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Category "Staff blog: Medicine Matters"

19Aug

False Creek private surgery clinic sold to Toronto equity company

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Dr. Amin Javer and his team perform sinus surgery on a patient at False Creek Healthcare Centre in Vancouver.


Arlen Redekop / PNG

A Toronto private-equity company has bought False Creek Healthcare Centre in Vancouver, one of B.C.’s first private surgery and diagnostic facilities.

In a memo to employees obtained by Postmedia, the owner of the facility and four others in Canada — Centric Health — says the deal is expected to close at the end of September. The buyer is Kensington Capital Advisers.

Doctors and patients can expect a “business as usual” transition followed by an improvement in facilities and quality of care, according to Kirk Hamilton, vice-president of Kensington. The company, which describes itself as an investor in “alternative assets” bought the clinics in Vancouver, Calgary, Winnipeg, Toronto and Mississauga for $35 million. The clinics will be owned by the Kensington Private Equity Fund.

False Creek was opened in the late 1990s by an entrepreneurial Vancouver anesthesiologist, Dr. Mark Godley. In 2011, he sold the Vancouver centre and a sister facility in Winnipeg to Centric Health for $24 million.

The surgical clinics have apparently been a drag on Centric’s financial bottom line. In the memo to employees, David Murphy, the Centric CEO, said the “bittersweet” transaction is the culmination of a year-long review to improve the company’s financial health.

The decision was made “that the most viable path forward was to divest some of our businesses and pursue a more focused strategy built around our seniors’ pharmacy business.”

Murphy nevertheless told employees the growth potential for the private surgery business is “immense” and that Kensington is “the right owner for this business” as it is committed to increasing investment in each of the surgical sites.

“I am confident they will partner with you to help this business realize its tremendous growth potential.”

In B.C., changing government policies initiated by the NDP have been destabilizing the private surgery business. There is the uncertain outcome of the continuing B.C. trial into the constitutionality of paying privately for expedited surgery in such clinics. Closing arguments in the three-year-long trial will not be made before the fall and a judge’s decision is not expected until sometime in 2020.

Murphy mentioned B.C.’s political and legal situation in the company’s latest quarterly report in which Centric cites risks in the private surgery business, including the B.C. trial and NDP government policies.

Asked about the wisdom of buying a private surgery centre in B.C., Hamilton said in an email: “The acquisition includes multiple facilities across Canada and isn’t limited to False Creek. Currently, the False Creek facility does not provide any services to the B.C. government. However, we would be open to providing similar patient services to the B.C. government in the future.”

He was referring to the fact that for many years, health authorities have paid several private clinics to help clear backlogs of scheduled surgeries. But most private clinics also take patients willing to pay out of pocket for expedited surgery, something the government maintains is illegal.

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 won’t do medically necessary work in both the public and private systems. If they refuse, they could be banned from doing publicly funded operations at private clinics that have contracts with health authorities.

Vancouver Coastal Health has contracted out elective surgery cases to the False Creek clinic in the past, but last year, Health Minister Adrian Dix instructed VCH to sever its contract with False Creek because an audit showed some patients were paying privately to get expedited access, contrary to provincial law.

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22Jul

Surgeons in B.C. get fee increase for operations on obese patients

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Dr. Kathleen Ross, president of Doctors of B.C.


Custom Photography / PNG

Some B.C. surgeons who operate on extremely obese patients are being paid a 25 per cent surcharge because surgeries on such patients often take longer and are riskier.

The change came into effect a few months ago for some physicians and will soon kick in for more medical specialists.

It came about after a survey three years ago showed that obese patients were falling through cracks. All but a handful of the B.C. surgeons who responded said they had delayed or declined to perform elective surgery on patients with a body mass index, or BMI, higher than 38. Four in five surgeons said they had delayed or declined to perform surgery over concerns about complications in patients with a BMI of 30 to 34.

Some patients have accused physicians of being biased against them.

Doctors of B.C. and the Ministry of Health have been working to solve the problem. General surgeons and anesthesiologists were the first to negotiate surcharges meant to compensate for added risks and time involved in treating obese patients. Gynecologists/obstetricians are also expected to get a surcharge soon.

