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Category "Medicine Matters"

15May

Richmond Hospital leads the way as birth tourism continues to rise

by admin

The number of pregnant foreigners coming to B.C. hospitals so their newborns can get automatic Canadian citizenship continues to rise.

Births by non-residents of B.C. increased 24 per cent from the 2016-17 fiscal year to 2017-18, from 676 babies to 837 the following year, according to records obtained through freedom of information requests.

About two per cent of all births in B.C. hospitals are now by non-residents, just as the birthrate among B.C. residents is dropping.

Richmond hospital continues to be at the forefront of the phenomenon, with the total number of babies born to non-residents of B.C. at the hospital rising from 337 in the 2014-15 fiscal year to 474 by 2017-18. Four years ago babies born to non-residents accounted for 15.4 per cent of all births at Richmond Hospital, compared to 22.1 per cent in the last fiscal year.

By comparison, St. Paul’s Hospital and Mount Saint Joseph Hospital — both operated by Providence Health Care — had a combined 132 babies born to non-residents of B.C. in the 2017/18 fiscal year.

While non-resident births account for about two per cent of all babies delivered in B.C., at Richmond Hospital, that proportion is 10 times higher. Indeed, as a New York Times article reported, the hospital is now perceived around the world as a coveted destination for so-called anchor babies, a term to describe children born here to non-residents to gain citizenship.

Health minister Adrian Dix is concerned by the numbers.

“The immigration issues are in federal jurisdiction. This is where concerns must be addressed, not by turning health professionals and skilled health care workers into immigration officers. That is not their role,” said Dix.

Richmond Mayor Malcolm Brodie agreed with Dix that birth tourism is a federal issue but said there are significant local impacts as well.

“As a city council, we haven’t discussed this but there are individuals who have concerns about the impacts on our already crowded hospital resources,” said Brodie, referring to the aging facilities and to situations when local women are diverted to other hospitals when Richmond Hospital is full.

Brodie said he supports a change to federal laws because he doesn’t believe anchor babies should get automatic citizenship.

“The practice of birth tourism should be curtailed,” he said.


Richmond Hospital continues to be at the forefront of birth tourism, with 474 babies born to non-residents of B.C. at the hospital for the fiscal year of 2017/18. Photo: Francis Georgian

Francis Georgian /

PNG

Birth tourism is not illegal and a report by the Institute for Research and Public Policy showed that the numbers are climbing year after year. In 2017, there were at least 3,628 births, mainly in B.C., Alberta, and Ontario, by mothers who live outside Canada.

In 2016, Postmedia reported 295 of the 1,938 babies born at Richmond Hospital for the year ended March 31 were delivered, largely to foreign Chinese mothers. And dozens of birth houses were cropping up across the municipality, catering to women who need housing, meals, transportation and help with documents like birth certificates and passports.

As Dix has said, the provincial government has taken the approach that it doesn’t endorse the marketing and provision of birth tourism services but at the same time, patients needing urgent care can’t be turned away. 

While hospital staff cannot refuse care when women in labour arrive at the front door, Dix said measures have been put in place to help ensure taxpayers aren’t subsidizing the costs of non-resident hospital care.

For instance, late last year the ministry and Vancouver Coastal Health decided to raise fees charged to non-residents when they go to the Richmond Hospital. The cost for a vaginal birth increased to $8,200 from $7,200 and the cost of a caesarean section rose by $300 to $13,300. If their medical care becomes more complicated patients are assessed higher fees.

In 2017, Vancouver Coastal Health billed non-residents of B.C. about $6.22 million for maternity services at Richmond Hospital.

For maternity cases at Richmond Hospital … the majority of non-residents pay their bills in full,” said Vancouver Coastal Health spokesperson Carrie Stefanson. Approximately 80 per cent of billing to non-residents is recovered, she added.

But sometimes, as in the case of Yan Xia, a birth tourist from China, patients leave Canada after giving birth and leave behind a healthy bill.

Vancouver Coast Health has filed a lawsuit against Xia, who gave birth at Richmond Hospital in 2012. The bill for an extended stay in hospital due to complications totalled $313,000.

The case remains in legal limbo as Xia’s exact whereabouts are unknown and the bill may eventually have to be written off by Vancouver Coast Health.

Stefanson said the Xia case is believed to be VCH’s only maternity debt lawsuit over $100,000.

Richmond Liberal MP Joe Peschisolido has sponsored a petition calling on the federal government to end birth tourism. The petition garnered 11,000 signatures and denounces the practice as “abusive and exploitative” for “debasing” the value of Canadian citizenship. The Peschisolido petition was presented to Parliament last fall.

“The Government of Canada is committed to protecting the public from fraud and unethical consulting practices and protecting the integrity of Canada’s immigration and citizenship programs,” said Ahmed Hussen, minister of immigration, refugees and citizenship in response to the Peschisolido petition.

“To this end, (we) are currently undertaking a comprehensive review, with a view to developing additional information and strengthened measures to address the practices of unscrupulous consultants and exploitation of our programs through misrepresentation.”

Birth tourism will likely be an issue in the upcoming federal election as the Conservatives have vowed to withhold citizenship unless one parent is a Canadian or a permanent resident.

