Hospital governance not by necessity a ‘democratic process’ — investigator

Posted on August 28, 2013 | 1 comment

Ontario’s public hospitals are private not-for-profit corporations. Most are built and operated with public money and sign accountability agreements with the provincially appointed Local Health Integration Networks.

At any time the Minister of Health can take over a hospital, appointing a supervisor who assumes the power of the CEO and board as she did this month in Iroquois Falls.

There used to be a time when most hospitals sold “memberships.” A membership was largely limited to voting to ratify a nomination to the board and getting to ask questions at the hospital’s annual or general meetings.

Over the years many hospitals have transitioned to self-appointing boards, cutting the public out of any direct power relationship, as limited as it may be.

Ontario is unusual in preserving individual hospital boards at all. Many provinces run their hospitals through more centralized bodies, such as directly through their Ministry of Health or by a regional health authority.

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Update: Matthews limits role of supervisor despite scathing report into northern hospital

Posted on August 27, 2013 | 5 comments

“In 1970, Dirk sued Stig, Nasty, and Barry; Barry sued Dirk, Nasty, and Stig; Nasty sued Barry, Dirk, and Stig; and Stig sued himself accidentally. It was the beginning of a golden era for lawyers…”– From the UK Comedy The Rutles

Iroquois Falls residents may have found the circumstances at their local hospital similar to Eric Idle and Neil Innes’ comedy The Rutles, but few of the 4,500 community residents of this northern Ontario town were likely laughing.

At one point even the Minister of Health’s appointed investigator realized that he was also subject of an action which was withdrawn before he could be legally served.

“This was the first time I had been made aware of this action,” Ron Gagnon wrote in a scathing report into the governance of the Anson General Hospital submitted at the end of June and made public in redacted form about a month later.

Gagnon, whose day job is CEO of the Sault Area Hospital, wasn’t the only one to be subject to litigation by the small northern hospital.

With an annual budget of $13.8 million and 157 staff, the Anson General was spending more than $10,000 a month on legal fees – an estimate Gagnon believes to be low.

The 34-bed hospital planned to take the North East LHIN to judicial review over its decision to appoint KPMG to investigate public complaints over how the hospital was being run — an investigation the hospital failed to cooperate with.

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2nd recall in 10 months raises concerns at blood agency

Posted on August 26, 2013 | 4 comments

The message was sent out at 4:06 pm on a Friday to staff at Canadian Blood Services. Described as a “developing situation,” Chief Operating Officer Ian Mumford told workers that the previous night the agency issued a recall of 1,500 units of blood used mostly by low birth weight infants and immune compromised patients.

The accompanying press release was posted on CBS’ website, but not on the news release service the agency normally employs.

The recall is the second at Canadian Blood Services within a year, the previous taking place in October when it was revealed donors in Regina had not be subject to all the normal precautionary screening questions. That resulted in a recall of blood donations going back 12 months.

This time it was the Calgary donor testing laboratory that had failed to do routine testing for cytomegalovirus (CMV) – a type of herpes virus. The lapse in testing took place between July 30 and August 2.

According to Wikipedia, this CMV “infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised, such as HIV-infected persons, organ transplant recipients, or new-born infants.” That is the target group for the blood product under recall.

CBS says they still have 250 units, which will be relabeled and sent out for general use. and that there are about 400 units remaining on hospital shelves which will be subject to the recall. The rest have either been already used or, according to Mumford, are outdated.

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Drug “paraphernalia,” a lost study revived, and temporary inspectors — short takes on recent events

Posted on August 23, 2013 | 1 comment

Kudos to Camille Quenneville, CEO of the Canadian Mental Health Association, for pointing out governments looking to contain costs and provide better service should address mental health issues within their own workforce. Writing in the Ottawa Citizen last week, Quenneville points out that every day 500,000 Canadians are absent from the workplace because of mental health problems. Someone suffering a mental illness will be absent from work on average twice as long as someone with any other disability. Mental health illness account for about 30 per cent of short and long-term disability claims. Clearly this is not just an issue with government, but with all employers. The CMHA CEO does acknowledge that many municipalities are already beginning to address the issue through wellness programs and education programs that particularly address stigma. Earlier this summer Partners for Mental Health launched their own workplace program “Not Myself Today.”

The Canadian Medical Association Journal reported over the summer on what could be a groundbreaking piece of research being conducted by Dr. Evelyn Forget at the University of Manitoba. From 1974 to 1978 Dauphin Manitoba took part in a unique “labour market experiment” in which locals were given a guaranteed annual income supplement to keep them out of poverty. The CMAJ says the experiment folded as a result of high interest rates and declining political interest in the concept. However for the last three years Dr. Forget has been wading through 2,000 boxes of data from the experiment. The data she is uncovering provides strong evidence that lifting people out of poverty has a remarkable effect on population health, especially with regards to mental health. Surprisingly, taking people out of poverty also reduced accidents and injuries. She also found that families kept their kids in school longer under the guaranteed income program. Given the revival of political interest in the social determinants of health, Dr. Forget’s ongoing research around a 35-year old experiment may pay some social dividends.

