11-year-old Kaitlyn, with help from mom Amanda Sidhu, gives Dr. James Lee a wave during her online appointment with the B.C. Children’s Hospital specialist. Kaitlyn was in Abbotsford, Lee in Vancouver Kent Kallberg
For Amanda Sidhu, ensuring her daughter Kaitlyn got the medical care she needed was complicated and time-consuming, living as they do in Mission.
As an 11-year-old with semi lobar holoprosencephaly, a brain condition that causes seizures, diabetes and bone problems, Kaitlyn sees several doctors at B.C. Children’s Hospital every couple of months. She uses a wheelchair, doesn’t speak and is fed through a tube.
Trips to the hospital were disruptive. Amanda had to take a day off work and arrange for a nurse to be in the car for the one-hour-plus drive each way into Vancouver for a 15-minute appointment.
The trips stressed out mom and daughter, who dislikes car rides and associates the hospital with the unpleasant experience of surgeries, said Amanda.
So she welcomes the opening of the two virtual care sites in the Fraser Valley, in Abbotsford and Chilliwack, which allows Kaitlyn to have an appointment online with neurologist Dr. James Lee and her other specialists.
“It takes a lot of the stress from her, like a long 2½-hour drive in the car, and this is just a short drive from home,” said Amanda, after Kaitlyn’s virtual appointment on Friday at the Abbotsford Regional Hospital. “It’s great, Dr. Lee’s amazing, and we’re able to talk about everything we need to talk about and get everything figured out over the computer.”
And Kaitlyn can be cared for by the nurse at the centre, if needed, she said.
She said she has friends and relatives who live in the Interior and they have to take a week off to travel to Vancouver for appointments.
The two sites in the Fraser Health region — where about 300,000, or 40 per cent of B.C.’s children, live — are the 18th and 19th virtual sites opened in B.C. for young patients to have virtual appointments with B.C. Children’s Hospital doctors, according to the hospital.
“This is a great opportunity for patients to get care closer to home,” said Lee, who said the video conferencing option removes the geographical and distance barriers to health care.
Having a virtual appointment can “decrease the burden of travel on our patients and their families,” especially with patients with complex medical needs that require seeing several specialists, he said.
A nurse is always in the room and can take vital signs and other measurements for the doctor, he said.
He said most young people are comfortable using computers to communicate. “For young people and children, this is probably completely pretty natural for them because they may not have known anything else,” he said.
It’s an innovative way to deliver care to pediatric patients across the province, said Kit Johnson, a provincial director with Child Health B.C.
The virtual sites are located in rooms with child-friendly decorations and pediatric equipment in facilities for health care providers, including hospitals, health units and wellness centres.
The 19 telehealth centres in B.C. is part of a collaboration between Child Health B.C., B.C. Children’s Hospital and the provincial health authorities.
B.C. Children’s Hospital doctors do about 140 virtual appointments a month.
It’s GoByBike week in B.C. But in Mission, most go by car.
A “pop-up” bike lane along 7th Avenue appears to be doing little to change that, as it was almost deserted Thursday afternoon.
“It’s just a pain,” said Michelle Leggett as she walked her six-year-old daughter Madeline Lutz home from school. “I think I’ve seen four bikers all week, and I’m pretty sure they’re regulars.”
To create the lane, city staff closed one side of the street to parking from Monday to Friday. As a result, the side streets around the high school have been overwhelmed with parents dropping off their kids.
“We’re just too far out here,” said Leggett. “People commute to Vancouver or Burnaby, and they need a car.”
But despite public reluctance, bike lanes are being built in some of B.C.’s most car-centric communities. Earlier this week, the provincial government announced $10 million in cycling infrastructure funding across the province. It will be up to municipalities to change public perception — and tackle the challenges that come along with building a cycling network in the suburbs.
Mission’s pop-up bike lane is part of that. Council has already approved a permanent bike lane along 7th Avenue, and the temporary lane is designed to increase public engagement and gauge public reaction to the idea, said Mission Community Cycling Coalition member Rocky Blondin.
“The design work on a permanent bike lane will be informed by what happens this week,” said Blondin, who is president of the Fraser Valley Mountain Bike Association.
The lane’s usage was “modest” at the start of the week, but seems to be increasing as people realize there is another option to get to school or the recreation centre. It’s the city’s first east-to-west bike lane and its first protected bike lane.
“It takes time for people to start thinking differently,” said Blondin.
There are several challenges to increasing cycling in the Fraser Valley, according to advocates. While the number of bike lanes in cities outside Vancouver is increasing, many communities still lack a comprehensive network that can safely and efficiently take cyclists where they want to go.
“The strength in Vancouver is in a cycling network that’s connected and can get people from Point A to B,” said Erin O’Melinn, executive director of non-profit advocacy group, HUB Cycling. “The Fraser Valley is not yet at that point.”