Dr. Kathleen Ross, the new president of Doctors of B.C., said the government didn’t come up with extra money. Instead, money was reallocated from what’s called the available amount given to sections of physicians. Within sections like anesthesiology, fees shrunk for some procedures to allow for the surcharge which is referred to as a “BMI modifier.”

Although obesity is typically defined as a BMI over 30, the premium only applies for operations on patients with a BMI over 35. Several other provinces offer surgeons a premium.

BMI is calculated based on a person’s height and weight. For example, a woman who is five-foot-eight and weighs 270 pounds would have a BMI of 41.0.


Body Mass Index Primer; Source: U.S. National Library of Medicine

“This is in recognition of the fact that in obese patients, there may be more complications and areas of the body are more difficult to access,” Ross said. “Operations are more technically complex.”

Dr. Stephen Kaye, an obstetrician/gynecologist, said obesity affects all of patient treatment, making the initial evaluation, the surgery and post-operative care more complex.

Obese patients can have higher rates of infections, require longer hospital stays and more hospital readmissions. It takes longer to prepare obese patients for surgery, including getting them in position on larger operating room tables. Getting them sedated takes longer, said Kaye, who is co-president of the Doctors of B.C. section of obstetrics and gynecologists.

“Specialized equipment and retractors are required in order to visualize and reach the surgical site,” he said. “When operating on the abdomen and pelvis, for example, the distance between the skin surface and the abdominal contents is increased by the thickness of the fat of the abdominal wall.

“These are high-risk patients and increasingly, the care of these patients is being concentrated in the hands of a fewer number of physicians who are willing to accept the patients and have the expertise or who work in hospitals that have greater resources to provide such care,” Kaye said.

In the case of a hysterectomy, for example, the $654 fee paid to a gynecologist/obstetrician would rise by $72 for every 15 minutes beyond the standard two hours. For anesthesiologists sedating hysterectomy patients, the fee would be billed at $38 minutes for every 15 minutes but the BMI modifier would add an extra $20 for every 15 minutes beyond the two-hour typical surgery time.

Some anesthesiologists and other surgical specialists are paid through contracts so their compensation would be structured differently.

Dr. Curtis Smecher, an anesthesiologist at Abbotsford Hospital and president of the B.C. Anesthesiologists Society, said that in the last round of negotiations, each section of physicians was given a pot of money to distribute for pressing needs and the BMI bonus was a high priority for doctors in his area.

“It’s a bit like shuffling deck chairs,” he said about the reallocation, adding that he won’t be surprised if orthopedic surgeons are next to seek the premium since surgeries like joint replacements are far more difficult in obese patients.

Anesthesiologists say their management of obese patients is more complex because of thicker necks, chests, and abdomens in such patients who often have sleep apnea and reduced lung and heart function, which can affect airway management and ventilation during anesthesia.

Physician services cost taxpayers almost $5 billion a year. Ross would not disclose how funds are being shuffled around to pay the premiums, but in the latest Physician Master Agreement with the government, there was also some shifting of funds to address disparities between physician groups. For example, cataract fees to ophthalmologists were reduced about 18 per cent, from $425 a year to $350.

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9Jul

Ballsy participants sought for Vancouver testicle study

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Dr. Ryan Flannigan inside VGH’s Robert Ho research building in Vancouver. Dr. Flannigan is leading a study on a new way to treat scrotum pain. Photo: Arlen Redekop/Postmedia


Arlen Redekop / PNG

Males who suffer debilitating scrotal pain can now sign up for a new study using an old but reformulated numbing medication with lidocaine.

Nearly five per cent of males can suffer so much that mere walking can be painful if they have chronic pain in their testicles and scrotum, the latter of which are the sacs of skin surrounding the testicles.

Dr. Ryan Flannigan, a Vancouver General Hospital urologist who is the director of the male infertility and sexual medicine research program at the University of B.C., said that he has seen up to 100 men with chronic scrotum pain in the last six months alone. Some patients come from as far away as the Northwest Territories. But many men don’t bother to seek medical attention because, as Flannigan points out, males are generally more reluctant than women to go to doctors and more inclined to brush off medical concerns.