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28Apr

Surgery delays deepen over compliance letters B.C. government has forced on surgeons

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Dr. Amin Javer and his team perform sinus surgery on a patient at False Creek Surgery Centre in Vancouver. That is where Mr. Justice John Steeves had his sinus surgery under a contract with Vancouver Coastal Health. But the provincial government has severed contracts between health authorities and clinics that allow patients to pay for their expedited surgeries.


Arlen Redekop / PNG

Patients are waiting even longer for operations like sinus or breast reconstruction because of the latest government crackdown on private clinics and the surgeons working in them, according to affidavits filed in court.

Sinus surgeon Amin Javer says he can’t even begin to make a dent in the number of patients waiting. That’s because he only gets four operating room days at St. Paul’s Hospital a month, allowing him to handle just 12 to 16 cases monthly.

He also operated on patients at False Creek Surgical Centre. But last fall, the government ordered Vancouver Coastal Health to end its contracts with False Creek because the centre was also taking money from patients who were paying the clinic’s facility fees to get expedited surgery.

Javer was the sinus surgeon who operated on the judge in the continuing constitutional trial launched by Dr. Brian Day. The judge would not be able to get that sinus surgery today because False Creek can no longer do business with the government. Yet False Creek is the only private clinic in B.C. with the sophisticated equipment Javer needs to do delicate sinus surgeries.

Not only can Javer no longer perform publicly funded operations at False Creek, but he’s also doing fewer at St. Paul’s because, as the hospital struggles to deal with growing waiting lists, his operating room days have been cut to eight hours from 10.

He has about 300 patients on a pre-surgical wait-list and another 220 waiting for surgery. “It will take me about four years to get through my current surgical wait-list.”

He used to tell patients they’d get their surgery in 2.5 years. Now Javer, the head of the St. Paul’s Sinus Centre and co-director of ear, nose and throat research at UBC, says he has to tell them the waiting time has gone up to four years.

“There’s no outsourcing at all, so the wait-list at the hospital continues to grow. And there’s no extra time being given to surgeons at public hospitals. All that extra operating room time we were promised hasn’t happened,” he said.

Dr. Nancy Van Laeken, a plastic surgeon who performs breast reconstructive surgery on breast cancer patients, said in her affidavit that the government did not increase operating room time in public hospitals enough to compensate for the private clinic crackdown. That means that fewer surgeries are being done in B.C., she said.

Van Laeken said she has privileges to work at five hospitals but only gets four operating room days in total each month. She is willing to do surgeries 10 days a month, but can’t get more time.

“Because of the limited OR time in the public hospitals, the wait times for surgery … in the public system are very long. For example, many of my patients wait (up to) 48 months for breast reconstruction surgery,” she said in her affidavit, noting that is 42 months longer than the target.

For years, health authorities have paid several private clinics to help because of backlogs of scheduled surgeries. But most private clinics also take patients willing to pay out of pocket for expedited surgery. The NDP government argues it is illegal for clinics and doctors to take money from patients for operations covered by medicare and the government is determined to stamp out the practice.

Last fall, the government introduced so-called compliance letters. Surgeons who do any work at private clinics that have contracts with health authorities must sign statements promising they will not do medically necessary work in both the public and private systems. If they refuse, they are banned from doing publicly funded operations at those private clinics that have contracts with health authorities.

If private clinics don’t agree to the same conditions, they won’t get contracts from health authorities or could have their contracts cancelled.

There are only a few private clinics that have agreed to the terms, including View Royal Surgical Centre in Victoria and the ASC Vancouver Surgical Centre.

Javer and Van Laeken are among a group of surgeons who want B.C. Supreme Court Justice Janet Winteringham to issue an injunction to stop the province’s latest stab at clinics until the end of the Day trial, which is being heard by Justice John Steeves. Winteringham has reserved her decision.

The government’s unwavering approach doesn’t end there.

“Doctors who work at Cambie have received warnings from health authority executives that they may lose their surgical privileges in public hospitals if they continue to treat patients wishing to be treated quickly and privately at our facility,” said Day, co-owner of the Cambie Surgery Centre.

Rob Grant, a lawyer for Day, the Cambie Surgeries Corporation and other plaintiffs, calls the government’s actions “authoritarian” and counter-productive because surgeons get a limited amount of time — often only a day a week — in hospital operating rooms. Private clinics have, for over 20 years, allowed surgeons to use their excess capacity to help more patients, he said.

According to the government, the new contracting out policy has not hurt patients and “more scheduled surgeries are in fact being performed.” In the Vancouver Coastal Health region, however, the latest figures show about a third of patients who were waiting for surgery in the last nine months of 2018 were waiting for more than 26 weeks — triple the target numbers. While  86.4 per cent of scheduled operations were completed within 26 weeks, the target is more than 95 per cent.

In Fraser Health, the latest report also shows targets not being met.