Unused bike lanes give critics fodder for their fight against more cycling infrastructure during public consultation on the issue, she said.
“But cities need to understand that you can’t build a north-to-south route and expect it to be used. You need east-to-west too. The network is the game-changer.”
Some Fraser Valley cities are also challenged by the fact that their main roads are highways. Many cyclists aren’t comfortable biking on the shoulder of King George Highway or Lougheed Highway. Side roads often end in cul-de-sacs.
In Mission, where up to 70 per cent of residents leave town for work, it’s difficult to increase bicycle commuting when people must travel long distances.
But O’Melinn said progress is being made. With funding contributions from other levels of government, many cities are beginning to create cycling infrastructure, which remains cheap compared to other transportation options.
Surrey, in particular, has made significant strides in connecting its downtown core, she said, although the municipality’s size presents a challenge for linking the entire community.
Abbotsford signalled its intentions to make cycling a priority earlier this year with a new pedestrian and cycling bridge over Highway 1 connecting the University of the Fraser Valley to a main thoroughfare. The bridge is adorned with dozens of recycled aluminum bike wheels.
Elsewhere in the Fraser Valley, progress on bike lanes is “hit and miss,” said University of the Fraser Valley urban geography professor John Belec. “It depends on the interest of each particular council to move forward on it.”
There is also significant backlash from a segment of the population that believes “roads are primarily for cars, and as a public space, cars have priority,” he said.
While councils may not be able to push through a comprehensive bike network all at once, many are beginning to lay the groundwork and put small segments in place.
“It takes courage and energy — and a faith that they will be used,” said Belec.
In Chilliwack, cycling advocates are working to fill in the “gaps on the map,” said David Swankey, co-chair of Cycle Chilliwack. Using a rail corridor that loops through the community, the challenge is to develop clear and safe routes from there. The city is still working to determine what those routes will look like.
Swankey said advocates want to see routes that are accessible and safe for everyone, including seniors and kids on their way to school, which would increase their use.
“It’s an ongoing to process to see how it will roll out in the years to come,” he said.
Earlier this week, the provincial government announced $10 million in funding for cycling infrastructure projects across B.C. Municipalities must apply for the grants, which cover between 50 to 75 per cent of project costs, depending on population.
The BikeBC money helps communities pay for new bikeways, or improve safety and accessibility on existing pathways.
Several cities on the South Coast received funding for 2019-20, including:
• The City of Abbotsford is approved to receive $299,685 for a separated two-way cycle track connecting elementary, middle and high schools to the recreation centre, library and the Discovery Trail.
• The City of Chilliwack is approved to receive $437,263 to extend a separated pathway between Airport Road and Hocking Avenue on the Valley Rail Trail, providing a north-south connection for all ages and abilities.
• The City of North Vancouver is approved to receive $1 million toward the Casano-Loutet cycling and pedestrian bridge over Highway 1.
• The City of Pemberton is approved to receive $7,500 to develop a cycling network plan that addresses active transportation within the community.
• The District of Squamish is approved to receive $210,450 for upgrades to the Dentville section of the Discovery Trail, which will include a separated paved path with lighting.
• The City of Vancouver is approved to receive $150,925 for cycling and pedestrian safety improvements at the 800 Robson Street Permanent Plaza.
• The City of Vancouver is also approved to receive $1 million for upgrades to the downtown bike network.
• The District of West Vancouver is approved to receive $50,700 for separated bike lanes between the districts of West Vancouver and North Vancouver.
The exterior of Surrey Memorial Hospital. Arlen Redekop / PNG files
Chilliwack Mayor Ken Popove is demanding answers from the Fraser Health Authority after a 76-year-old woman with mobility and severe incontinence issues was discharged from Surrey Memorial Hospital and sent by taxi to the Chilliwack Salvation Army shelter early last month.
In a letter to Fraser Health CEO Dr. Victoria Lee, the mayor said he is aware of two cases in which shelter staff were asked to take patients from the Surrey hospital without being told about the care they required.
“A homeless shelter is no place for a person with health concerns or special medical needs,” the mayor said in the letter, which was sent to Fraser Health on Tuesday. “Discharging patients into homeless shelters when they still require some level of care is not an acceptable practice. Homeless shelters provide clients with a cot for the night which is not suitable for a recently discharged patient.”
In his letter, the mayor recounted the case of an elderly woman who arrived from the hospital by taxi on Feb. 2.
“According to the Salvation Army, this elderly individual arrived with a walker and some significant health concerns, including incontinence, and is unable to clean herself,” said Popove. “Shortly after her arrival, it was clear that the Salvation Army would be unable to accommodate her at their shelter due to sanitary and safety concerns.”