Flannigan, who specializes in testicular and penile abnormalities, said testicular pain is described by patients as either constant aching or episodes of sharp pain.

The scrotal pain condition occurs in a range of ages — from teenagers to men in their ’60s — but it most commonly affects those in their 20s and 30s, Flannigan said.

While conventional treatment has involved injecting a lidocaine anesthetic into the spermatic cord to help numb pain, it is temporary relief for only up to four hours. So in the new study, soon to enrol 20 patients, lidocaine will be reformulated into a polymer paste that is designed for a slow, more sustained release, over seven to 14 days.

The needlepoke through the skin at the top of the scrotum into the spermatic cord can be uncomfortable but Flannigan said he tells patients “it’s like a visit to the dentist when the freezing goes in.”


In a study that will soon enrol participants who suffer from severe scrotum pain, Dr. Ryan Flannigan will be injecting a newly formulated solution of a numbing agent designed to provide longer relief. Photo: Arlen Redekop/Postmedia

Arlen Redekop /

PNG

The paste, developed by a UBC spinoff company called Sustained Therapeutics (which is funding the study), will be injected into tissues, not blood vessels. Flannigan said the polymer material will “naturally break down” as it is metabolized.

Besides lidocaine-based injections, other treatments that may be tried include anti-inflammatories, steroids, and sometimes even surgery to cut nerves that are transmitting the pain. Physiotherapy can also help when the pain originates in another area of the body and is referred to the testicles.

Preclinical trials in animals at UBC affirmed the safety and proof of concept behind the intervention. Now the goal of the Phase 1 trial in humans will be to determine a safe and effective dose.

Flannigan said common causes of the condition include a blow to the testicle area, a previous infection in the area, inflammation in the spermatic cord that stores and carries sperm, and nerves pinched during hernia repair or a previous vasectomy. Pain can also be caused by enlarged veins in the scrotum, cysts, or kidney stones. The cause remains unknown in nearly half of cases.

Flannigan said men from around B.C. — or even outside the province — will be considered for the trial. To register an interest, males should contact the clinical trials unit at the Vancouver Prostate Centre or call 604-875-5675.

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19Jun

New leader for B.C. Cancer agency is a prestigious oncologist and researcher

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Dr. Kim Chi has been named the new leader of the B.C. Cancer agency.


NICK PROCAYLO / PNG

Dr. Kim Nguyen Chi, a renowned prostate cancer researcher and highly respected oncologist, will take over as head of the B.C. Cancer agency on July 1.

He is the first visible minority leader since the agency was established 45 years ago.

Chi, who went to medical school at the University of Ottawa, succeeds Dr. Malcolm Moore who announced four months ago that he would be leaving his post about a year early. Moore said he was moving back to Toronto for personal and professional reasons. The typical duration of such leadership positions is five years but the agency has had trouble keeping leaders. Dr. Max Coppes stayed in the job for two years and Dr. David Levy stayed just 18 months.

Chi came to B.C. in 1996 to do an oncology fellowship at BC Cancer, following an internal medicine residency in Ottawa.

BC Cancer has had a high churn rate for leaders and it has been criticized for too often choosing Americans over Canadians, and out of province experts over local ones.

In a press release, the agency says Chi understands the “intricacies of patient care and operations based on his current role as B.C. Cancer’s Director of Clinical Research and Medical Director for the Vancouver Centre.”

Chi has an interest in developing biomarkers and new treatments for those with the most advanced form of prostate cancer. He was a lead and collaborating author on some recently published studies on new drug treatments for men with metastatic prostate cancer.

Chi said he’s honoured to take over.

“As I step forward now, I do so with the profound understanding that B.C. Cancer is not about one person or one leader, it is about our tremendous history of achievement — of world-class research and knowledge translation and unparalleled patient care — made possible by the collective will of all of our clinicians, researchers and staff. I am proud to be the one who will take us forward in building on that legacy.”

Health Minister Adrian Dix called Chi an excellent choice.

“He understands firsthand the worlds of medical oncology and cancer research, but he also knows where B.C. Cancer has come from and where the opportunities lie to leverage the investments the B.C. government has made in cancer care to improve the lives of patients in every corner of our province.” 

