Tuesday, December 13, 2011

Ontario needs an inquest into the 'misconceptions' of Liberal monopolist health care

Compare these two stories:

Alison Langley wrote in "Douglas Memorial not equipped to handle serious trauma cases, inquest told" (posted Dec.12, 2011, Niagara Falls Review):

Douglas Memorial Hospital was not equipped to handle serious trauma cases long before the Niagara Health System proposed its emergency department be downgraded to an urgent-care centre, an Ottawa physician who reviewed the NHS hospital improvement plan said Monday.While he understands residents can be "very passionate" about their local hospitals, Dr. Jack Kitts testified there were a lot of misconceptions surrounding the NHS's plans for the Fort Erie and Port Colborne hospitals.
"The public felt they had a full-service hospital, but in reality they didn't," he said.
At an inquest probing the death of Reilly Anzovino, Kitts testified Douglas Memorial had not been a full-service hospital since the mid-1990s.
The hospital did not have a surgeon on site and it did not have diagnostic tools such as a CT scan.
Paramedics have taken patients from the Fort Erie area to hospitals in Niagara Falls, Welland, St. Catharines or Hamilton for a number of years, he added.
"Severely injured patients should not go where they can't be helped," Kitts told the three-woman, two-man jury.
The Hamilton Niagara Haldimand Brant Local Health Integration Network in July 2008 appointed Kitts to review the feasibility of the NHS hospital improvement plan.
Kitts hosted a number of town-hall forums across the region to consult the public on the controversial plan.
"There was a lot of media (coverage) and a lot of negative reaction by physicians and members of the community," Kitts said.
Kitts' report, released in November 2008, largely endorsed the NHS restructuring plan, which recommended the emergency rooms at Douglas Memorial and Port Colborne General be downgraded to urgent-care facilities.
Less than two months later, Anzovino suffered critical injuries following a two-vehicle collision on Highway 3 between Fort Erie and Port Colborne.
Paramedics rushed her to Welland County General Hospital where the 18-year-old college student was pronounced dead.
"My heart goes out to the Anzovino family," Kitts said. "I have two daughters myself. I really feel for you."
Fort Erie family physician Dr. David Henry testified that prior to the NHS's reorganization of Douglas Memorial, the hospital was capable of stabilizing serious trauma patients so that they could be transferred by ambulance to another facility.
That ability, he added, remains in effect.
"Our capabilities remain the same, it's just that we lost the designation of ambulance destination."
Since the reorganization, Henry added, the volume of patients going to Niagara Falls and Welland hospitals have "totally clogged up their ERs."
In his review, Kitts supported the NHS proposal of creating centres of excellence as a way to save money, and to concentrate resources to ensure the best quality care for patients.
"Instead of having five separate hospitals all fighting for limited resources, use the five together to benefit the whole Niagara peninsula by creating these centres of excellence," he told the jury.
He said a Welland surgeon's suggestion last week that an NHS site be designated as a trauma centre could fit in that "centre of excellence" definition.
Such a proposal, he added, would require an extensive feasibility study.
The nearest designated trauma centre in Ontario is Hamilton General Hospital.
Henry said the closest trauma centre, Erie County Medical Centre in Buffalo is less than 15 minutes from Fort Erie.
Bureaucratic obstacles, however, have made it "near impossible" to get approval to send patients across the border, he added.
The inquest continues today in Welland.

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John Robbins reported in "ER conversion not to blame: Kitts
Dr. Jack Kitts testifies at Anzovino inquest" (Dec.12, 2011 Niagara This Week):

