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Posts Tagged "surgery"

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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28Apr

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

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


Arlen Redekop / PNG

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Twitter: @MedicineMatters




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5Feb

BC wait times to be cut for Parkinson’s patients needing brain surgery

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Surgical operating room.


Vancouver Sun

British Columbia plans to double the number of deep brain stimulation surgeries for patients with Parkinson’s disease whose symptoms don’t improve with medication.

The Health Ministry says 72 surgeries will be performed in the current fiscal year, up from 36 operations, as part of a program starting in April.

Health Minister Adrian Dix says the surgeries at UBC Hospital in Vancouver will be done within 12 weeks.

Only one neurosurgeon does the surgeries in B.C., and Dix says the province aims to recruit another doctor to increase access for patients who often experience tremors, stiff muscles and balance problems.

Dr. Christopher Honey currently performs the primary surgery as well as replacement of batteries that are like pacemakers implanted in patients’ chests, but Dix says another surgeon will now assist with the latter operation.

Deep brain stimulation is an invasive eight-hour surgery performed while the patient is awake to target a specific area of the brain and alter its activity.

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4Feb

Shot transit cop to undergo surgery

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The Metro Vancouver transit cop who was shot while working in Surrey is scheduled to have surgery later this week.

Transit Police Const. Josh Hams, 27, was injured when he was shot at the Scott Road SkyTrain Station Jan 30.

Harms was taken to hospital but later released. 

Daon Glasgow, who was wanted in connection with the shooting, was captured early Sunday morning in a large police operation after a four day manhunt led them to a Burnaby house in the 7500 of Boundary Road.

The nature of the confrontation between Harms and Glasgow has not been released, nor has any information about Hams’ injury.

According to Transit Police spokesman Sgt. Clint Hampton, Harms insisted on going into work over the weekend to speak in-person with his troop mates.

“That was something that he wanted to do on his own. He felt it was important for his colleagues to see him walking and talking … to know that he will recover,” said Hampton. “Obviously he’s got a long road ahead.”

Harms’ wife is expecting the couple’s first child in about a month.

He has a family connection to his employer. Father-in-law Mike Cumberworth is Metro Vancouver Transit Police’s deputy chief of operations.  

The Surrey RCMP has released this composite of Glasgow’s many looks. (Surrey RCMP)

According to Hampton, the approximately 100 members of the Metro Vancouver Transit Police carried out close to 900 warrant arrests in 2018.

Glasgow was out of prison on statutory release and wanted on a warrant for being unlawfully at large at the time of the shooting. 

Glasgow previously pleaded guilty to manslaughter in a fatal 2010 shooting that took place during a drug deal in a McDonald’s washroom, only blocks from where Harms was shot. 


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4Feb

Shot transit cop undergoes surgery

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The Metro Vancouver transit cop who was shot while working in Surrey is undergoing surgery today for his undisclosed injuries. 

In a statement, Const. Josh Harms said he thanks God his injuries were not worse. 

“Though I have a long road ahead, I am going to make a full recovery and rejoin my colleagues as soon as possible,” he said. 

The 27-year-old was shot while on patrol at the Scott Road SkyTrain Station Jan 30.

Harms was taken to hospital but later released with non-life threatening injuries.

Daon Glasgow, who was wanted in connection with the shooting, was captured early Sunday morning in a large police operation after a four day manhunt led them to a Burnaby house in the 7500 of Boundary Road.

Traffic Const. Josh Harms and a furry friend in an undated Facebook photo. He and his wife are expecting their first child in March. (Facebook)

The nature of the confrontation between Harms and Glasgow has not been released, nor has any information about Hams’ injury.

According to Transit Police spokesman Sgt. Clint Hampton, Harms insisted on going into work over the weekend to speak in-person with his troop mates.

“That was something that he wanted to do on his own. He felt it was important for his colleagues to see him walking and talking … to know that he will recover,” said Hampton. “Obviously he’s got a long road ahead.”

Harms’ wife is expecting the couple’s first child in about a month.

He has a family connection to his employer. Father-in-law Mike Cumberworth is Metro Vancouver Transit Police’s deputy chief of operations.  

The Surrey RCMP has released this composite of Glasgow’s many looks. (Surrey RCMP)

According to Hampton, the approximately 100 members of the Metro Vancouver Transit Police carried out close to 900 warrant arrests in 2018.

Glasgow was out of prison on statutory release and wanted on a warrant for being unlawfully at large at the time of the shooting. 

Glasgow previously pleaded guilty to manslaughter in a fatal 2010 shooting that took place during a drug deal in a McDonald’s washroom, only blocks from where Harms was shot. 


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15Jan

B.C. surgery wait list has grown faster than population, anesthesiologists say

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Surgical operating room.


Vancouver Sun

Anesthesiologists in British Columbia say the waiting list for medically necessary surgeries has grown to more than 85,000 patients.

The B.C. Anesthesiologists’ Society says since 2002, surgical waiting lists have increased by about three times the growth rate of the provincial population.