Chi started at the B.C. Cancer agency 20 years ago. He says the bond between patients and physicians is nowhere stronger than in cancer care “where you are helping a person navigate one of the most serious issues they will ever face.”

Chi’s official title will be Chief Medical Officer and head of B.C. Cancer as well as vice-president of the Provincial Health Services Authority, to which the cancer agency is accountable.

Chi takes over during a time of relative calm. That had not been the case in the past decade or two. Scientists and clinicians have in the past cited concerns about poor staff morale, long patient waiting times and inadequate government funding.

The B.C. government’s latest budget included increased funding for the cancer agency, earmarked for increased cancer-related surgeries, diagnostic imaging, expanded positron emission tomography and computerized tomography scans, and chemotherapy demands.

More to come…..

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18Jun

New St. Paul’s Hospital to get $12 million for hearing loss centre

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The new St. Paul’s Hospital will feature a state of the art hearing loss centre, funded through $12 million in equal $6 million commitments from a Rotary Club foundation and the hospital’s own fundraising arm.


PNG

The new St. Paul’s Hospital will feature a state of the art hearing loss centre, funded through $12 million in equal $6 million commitments from a Rotary Club foundation and the hospital’s own fundraising arm.

The Rotary Club of Vancouver has been supporting hearing loss or deafness for three decades. In 1985, it formed the Rotary Club of Vancouver Hearing Foundation to address an unmet need in the philanthropy community. Through bike-a-thons and other events, it has raised over $3.5 million.

But the $6 million pledge is the biggest fundraising challenge for the charity. Jack Zaleski, president of the Rotary’s hearing foundation, said the St. Paul’s endeavour will be separate from the smaller donor bike events.

“We recognize with this opportunity that we can do something truly extraordinary, creating the premier clinic for those afflicted with hearing problems and deafness, a centre where everything will be under one roof.”

Zaleski said the foundation will leave no stone unturned in its mission to raise money. It will approach pharmaceutical companies, technology companies and everyone else involved in supplying services and equipment for the hearing community.


The provincial government hopes that a new St. Paul’s Hospital will open for patients by 2026.

The most recent big donation to the hospital development project came from the Louie family, which owns London Drugs. Two years ago, Vancouver billionaire Jimmy Pattison pledged $75 million for the new hospital, which is expected to be built by the fall of 2026 at a cost of nearly $2 billion. The existing hospital on Burrard Street will likely be demolished with land sales helping to fund the redevelopment of the False Creek flats site.

The B.C. Rotary Hearing and Balance Centre will include examination rooms, surgical suites, research space and laboratories. Funds will be earmarked for audiology testing and research, tinnitus and vestibular conditions that often affect balance. Since hearing often affects seniors, the centre will have specialized care for those who, because of age, mobility and geography, are less likely to access specialized hearing care.

“Benefiting thousands of patients provincewide, this funding will help us transform the patient experience …” said Dr. Brian Westerberg, head of the division of otolaryngology at St. Paul’s.

He noted that hearing problems are sometimes linked to other conditions so the new centre will allow for improved interactions and collaborations between doctors and health researchers in numerous areas including neurology, physiotherapy, kinesiology, psychiatry, ophthalmology and gerontology

The existing BC Rotary Hearing and Balance Centre at St. Paul’s Hospital had 4,629 patient visits from April 1, 2018 to March 31, 2019.

Broek Bosma, chief development officer for the St. Paul’s Foundation, characterized the donation pledge by Rotary as a “golden opportunity we did not want to miss.”

St. Paul’s has been the province’s main referral centre for patients with complex ear and hearing problems and it was the first hospital in Canada to offer cochlear implants in 1982. Since then, nearly 800 adult patients have had the revolutionary procedure there. B.C. Children’s Hospital offers the procedure as well to pediatric patients.

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12Jun

9,500 patient complaints lodged with B.C. health authorities over treatment quality

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A record number of complaints were filed with health authorities last year over patient care, more than 9,500 according to the Patient Care Quality Review Boards report for 2017/18.


Gerry Kahrmann / PROVINCE

A record number of complaints were filed with health authorities last year over patient care – about 9,500 according to the Patient Care Quality Review Boards report for 2017/18.

