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7Oct

Hospital foundation has raised 75 per cent of its pledge for new St. Paul’s

by admin

https://vancouversun.com/


The Pattison Foundation has made a $75 million donation to fund the Jim Pattison Medical Centre at the new St. Paul’s Hospital. The new facility is described as “a purpose-built, fully-integrated health campus, comprising the entire 18.4-acre site on Station Street in the False Creek Flats.”


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The St. Paul’s Foundation has set its sights on raising $225 million toward the cost of a new hospital to be built three kilometres away, on an unused field in the False Creek flats.

With pledges and donations totalling $168 million to date, the foundation is three quarters of the way to completing what’s been called the largest hospital fundraising campaign in Western Canada. The single largest donation was for $75 million from the Pattison Foundation, the philanthropic arm of Vancouver billionaire Jim Pattison‘s empire.

The health care campus will be called the Jim Pattison Medical Centre.

The price tag for the new 12-storey hospital at 1002 Station Street is an ever changing, ever-escalating target, most recently estimated at almost $2 billion. The site, currently a gravel lot atop a former mud flat at the end of False Creek inlet, will be divided into parcels allowing for phased-in construction of buildings. The hospital, a 69-space child daycare centre, outpatient medical clinics, and offices for administrators and researchers are expected to be completed first, by about 2026.

In the second phase of construction, other parcels will be developed for rental housing offered to health care workers, a hotel with kitchenettes for patients seeking care at the hospital as 40 per cent of St. Paul’s patients come from communities outside the Lower Mainland, more offices and a second daycare centre. The initial business plan approved and funded by the government does not cover other structures, only the hospital, according to Providence Health spokesman Shaf Hussain. 

Geotechnical remediation work on the False Creek Flats land that is susceptible to liquefaction has not yet begun. The rezoning hearing, to change the site from industrial to comprehensive development, is October 22 and although construction is not expected to begin for another year, government and hospital leaders maintain the new facility will open in 2026.

While the proportion being raised through philanthropy may appear small, relative to the overall cost, it is ambitious in relation to other health sector fundraising campaigns, according to material gathered by staff of the St. Paul’s Foundation.

For example, the B.C. Children’s Hospital Foundation capital campaign target for its new hospital was $150 million. And the Lion’s Gate Hospital Foundation target for a new medical/surgical centre was $100 million. The Royal Columbian Hospital Foundation capital campaign target for a multiphase redevelopment is also $100 million while the Richmond Hospital Foundation will try to raise up to $50 million for its new building.

All of those projects pale in size when compared to the new St. Paul’s. 

Paul Hollands, the chairman of A&W Food Services of Canada, and chair of the St. Paul’s Foundation fundraising campaign committee said that private donor fundraising will account for about 10 per cent of the total cost of the hospital.

“We came up with this amount of $225 million after looking at other capital campaigns, talking to key leaders and gauging support in the community. It’s a big number but in the coming months, you will hear about some more big and smaller donations. People are seeing how we are trying to do something extraordinary because this is a once in a lifetime opportunity,” he said, referring to the blank canvas the vacant, 18.4-acre site offers.

“Eight or nine years ago we were more modest in our ambitions. But the fact that we’ve had this very long gestation period means we’ve been able to crystallize our desire to create something really special.”

The existing 6.7 acre St. Paul’s site has already been listed and is expected to yield at least $800 million. Taxpayers will fund the remaining amount of the new hospital construction.

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Twitter: @MedicineMatters

25Sep

Physicians need to do a better job of protecting patient files: B.C. privacy commissioner

by admin

https://vancouversun.com/


BC Information and Privacy Commissioner Michael McEvoy.


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Doctors’ offices regularly breach patients’ privacy so clinics across B.C. must do more to protect the information in their possession, says a report released Wednesday by the Office of the Information and Privacy Commissioner for British Columbia (OIPC).

The audit and compliance report is based on 22 randomly selected medical clinics where at least five doctors worked. The audit sought to find out whether clinics and their staff are meeting legal obligations under the Personal Information Protection Act (PIPA). The act dictates how private organizations collect, use and disclose personal information.

Medical clinics were chosen for the review because of the massive amount of sensitive personal information they collect and because relative to other private sector organizations, physicians’ offices, medical clinics and labs “account for the largest number of complaints and breach files received by the OIPC over the past five years.”

The scope of the review did not entail a physical inspection of electronic medical records systems, patient files storage systems or actual visits to the clinics. Rather, designated staff at the clinics answered questions and provided written material.

