (not including physician costs) was $43,200.
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http://www.theglobeandmail.com/servlet/story/RTGAM.20080122.wneuro22/BNStory/National/Ontario/

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