The society says its research up to the end of the 2018 fiscal year shows about one-third of those who require surgery have been delayed longer than the benchmark limit.

CEO Dr. Roland Orfaly says the purpose of a discussion paper released Tuesday is to signal that anesthesiologists want to work with the government and other health-care providers to find solutions.

The society represents 400 specialist doctors who work at every major hospital in the province and care for about 300,000 surgical patients every year.

The Health Ministry was not immediately available to comment.

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16Nov

B.C. government to bring lower transgender surgery to the province

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Reconstructive lower surgery for transgender people will soon be available in British Columbia.

Health Minister Adrian Dix says the trans community has advocated for a number of years for improved access to care for the complex surgeries in B.C.

Up until now, those wanting the surgery had to travel to Montreal or the United States, which Dix says resulted in additional medical risks associated with travelling long distances after surgery and with follow-up care.

The Health Ministry says gender-affirming surgery will be available at Vancouver Coastal Health starting next year and trans people will also have improved access to publicly funded chest and breast surgeries throughout the province.


Health Minister Adrian Dix

Nick Procaylo /

PNG

Dix says B.C. is the first province in Western Canada to provide the surgeries.

The government says about 100 people travel out of the province for the lower surgeries every year and about 200 chest and breast surgeries are expected to take place in B.C. in the coming year.


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7Nov

Pipes at VGH burst, sending dirty water into operating rooms while patients had surgery

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A full complement of 18 to 20 operating rooms at Vancouver General Hospital will finally be back in use Thursday after a burst water sprinkler pipe caused unsterile water to leak into multiple operating rooms through lights and air vents while surgeries were taking place.

Postmedia has learned that midway through long, complex cancer and other urgent surgeries on Oct. 30, medical teams noticed water dripping from a handful of operating room (OR) ceilings, potentially compromising the safety of patients undergoing surgery. Operations in progress were completed, but half the ORs were then closed, resulting in the cancellation and rescheduling of nearly 100 urgent and lifesaving cases.

Hospital officials confirmed the crisis Wednesday.

A mishap during construction work on the third floor of the hospital was what led to the burst pipe, causing water to leak through a mechanical subfloor just above all the ORs on the second floor of the Jim Pattison Pavilion. The water then dripped through light and ventilation shafts into the ORs, but fortuitously, not directly onto anesthetized patients undergoing surgery.

It was 11 a.m. and several operations — some of them five hours in duration and longer — were in progress, with numerous patients in the holding area. Surgeons and infection control experts made immediate assessments on whether it was safe to continue the operations. In one case, a surgeon decided it was not safe to continue working in the leaking OR, so the patient on the table was temporarily closed up with sutures and the medical team moved the patient to an adjacent room where the all-day operation resumed.

One cardiac case that was in a critical stage proceeded in the leaking room as hospital staff sealed off the sterile area with plastic.

Dr. Marcel Dvorak, a spinal surgeon who is associate medical director at Vancouver Coastal Health, said multiple ORs had “active water” dripping into the peripheral areas of the ORs. Nurses and other hospital staff “flew into action” using blankets to soak up water on the floors and suctioning water off equipment and surfaces. Tens of millions of dollars worth of electronic and sterile surgical equipment had to be protected and sealed with plastic.

In the 10 days since the leak, dehumidifiers have been drying out the moisture and new drywall has been installed.

There were no “untoward” incidents involving patients developing infections or other surgical complications as a result of the mishap, according to hospital administrators. The event was disclosed to all patients effected.

In one OR, the operation continued without incident for a number of hours, and in another, a patient was moved while under anesthetic “because it was deemed to be the safest thing to do.” Several rooms were considered “mechanically safe” with electrical and humidity systems intact so operations in progress were completed, but 13 other cases that were scheduled for that day were cancelled, Dvorak said.

“All emergency cases, like trauma, were managed, and that’s saying a lot because 60 per cent of our cases are emergencies — like transplants, ruptured aneurysms, cardiac emergencies, spinal cord injuries, etc., which means they are unscheduled,” he said.

The construction work going on the floor above the operating rooms is a $102-million OR expansion that will see 16 new ORs open in 2021.

VGH does about 16,800 surgical cases a year and with the addition of 16 more, capacity will increase to about 19,000 cases per year. Typically surgeries that take place at VGH are complex cases, while UBC Hospital shoulders the “more predictable” day surgeries.

“VGH treats the sickest of the sick from all over the province,” Dvorak said.

The existing ORs at VGH are 30 years old and considered too small for many types of cases requiring big medical teams, robotics and imaging equipment. Eventually, the existing ORs could be decommissioned or replaced. Dvorak said the OR expansion is “on time and on budget.”

He said anyone who has ever done renovations knows they can expect problems of some sort. “This was an out of the blue incident.”


Andrea Bisaillon is VGH’s operations director for surgeries.

Arlen Redekop /

PNG

Andrea Bisaillon, an operations director at VGH, said: “The exact details of who did what is now being investigated. Our first priority was focusing on keeping patients and staff safe.”