The woman was transferred to a temporary shelter without stairs, but “her physical and mental health needs continued to make it impossible for staff to care for her.” She left the shelter on her own and returned to the Salvation Army.
On Feb. 22, the shelter received another call from Fraser Health about a man who was being discharged from Surrey Memorial and needed a bed.
“After further investigation, they learned that the patient was in a wheelchair, had open wounds on his feet and needed to be in a hospital bed,” said the mayor. “This information was not disclosed by the social worker, and shelter staff realized they would be unable to provide the level of care this individual requires.”
The mayor asked the Fraser Health CEO to answer several questions, including whether hospitals regularly discharge patients into homeless shelters.
“I would like to know why vulnerable people are being sent to Chilliwack homeless shelters from another community,” Popove added. “How is it possible that a 76-year-old woman with multiple significant health concerns could have been discharged from Surrey Memorial Hospital and sent via taxi to a homeless shelter in Chilliwack over 70 kilometres away from her home, friends and family?”
Popove asked for a meeting with Lee to discuss the situation and “to ensure this woman is reconnected with her community and proper care.”
Fraser Health spokesperson Tasleem Juma said Fraser Health received the letter late Wednesday and is looking into the mayor’s claims. She could not comment on specific cases, but explained that patients are sometimes discharged from hospital into a shelter when they are “deemed to be medically stable.”
Like someone who is being discharged to a home, Fraser Health ensures community supports are in place for the person, and shelter staff are informed and must agree to the situation, she said.
Juma was unable to say if Fraser Health staff followed this procedure in the two cases mentioned by Popove in his letter.
There are now 17 cases of measles in B.C., the latest of which is located in the Fraser Valley and is linked to the Vancouver outbreak.
The most recent case was confirmed Wednesday in a Fraser Valley resident, according to Fraser Health medical health officer Aamir Bharmal. The individual had been exposed to one of the infected measles patients in the outbreak originating at two Vancouver schools.
“This individual was isolated since their exposure and there is no concern relating to public exposure at this time,” Bharmal said in an emailed statement.
He also confirmed there is no measles outbreak at any Fraser Health-area schools and no known measles exposure in Fraser Health’s coverage areas.
The Fraser Health authority is warning anyone who uses drugs that fake pills are being sold on the street as pharmaceutical Xanax that are tainted with a synthetic opioid and cannabinoid.
Fraser Health said in a public drug alert that it tested pills at the Safepoint supervised consumption site in Surrey and detected the synthetic opioid U-47700 as well as a synthetic cannabinoid. People who use the drug could potentially overdose or die.
“Reports indicate there may be large quantities ready for distribution,” according to Fraser Health.
The harm-reduction website Erowid reports that U-47700 first became available through online vendors in late 2014, and has been detected in counterfeit pharmaceutical opioids and associated with deaths.
Synthetic cannabinoids are a class of chemicals that affect the body in a similar way to cannabinoids found naturally in the cannabis plant, according to Erowid.
The health authority said U-47700 will respond to the overdose-reversing drug naloxone but because U-47700 is not related to fentanyl, people who bring the fake Xanax pills to be checked with fentanyl test strips will get a negative result.
“This may lead them to think their pill is a pharmaceutically made drug and safe to use, which is incorrect,” Fraser Health said.
The health authority is urging people who use drugs to look out for each other. It recommends they not use alone or plan for someone to check on them, stagger use with friends so someone can respond in the case of an overdose, test their drugs by using small amounts first and going slowly, and not mix drugs with alcohol or other drugs.
If someone does overdose, they should call 911, open the person’s airway and give rescue breathing, and administer naloxone if possible.
A Vancouver Coastal Health spokesman said Friday that the fake Xanax pills haven’t been recently reported in the region, but urged people who use drugs to follow the safety protocols noted by Fraser Health.
A year after Fraser Health told hospices and other care facilities to stop transferring clients for medically assisted deaths, the Delta Hospice Society continues to openly defy the edict.
Operators of many palliative care hospices — even those that are non-denominational — refuse to provide medical assistance in dying (MAiD) because they contend it conflicts with their principles that death shouldn’t be hastened.
Freedom of information documents (FOI) obtained by Dying With Dignity show there appears to be ongoing confusion about the process when it comes to patients seeking MAiD in facilities like the Irene Thomas Hospice in Ladner (operated by the society) that don’t want to provide it.
Each month, patients in pain are being moved from hospices to places like Queen’s Park Care Centre in order to get their dying wishes respected, the documents requested by Dying With Dignity reveal. The problem with transfers is that they’re uncomfortable and distressing for patients and their families.
“The documents speak to why Fraser Health made its decision late last year (to compel MAiD to be provided where patients reside), and they also complicate the Delta Hospice’s narrative that forced transfers for MAiD are not harmful and not a significant problem,” said Dying With Dignity’s spokesman Cory Ruf.
