May 02, 2002

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B.C. healthcare's brave new world

Opinions expressed on this page are the author's and do not necessarily reflect the opinions of Simon Fraser University News or those of Simon Fraser University. Simon Fraser University News welcomes your opinions on this article, or any other issue of interest to the broader SFU community. Letters to the editor and submissions for the Comment page can be sent to the editor, media and public relations, room 2200, strand hall, fax 604.291.3039, or by (email). Letters should be brief, no more than 300 words, signed with a contact phone number or email address. Letters may be edited for clarity or brevity.
The problems presented by the government's healthcare changes are glaring.
- By Tom Koch

Editors Note: The day the B.C. government announced changes to the province's health delivery system we asked SFU adjunct professor Tom Koch to comment. His remarks, written April 24, were based on a first review of the province's program announced the previous day.

I do not trust promises of a Brave New World. I am suspicious when retrenchment is promoted as enhancement and full-scale closures are defined as reorganization. When someone tells me less is more I am worried.

The changes announced last week by the B.C. government in its attempts to fix the provincial healthcare system promise a brave new world in which hospital closures, service consolidation and job cuts are, minister of health Colin Hansen assured us, a triumph.

As a medical ethicist and writer, and as a geographer who sometimes maps service issues, the problems presented by the government's health care changes are, I think, glaring.

Think of health as a network in which hospitals and other clinical centres are the knots that hold the lines of service together. It is something like a fishing net. Unravel the knots at the edge of the net, the ones that ensure the catch will hold across the area. Then unravel a series of knots in the centre of the net, the ones that take the most weight. Now go fishing.

That, in essence, is what the B.C. government has done. It is shutting down hospitals in, among other places, Kimberly, Enderby, Lytton and Slocan. Ninety-one acute care beds will be lost in the northern healthcare district. Closer to the net's centre are Delta and UBC hospitals, as well as other sites to be cut in the Greater Vancouver region. The net is tightened on the island, too, where Victoria and Nanaimo are the last and only major links for those in need of treatment.

“This is not about cutting,” Premier Gordon Campbell told reporters. “This is about changing the way we deliver health care.” Bosh. This is cutting with a vengeance.

The ministry of health also announced it was establishing minimum standards for the distance B.C. residents will have to travel to get healthcare. We will do better because of this, Hansen said. These are not new and rigorous limits but standards that are already met by the health service reorganization that has been proposed. To promote this as a triumph - and a promise kept - is like a blind man shooting a pistol and then having the bullseye drawn for him afterwards.

The standards require that “98 percent of the people in any health region must be within 100 kilometers or two hours of an acute care hospital.” That means that persons with a heart attack, a stroke, or who have been injured in an auto accident may have to wait at least 2.5 hours (30 minutes to get an ambulance in the interior is not uncommon) before treatment can begin. When bridges are washed out and tunnels backed up - as often happens on B.C. roads- the wait will be even longer. Ninety minutes until care begins is more than enough time to die when the condition is serious.

My suspicion is the Bosnians do better.

Even Arkansas and Texas do better than this.

Another standard presented by the government is that 24-hour emergency care will be available within 50 kilometres or an hour travel time for most or all B.C. residents. Apparently this care will not include surgery, however. That's two hours away. Even where surgery is not necessary, that's a long time to wait while in the midst of a cardiac event, or a stroke. An aneurysm? Forget it. It will be deadly, too, for people with gunshot wounds and the type of trauma that Saturday night emergency wards are heir to.

Undergraduate network theory - often used in ambulance and hospital allocation problems - explains what happens when a net's connectors are diminished. Traffic backs up along the remaining pathways. The strain on the remaining nodes increases. In this case, the increased traffic will be carried by a paramedic service that is already stretched to its limit.

One reason for this is that emergency rooms are backed up in populated areas like the Lower Mainland where health support is already inadequate. The problem is that without other service personnel, paramedics must wait with their patients until a doctor is available.
Even if, as the government promises, the B.C. ambulance service is strengthened its members will be holding for hours in the emergency rooms where waiting times necessarily will increase.

Even if the province's emergency wards were to be beefed up immediately - at VGH, for example, or St.Paul's in Vancouver - who will staff them?

There are not emergency specialists waiting to work for the Campbell government. We have long waiting lines in emergency rooms today because of insufficient staff. Nurses and doctors who have seen their hospitals closed, and their careers truncated in towns like Enderby, or in the Lower Mainland at UBC and Delta hospitals (both on the block), may not choose to stay in B.C. Why should they?

They will be welcome in, say, Ontario and Alberta. They can move to Arizona, Montana, Oregon or California.

Within its short tenure this government has made it clear to nurses that they will accept what officialdom offers, or else. The physicians are still angry over the government's handling of their arbitrated pay settlement.

They have now been told not simply that their places of work are redundant but that there is no security anywhere in the B.C. health care system. Sayonara Enderby. Bye Bye Delta. Tucson, here we come.

In its fit to break what mostly needs skilled tinkering, the B.C. government also announced it was considering the closure of G. F. Strong, western Canada's premier rehabilitation centre. Early stories - leaked the weekend before the official announcement - said it would then sell the rehabilitation centre's land while shifting its services to VGH.

Unfortunately for Colin Hansen, the land is privately owned and cannot be used to raise money. So . . . why shift the services of a premier centre to VGH at all?

The literature typically suggests better outcomes result when rehabilitation and acute care are separated. There are a lot of reasons for this - not the least of them is that patients prefer it. As importantly, perhaps, the long road of rehabilitation is very different from the short path toward medical stability. Good surgeons are often lousy rehabilitation counselors and find the long and difficult route toward recovery irksome.

On the other hand, centralizing rehabilitation at VGH makes bureaucratic sense to some, and political sense to others. That it may not be best for patients, or for service, is another issue entirely.

Will these changes save money? Probably, but only in the short run. Within five years many of the services now being truncated will ha

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