Tuesday, April 28, 2009

Behind the NDP's MRI wait time debacle; plus more listener comments on ER's, nursing, and health care

As solely reported on this blog and on 92.9 Kick-FM last week,
Manitoba stands alone in Canada as the ONLY place where wait times for MRI's is trending LONGER - more than doubling from an average maximum wait time of 54 days in 2006, to 91 days in 2008.

After downplaying the true depth of the march backwards for MRI patients (and misrepresenting the failure of the NDP to meet the 6 month benchmark for 75% of knee replacement surgeries), teachers' pet -- er, the Winnipeg Free Press, ran to get the official spin, without a word from the opposition or any analysis:

Health Minister Theresa Oswald said the number of MRI tests being ordered has jumped dramatically since family physicians became able to order them.

She said the province has extended hours for MRI scans and increased available overtime to manage the increased load. "We've plateaued and (the wait) is coming down."

Only TGCTS has gotten the view of insiders to explain the real reasons how and why the government has failed Manitobans yet again when it comes to their health services.


Two city doctors, from different hospitals, emailed us their perspectives:

"Hello Marty,


I heard this part of your show yesterday, and i was hoping to talk to you about some of the results of the study and the article that you cited.

Now you may not be aware of this, but i hate passionately the NDP government for so many reasons, but their dishonesty and many attempts to mislead, misguide and lie to Manitobans is criminal. Furthermore i see the WRHA as a political monster which needs to be disassembled and rebuilt to a much smaller, more efficient, less political and more strategic version of itself.

Having said all that, I have to support Ms. Oswald's claim. A province full of family physicians who heretofore have not used MRI, and may not be fully aware of its appropriate use and limitations suddenly had access to its diagnostic abilities.

Although i do not know this for a certainty, i am guessing that many imaging studies that could have been foregone; ligament strain in various joints, disc herniation, abdominal pain - that may have reliably been diagnosed with CT, U/S, and colonoscopy, etc. - had been acquired by family physicians too eager to use this new "toy".

This is not to say that we do not know what we are doing, or that these studies were not necessary, however we do not know if any useful data was added by the increased use of the MRI. So it is quite reasonble to have expected the wait time for MRI to increase.

In the meantime, it is not enough to simply have access to MRI, but we also need radiologists to read the studies. This is another resource that is profoundly lacking in this great province of ours.

With regards to wait times for hips and knees - again i must point the finger inwards at us as family physicians. Some of us are so lax as to send surgeons consult letters stating "knee pain, please assess". I believe we do have enough orthopedic surgeons to dramatically cut waiting times, if they get more "convertable" cases - i.e. consults that proceed to surgery - relative to the overall number of consults.

The WRHA actually does have a program in place to address the wait times in Manitoba for which i am hoping to provide input called "Bridging Specialist and Generalist Care" which i am more than happy to discuss with you.

Regards, Dr X "

and in response, an analysis from the other doctor:

" The basic claims in this letter regarding MRI are correct. The increase in MRI wait times is largely artificial, related to the relatively new abilility of general practitioners to request these studies. The number of requests has skyrocketed, whereas the number of MRI scanners, the hours that they operated and the number of radiologists to interpret the studies have remained relatively static.

Hence, increased wait times.

I really don't know who decided to let GP's order MRI's. But the ability of GP's to order MRI's is the norm in most other provinces as far as I know.

Dr XX "

Then a listener saw thru the NDP spin:

"In other words, when you compare apples to apples, we're still behind the set goal. So all this time the NDP has been misleading people about how great our MRI wait times are, compared to other provinces, knowing all along that this was only because they (Manitoba NDP) restricted who could order an MRI.

The doctors say there's no "data" that people are getting better diagnoses because now their family doc has MRI information. That's not the point. The people are paying for MRI's, they want MRI's and they should be able to get MRIs, whether its through the public system or through a private clinic. Times have changed from the socialist days of Howard Pawley. "
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Meanwhile, we had told the story of a 5 year old girl, taken to the Seven Oaks emergency ward at 1 AM suffering from an internal infection. Her father was told it would be hours before she could be treated, and he had to hustle her out a backdoor to avoid the undignified antics of drunken louts who had been hauled into the ER by police.