That’s up from 8,900 the year before and about 9,000 the year before that.

Patient Care Quality Offices and review boards were formed 10 years ago to give health system users and their families an outlet to voice their frustration. The boards in each health region accept complaints from patients and others only if their concerns about their experiences are not resolved to their satisfaction by Patient Care Quality Offices in each health region.

Less than two per cent of complaints are escalated to the review boards which suggests patients are largely satisfied with how their local health authorities are handling their concerns, said Richard Swift, chair of the Island Health Patient Care Quality Review Board.

Given the fact there are tens of millions of health care interactions, the number of complaints is relatively small, said Swift.

The latest annual report gives scarce information about the nature of complaints and recommended changes but a few of them include:

Island Health

• A complaint pertained to various issues including extraordinarily long wait time for care in a hospital emergency room for which Island Health acknowledged and apologized. The complaint also involved an allegation that a patient was assaulted by a staff member in the ER. The health authority agreed to develop a policy detailing what actions must be taken when such complaints are made, including when police or regulatory bodies for health professionals should be contacted.

• The Island review board recommended a hospital conduct exit interviews with patients to ask about their satisfaction levels with the quality of care and communication. Currently, the health ministry sends out surveys on a random basis which are then reported to health authorities on a quarterly basis. But Swift says more can be done to ensure patients are given opportunities to comment on their care.

Fraser Health

• A care aide escorted a frail patient to the bathroom but then left the patient alone to attend to another matter. The low cognition patient fell in the bathroom. There are more than a dozen policies regarding the prevention of falls, some of which were not followed in this case.

Vancouver Coastal Health

• A complaint was lodged about a vulnerable patient who went to a hospital emergency department. The board said the case was an example of how not to “prejudge patients who appear to be homeless, suffering from mental health, addiction issues and/or other challenges.” In response, hospital staff said there were departmental meetings where staff was reminded about the need to “provide care for the patients as a whole, the importance of listening to patients and their family, and the need to not prejudge patients on any aspect of their presentation.”

• In a case not highlighted in the annual report, a patient bled to death after paramedics could not get access to the individual’s Downtown Eastside building because of multiple security locks on doors and elevators. Health minister Adrian Dix said family members were not satisfied with the way complaints were handled so he has taken the rare step of ordering an independent review. 

The case pertains to Tracey Gundersen who bled to death last November after it reportedly took paramedics over half an hour to get to her sixth-floor suite. Firefighters who have master keys to such buildings were eventually dispatched to get paramedics inside. But a few years ago, B.C. Emergency Health Services changed policies and procedures to cut down on multiple crews attending each call so firefighters are no longer sent as first responders to many cases.

Gundersen’s daughter told CBC her mother was dying while on a phone line with a dispatcher and she’s angry that her mother’s case was not treated as life-threatening and that paramedics didn’t call for firefighters’ help sooner, especially since a firehall was just a block away.

Interior Health

• An incapacitated patient’s valuables and personal effects went missing at a hospital and were never recovered so the health region offered $500 in compensation. The board ordered the health region to have designated staff members whose job entails the safekeeping and documentation of patients’ belongings.

Northern Health

• A long-standing complaint going back to 2015 when Northern Health officials were alerted by a staff member to lapses in medical device disinfection and sterilization procedures related to instruments called endoscopes. Thousands of patients had procedures like colonoscopies that relied on the scopes but a consultation with the B.C. Centre for Disease Control did not show any “increase in specific infection types” during the two year period when the errors took place.

Although patients were sent letters to inform them of the breeches, the review board recommended a more fulsome public communication plan including direct meetings with patients or even town hall meetings to broadcast the errors, risks, actions, and any mitigating steps. As well, the region has to ensure that when such things happen, all affected patients should have a doctor who can address any concerns and ongoing needs.

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How and where to complain

8500 patient complaints




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10Jun

New drug helps extend survival rate of men with advanced prostate cancer: B.C. Cancer Agency study

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Dr. Kim Ch, who led a clinical trial which found that over half of patients who used a new type of hormone-reducing medication saw a reduction in their risk of cancer progression and a 33% improvement in overall survival, in Vancouver BC., June 10, 2019.