The man who gave the thumbs up to Niagara’s controversial hospital restructuring plan three years ago says the conversion of emergency departments in Fort Erie and Port Colborne in no way contributed to the death of Reilly Anzovino.
Dr. Jack Kitts, president and chief executive officer of the Ottawa Hospital, took to the stand at the inquest probing the December 2009 death of the 18-year-old Fort Erie teen, who had been critically injured when the car she was a passenger in spun out on an icy stretch of Highway 3 almost midway between the Port Colborne General and Fort Erie’s Douglas Memorial hospitals.
Kitts, who in the summer of 2008 was asked to review the Niagara Health System’s so-called hospital improvement plan, testified before the inquest Monday in Welland the ERs at Douglas Memorial and Port Colborne General had been treating few seriously ill patients and virtually no trauma patients for more than a decade by the time the NHS redesignated the ERs at those two facilities “urgent-care centres.”
Rather than some kind of overnight change, the conversion happened gradually as a result of changes in medical technology that left the two hospitals behind as well as the loss of on-call general surgery capability.
“They (the ERs) had converted over time to that,” said Kitts. “This was a formalization of what they had become.”
Sitting in the witness chair a few dozen feet away from Reilly’s parents, Tim Anzovino and Denise Kennedy, both of whom have been attending the inquest every day it has met since Oct. 31, Kitts offered his condolences on the loss of their daughter.
“My heart goes out to the Anzovino family,” said Kitts. “I hope with the passage of time something good can come out of this.”
Just what can be done to prevent similar deaths – one of the key questions the five member inquest jury has been charged with answering – remains unclear.
All previous witnesses at the inquest have said they know of nothing that could have been done to save Anzovino, who, according to medical witnesses, went into cardiac arrest as the result of massive internal bleeding caused by the force of the collision around 11:30 p.m. on Boxing Day 2009.
Bad weather contributed to a delay in getting Anzovino to hospital by ambulance. By the time she arrived at Welland County General hospital about an hour later, she was considered VSA or vital signs absent.
The emergency room team at Welland County General spent more than 50 frantic minutes trying to revive her in hopes of sending her to surgery to stop the internal bleeding.
The ER doctor who worked on Anzovino that night testified last week that her injuries were so extensive that even if the accident had happened outside a specialized trauma centre, such as Hamilton General or Toronto’s Sunnybrook hospital, she likely couldn’t have been saved.
None of the NHS hospital sites is a designated trauma centre, which would typically have a team of specialist surgeons and nurses and at least one operating room ready at all times to receive critically injured patients by land or air ambulance.
Kitts said the “definitive care” for trauma patients such as Anzovino is such a trauma centre – including near by Erie County Medical Centre, in Buffalo.
If unable to transport to one of those facilities, the next best place for trauma patients to go is one of the NHS’s three larger hospitals – Welland County General, Greater Niagara General and St. Catharines.
While not trauma centres, all three of those hospitals have on-call general and orthopedic surgeons and anesthesiologists.
The hospital improvement plan, or HIP as it has come to be known, is nearly three years into the implementation-phase, and it has failed to gain widespread support from either the medical community or from citizens.
The plan was first made public in 2008. It’s a five-year strategy to improve the quality of care at Niagara hospitals and balance the NHS budget by 2013.
To achieve these goals, the plan calls for a sweeping reorganization of hospital services across the region by clustering clinical programs into what are termed “centres of excellence.”
Only a portion of the changes envisioned in the plan have been implemented, such as the conversion of emergency rooms at hospitals in Fort Erie and Port Colborne into urgent care centres.
Many of the proposed changes, including the closure of maternity and pediatric wards in Niagara Falls and Welland, are contingent upon completion of the new St. Catharines health-care complex.
Kitts said it while in Niagara in 2008 reviewing the plan and repeated it again at the inquest Monday: The centres of excellence make for a “critical mass” of patients, where medical staff and expensive equipment can be used to their maximum potential.
“If you don’t have critical mass, you won’t have the best (care),” said Kitts, adding it’s sometimes better for a patient to travel further for the most appropriate care rather than go arrive sooner at the nearest hospital, which may not be able to provide the proper care.
The hospital improvement plan is no more popular today than in 2008, when thousands of people in Fort Erie and Port Colborne rallied in opposition to the changes at their community hospitals.
Kitts said many people in both communities were and likely still are under the wrong impression that they had a full-service hospital at the time the ERs were converted to urgent-care centres.
Among those who protested the changes was Dr. David Henry, a Fort Erie family physician and emergency room doctor, who was also called to testify at the inquest on Monday.
Like Kitts, Henry said Douglas Memorial was not equipped to handle trauma cases like Reilly Anzovino at the time the ER was converted to an urgent-centre, nor had it been able to do so for many years before.
“I don’t think Fort Erie or Port Colborne would have made a difference (in Anzovino’s case),” said Henry. Fort Erie did at one time have a general surgeon, but he retired in the mid 1990s and was never replaced. After that, the hospital did mostly minor procedures and day surgeries until the operating rooms were closed for good as part of the hospital improvement plan.
Although the hospital still has a supply of blood products and at least one doctor working around the clock inside the urgent-care centre, Anzovino needed surgery to stop the internal bleeding, said Henry.
In cases were a person suffers major injuries in an accident, they are better off going to a full-service hospital where there is a surgeon available.
“It’s as simple as that,” said Henry.
Despite the conversion to an urgent-care centre, Henry said Douglas Memorial still does treat some critically ill medical patients, such as people having heart attacks.
He estimated before the ER conversion about one half of all heart attack patients came to hospital by car, rather than ambulance. While ambulances no longer bring critically ill patients to Douglas Memorial, some people still present at the hospital on their own, often thinking they have something less serious wrong with – such as indigestion – when in fact its a more serious cardiac problem.
“We still get those drive-ins despite all of the publicity (to the contrary).”
Henry bemoaned the fact that it has, in his opinion, become more difficult in recent years to transfer patients to Erie County Medical Centre, a recognized leader in trauma care, in recent years.
“That’s the bureaucracy of Ontario. They don’t want their patients going to Buffalo,” said Henry.
Both Henry and Kitts supported in principle an idea put forward earlier in the inquest by Welland surgeon Dr. Peter Willard, who suggested while Niagara may not be big enough to warrant a full trauma centre, there may be some merit in pooling resources currently spread out across the NHS’s three largest hospital sites into a single location.
A model for this kind of thing already exists in Niagara. All stroke patients are taken to Greater Niagara General hospital in Niagara Falls, which is home to a dedicated stroke team.
Pooling resources into one site could maximize the use of available manpower. With high volumes of patients, medical staff would have more opportunity to hone their skills.
Kitts suggested a feasibility study would need to be done first to fully explore the idea and determine whether it makes sense to have a dedicated trauma unit and where best to locate it.
“It isn’t just flip a coin and pick the best (hospital site),” Kitts said.
The inquest continues Tuesday.