The father got a surprise call after we told his story:

"Wasn't I surprised if not shocked to recieve a call today from Dr. Ricardo Lobato de Faria and as he identified himself as the head of Seven Oaks Hospital! Or as he began, "I understand you had an incident one night last week at the Seven Oaks Hospital, well, I run the place!"

He spoke of how what he had heard had occured that evening with my daughter and I and appeared to be alarmed with what he heard.

He mentioned he was saddened to hear about my daughter and I getting the runaround and commented on how I had to shield my daughter from the drunks the police were brining in! He was extrememly well versed on my dilemma, considering I had not contacted them myself on this incident! He seemed to be greatly dissapointed to hear how the tri-age nurse didn't at least give me some kind of assessment for my daughter at the VERY least and felt further investigation would be needed.

I also told him about the security guard who escorted us through the hospital who made the comment to me about, "Yeah, sometimes we get people here that don't really need to be here" and asked, "was he talking about he drunks speciffically?" to which I responded, "No, I took it as an in-general type of comment."

Well, he did not appreciate hearing that and said the guard should NEVER had said that and it was an unprofessional comment to make!

The doctor also told me he will be following up with the tri-age nurse on duty that evening and how besides not even assessing my daughter, she should have given me an actual time-line to when my daughter could have gotten in, if not make an actual follow-up appointment first thing in the morning!

He asked how my daughter was doing and I told him fortunately, she was fine. I had repeated to him her symptoms, (high fever, body aches, chills, sweats, no bathroom trips in the prior 24 hours) and was pleased to hear I was able to get her into her pediatrician the next day.

We discussed briefly the one doctor on staff overnight and he stated that this happens in most Winnipeg hospitals on most nights! No apology there, just stated matter-of-factly.

He then assured me there will be a follow-up with the staff on duty that evening and I would also recieve an official apology in writing soon as well. In that letter to come, he mentioned any suggestions or comments I'd like to make could be added and resubmitted back to him as well.

Throughout the entire conversation, I found Doctor Lobata de Faria to be very professional, and gentlemanly. And I did thank him and told him I appreciated the fact he called. And I do.

By the way, great work Marty! Make sure you let the people know the only way I would have gotten that phone call was because of The Great Canadian Talk Show! Thank-You For that!

P.S. You have my vote to be President of Aurtarlia!"
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On the show we also mentioned this father has a friend, a nurse who wants to return home from the US and work locally.

She could not get a call back from one hospital that is advertising vacancies no matter how many messages she left with the HR person; this at the same time Minister Oswald was forced to admit to the Free Press that the province is in fact short at least 700 'new' nursing positions (the Tories claim it is 1300 in total).

"Oswald said her government has increased the number of front-line health-care positions in Manitoba by 3,400 since 2000 and filled about 80 per cent of them."

The nurse got ahold of her friend and he sent this along :

After I sent the link to Marty's show to some friends of mine in Winnipeg these are a couple of the responses I got....


"That's embarrassing that you didn't even get a call back. The whole province is begging for nurses and one of our own is coming back with a world of experience, and they don't even pursue you? What a Gong Show.

I knew when you said you were thinking about xxxx it wasn't really a great idea. It's up to you, and a job's a job, but, I'd stay away from the community hospitals. 7 Oaks has the nickname of 7 Jokes. It's fine for day surgeries, Geriatrics and placement medicine patients, but that's about it. You are too worldly to deal with that. HSC and St. Boniface are the two big centres. St. B, is were the "hearts" go, and HSC is for the Traumas. I can't say that any hospital is perfect, but what centre can say that anyway. At the end of the day, if I was sick, I'd go to HSC. That's the bottom line I guess."

and...