Even without a physical inspection of such clinics, the review discovered numerous problems with the way clinics handled patient information. Many lacked a designated privacy officer, put insufficient resources into privacy procedures and failed to stay abreast of technological advances that would help protect information.

The compliance review report says although there’s an inherently strong bond of trust between doctors and patients, the “troubling reality” is that privacy issues occur regularly in the medical field and the privacy commissioner routinely hears complaints about privacy breaches. Such breaches include accidental disclosures by email, files stolen from doctors’ vehicles, and computer systems that are compromised.

“The harms caused by these breaches can be very serious, leaving victims vulnerable to everything from damaged relationships to humiliation, financial loss and more.”

Michael McEvoy, B.C.’s information and privacy commissioner, said the compliance audit focused on medical clinics because of the large volume and sensitivity of the personal information they collect.

“The results show that while some clinics were complying with their obligations, many have work to do when it comes to improving their privacy practices. There is no question about the intense demands medical professionals face. However, respecting and protecting patients’ private information is critically important.

“Doctors and staff at clinics not only owe it to their patients to do their utmost to build and maintain strong privacy programs, but they are also legally obligated to abide by privacy legislation. I hope that the focus of this report underscores the need for clinics to address gaps in how they protect this sensitive personal information and my office’s willingness to assist them in doing so.”

The report has 16 recommendations aimed at helping clinics address the gaps in their privacy management programs, building better policies and safeguards, and ensuring they provide adequate notification about the purposes of collecting personal information online. The report recommends that clinics develop more robust privacy protocols, better responses to breaches, improved monitoring to ensure compliance and prevent breaches, provide more training for staff, and use more caution when collecting and sharing information online.

More to come.

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Twitter: @MedicineMatters

1Sep

Real benefits to stenting multiple blocked arteries, not just the one that caused a heart attack, study says

by admin

Unblocking additional plaque or cholesterol-clogged coronary arteries with stents after a heart attack — instead of just the one that caused the heart attack — leads to a reduction in the risk of dying or having another heart attack, a multinational study involving B.C. experts and patients shows.

Experts predict the “landmark” study will have immediate implications for heart attack patients as interventional cardiologists will now stent additional coronary arteries with significant narrowing (more than 70 per cent) instead of just the culprit artery that caused the heart attack. There are three major coronary arteries and when heart attack patients have one blocked artery, it is not unusual to see blockages in the others, referred to as multi-vessel coronary artery disease.

The study began in 2013 at hospitals in 31 countries, predominately in Europe and North America. It was published in the New England Journal of Medicine and was presented as a late-breaking session at the World Congress of Cardiology in France.

The COMPLETE study, as it is called, involved 4,041 patients (200 in Vancouver) who were followed for about three years. All patients got stents in the culprit arteries as an emergency rescue measure. But in one arm of the study, half were then released from the hospital and prescribed the usual post-angioplasty medications while in the other study arm, patients had their other blocked arteries stented in what is called complete revascularization, either at the same time as the heart attack causing culprit stenting or within 45 days.


Participants in the COMPLETE trial

Deaths from heart disease, further heart attacks or related to the medical procedure occurred in 179 patients (8.9 per cent) in the complete revascularization group, compared to 339 (16.7 per cent) of those who had only one stent put in.

After a median followup of three years, the risk of a second heart attack or death from heart disease occurred in 7.8 per cent of the patients who had complete revascularization while it was 10.5 per cent in those who got one stent.

“In the past, the gestalt was you do an immediate angioplasty to open the culprit blocked artery and then do less with the other ones, put patients on meds and monitor them instead of fixing the additional blockages at the same time or right after,” said Dr. David Wood, the Vancouver co-principal investigator and director of the Vancouver General Hospital Cardiac Catheterization Lab.

“But in this study, the results show that doing more stenting, even within the first 45 days after the heart attack, was beneficial. There was a 26 per cent reduction in the patients’ risk of dying or having another heart attack.”


Dr. David Wood and Dr. John Cairns at Vancouver General Hospital. The pair participated in the COMPLETE trial, focusing on the effect of stenting additional arteries of heart attack victiims. Photo: Arlen Redekop/Postmedia

Arlen Redekop /

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Dr. Shamir Mehta, the principal investigator of the study led by McMaster University and Hamilton Health Sciences, said the data shows that there are benefits to clearing all the arteries and no major downside to the additional procedures.

“Given its large size, international scope and focus on patient-centred outcomes, the COMPLETE trial will change how doctors treat this condition and prevent many thousands of recurrent heart attacks globally every year,” said Mehta, an interventional cardiologist and a senior scientist at the Population Health Research Institute.