She said PCL is the overall contractor for the construction project. The restoration company that has been retained for the salvage effort is called Proactive and “they are extremely aware of the fact that our first priority is the safety and lives of our patients.”

Dvorak said emergency preparedness exercises that hospital staff undergo to prepare for natural disasters such as earthquakes or other crises proved their worth.

“Simulation exercises that we do to learn how to handle mass casualties and other critical incidents help us prepare for these kinds of scenarios.”

Carrie Stefanson, a spokeswoman for the hospital and health authority, praised the efforts of hospital staff, both during and after the crisis.

During a week of repairs and remediation, VGH has continued to meet the needs for emergent, urgent and transplant surgeries, including a cardiac diversion case from Royal Columbian Hospital.”

The leak issues at VGH evoke a similar — if not more serious — crisis at Surrey Memorial Hospital six years ago when contractors broke a water main causing knee-deep flooding in the emergency department and other areas.

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Twitter: @MedicineMatters




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23Oct

After surgery, 15 per cent of B.C. patients rush back to hospital, mainly due to pain, bleeding or infections

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Royal Columbian Hospital Emergency Room entrance.
While Dr. McDonald said the study was done on patients who went to the Chilliwack hospital, she believes the results can be applied more generally.


Ward Perrin / PROVINCE

Post-operative visits to the emergency department are fairly common with just over 15 per cent of patients going to a hospital emergency department within six weeks after any type of surgery, a B.C. study shows.

The most frequent complaints and diagnoses were surgery-related pain, infections, and bleeding, according to the cover-featured study published in the B.C. Medical Journal.

Study co-author Dr. Susan McDonald said that since more and more patients are released the same day as their operations, patients are losing close attention and education from nurses. That loss in post-operative oversight has increased the likelihood that patients will experience concerns or complications after they’ve been discharged.

McDonald, a general surgeon at Chilliwack General Hospital, said some surgeons tell patients to come back for follow-ups two to three weeks after their operation, while others stipulate six weeks; often it has to do with the complexity of the procedure. But patients often feel they can’t wait that long when problems arise.

The finding that 15.1 per cent of surgery patients are rushing to the emergency department within weeks following surgery suggests there are quality improvement measures required, McDonald said. She’s urged the Fraser Health Authority, for example, to immediately notify surgeons when one of their patients has returned to the hospital. But she said the health authority has to find a workaround to alter the way computerized hospital records are formatted so that surgeons can receive such notifications whenever one of their patients has a post-operative problem.

“As a surgeon, I want to be alerted about patients who have complications. I can’t fix anything I don’t know about,” McDonald said. “Surgeons need this information as well for their own personal learning. It’s disheartening when patients develop infections. They lose faith in their doctors and in the system.”

She said patients also need to ask more questions, be given more information as part of their informed consent process, and be urged to read and retain the handout brochures they are given so they know what to expect after surgery.

The study was based on the charts — marked for the study purposes with a red dot — of about 250 post-operative patients who went to the Chilliwack hospital in the summer of 2015.

Of the total, just over half had their surgery at that hospital while the rest had their operations in other hospitals. Only two patients who went to the ER required admission to hospital while the rest were prescribed antibiotics, other medications, or some form of treatment and then released.

McDonald said while the study was done on patients who went to the Chilliwack hospital, she believes the results can be applied more generally.

“There are not a lot of studies that have been published that look at things from this approach. Most studies look at either specific diseases or procedures and then look back retrospectively to determine the rate of emergency room visits. But I believe we were very close to the numbers quoted in those other few studies.”

The takeaway message for patients and doctors is that communication is critically important, she said. Anticipated or even unexpected issues should be covered during consultations with surgeons. Patients should know what to expect, including how much pain and discomfort may be expected since all surgery does involve some pain. Patients should also have discussions with doctors about who to see or where to go if they have problems so that emergency departments aren’t necessarily the default destination for visits that aren’t true emergencies.

But McDonald admits it’s also likely that the growing number of patients without primary care physicians is contributing to a high number of patients using ERs.

“Up to 30 per cent of patients in Chilliwack don’t have a family doctor. This is definitely something on my radar now and may be a strong factor in why people are going to the ER.”

McDonald said while an ideal scenario would involve emergency doctors calling surgeons when their patients attend the ER, she knows they are usually far too busy to do that, not to mention reluctant to call surgeons late at night or on weekends.

“Emergency doctors are awesome, they’re doing their best, but they are overworked. Still, this is an issue about the need for better communication so no one should be afraid to pick up the phone or notify surgeons who may want to know what the problem is and how to rectify it.”

McDonald said further research is taking a deeper dive into the data.

A few months ago, another B.C. study showed that this province has the second highest hospital readmission rate in the country. Hospital readmission rates are a marker of health system performance and add substantial costs to hospitals.

The national average for urgent, unplanned readmissions for medical problems like mental health issues, cancer, heart failure, and chronic obstructive pulmonary disease is 9.1 per cent. But the B.C. rate is 9.6 per cent while Saskatchewan has the highest rate — at 9.9 per cent.

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