"I don't find this entire situation as shocking as I should, unfortunately. The amount of incompetence in the world today is beyond belief. Especially in the health care system.

When my mom was ill for so long, I logged a lot of hours in the ER and in the wards, and I was always amazed by the care she received, and never in a good way. If she ever got a good nurse or a doctor that didn't need a week to get with the program we were shocked. They could never figure out how to deal with more than one problem at a time, like get her heart problems fixed up, without letting the ulcer on her foot (that family and I and numerous home care nurses were keeping under control and dressing twice daily) be completely ignored.

Sometimes it went for more than a day and a half (with us asking) for them to change it, and I've seen them let it be unbandaged and exposed, or leaking through the dressing, and having her have to walk without anything protecting it to the washroom. YOU know what hospital floors are. One of us practically stayed with her all of the time, because if you don't have an advocate, someone who is willing (reluctantly) to be demanding, and sometimes a bitch, you're done. But you'd have to be careful to kiss everyone's ass at the same time, because for sure there could be retaliation, and when she was alone, she was at their mercy.

My mom hated confrontation, and so she was an easy target for cruelty and callousness (yes, the health system has more than its share of sadists!). She had scar tissue in the crook of one of her arms from a botched angiogram, and drawing blood from there was nearly impossible and absolutely excruciating. I can't count how many times nurses and technicians insisted, absolutely insisted, on poking there despite being told not to, just because they could. They either didn't believe us, or just didn't care, or wanted to cause someone pain, or just wanted to be proven right. One even lied to my mom, and said that he wasn't going to, he just wanted to look, and then jabbed anyways. Unbelievable.

That said, I saw how all of the nurses were overworked and overwhelmed and powerless in a system that gave doctors all of the power, even for common sense things, and how often their hands were tied and they were doing their best. But it was obvious how some nurses were just in it for the power, and really couldn't give a shit about the person they were treating, they just wanted to be the boss. You know what they say though, that shit runs downhill, and I'm sure some of them were mirroring how they were treated by doctors and the system. But that's only half of the problem.

The ER is constantly being clogged up by people that have no business being there. People who don't want to take time off work to go to their own doctor, or a walk in clinic or people who are just plain stupid. Once I took my daughter screaming in agony to the Children's ER, because she had a sudden and agonizing belly ache. The place was jammed, and instead of waiting quietly for their turn, people kept going up to the triage nurse and asking when it would be their turn, as if they were in a doctor's office with an appointment.

Meanwhile, kids were coming in on stretchers by ambulance in really bad shape, and the doctors and nurses had their hands full. But most of the kids in the waiting room were playing and laughing and their parents were visiting, etc. It looked for the most part like a pediatricians office on a regular day. Some kids, like ours were obviously ill and unhappy, but most of the others looked like they had colds or whatever.

A nurse came on the intercom a couple of times to ask that people stop coming to the desk asking about the wait, that it was very busy, and it was on a need-to-be-seen basis. Finally a male doctor came on and started yelling about how everyone needed to stop bothering the nurses, and that they were seeing some very sick children, and that regardless of what everyone in the room was waiting to be seen for, the wait would likely be several hours at least. Good for him! But did that ever clear out the waiting room. Everyone whose kid had a cold or sore ear got up and left, just like that. Those of us who really needed to be there waited.

Another time, my daughter tripped on the stairs and I took her because her ankle immediately swelled up, and it looked like it might be something. While we waited, and we were prepared to wait, since it was only her ankle, and this is after all Manitoba, a mother and her mother arrived with a baby, who was sick. Apparently, this baby had been to the doctor that afternoon, and been given antibiotics for an ear infection, and the mother was upset that the baby wasn't better yet. The triage nurse was frustrated, because you could hear her tell the woman that it had only been 4 or so hours after the first dose, and that it would take up to 48 hours, but what could she do? Isn't there a policy that they can't turn people away if they want to be seen?