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Compare the above two stories, and note the two completely different reports about Dr. David Henry's testimony:

Alison Langley of the Niagara Falls Review reported this:

Fort Erie family physician Dr. David Henry testified that prior to the NHS's reorganization of Douglas Memorial, the hospital was capable of stabilizing serious trauma patients so that they could be transferred by ambulance to another facility.
That ability, he added, remains in effect.
"Our capabilities remain the same, it's just that we lost the designation of ambulance destination."
Since the reorganization, Henry added, the volume of patients going to Niagara Falls and Welland hospitals have "totally clogged up their ERs."

...while John Robbins of Niagara This Week reported this:

Among those who protested the changes was Dr. David Henry, a Fort Erie family physician and emergency room doctor, who was also called to testify at the inquest on Monday.Like Kitts, Henry said Douglas Memorial was not equipped to handle trauma cases like Reilly Anzovino at the time the ER was converted to an urgent-centre, nor had it been able to do so for many years before.“I don’t think Fort Erie or Port Colborne would have made a difference (in Anzovino’s case),” said Henry

Which of these versions is accurate?

Did DM have the "capabilities" to treat and stabilize trauma patients before DM lost its ambulance destination designation (as Henry seemed to be saying in Langley's story), or, were these capabilities not there at all, regardless of the Anzovino incident, as Kitts seems to be saying?

It's like these two reporters were at two different hearings - not when it came to what Kitts was saying, but what Henry was saying.

Robbins wrote that Henry seemed to agree with Kitts that DM was not equipped to handle trauma cases, and hadn't been for years.

Yet Langley reported of Henry saying that  'prior to the NHS's reorganization of Douglas Memorial, the hospital was capable of stabilizing serious trauma patients so that they could be transferred by ambulance to another facility. That ability, he added, remains in effect'.

Furthermore, why isn't anyone examining specifically why Buffalo's medical facilities aren't being more often utilized? Why is or isn't ECMC being utilized by Ontario? Have patient transfers to the U.S. from Ontario (especially Niagara) gone down? Has - as Henry says - it  become more difficult to send Canadian patients to the States??

Why aren't any reporters asking these questions? They've had three years to examine the issue!