NICK PROCAYLO / PNG

A new drug has helped reduce the risk of death by 33 per cent in men with prostate cancer that has spread, according to the results of an international trial led by the B.C. Cancer Agency’s Dr. Kim Chi.

The double-blind study on the androgen receptor inhibitor drug called apalutamide was conducted in 23 countries at 260 cancer centres. It involved 1,052 men whose median age was 68. The study was sponsored by Janssen, the drug company who makes apalutamide.

At two years, those taking the treatment drug in addition to their standard treatment had a 52 per cent lower risk of cancer spread or death.

The findings of the TITAN (Targeted Investigational Treatment Analysis of Novel Anti-androgen) trial which began in 2015 are published in the New England Journal of Medicine (NEJM). Results were also recently presented by Chi at the annual meeting of the American Society of Clinical Oncology.

Chi, an oncologist, said overall survival rate is only about five years once prostate cancer has spread beyond the prostate so new treatments are desperately needed. The percentage of patients who took the drug whose cancer did not spread was 68.2 per cent, but in the placebo group the proportion was 47.5 per cent. There was a 33 per cent reduction in the risk of death for those who took the drug.

After about two years, 82 per cent of men in the investigational drug group were alive compared to 74 per cent on placebo. Men in both groups also took standard male hormone deprivation therapy showing that combination therapy helps to improve survival. Male hormones (androgens) like testosterone feed prostate tumours and currently, men with metastatic cancer are put on hormone deprivation treatment that has been the standard of care for many decades. Apalutamide, also called Erleada, is said to more completely block male hormones.

Chi said the drug is “not toxic” and there were no significant differences in the proportion of study participants in the intervention or placebo groups who experienced side effects, but skin rashes were just over three times more common in the drug group.

The drug has already been approved in Canada for certain patients with hormone-resistant, non-metastatic cancer but Chi said now that it is showing benefit for patients whose cancer has spread, he expects the drug will be approved by Health Canada for those patients as well, perhaps later this year. After that approval, provinces will have to decide on whether to expand funding for the drug, which costs about $3,000 a month. Chi said he expects more Canadian patients will have access to it next year.

“This is a next generation, better-designed androgen inhibitor and we really need better drugs for those with metastatic prostate cancer,” Chi said.

“There’s a critical need to improve outcomes for these patients and this study suggests this treatment can prolong survival and delay the spread of the disease.”

Chi was also a co-author on another drug trial, the results of which were published in the same issue of the NEJM medical journal. The ENZAMET trial, as it was called, is on a drug called enzalutamide (Xtandi). The results of that trial were similarly favourable.

About 2,700 men will be newly diagnosed with prostate cancer in B.C. this year. More than 600 men will die from it. 

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29May

New probe into patient’s death ordered by B.C. health minister

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Health Minister Adrian Dix.


Francis Georgian / PNG

Health minister Adrian Dix said he’s taking the rare step of ordering an independent review into a patient’s death because of the family’s continuing concerns after the initial investigation conducted by two health agencies.

The Vancouver individual, whose identity is being withheld, died in November 2018 and the only detail Dix would disclose is that paramedics had difficulty “accessing” the patient.

Dix conceded it is rare for health ministers to intervene in such cases and this is the first time he has done so since he became health minister two years ago. But he felt it was important for family members who told him  that they wanted “fresh” eyes on the circumstances leading to the death.

“I just felt we needed to do more,” he said, referring to the patient safety review that B.C. Emergency Health Services and Provincial Health Services Authority carried out right after the death.

The new review  will delve into the medical care in the weeks before the death and the emergency response “in the hours surrounding the death.”

The previous investigation was conducted with so-called Section 51 protection, which means there is no public disclosure. Section 51 safety reviews are conducted to see if anything can be learned from a death and suggest steps to prevent reoccurences.

Dix said the new study will have more transparency and will give family members more access to information and findings; the report will also be made although some information may be redacted “for the sake of privacy.”

Dix said he could have referred the case to the Patient Care Quality Review Board but in this case, there was a “technical glitch” that would have meant passing a new regulation. So, he said he decided to refer the case to Dr. Jim Christensen, an emergency physician at St. Paul’s Hospital in Vancouver and head of the academic department of medicine at the University of British Columbia. He will be assisted by Dr. Michael Feldman, the paramedic services medical director and provincial dispatch medical director at Toronto’s Sunnybrook Centre for Prehospital Medicine.