Dr. John Cairns, a Vancouver cardiologist who is the former dean of UBC medical school and a study collaborator said: “(Additional) blockages should be fixed in the first 45 days after a patient’s initial heart attack.”

Leslie Carey was one of the trial participants. In 2015, the Burnaby resident had a heart attack while riding a bus to work,

Carey’s chest pains were so severe that he got off the bus and called 911. Paramedics quickly attended to him in a nearby parking lot, whisking him off to VGH.

Life was stressful at the time but his health was pretty good, or so he thought.

“I didn’t have high blood pressure or diabetes but I was taking meds on and off for cholesterol,” said the 58-year old marine administrator for the Royal Vancouver Yacht Club.

Right after a coronary artery was stented, Carey said he felt so much better. His chest pain was gone. Since he was randomly assigned to the trial arm of patients who would get further treatment, he then had another stent inserted into another partly blocked artery. And months later, yet another stent was added so he now has three stents propping open his major coronary arteries.

“I’m fully wired now,” said Carey.

About 20,000 B.C. residents have diagnostic angiograms and angioplasties — usually with stents — each year and another 2,000 have open heart surgery, which is indicated for more serious cases and for patients with diseases like diabetes, according to a Cardiac Services B.C. provincial registry.


Leslie Carey had a heart attack while on a bus to work at Royal Vancouver Yacht Club and had three stents put in. Photo: Arlen Redekop/Postmedia

Arlen Redekop /

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Mehta said patients who had angioplasties were on the right medications to reduce their risk of a heart attack. No one should jump to the conclusion that the medications weren’t effective.

“We don’t know if the same benefit of angioplasty would be there if they were not on the medication. The angioplasty can be considered as an add-on to the medications to prevent further events.”

Mehta, Cairns and Wood agreed that doing more angioplasties on patients with heart attacks is not going to overburden the Canadian health care system. A future study may look at the economics of “front-loading” angioplasties and Cairns said he thinks there could be some cost efficiencies in addition to health benefits.

“We are well equipped in Canada to perform the additional procedures, particularly since the trial shows they can be done any time within 45 days of the index (first) heart attack,” said Mehta.

The median age of trial participants was about 62 and 80 per cent were male. Study authors said that is because more men have large heart attacks.  About 50 per cent of study participants had high blood pressure and 40 per cent were smokers. Just under 40 per cent had high cholesterol.

The study cost over $14 million; $3 million came from the Canadian Institutes of Health Research and just over $11 million from Boston Scientific and AstraZeneca. The companies had no role in trial design, analysis or manuscript writing, according to the authors.

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Twitter: @MedicineMatters

3Aug

REAL SCOOP: Murdered sailors linked to botched cocaine load

by admin

UCLUELET, B.C. — The small craft harbour here in this stunning spot on Vancouver Island’s west coast is a hub of activity.

Tourists from all over the world board sport-fishing charters and whale-watching boats to check out the rugged coastline. Commercial fishermen tend to their vessels. And visitors sail in for a day or two on boats based in Vancouver, Victoria or farther away.

But all is quiet on the Astral Blue — a 14-metre sailboat whose last two crewmen mysteriously disappeared in the mid-afternoon of May 16, 2018.

The bodies of Squamish resident Dan Archbald and his close friend Ryan Daley, of Jordan River, were found less than a month later on a rutted decommissioned logging road about 12 kilometres from the harbour.

Fifteen months have passed and no one has been charged with their murders.

But a Postmedia investigation has found that the two men were likely casualties of a botched cocaine-smuggling job that they were recruited to do by a Lower Mainland biker.

The bodies of Daniel Archbald, 37, and Ryan Daley, 43, were found 15 months ago, near Ucluelet. RCMP / PNG

RCMP Supt. Sanjaya Wijayakoon, who oversees the Vancouver Island Integrated Major Crime Unit, told Postmedia that the police investigation is still extremely active.

“They are absolutely continuing to investigate both of these deaths. Right now, they are in the process of analyzing physical and digital evidence. They are still speaking to potential witnesses and they are trying to figure out a timeline leading up to both Daley and Archbald’s deaths,” Wijayakoon said in a recent interview.

Key to that timeline is figuring out what the two men did between their landing here on Sunday, May 13 — Mother’s Day — and when they made a final eerie appearance on the harbour security camera three days later, lugging heavy duffel bags out through the parking lot.

Wijayakoon said investigators still need the public’s help to put together all the pieces of the puzzle.