“I would say that the conflict between the health authority and the hospice is unique and potentially nationally significant. I’m not aware of any instances of a hospice battling a regional health authority over the provision of assisted dying,” he said, referring to the fact that Delta Hospice Society leaders have repeatedly stated they will not provide MAiD. The society’s leaders couldn’t be reached for comment Tuesday but in previous interviews Delta Hospice society operators complained they were victims of Fraser Health bullying and MAiD activists who want the service provided in all hospice palliative care facilities.
The FOI documents show that just over 20 per cent of MAiD deaths in the region between June 2016 (when MAiD became legal) and December 2017 (when Fraser Health told facilities to stop making transfers) involved a transfer from a hospice. During that 18-month period, 107 people reportedly used MAiD in the Fraser region. And of those, 27 involved transfers to homes, hospitals and other facilities so the service could take place.
“This number is astounding,” said Ruf, adding that while transfers are occurring across the country since many faith-based facilities are opting out of MAiD, hospices haven’t been given an exemption since they’re usually non-denominational.
“As an organization, we find it extremely problematic that people at end of life are being discouraged from getting, or are being denied access to, hospice palliative care simply because they’re considering a request for MAiD.”
Hospices are places where individuals go to receive palliative care for pain and symptom management of their life-limiting illnesses. Average stays are usually about two weeks. The goal is to offer physical comfort and emotional support at the end of life when dying is a “normal” process.
Fraser Health didn’t respond to questions about the controversy Tuesday, nor did the Ministry of Health.
The Ladner hospice has a contract with Fraser Health to supply 10 beds; it derives a sliver under half its income from the health authority while the rest comes from charitable donations and fees.
Ruf said transfers aren’t unique to Fraser Health. Dr. Ellen Wiebe, a Vancouver MAiD provider, said her patients are being transferred from hospices “on the last day of their lives.”
“People are in hospice because they are at the end of life and cannot manage at home. In hospice, they have comfortable private rooms with staff to help them. To be forced to transfer into a wheelchair or stretcher, travel by van to another facility, and then transfer to another bed can be exhausting and excruciatingly painful for someone at the end of life. In the last hour of his life, one of my transferred patients had to wait for an elevator beside three men using jackhammers. Another was so weak and exhausted after the trip that, although he had transferred himself at the hospice, he could not do so at the other facility and fell. This kind of suffering is preventable and unacceptable.”
On Vancouver Island, Dr. Tanja Daws said there are no non-denominational, non-Catholic hospital or hospices in Comox to deliver MAiD to her patients and in one case recently an individual had MAiD in the lobby of a funeral home while another had to be transferred from a hospice to a conference room where the board table and other furniture had to be moved around. “The janitor was just outside, in the hallway, and we had no choice but to try to keep him away.”
The FOI documents Ruff obtained show that there have been complaints over various matters, including one family being told in error that paying for the transfer was their responsibility when in fact that facility doing the transfer is obliged to pay.
“One social worker with the FHA’s MAiD program wrote that a transfer involved moving mountains and expressed concern that these policies don’t represent a patient-centred approach to care,” he said.
The federal legislation states that no individual can be compelled to provide medical assistance in dying. But it doesn’t define where assisted dying should be provided. It’s up to provinces and health authorities to figure out how to deliver services and to create policies.
The federal governments latest report on MAiD shows that across Canada there were 3,714 MAiD deaths from December 2015 to the end of 2017. Hospitals and homes are the preferred setting, each accounting for about 42 per cent of MAiD cases while hospices account for only three per cent of cases in Canada (five per cent in B.C.) B.C. and Ontario led the country in MAiD cases. There were 365 cases in the last half of 2017 in B.C. and about 100 more than that in Ontario.
Alex Muir, a Dying with Dignity volunteer in Vancouver, has sent a letter to the premier, health minister and other B.C. officials, describing procedures that are limiting access to MAiD. Patient transfers are a big problem, he says, because if a frail person nearing the end of life needs hospitalization and paramedics take them to St. Paul’s, a Catholic-based Providence Health facility, then they won’t get MAiD there since the hospital has been given a religious-based exemption by the province.
“The transfer itself can be physically brutal for the patient and emotionally draining to that person and their loved ones,” he said.
As well, since patients awaiting subsidized residential-care beds can’t always choose the facility where they will be admitted, they may end up in one that doesn’t allow MAiD, “again resulting in a forced transfer if they choose this path.”
The forced transfers should end, Muir says.
“While the government has allowed clinicians who oppose MAiD to opt out of directly participating in it, this right should not be afforded to facilities. An individual has a conscience. Bricks and mortar do not,” Muir said.
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