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25Apr

North Vancouver doctor’s painful ambulance ride led to ketamine on board

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Paramedic Specialist Ryan Stefani holds ketamine, shown here ready to be used as a nose spray. In a recent paramedic trial, used intranasally, the drug reduced patient pain significantly. Photo: Courtesy of BCEHS


PNG

Gary Andolfatto spent four hours hobbling nine kilometres on one leg over snowy forest trails, using his bike as a crutch, after breaking his leg four years ago in a cycling mishap.

When Andolfatto, an emergency room doctor at Lions Gate Hospital, was discovered by Lynn Canyon park rangers and loaded into an ambulance, his immediate need was pain control.

Andolfatto was shocked when the paramedic riding in the back with him could only offer nitrous oxide, commonly referred to as laughing gas.

“He told me how frustrating it was that it is all primary care paramedics are permitted to give since they aren’t trained or permitted to inject drugs or give opioids,” said Andolfatto.

“I was ashamed, and felt so humbled that I didn’t realize what their limitations were and how bad it must be for them and their patients in serious pain. It really struck a chord and it gave me the impetus to do something that would be a game changer. Maybe I was meant to break my leg that day.”


Dr. Gary Andolfatto, ketamine researcher and emergency room physician at Lions Gate Hospital.

Some innovators jot down the kernels for good ideas on napkins. While lying on a stretcher, with a broken left femur, Andolfatto conceived a research study that would involve paramedics spraying low doses of ketamine — a non-opioid, but still a controlled substance — into the nostrils of patients.

Unlike opioids like fentanyl, ketamine doesn’t suppress respiration so it is considered much safer.

“With low-dose ketamine, the risk of doing serious harm is zero,” said Andolfatto. “There are many reasons why it makes sense for this to be used more widely in an ambulance setting. On the other hand, laughing gas (delivered through a mask) requires a certain amount of co-operation (inhalation) from patients.”

Laughing gas is also not as effective as ketamine for controlling pain, added Andolfatto.

The research Andolfatto envisioned that day was recently published in the Annals of Emergency Medicine.

Now primary and advanced care paramedics with B.C. Emergency Health Services (BCEHS) are enthusiastically starting to deliver intranasal ketamine. Critical care paramedics with advanced training have been using intravenous ketamine on patients since 2008 but 70 per cent of the more than 4,000 paramedics in B.C. are at the primary care level and not permitted to do so.

The research led by Andolfatto has paved the way for use of a drug that is economical ($10 a dose), effective, safe and delivered quickly without needles, said Joe Acker, director of clinical and professional practice at BCEHS.

But before ketamine can be widely used by paramedics the provincial government will have to change statutes pertaining to the scope of practice of primary care paramedics as it is a controlled substance, said Acker. Health Canada will also have to give its approval.

BCEHS also has some challenging logistical issues to work on to prevent theft of ketamine by patients, paramedics or others. Biometric safes for storage and audits — similar to what hospitals have done to prevent drug diversion — are two of the strategies being implemented. 

“The onus is now on us to do our due diligence,” Acker said, adding that paramedics have for too long been hampered when it comes to relieving pain experienced. In rural areas, such transports may take hours and when paramedics witness such pain, it can be traumatizing, “opening huge moral wounds for paramedics frustrated that they cannot offer more.”

The study involved 120 patients who were transferred by ambulance to Surrey Memorial Hospital between November 2017 and May 2018. Patients were randomized to receive either a ketamine nasal spray or a placebo of saline solution. Those who got ketamine, along with nitrous oxide, reported having a significant reduction in pain after 15 minutes. A majority of patients who got ketamine said they felt dizziness and a feeling of unreality, but their levels of comfort were higher than those who received a placebo spray into the nostrils.

“We now have the science to show us that it can be used effectively and safely by primary care paramedics,” Andolfatto said. “Now it’s time to allow primary care paramedics to start using it and doing the quality assurance piece to ensure it provides a real benefit, is financially feasible and won’t potentially be abused.”

The $26,000 study involved researchers from UBC, Lions Gate Hospital, Surrey Memorial Hospital, and BCEHS. It was funded by the Vancouver Coastal Health Research Institute and the B.C. Emergency Medicine Network.

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17Apr

Doctors approve new fee agreement with B.C. government

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The Doctors of B.C. president, Dr. Eric Cadesky.


Doctors of B.C. / PNG

B.C.’s physicians have voted overwhelmingly in favour of a new agreement with the B.C. government in a deal that will cost taxpayers at least $331 million over the three-year deal.

Last year, the government paid out $4.516 billion for physician services. By the end of the three-year deal that took effect on April 1, that will rise to $4.85 billion.

One of the elements of the deal is a signing bonus-like payment of $7,500 to each physician who earned over $75,000 in income in 2018, or in any of the past few years, to help offset rising overhead and other costs of running their offices.

Dr. Eric Cadesky, president of Doctors of B.C., said the sum is a one-time payment. But the help with overhead costs like lease payments doesn’t end there. In 2020, the government will give physicians — in Vancouver, Victoria and other urban areas — premiums to help offset inflationary costs like higher rents.

Doctors who have offices in Vancouver, for example, will get a five per cent increase that will be capped at a daily maximum of $60; Victoria doctors with private practices will get four per cent more with a maximum of $48 a day. And in Kelowna, Nanaimo, Kamloops, Vernon and Penticton, doctors will get three per cent more up to a daily maximum of $36.