Why is it - that in the last three years - no local press ever bothered to ask Niagara's secretive Liberal health care monopolist Jim Bradley about his government's policies on patient export?? Why is Niagara's press so protective of Liberal  Jim Bradley - especially in light of how smug Liberals such as Bradley, Smitherman, and Dalton McGuinty loved to demean and denigrate the American health care model - which is there, available just across the river in the U.S., but which would be illegal if it was on McGuinty's side of the river? What have Bradley's Liberals done to remove "bureaucratic obstacles" when it comes to emergency patients being forced to leave Ontario because Bradley's monopoly can't provide for them here in Canada?

Aren't the politics of Liberal bait-and-switch health-care monopolism part and parcel of this inquest?

Listen closely to what Kitts tells us:

"The public felt they had a full-service hospital, but in reality they didn't," he said.
At an inquest probing the death of Reilly Anzovino, Kitts testified Douglas Memorial had not been a full-service hospital since the mid-1990s.

Is this a 'blame Harris' move by Kitts?! If so, the St.Catharines Standard will be ebullient with this !! See, toldja: it's Harris' fault!! Kitts says DM has not been a full service hospital since the mid-90's; yet, Henry says that DM was capable of treating trauma victims, until the HIP cuts (which were forced onto the NHS by Liberal Smitherman). Well, which version is correct?!

And  - 'if in reality, DM was not a full service hospital' as Kitts says - then what exactly did McGuinty's Liberal majority government do about that, since 2003???!!! Were Kim Craitor's and Jim Bradley's Liberals running a NON-FULL-SERVICE hospital in Fort Erie, and passing it off to the public as something else?

Oddly enough, no local Niagara reporters are scrambling to ask Kim Craitor or Jim Bradley about that! Precious, ain't it?

Henry says the 'bureaucracy of Ontario doesn't want patients taken to Buffalo' - so, why aren't the local Niagara reporters looking into that? This isn't, um... news to them - is it?  McGuinty's Liberals control Ontario's bureaucratic health monopoly!

Where are all the investigative reports from Niagara This Week, from the St.Catharines Standard, from Niagara Advance, from the Niagara Falls Review, over the last eight years, detailing their local MPP's comments and responses to their Liberal healthcare monopoly's patient export policies?!

Good luck finding anything about that from Niagara's Liberal ass-kissing press.

Notice the spin Robbins puts on Dr. Kitts as being the person who "gave the thumbs up" to the HIP.

In fact, Kitts was hired by the NHS to review the HIP which the LHIN had forced the NHS to produce.

Interestingly, Robbins - and his editors - just somehow plain forgot hyuck hyuck  to mention that the very same Liberal LHIN also had the final authority to approve (or NOT to approve) the HIP for implementation! So, this wasn't Kitts' call, all on his own; nor the NHS's call, all on its own.

It was George Smitherman's Liberal LHIN which had demanded that the NHS create a HIP in the first place; and it was this exact same Liberal LHIN [when it got its ducks lined up in the way which McGuinty's Minister of Health wanted] which then approved the HIP's implementation.

Robbins - oooppsie doesn't bother mentioning that the Liberal LHIN - after considering the HIP, even after considering Kitts' "thumbs up" review of the HIP - could have gone another way, and not approved it. Funny, eh, how that didn't make it into Robbins' story, huh?

Robbins forgot to report that it was actually McGuinty's LIBERAL LHIN which gave the FINAL "thumbs up" to the HIP, and, which ordered the NHS to then implement the HIP.

Funny, how these wee wittle factoids just seem to get lost in the statist-friendly narrative.

The NHS did not close/re-purpose the Fort Erie and the Port Colborne hospital ER's all on its own: the decision to do so was initialized, then approved, and then finalized BY McGUINTY'S LIBERAL LHIN.

Also note another amazing thing: that in the last THREE YEARS since the Kitts Report, Liberal MPP Jim Bradley has never been interviewed by his Fan Club in the press about his views regarding the Jack Kitts HIP report!! Dare you to find anything about Liberal MPP Jim Bradley's reaction to and comments about the Jack Kitts HIP review!!

More pathetically: no-one's bothered to ask Ole Jimmy about it since, either! And: no-one's asking him NOW!!!

Why isn't George Smitherman, McGuinty's former health minister, the person responsible for the HIP, testifying at this inquest?!
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