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Police call on government to step up mental health support

Posted on August 22, 2013 | Leave a comment

As Kingston’s Providence Care prepares to shed nearly a fifth of its workforce and close beds at the former Kingston Psychiatric Hospital, there have been a number of media stories this week providing clear evidence capacity for mental health services in Canada is already woefully inadequate.

Yesterday CTV reported that Canada’s police chiefs called upon government to step up support for mental health services.

Association President Jim Chu of the Vancouver Police services said the number of people apprehended in that city under the Mental Health Act has more than quadrupled since 2002.

“We went from the agency of last resort to the mental health service agency of first resort,” Chu told CTV. “And that’s wrong. That’s failing those who are mentally ill and who deserve better care.”

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Centric claims physiotherapy funding decision will have little impact on its private clinics

Posted on August 22, 2013 | Leave a comment

It came as no surprise that the private designated OHIP physiotherapy clinics failed in their legal bid to use a judicial review to slow down plans to transfer their publicly funded patients to the Community Care Access Centres.

While the government actions may have been legal, the rushed process has definitely left much to be desired. Whether the CCACs can absorb the influx of so many new physiotherapy patients beginning today is an open question. At least one company in question is also suggesting in the wake of the decision that much of that CCAC work will be coming directly back to them.

Centric Health – one of four corporations that dominate ownership of the for-profit clinics — issued a press release yesterday saying the impact of the government’s changes would be about six per cent of consolidated revenue – or about $27 million.

Centric points out that much of the money being reallocated to the long-term care homes will be coming back to them.

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When poverty is the disease, money is the most effective prescription

Posted on August 21, 2013 | Leave a comment

Dr. Gary Bloch’s patients suffer from a health condition to which many doctors believe there is no prescription – money.

Bloch became obsessed with this question, and at one time found he could do just that – filling out forms that would allow patients on social assistance to access $250 a month more for a special dietary supplement.

Working at the time with the Ontario Coalition Against Poverty, Bloch even participated in a clinic on the lawn of Queen’s Park where he could assist thousands with what they needed most.

Short sighted, the province changed the rules, but it hasn’t deterred Bloch.

Speaking at a TEDx forum in Stouffville as the founder of Health Providers Against Poverty, Bloch says there are four things doctors can do that can dramatically improve patient health.

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New CMA president-elect looks to Scotland as model of improvement

Posted on August 21, 2013 | Leave a comment

Kingston’s Dr. Chris Simpson has been acclaimed president-elect of the Canadian Medical Association. His term as President begins August 2014.

Simpson is professor of medicine and chief of cardiology at Queen’s University as well as medical director of the Cardiac program at Kingston General Hospital and Hotel Dieu.

Simpson’s interest in health care policy is reflected in his BLOG which focusses on such issues as wait times, health human resources planning, and health care reform.

Critical over rising wait times towards the end of the 2004 Health Accord, Simpson is surprisingly frank: “The reasons are many but they essentially boil down to one indisputable truth: the money that was invested didn’t buy change. All we did was to make the numbers look a little better for a short time.”

In his BLOG he particularly looks at the achievements made in the Scottish Health System, suggesting our proximity to the United States makes it difficult to similarly modify our own system.

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SBGHC — Rosebush sets objective to balance budget without cuts to staff or services

Posted on August 20, 2013 | Leave a comment

If there has been one good news story this summer it’s this: CEO Paul Rosebush sent a memo to all physicians and staff at his South Bruce Grey Health Centre in July telling them that the hospital’s fiscal shortfall for this coming year has shrunk from $700,000 to $300,000.

This may not sound like a big deal, but SBGHC operates on a modest budget of about $42 million.

Small rural hospitals weren’t supposed to be affected by the introduction of the new hospital funding formula last year, but the four small hospitals that make up SBGHC were big enough as a single corporate entity to qualify. That meant a drop in base funding — an especially tough pill to swallow while hospitals are under a base funding freeze for the second year in a row.

Rosebush had appealed to the South West Local Health Integration Network (SW LHIN)  that this was unfair. By virtue of working together the four hospitals were being penalized under the formula.

The SW LHIN listened and has partially mitigated the hospital’s circumstances for now. There is a promise to revisit SGBHC’s funding for future years.

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Tainted — Play a timely intervention on the paid plasma issue

Posted on August 20, 2013 | 3 comments

A generation has passed since more than 30,000 Canadians became infected with HIV and hepatitis C through the blood system. According to the Canadian Medical Association Journal, Justice Horace Krever’s 1997 report on the tragedy is considered to be one of the most influential reports on public health in Canadian history.

The CMAJ notes that two aspects of Krever’s recommendations transcended the blood system and have influenced broader health care policy – the adoption of the precautionary principle and a governance system that prioritizes safety.

A recent proposal to set up a series of privatized plasma collection sites across Canada using paid donations has raised questions as to whether those two principles continue to be applied. Surprisingly, Canadian Blood Services has itself played down any potential threats to both the health risks of paid donation and its own ability to compete for donors.

Given expectations around Health Canada’s decision whether to license the private collection centres, Moyo Theatre has emerged with a timely cultural intervention.

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