It's a nightmare everywhere you look. Not enough doctors, not enough nurses, incompetent doctors and nurses, uncaring doctors and nurses, not enough diagnostics, equipment, and resources. Nurses and doctors who are burned out because they are working too many hours. Uneducated patients, not enough doctors who will take on new patients, or doctors who have so many patients, that sick patients can't get in to be seen. Even walk in clinics are cutting their hours if they can't be staffed.

My daughter's ankle was a non emergency, but where do you go when something like that happens outside of office hours? For sure not to the Misericordia, the Urgent Care facility, since they only have one doctor on staff, and I know of at least 2 people who had broken bones casted there, and it was done wrong, after waiting for more than 8 hours. So my daughter turned 16 in an emergency room, but at least when she came out in her cast and crutches,(just a bad sprain, thank goodness), I knew she was OK."

The prodigal nurse added:
Another friend whose e-mail I accidently deleted also referred to Seven Oaks as 7 Jokes and said that her step Dad was taken there when he was sick, misdiagnossed, shuffled around, lost, then finally transferred to HSC where he died as help came too late.

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Around and about...

Check out this story about our good friend Kenny Omega, making an impact with Ring of Honor as they tour wrestling venues around the continent:

http://slam.canoe.ca/Slam/Wrestling/2009/04/20/9176016.html

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One of the best local bands playing the club circuit is fronted by a dear old friend, Shandra Levreault. She can belt out anything from the Beatles to Shania with style and soul. And she's funny as hell too.

Slow Motion Walter are playing May 8th and 9th at the Royal George in Transcona. http://www.facebook.com/home.php?ref=home#/event.php?eid=94002276132.

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Another TGCTS favorite, David Richert, continues to make his mark in the world of racing:

Winnipegger Learns from Daytona 500 WinnerAlton, Virginia
The opening two rounds of the Volkswagen Jetta TDI Cup took place this weekend at Virginia International Raceway (VIR) in Alton, Virginia.

Winnipeg race car driver, David Richert, was competitive all weekend finishing 14th in Race 1 and 15th in Race 2. Richert was also able to continue his streak of bringing the Jetta TDI Cup car home in one piece. “It’s difficult driving in conditions where you know that even a small dent on your car means you may not make the next race” he says, “but hopefully we’ll take care of business and find another group to join Rainbow Trailers and Wallace & Wallace Fences. Then we can start contesting for race wins and bring a trophy back to everyone in Winnipeg”.

2002 Daytona 500 winner Ward Burton was on hand for the festivities as was ex-Formula 1 driver turned TV commentator Derek Daly. Both were asked to share their vast amount of knowledge with the group of young Jetta TDI Cup drivers. Ward’s son Jeb Burton was entered in the race as a guest driver and finished 24th. Also seen rubbing shoulders with Jetta TDI Cup drivers was former Indianapolis 500 Champion and racing legend Bobby Rahal, who currently owns a race team together with late night talk show host David Letterman.

Also worth noting is that Richert was able to complete every minute of both races this weekend, meaning that $1,200 will be donated to Samaritan’s Purse for the purchase of 12 BioSand Water Filter units. These water filters will be constructed in homes around the world where inhabitants do not have access to clean water for their daily needs.

David Richert is 26 years old and hails from Winnipeg, Manitoba, Canada. From a group of 3,900 race car drivers, Richert earned a spot racing for Volkswagen in the 2009 Jetta TDI Cup where the series champion goes home with $100,000. Partners of David Richert Racing include Rainbow Trailers, Wallace & Wallace Fences, Winnipeg Free Press, Onext Media, Sunrize Group and Creative Printall.

For additional comment or information, please contact David Richert Racing at 204-371-8700, or by email at public.relations@richertracing.com

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and finally, we'll give you a months' notice for this great event,
"Family Day of Magic" on Sunday, May 24.
Two shows at 1 and 3.30 PM.
Hosted by Magic Club of Winnipeg
Winnipeg Art Gallery - Muriel Richardson Auditorium
Tickets are $5, at the door or in advance.
http://www.facebook.com/event.php?eid=51639893747