“I know my guys are still hoping that people in the public are able to come forward and that something triggers their memory and they come and talk to us. We are still hoping for that,” he said.

The 14-metre Astral Blue has been moored at Ucluelet’s small craft harbour since May 13, 2018, when its two crewmen arrived from Panama. Boat owner Dan Archbald and his friend Ryan Daley disappeared three days later and were found murdered in mid-June of 2018. KIM BOLAN / PNG

The Astral Blue looks much as it did when it arrived here. The deck is strewn with yellow, red and blue plastic containers. There’s a small rusted-out barbecue tipped over near the stern. A rubber dinghy is upside down over the cabin.

Some fibreglass on the starboard side is damaged. There is no indication of anything untoward.

The white and blue sailboat, built in Taiwan in 1979, was registered with Transport Canada on July 25, 2016, listing its home port as Vancouver, despite then never having landed in Canada.

The boat’s owner remains a B.C. company called Astral Ocean Expeditions Inc.

Corporate records obtained by Postmedia show Archbald and a friend registered the company in B.C. on May 10, 2016. Its address is listed as a Richmond lawyer’s office.

The friend, who asked not to be identified, told Postmedia that he owned only a one-per-cent share of the company and had no direct involvement with the purchase of the Astral Blue.

“Technically, I suppose I’m an owner,” he said, adding that the boat is really owned by Archbald’s widow, who is trying to sell it.

He said he and Archbald had talked for years about running a charter business on the west coast.

“I am also a sailor and if I had the opportunity to do some trips, it would have been great,” he said. “But it wasn’t meant to be a business I was running.”

He confirmed that as he understood it, the boat was purchased in Ecuador, then moved to Panama, where it was moored until Archbald and Daley began their fateful eight-week journey last year.

“I wasn’t even tracking it,” the friend said.

He would have been surprised if Archbald had got mixed up in a drug-smuggling operation, he said, though he admitted that is now the rumour circulating around Squamish and here in Ucluelet.

“I have talked to the police a few times. I didn’t have much to offer them,” he said. “Dan was one of my better friends and I miss him a lot.”

Archbald, a 37-year-old father of two, sometimes worked in construction. And sometimes he worked in the film industry.

Sometimes he was “tight for money,” the friend said, adding that he did not know Daley, a 43-year-old former Squamish resident.

Messages left for several relatives and friends of each man asking for comment for this story were not returned.

The remains of Dan Archbald and Ryan Daley were found in mid-June on E Road, a rutted decommissioned logging road off of the Pacific Rim Highway that is barely more than a trail. KIM BOLAN / PNG

Postmedia has learned that the pair agreed to sail from Panama to Canada with a load of cocaine, believed to total several hundred kilograms. The person behind the smuggling operation is a full-patch Hells Angel, the sources said.

As the men got closer to the B.C. coast, they encountered a U.S. government vessel and panicked. They dumped most of their illicit cargo overboard.

The problem is that they kept some of the cocaine for themselves without telling the person who hired them. Their plan was to dump it at the last minute if they saw anything suspicious as they approached Ucluelet, the sources said.

While authorities didn’t intercept Archbald and Daley, and the remaining cocaine, when they arrived in Ucluelet, associates of the Hells Angel did.

Postmedia has learned that Hells Angel Chad Wilson — a friend of the person behind the cocaine shipment — was tasked with taking care of “the problem” in Ucluelet. Wilson, who was murdered last November, was on Vancouver Island at the time that Archbald and Daley went missing, sources confirmed.

Wijayakoon, the RCMP superintendent overseeing the investigative team, wouldn’t comment specifically on the information obtained by Postmedia.

“My guys are looking at all avenues and it is very, very active still,” he said.

Retired Mountie Pat Convey is all too familiar with the situation in which Archbald and Daley likely found themselves.

When he was a senior member of the RCMP’s Vancouver Island drug squad, he investigated similar cases along the coast here where drugs were smuggled aboard sailboats and fishing vessels. Organized crime “absolutely” sees marine transportation as a tried and true method to move drugs, Convey said.

The largest bust came in February 2001 when U.S. agents intercepted the Western Wind in the Strait of Juan de Fuca off southern Vancouver Island. The fish boat carried more than two tonnes of cocaine destined for Canada.

Boat owner John “Phil” Stirling and three crewmen were arrested and turned over to the RCMP. But they were never charged despite the record drug haul.

“As far as contraband, it was the biggest,” Convey said of the Western Wind.