There is no cap on this weekly “business cost premium”, so doctors who keep their offices open seven days a week could earn $420 more each week.

“A reasonably active physician in the city of Vancouver could earn an additional $13,200 annually when the BCP is implemented in 2020,” Cadesky said.

For several years, doctors in private practice have been complaining about rising costs of running offices. Cadesky said it was important to have a premium in the contract that would offer some relief. Alberta has a similar program but the premium is applied as a flat rate of 1.1 per cent across the province while in B.C., the premiums rise in communities where overhead costs are higher.

Clauses like this one clearly appealed to physicians even though only about 4,000 of the 12,000 doctors in the province voted during the ratification process. Only three per cent voted against the new deal. Doctors had sought a five year deal like the term they got under the Liberals but this government wanted to keep the deal at three years, consistent with other public service contracts.

 

Doctors will also get an additional half of one per cent more in fees in each of the three years and an assortment of other compensation payments to help with retirement plans, malpractice insurance premiums, and pay for work previously not compensated, like adding information to patient charts, writing reports, following up on lab and diagnostic tests, and maintaining electronic medical files.

The new contract is outlined in nearly 400 pages and is called the Physician Master Agreement. Cadesky said it will go a long way toward helping support family physicians who want to deliver a full spectrum of care — often referred to as cradle-to-grave patient care.

Patients should benefit because the new contract includes a commitment from the government to hire more doctors to “address growth in the workload of existing physicians (such as) emergency room physicians and medical oncologists.”

The contract also addresses some fee disparities between various medical specialists. There’s a sum of $42.73 million to shrink gaps between lower and higher paid physicians — highly paid ophthalmologists, for example, compared to geriatricians, pediatricians and psychiatrists.

The government has made good on its pledge to reduce the amount of money ophthalmologists earn doing cataract removal surgery. When negotiations began last year, the government’s starting point was a fee cut of 80 per cent, provoking a near revolt on the part of such surgeons. After many months of negotiations, the parties settled on a fee of $350, down from $425, about 18 per cent lower.

The savings — $4.7 million — are to be used to raise fees of other surgeons and specialists who are considered relatively underpaid. 

The contract also boosts government funding for things like continuing medical education, disability insurance  and rural physician funding. There are pledges by the government to consult more with doctors, including on violence prevention in health facilities, electronic medical records, and new payment models.

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16Apr

Low doses of peanut a safe, effective way to fight allergies: study

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Five year old Saiya Dhaliwal would break into hives if she accidentally ingested peanuts but after participating in a study led by B.C. Children’s Hospital, she can now eat 10 peanut M&Ms without reacting.


Ravinder Dhaliwal

Most preschoolers who are allergic to peanuts can be safely and effectively desensitized by eating small amounts of peanut protein as directed by allergy specialists, a study led by University of B.C. and B.C. Children’s Hospital researchers shows.

In the study, published Tuesday in the Journal of Allergy and Clinical Immunology: In Practice, 243 children (90 per cent) reached the desired, desensitization dosage in an average period of 22 weeks. The other 10 per cent dropped out for reasons such as repeated allergic reactions and child and parental anxiety. Participants lived in B.C., Alberta, Manitoba and Nova Scotia.

“According to our data, preschoolers with peanut allergies can be considered for oral immunotherapy,” said the lead author, Dr. Edmond Chan, who is the head of pediatric allergy and immunology at UBC and at B.C. Children’s Hospital. “However, it’s important to note that it should always be done under allergist supervision, and not attempted by parents on their own or with health care providers who aren’t allergists.”

He said older children with a history of severe, life-threatening reactions to peanuts and those anxious about the treatment are not good candidates for the desensitization approach.

While some experts have opined that allergic reaction effects can compound and get worse each time anaphylaxis occurs, Chan said the severity of food allergic reactions is difficult to predict. “The likelihood of outgrowing a food allergy depends on the type of food and other factors (and only) only about 20 per cent of children outgrow peanut allergy.” 

Oral immunotherapy is a new approach in which children consume small amounts of an allergy-causing food with the amount gradually increasing to a predetermined maximum or maintenance level that is held for a year or two. The goal is to desensitize them so that if they are accidentally exposed to the allergen, they won’t have a life-threatening reaction.

In the study, children with a median age of 23 months went to an allergy clinic every few weeks — a total of eight to 11 times — to be watched each time their peanut protein dose was increased. The top daily dose was 300 mg of peanut protein, the equivalent of one peanut or 1/4 to 1/3 of a teaspoon of peanut butter.

Children in the study ate their doses of peanuts in powder form (mixed into yogurt, for example) or in popular Israeli peanut snacks called Bamba.

Nearly 68 per cent of preschoolers experienced at least one allergic reaction during the buildup phase, but the reactions were largely mild.

Only four per cent of the children in the trial required epinephrine to counteract allergic responses, while 1.5 per cent experienced severe reactions requiring a trip to the hospital emergency department.

 


Dr. Edmond Chan, head of pediatric allergy and immunology at B.C. Children’s Hospital and the University of B.C.