In a purposely vague media release, the ministry of health said the review panel will have the “co-operation” of four agencies — Providence Health Care, VCH, BCEHS and PHSA.

“British Columbians can and do rely on our emergency responders when they are at their most vulnerable,” Dix said in the announcement. “Whenever we are faced with a case that may warrant a review, we look to independent experts who can look for learnings and suggest improvements that will benefit patients, first responders and the system as a whole.”

The government will receive the report by July.

Officials with PHSA would not comment on the internal review process that has already taken place. On its website, PHSA states: “When a patient safety event occurs, the goal is immediate management, disclosure and analysis of the event through a structured process, focused on system improvement, that aims to identify what happened, how and why it happened, whether there are any ways to reduce the risk of recurrence and make care safer. PHSA conducts patient safety event reviews in accordance with Section 51 of the B.C. Evidence Act.”

The review is meant to enable “full, open and candid discussions amongst health care professionals” with the goal of improving care for future patients. Further education or policy changes may be recommended.

“Patient safety event reviews do not preclude health-care professionals from cooperating in other reviews by outside investigative bodies, such as the police or regulators, nor do they shield health care professionals or PHSA from potential civil suits.”

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27May

B.C. becomes first province to force change to biosimilar drugs

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Biosimilars are manufactured after the 20-year patent period expires on biologics.


Francis Georgian / PNG

Starting today, over 20,000 B.C. patients with cancer or chronic diseases like arthritis, colitis and diabetes will have six months to transition to drugs that are similar to those they’re taking as the province becomes the first in Canada to stop covering some expensive, formerly patented drugs.

Health Minister Adrian Dix promised that no harm will come from the change that will initially save the government more than $96 million in its prescription drug program (PharmaCare).

The savings will be plowed back into the drug budget to allow for funding of drugs that have not yet been covered such as Jardiance, a medicine known as an SGLT2 inhibitor for diabetes. Another drug for psoriatic arthritis called Taltz will also be immediately available.

Since some of the soon to be phased-out government-funded drugs like Remicade have to be given at infusion clinics, Dix said there may be some inconveniences as patients find new locations. But patients will work with their doctors to make the switch to “biosimilar” drugs, which are the just-as-safe and effective copycat versions of brand name bioengineered drugs called biologics.

Biosimilars are manufactured after the 20-year patent period expires on biologics. They cost anywhere from 25 to 50 per cent less than the original biologic drugs which are said to be the single biggest expense for public drug plans like PharmaCare.

European countries have led the way in transitioning patients to biosimilar drugs, but Canada has lagged far behind.

In 2018, B.C. spent $125 million on Lantus, Enbrel and Remicade, three biologic drugs that treat chronic conditions such as diabetes, arthritis and Crohn’s disease.

“Biosimilars (like infliximab) are a necessary step to ensure PharmaCare provides existing coverage for more people and funds new drugs well into the future,” Dix said.

PharmaCare coverage for certain biologics will end Nov. 25. After that time, PharmaCare will provide coverage for the original drugs only in exceptional cases and they will be decided upon on a case-by-case basis.

B.C. has spent the last nine years studying the matter before making the decision. It consulted with physician and patient groups like the B.C. Society of Rheumatologists, endocrinologists, Doctors of B.C., Arthritis Consumer Experts, Canadian Arthritis Society, B.C. Pharmacy Association, Neighbourhood Pharmacy Association, regional health authorities, Health Canada, and the Patented Prices Medicine Review Board.

About 2,700 Crohn’s and ulcerative colitis patients will also be affected by the transitioning policy, but information for gastroenterology patients will be available in a month or two.

Rheumatologist Dr. John Esdaile said B.C. becomes an overnight Canadian leader with the cost-saving policy change.

“It’s a great day for B.C., for patients, for PharmaCare and for health care in general,” he said, noting that many European countries have had such a policy for 10 years with no evidence of detriment to patients. “I don’t know of any bad news,” said Esdaile, scientific director of Arthritis Research Canada, which has been “badgering” the province to enact such a change.