Stirling continued to sail in troubled waters for years afterwards.

“He is a pretty infamous old bandit as far as bringing stuff in,” Convey said.

In May 2006, Stirling and four others were arrested again — this time here in Ucluelet — after police found $6.5-million worth of marijuana aboard a 47-metre fish boat registered to Stirling. The men were all charged with drug-related offences, but all counts were later stayed.

The Americans captured the notorious B.C. skipper off the coast of Colombia in 2011. His sailboat carried 381 kilos of cocaine. He pleaded guilty in 2013 in Florida and was sentenced to seven years. Less than a year after his 2018 release, Stirling, now 65, was found alone on another vessel off the coast of Oregon this past April. The boat carried 28 seven-gallon jugs containing liquid methamphetamine. He goes to trial in Portland later this month on drug smuggling charges.

Convey said that once someone agrees to sail a shipment of drugs for organized crime, they are responsible for any loads lost — meaning they usually have to continue transporting the criminal contraband to pay off the debt.

“You will be told that whether you like this or whether you don’t like this, you are going to go do this,” Convey said. “If you don’t comply, your chances of survival are not good.”

Like Archbald, Stirling would register a company in B.C., then purchase a vessel in the company’s name. He once told a Province reporter that the record Western Wind shipment was done for the benefit of some B.C. Hells Angels.

Convey said even people without criminal records are willing to take the risk, hoping for a big payoff. Maybe they think they can get away with it just once.

“There is a lot of money involved,” he said. “Just the investment put into it for purchasing the drugs is a large amount of money. So it is not something where one individual would just go down there and pick up a load and come up here and distribute it. It is all taken care of a long time before they set sail from here as to what they are going to do, what their plan is. And also who is going to be involved along the way.”

Sometimes a relatively small vessel carrying cocaine will sail right into a harbour in a place like Ucluelet, which doesn’t have a Canada Border Services Agency post.

And sometimes it will be a “mother ship” operation “where they will come up and they will be met offshore, right out in the international waters, by offload boats that will come right up and meet them and then distribute (the drugs) to several different places or one place depending on what they contracted,” Convey said.

“I have been out of the game for awhile, but I don’t see anything changing significantly. I got involved in it as far back as the ’70s and it didn’t change a lot even in the 2000s when I finally retired.”

Stirling is not the only “bandit” using the open seas to smuggle narcotics into Canada.

In March 2010, Vancouver Island commercial diver Scott Pederson and Mexican citizen Vincente Serrano-Hernandez transported 1,001 one-kilogram bricks of cocaine from Panama to Port Hardy via Ecuador aboard the sailing vessel Huntress. Both were convicted and sentenced to 16 years.

Both have since been released. Parole documents obtained by Postmedia say Pederson now owns two food carts, which prompted some concern from the parole board in July 2017.

“While there may be some concerns with respect to the idea of a convicted drug importer operating a business that is based primarily in cash and therefore would be a good front for drug trafficking or money laundering, there is no reliable and persuasive information indicating you are involved in any illegal activity,” the board’s written decision said.

As for Hernandez, he continued to deny knowledge of the tonne of cocaine he sailed into B.C. waters, claiming he was “to be paid $2,000 to accompany the lone captain to Canada and that once in Canada you would be offered a job,” the parole board noted in 2016. “In Mexico, you lived in the Sinaloa region which is well known for drug cartel activities. You have denied any involvement with gangs or Mexican cartels.”

He has since been deported.

The drive from the small craft harbour through the Ucluelet-Tofino junction then east along the Pacific Rim Highway to the entrance to E Road takes less than 15 minutes at the posted speed limit.

The killer or killers would have driven through the dense coastal forest, past Lost Shoe #1 Creek, then Lost Shoe #2 Creek before turning right on the gravel road where Archbald and Daley were dumped.

After about 300 metres, the unmarked logging road is barely more than a trail, suggesting the suspects would have had to turn around in the only small clearing to escape back to the highway. A woman walking her dogs found the remains of Archbald and Daley four weeks later.

The double murder — an extremely rare occurrence in this part of B.C. — has not really set the locals on edge. They don’t feel a strong connection to the case. They didn’t know the victims. They don’t believe that any suspects are in their midst.

The last person slain here was Shirley Ann Taylor-Seydel, who was bludgeoned to death on the docks on July 6, 1991, by fisherman Steven Hillairet, a stranger with mental health issues. There is a small picnic area in her memory overlooking the harbour.

The Astral Blue remains moored here for now. A brokerage company has been contacted and the boat, estimated to be worth about $100,000, will soon be sold.