Arlen Redekop /

PNG

Chan said the study, which had 18 co-authors, should help calm fears about such an approach.

“The goal of our group was to be as safe as possible since this was not a clinical trial and allergists were not always available if an allergic reaction occurred at home.

“So we erred on the side of caution and encouraged parents to give epinephrine if there was a possibility that anaphylaxis was occurring.”

Ravinder Dhaliwal entered her then four-year-old daughter, Saiya, in the study because, as a pediatric emergency nurse at Surrey Memorial Hospital, she has seen how serious peanut and other food allergies can be.

“I’ve seen a lot of anaphylaxis, never a death, thank God, but it’s my biggest fear. At work just recently, a child in anaphylaxis had to be put in the intensive care unit and was then transferred to B.C. Children’s Hospital,” she said.

While her daughter’s allergic reactions in the past were mild, there is no way to predict when a life-threatening response might happen. Her daughter, now five, had only one bout of vomiting after the peanut dose was increased.


Bamba snack ingredients

It’s about a year and a half since Saiya entered the study, and she can now eat the equivalent of 10 peanuts without a reaction.

“We will always have a certain level of anxiety about this,” Dhaliwal said. “We still carry an EpiPen and she is still considered allergic to peanuts but now it’s like having a protective shield around her,” she said.

Saiya is also allergic to tree nuts and is on the same immunotherapy protocol for those.

Chan believes the protocol is ready for wider use.

“Our data suggests peanut oral immunotherapy in preschoolers is ready for prime time. A strength of our study is that about 90 per cent of the allergists who participated practise in the community.

“To ensure patient safety, it should only be offered by allergists with adequate training and experience in performing oral food challenges and managing life-threatening anaphylaxis.”

Offering the treatment to children when they are young “will give parents valuable peace of mind and help improve children’s quality of life and reduce their anxiety as they grow up.”

The study says the rate of epinephrine use in the study was about 1/50th of what it is among allergic children who are accidentally exposed to peanuts.

The desensitization protocol is, therefore, a way to “seek a safety margin for accidental exposures.”

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16Apr

Investigations continue after teen’s suicide in Lions Gate Hospital ER

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A boy died by suicide while in care at the emergency department in Lion’s Gate Hospital.


NICK PROCAYLO / PNG

Parallel investigations into the suicide last month of a teenager at Lions Gate Hospital in North Vancouver are continuing by the B.C. Coroner’s Service and Vancouver Coastal Health.

The death happened in the emergency department.

Andy Watson, the spokesman for the coroners service, said all sudden, unexpected and/or unnatural deaths are investigated. A report will be written with the coroner’s findings and recommendations made to prevent future deaths by similar means.

An inquest may also be scheduled if a potentially dangerous practice or circumstance has been identified or if the death raises issues that are in the public interest and need more awareness. An inquest is conducted before a jury of five to seven individuals.

Vancouver Coastal Health is also doing a critical incident review, said spokeswoman Carrie Stefanson.

“The investigation is ongoing and we are restricted in comments we can make at this time. … The critical incident review will examine the circumstances surrounding the case and our processes in the care of this patient.”

The date of the suicide was March 23. According to an individual with knowledge of the event, a 17-year-old man on a “suicide watch” was alone in a dimly lit room when he used a piece of medical equipment in the room to asphyxiate himself. The hospital would not confirm the means by which the teen took his life.

Patients on suicide watch are generally monitored by guards or others and checked on frequently. It is believed there was someone sitting outside the room in which the teen was placed.

Watson said over 5,000 deaths each year are investigated by the coroner’s service. There are between 500 and 600 suicides annually in B.C., with 20 to 30 of them among individuals under the age of 19.

Meanwhile, the coroners service has announced a June 17 inquest into the death by drug overdose of another teenager, 16-year old Elliot Cleveland Eurchuk. Eurchuk died in April, 2018, after being found in an unresponsive state in his bed in his Oak Bay family’s home. His parents say that he became addicted to painkillers prescribed before and after surgery for athletic injuries. And then he became addicted to illicit drugs.

At one point, Eurchuk was discharged from the hospital even though he had overdosed in his hospital bed just days earlier. That inquest could last for two weeks as it will explore relevant issues around addictions and mental health, the education, health and justice systems.

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2Apr

College of Physicians and Surgeons penalizes doctor for not answering questions

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The medical office of Dr. Viem Chung Nguyen at 1209 Kingsway in Vancouver.


PNG

A Vancouver doctor who was ordered to repay the provincial government $2 million in 2017 for overbilling has now been disciplined in another matter by the College of Physicians and Surgeons of B.C.

Dr. Viem Chung Nguyen, a Vancouver physical and rehabilitation specialist, admitted that he failed to respond to multiple communications and correspondence from the college. He has been reprimanded and fined $7,500 by the college. He was also ordered to pay an additional $8,731 in costs after a consent agreement was reached.

Nguyen has also promised not to ignore the college and must respond to all future communications within a month of such requests.

In a bulletin, the college said:

“The inquiry committee was critical of Dr. Nguyen’s failure to respond to College communications. Given the importance that must be placed on physicians being responsive to the regulator, the inquiry committee determined a disciplinary outcome was appropriate.”