“For years, B.C has been spending money it doesn’t need to spend on expensive biologics instead of using biosimilars which I call biogenerics since they work just as well,” Esdaile said.

Cheryl Koehn, president of Arthritis Consumer Experts, said society will benefit from the new policy because coverage for other conditions and drugs will expand.

MORE TO COME.

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23May

‘Corporate medicine’ model is wrong approach for urgent care centres: think-tank

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City Centre Urgent Primary Care Centre at 1290 Hornby St. in Vancouver.


Francis Georgian / PNG

Vancouver Coastal Health is being criticized for waving “profit-motivated” corporate partners through the door to manage an urgent and primary care health clinic in downtown Vancouver funded by taxpayers.

The Canadian Centre for Policy Alternatives says it welcomes the idea of the clinics established by the province — where doctors, nurses and other health professionals work as a team — but says they should be run on a not-for-profit basis with community oversight or governance.

“Unfortunately, there is an alarming development taking place under the watch of Vancouver Coastal Health,” the CCPA says in a report released today that refers to the City Centre Urgent Primary Care Centre at 1290 Hornby St. in downtown Vancouver and a clinic planned for south Vancouver.

Opening such clinics across the province has been a major priority for Health Minister Adrian Dix but the government has not been open about business models and financing structures, so Postmedia and groups like CCPA have had to submit freedom of information requests to get details.

In a fact-checking exercise, Postmedia showed that in February’s throne speech,  the government inflated the numbers of doctors and nurses being hired to work in such clinics. The government’s primary health strategy includes funding for an additional 200 family doctors, 200 nurse practitioners and 50 pharmacists. But they won’t all be working in such centres.

There are eight urgent and primary care centres in B.C. with a variety of business models. Another two — in as-yet undisclosed locations — are expected to open soon.

Documents released to Canadian Centre for Policy Alternatives, a left-leaning think-tank, show that Coastal Health invited medical corporations to run centres, says Alex Hemingway, a CCPA economist and public policy analyst. The only clinic to open in Vancouver so far was contracted by Coastal Health to an entity called Seymour Health Centre Inc., whose CEO is Sabi Bening

The downtown Vancouver centre operates like other medical offices and walk-in clinics in the sense that services provided to patients are covered by the public health insurance plan. But many family doctors are opting for $250,000 salaries instead of paying overhead and then collecting a medicare fee for each service. The clinics have extended hours, some doctors have emergency training and the model is meant to take the pressure off hospital emergency departments.

It’s also intended that the clinics will assist the many patients who don’t have family doctors to get attached to one. Health outcomes are better when patients have a history and continuity with doctors.

Although the vast majority of doctors’ offices are privately managed by their own corporations, Hemingway said there is plenty of evidence to show that not-for-profit models deliver superior care. Hemingway said doctors’ practices are “small scale” compared to the new models of combined urgent and primary care clinics.

Hemingway said it’s worrying that Seymour Health was contracted by the health authority to run Vancouver’s first urgent care centre. According to the government, the startup costs of the clinic were $1.9 million. City Centre Urgent Primary Care has a taxpayer-funded operating budget of about $3.7 million annually, including salaries, administration and overhead cost. The centre is a partnership of the ministry, Coastal Health, Providence Health Care, the Vancouver Division of Family Practice, Doctors of B.C. and Seymour Health Care.

Hemingway said the health authority is leasing the property from a private owner, “meaning it appears to be using public dollars to enhance a privately owned real estate asset. This is an unwise use of public capital investment dollars, which could be invested in publicly owned assets instead.”

Gavin Wilson, a spokesman for Coastal Health, said the Seymour group has 80 years of experience operating primary health care clinics. The costs and the agreement between Coastal Health and Seymour “are similar to contracts we hold with not-for-profit health service providers.”

Wilson said urgent primary care centres provide same-day care for non-life-threatening problems to people who would otherwise have no other option than to go to an emergency department. They have more services than traditional walk-in clinics since they have diagnostic equipment, such as X-ray and ultrasound machines, and labs and pharmacy services.

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Twitter: @MedicineMatters




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