At the Cap’n Hook, a unique shop selling fishing tackle and cappuccino, patrons sip their coffee, look out over the harbour and speculate about whether the boat will go for a bargain price.

Caleb Cameron, who was born and raised in Ucluelet, owns Cameron Ocean Adventures – a whale watching and sports fishing company.He says locals assume that the Astral Blue was smuggling drugs at the time the two crewmen disappeared and were later killed. KIM BOLAN / PNG

Caleb Cameron, who was born and raised in Ucluelet, is down on the docks every day operating his whale-watching and sports-fishing company — Cameron Ocean Adventures.

“When the murders happened, it seemed like a very isolated incident. There have been drug busts here in the past but not anything like this,” he said. “It seemed like a major case — a larger case than we usually see — because of all the police resources that were brought here.”

He didn’t see the two men at all between May 13 and 16, though he noticed the Astral Blue after it docked as a boat he wasn’t familiar with.

“It was fairly shocking. From the rumours that had been circulating that it was a drug boat that came up from Panama, it made sense,” he said. “I do have some people come down and ask about it. It is known on the dock as ‘the drug boat.’ ”

Ucluelet Mayor Mayco Noël said the murders have had “zero impact” on the community of 1,800.

“There is nobody up in arms, racing to the RCMP detachment saying that there’s a problem. It is something very isolated and local to that event,” Noël said this week. “It is just isolated to those certain groups and those individuals. No one in the community is feeling threatened in any way.”

Ucluelet residents still “are just curious to know what happened,” the mayor said.

“Everyone has got their own theory, so it will be interesting to see what actually comes out of it.”

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Blog: vancouversun.com/tag/real-scoop

twitter.com/kbolan


22Jul

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

by admin


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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Twitter; @MedicineMatters




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23May

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

by admin


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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15May

Richmond Hospital leads the way as birth tourism continues to rise

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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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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

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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29Jan

Overbilling Vancouver physician faces discipline hearing

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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 $2 million related to medical service over-billings now faces a disciplinary hearing for refusing to answer questions from the College of Physicians and Surgeons of B.C.

Nguyen has been summoned to the college discipline committee meeting Feb. 12. The purpose of the hearing is to inquire into his “conduct or fitness to practise medicine in B.C.”

He is charged with failing to respond to multiple communications and correspondence from the college. But when there are serious findings by the Medical Services Commission about irregular, or even fraudulent, billing by doctors, as there was in 2017, the case often ends up back at the college for an investigation into the doctor’s ethical and professional conduct.

Nguyen graduated from the University of Montreal medical school in 2002. He specializes in physical and rehabilitation medicine, otherwise known as physiatry. Such doctors — there are three dozen in B.C. — have a broad range of knowledge about the musculoskeletal, neurological, rheumatological and cardiovascular systems.

Outpatient physiatrists (those working in communities as opposed to in hospitals) would see patients with orthopedic injuries, spine-related pain and dysfunction, occupational injuries and overuse syndromes, and chronic pain, for example.

Kristy Anderson, a spokeswoman for the Ministry of Health said Nguyen can’t bill the Medical Services Plan until he is eligible to re-enroll after May 31 of this year. Strangely, Nguyen’s medical receptionist told a reporter over the phone that an appointment could be booked after a doctor’s referral and that he doesn’t charge patients directly; a B.C. Services Card (formerly known as the CareCard) can be used, she said.

Although the government insists that doctors should never bill patients directly for medically necessary services, Nguyen can do so during the temporary de-enrolment.

“During this time, Dr. Nguyen can practise medicine; it is only the college of physicians and surgeons that can remove that right. But he cannot bill to the Medical Services Plan,” Anderson said.

Susan Prins, spokeswoman for the college, said that as a specialist in physical medicine and rehabilitation, “it is reasonable that a major part of his work might be privately funded, independent medical exams, but I can’t confirm that’s the case.”

Neither of the officials could answer why the receptionist told a reporter posing as a prospective patient that a visit would be publicly funded.

It’s unclear if Nguyen has paid back the $2 million he agreed to repay after an audit found a large number of billing irregularities. The government refuses to divulge 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 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,” she added. 

Last year, the commission issued a report that said an onsite 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.” 

According to the latest commission report, the government body was able to recover about $8 million in 2017-18 from 18 audited doctors who were deemed to have over-billed in recent years.

There are about 11,000 doctors in B.C.

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Appeal court rejects bid by first doctor ever thrown out of B.C. Medical Services Plan

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