The college licenses and regulates over 11,000 physicians across B.C. Its role is to protect the public through the enforcement of high standards in clinical qualifications and ethical practices.

Nguyen’s problems with the Medical Services Commission regarding overbilling dates back to 2017. He was barred from billing the Medical Services Plan for two years but is eligible to re-enroll anytime after May 31. He was able to bill patients and third-party insurers on a private basis since during the time he was temporarily de-enrolled from the public plan.

It is unclear whether Nguyen has paid back the $2 million he was ordered to repay after an audit found a large number of billing irregularities. The government will not disclose such information. 

“Due to privacy restrictions under the Freedom of Information and Protection of Privacy Act, the ministry is unable to release any third-party financial information or personal details,” said ministry spokeswoman Kristy Anderson. 

“If an individual fails to pay an amount assessed by the audit, they are referred to the Ministry of Finance to pursue collection action as outlined in the Financial Administration Act or the governing statutes.” 

Last year, a government report said an on-site audit found poor documentation of Nguyen’s patient records and “for several patients, there was no evidence that Dr. Nguyen ever provided any care to that patient.” 

The college’s director of communications, Susan Prins, said she couldn’t divulge whether there is an ongoing investigation into Nguyen’s overbilling.

“This is protected information unless it results in discipline,” she said.

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28Mar

Some medical waits shrink, but B.C. still has long waits compared to several other provinces

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Health Minister Adrian Dix tours a hip and knee program replacement program on Vancouver Island last year.


Don Craig | B.C. Government / PNG

B.C. performs worse than several other provinces when it comes to meeting recommended waiting times for various medical procedures, including cancer radiation therapy, a federal report released today shows.

Benchmarks are defined as “evidence-based goals each province or territory strives to meet.” They reflect the maximum waiting time that medical experts consider appropriate to wait for a particular procedure.

The Canadian Institute for Health Information report shows that while there are glimmers of improvement in some categories, B.C. generally lags behind a handful of other provinces.

For hip replacements, for example, 67 per cent of patients got their surgery in B.C. within the recommended six months in 2018, compared to 61 per cent in 2016. The national average in 2018, however, was 75 per cent. And in Ontario, 84 per cent of patients got surgery within the time period; in Quebec, 80 per cent.

Long waiting times are generally a function of operating rooms being available for surgeons and other resources like funding, hospital beds, nurses for the operating rooms, recovery and ward beds.

For knee replacements, 59 per cent of B.C. residents got the surgery within the six-month recommended time. That was an improvement over 47 per cent in 2016, but again, lower than the national average of 69 per cent.

For cataract surgery, 64 per cent of B.C. residents got the cataract removal procedure within the recommended wait of four months for high-risk patients. That was slightly worse than in 2016 when it was 66 per cent of patients. The federal average in 2018 was 70 per cent.

For procedures that are especially time-sensitive, B.C. was near the bottom.

For hip fracture repairs, it is recommended that patients wait no longer than 48 hours. In 2018, 85 per cent of B.C. patients got surgery within the recommended time; the national statistic was 88 per cent.  Alberta was tops at 94 per cent meeting the benchmark. Only Saskatchewan and Prince Edward Island had longer waiting times than B.C. on this measure.

On radiation therapy, B.C. had the worst ranking with 93 per cent of patients getting treatment within the benchmark of 28 days. The other provinces reported that 95 to 100 per cent of patients were treated within 28 days.

The B.C. Health ministry says on its website that the number of patients waiting for radiation in 2017/18 rose to a high of 467 and the number of cancer patients who got radiation therapy in 2017 declined substantially to 10,663, from about 13,000 from 2015. It is unclear if far fewer patients required radiation or whether B.C. Cancer can’t offer it to as many patients as in prior years.

In an emailed statement, Health Minister Adrian Dix said the report shows B.C. is on “the right track” to improving surgical care, especially for case types that have the longest waiting times.

“We are seeing improvements throughout the health authorities. For example, Island Health’s rate for hip replacements within the benchmark went from 45 per cent in 2016 to 49 per cent in 2017 and 66 per cent in 2018. The rate for knee replacements was even more stunning: In 2016, 29 per cent; in 2017, 32 per cent and in 2018, 57 per cent.

“We know there is more work to do (and) our surgical and diagnostic strategy is not a one-time effort. It is a multi-year plan that is supported with ongoing targeted funding of $75 million starting in 2018-19, and increasing to $100 million in 2019-20,” Dix said, noting that targeted funding should ensure that other surgeries, besides the ones benchmarked, don’t fall behind.

Bacchus Barua, associate director of health policy studies at the conservative think-tank, Fraser Institute, said the CIHI reports shows that many British Columbians still do not receive their treatments within “remarkably long pan-Canadian benchmarks.

“Our own annual survey of waiting times reveals that while the total wait time (between referral from a family doctor to treatment) across 12 specialties has fallen in B.C. between 2016 and 2018, last year’s 23.2-week median wait is nevertheless more than twice as long as the 10.4 week wait time in 1993.

“Wait times are not benign inconveniences. They can, and do, have a real impact on patients’ lives,” he said.

 

[email protected]

Twitter: @MedicineMatters




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26Mar

‘Not a job for old people’: Doc series shines spotlight on B.C. paramedics

by admin


A Vancouver paramedic specialist with advanced training tends to a heart failure patient, en route to St. Paul’s Hospital. The scene is in the last episode of a new documentary series on Knowledge Network, Paramedics: Life on the Line. It premieres April 2.


TBA / PNG

After the success of its documentary series on life and death in the emergency room, the Knowledge Network wasted no time commissioning a riveting “prequel” consisting of 10 episodes on paramedics working throughout the Lower Mainland.

The series, which streams online and on television April 2, won’t disappoint those craving insight into the jobs and personalities of 911 call takers, dispatchers and the paramedics who race to scenes in their “moving emergency rooms.”

As many already know, ambulance drivers frequently encounter distracted pedestrians looking down at their cellphones as they cross streets, oblivious to speeding ambulances with lights and sirens, not to mention drivers who take far too long to get out of the way. The producers even made a short video calling attention to bad drivers.

It’s just one exasperating part of the job.

“Threading the needle” is the term one ambulance driver uses to describe the precarious weaving (“c’mon kid, I’m not skiing”) to manoeuvre through traffic. A dash cam installed by the film company partner, Lark Productions, captures the driver’s candid banter with her colleague as she aggressively steps on the gas and quips: “It’s fun driving fast with lights and sirens, let’s be honest.”

Those who’ve opined that such health professionals must be adrenalin junkies thriving on chaos will also observe how calm the call takers and paramedics appear as they’re taking information from people in medical crises and rushing to the scene of gruesome accidents to provide care to those in need.

The series reinforces the understanding that the work takes a huge toll, both physically and emotionally. Post-traumatic stress disorder was the focus of a CBC documentarybut the physical toll, especially on the musculoskeletal system, is also harsh and a common cause of days off work.

“I’ve been doing this for 25 years. I’m hoping to make it to retirement in about six years if my body holds up. It’s no job for old people,” said one paramedic in an episode titled No Occupation for Old Men.

Ironically, there is no mandatory retirement age for paramedics and many work well into their 60s, according to B.C. Emergency Health Services.

British Columbia's first report on road safety recommends a speed limit of 30 kilometres an hour in urban areas to reduce deaths among pedestrians and cyclists.


Knowledge Network shines the spotlight on paramedics.

RICHARD LAM /

Vancouver Sun

They eat on the go, wolfing down a sandwich or an ice cream with one hand while deftly steering ambulances with the other. They use deadpan sarcasm and droll humour to lighten the mood. And they must have good chemistry and trust with their shift partners.

There are only two deaths shown in 10 episodes of the docuseries. The paramedics on the scene of one cardiac arrest try everything to save the male and even call a hospital doctor to verify there’s nothing they’ve missed.

“Death is part of life, we’re all gonna die one day,” a paramedic says as a body is covered with a flannel sheet. It was one of at least 17 calls he had responded to during the 12-hour shift.

Viewers might find themselves frustrated by not knowing what happens to patients, like the East Vancouver woman who encountered a complication during a midwife-assisted water birth at home or the 46-year-old heart failure patient waiting to go on a heart transplant wait list.

That sentiment is often shared by the paramedics themselves, said Erin Haskett, a Lark Productions series executive producer. Many expressed frustration that they often don’t learn the outcomes of their cases after patients are handed off to hospital teams.

The series took 130 days of filming from December 2017 to June 2018. The 10 episodes are each under an hour but 1,500 hours of filming was done, often by crews embedded in ambulances at all hours of the day and night. Patients were asked for consent to film before they were handed off to the hospital and again after.

While rural paramedics were left out because of logistical challenges, about 40 of those working in Vancouver, North Vancouver, Burnaby Richmond and Surrey are featured. There are about 3,800 paramedics with various levels of credentials and 300 dispatch staff working for B.C. Emergency Health Services across the province.

Linda Lupini, executive vice-president of BCEHS, said the agency was reluctant to participate in the series.

“Initially we didn’t want to do this and we actually spent a few years talking to Knowledge Network about our concerns about logistics, about patient privacy, etc. So we hired a legal analyst and a top privacy expert. They came up with a lengthy list of things to ensure everyone met all the requests.”

There are numerous tricks used by the show’s editors to obscure locations and identities. In some cases street signs are even switched in the editing process and passersby who were on foot are shown on bicycles.

Among the incidents included in the series are a sexual assault call, a baby in respiratory distress, a cyclist hit by a car, a truck-bus crash, a fall at a construction site, an overdose at a SkyTrain station and an unconscious restaurant customer.

“I call our health professionals the first-first responders,” said Lupini. “People who watch this series will see their incredible compassion and patience. They often don’t get the recognition they deserve and I think this is a powerful way to showcase that.”

Viewers may be left wondering why anyone would want a job that takes such a toll on the human spirit. Lupini acknowledges she worried, initially, that the authentic conversations paramedics have about their work might deter people from entering the profession.

“In the series, paramedics talk about why they love their jobs but they also speak honestly about the challenges,” she said.

[email protected]

Twitter: @MedicineMatters




Source link

26Mar

“Not a job for old people” — documentary series shines spotlight on paramedics

by admin


A Vancouver paramedic specialist with advanced training tends to a heart failure patient, en route to St. Paul’s Hospital. The scene is in the last episode of a new documentary series on Knowledge Network, Paramedics: Life on the Line. It premieres April 2.


TBA / PNG

After the success of its documentary series on life and death in the emergency room, the Knowledge Network wasted no time commissioning a riveting “prequel” consisting of 10 episodes on paramedics working throughout the Lower Mainland.

The series, which streams online and on television April 2, won’t disappoint those craving insight into the jobs and personalities of 911 call takers, dispatchers and the paramedics who race to scenes in their “moving emergency rooms.”

As many already know, ambulance drivers frequently encounter distracted pedestrians looking down at their cellphones as they cross streets, oblivious to speeding ambulances with lights and sirens, not to mention drivers who take far too long to get out of the way. The producers even made a short video calling attention to bad drivers.

It’s just one exasperating part of the job.

“Threading the needle” is the term one ambulance driver uses to describe the precarious weaving (“c’mon kid, I’m not skiing”) to manoeuvre through traffic. A dash cam installed by the film company partner, Lark Productions, captures the driver’s candid banter with her colleague as she aggressively steps on the gas and quips: “It’s fun driving fast with lights and sirens, let’s be honest.”

Those who’ve opined that such health professionals must be adrenalin junkies thriving on chaos will also observe how calm the call takers and paramedics appear as they’re taking information from people in medical crises and rushing to the scene of gruesome accidents to provide care to those in need.

The series reinforces the understanding that the work takes a huge toll, both physically and emotionally. Post-traumatic stress disorder was the focus of a CBC documentary but the physical toll, especially on the musculoskeletal system, is also harsh and a common cause of days off work.

“I’ve been doing this for 25 years. I’m hoping to make it to retirement in about six years if my body holds up. It’s no job for old people,” said one paramedic in an episode titled No Occupation for Old Men.

Ironically, there is no mandatory retirement age for paramedics and many work well into their 60s, according to B.C. Emergency Health Services.

British Columbia's first report on road safety recommends a speed limit of 30 kilometres an hour in urban areas to reduce deaths among pedestrians and cyclists.


Knowledge Network shines the spotlight on paramedics.

RICHARD LAM /

Vancouver Sun

They eat on the go, wolfing down a sandwich or an ice cream with one hand while deftly steering ambulances with the other. They use deadpan sarcasm and droll humour to lighten the mood. And they must have good chemistry and trust with their shift partners.

There are only two deaths shown in 10 episodes of the docuseries. The paramedics on the scene of one cardiac arrest try everything to save the male and even call a hospital doctor to verify there’s nothing they’ve missed.

“Death is part of life, we’re all gonna die one day,” a paramedic says as a body is covered with a flannel sheet. It was one of at least 17 calls he had responded to during the 12-hour shift.

Viewers might find themselves frustrated by not knowing what happens to patients, like the East Vancouver woman who encountered a complication during a midwife-assisted water birth at home or the 46-year-old heart failure patient waiting to go on a heart transplant wait list.

That sentiment is often shared by the paramedics themselves, said Erin Haskett, a Lark Productions series executive producer. Many expressed frustration that they often don’t learn the outcomes of their cases after patients are handed off to hospital teams.

The series took 130 days of filming from December 2017 to June 2018. The 10 episodes are each under an hour but 1,500 hours of filming was done, often by crews embedded in ambulances at all hours of the day and night. Patients were asked for consent to film before they were handed off to the hospital and again after.

While rural paramedics were left out because of logistical challenges, about 40 of those working in Vancouver, North Vancouver, Burnaby Richmond and Surrey are featured. There are about 3,800 paramedics with various levels of credentials and 300 dispatch staff working for B.C. Emergency Health Services across the province.

Linda Lupini, executive vice-president of BCEHS, said the agency was reluctant to participate in the series.

“Initially we didn’t want to do this and we actually spent a few years talking to Knowledge Network about our concerns about logistics, about patient privacy, etc. So we hired a legal analyst and a top privacy expert. They came up with a lengthy list of things to ensure everyone met all the requests.”

There are numerous tricks used by the show’s editors to obscure locations and identities. In some cases street signs are even switched in the editing process and passersby who were on foot are shown on bicycles.

Among the incidents included in the series are a sexual assault call, a baby in respiratory distress, a cyclist hit by a car, a truck-bus crash, a fall at a construction site, an overdose at a SkyTrain station and an unconscious restaurant customer.

“I call our health professionals the first-first responders,” said Lupini. “People who watch this series will see their incredible compassion and patience. They often don’t get the recognition they deserve and I think this is a powerful way to showcase that.”

Viewers may be left wondering why anyone would want a job that takes such a toll on the human spirit. Lupini acknowledges she worried, initially, that the authentic conversations paramedics have about their work might deter people from entering the profession.

“In the series, paramedics talk about why they love their jobs but they also speak honestly about the challenges,” she said.

[email protected]

Twitter: @MedicineMatters

 




Source link

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