Wednesday, April 01, 2009

Did Canadacare kill Natasha Richardson?

By Michelle Malkin

Dr. Cory Franklin had a provocative piece in the New York Post yesterday exploring whether Canada’s government-run health care system contributed to the tragic skiing death of Natasha Richardson. He writes:
Richardson died of an epidural hematoma — a bleeding artery between the skull and brain that compresses and ultimately causes fatal brain damage via pressure buildup. With prompt diagnosis by CT scan, and surgery to drain the blood, most patients survive.

Could Richardson have received this care? Where it happened in Canada, no. In many US resorts, yes.
Between noon and 1 p.m., Richardson sustained what appeared to be a trivial head injury while skiing at Mt. Tremblant in Quebec. Within minutes, she was offered medical assistance but declined to be seen by paramedics.

But this delay is common in the early stages of epidural hematoma when patients have few symptoms — and there is reason to believe her case wasn’t beyond hope at that point.

About three hours after the accident, the actress was taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the resort. Hospital spokesman Alain Paquette said she was conscious upon reaching the hospital about 4 p.m.

The initial paramedic assessment, travel time to the hospital and time she spent there was nearly two hours — the crucial interval in this case. Survival rates for patients with epidural hematomas, conscious on arrival to a hospital, are good.

Richardson’s evaluation required an immediate CT scan for diagnosis — followed by either a complete removal of accumulated blood by a neurosurgeon or a procedure by a trauma surgeon or emergency physician to relieve the pressure and allow her to be transported.

But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn’t have specialized neurology or trauma services. It hasn’t been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada.

Actually, it has been reported that Richardson received a CT scan at Centre Hospitalier Laurentien. The hospital does have the equipment.

Defenders of universal health care think this ends the debate and accuse critics of Canada’s system of “exploiting” Richardson.

But health care blogger Dr. T points to the government-engineered lack of specialists in Canada:
Neurosurgeons are not so easy to find in Canada where subspecialization is not rewarded, and 50-60% of boarded neurosurgeons leave the country to practice somewhere else within 2 years of their certification.

The last good data I could find listed only 174 neurosurgeons in the entire country. In the U.S. we have 3,500. A study on the need of neurosurgeons listed the density of neurosurgeons in the U.S. to be about 1/55,000 people which means that an analogous number of neurosurgeons needed in Canada would be about 604.

It is true that neurosurgeons eschew emergency room coverage in the United States, but it is for completely different reasons than in Canada. Here, our ED’s don’t want to pay what it takes to hire a neurosurgeon for coverage; in Canada, no one wants to even be a neurosurgeon.

So, in a sense, the Canadian model for health care failed Natasha Richardson because of an artificially created shortage of subspecialists, which is a purposeful design meant to keep costs low in a taxpayer-funded-system. The U.S. would very much like to go in this direction and the plan is to broaden non subspecialized care options while reducing higher-tech procedures, diagnostics and physicians.

But as we go towards a single-payer system, we can all expect that when we need it most, the system will not be there for us, as it was not there for Natasha Richardson.

Additionally, Matthew Vadum and a top Montreal doctor point to Canada’s woeful lack of a medical flight system.
There’s no shame in asking what went wrong, how our health care system can minimize preventable deaths, and whether current proposals to radically alter our health care system would increase these tragedies.

It would be irresponsible to do otherwise.


Read this. Hat tip - Greg Pollowitz:
Connie and Donald McCracken were watching CNN one evening last week when they learned of the tragic death of actress Natasha Richardson from a head injury. Immediately, their minds turned to their 7-year-old daughter, Morgan, who was upstairs getting ready for bed.

An injured Morgan McCracken has benefited from awareness after Natasha Richardson’s death. Two days earlier, Morgan, her father, and brother had been playing baseball in the yard of their Mentor, Ohio, home when her father hit a line drive that landed just above Morgan’s left temple. A lump formed, but the McCrackens iced it down and the swelling subsided within an hour.

“For the next two days, she was perfectly fine,” Donald McCracken says. “She had no symptoms. She went to school both days and got an A on her spelling test as usual. There were no issues whatsoever.”

But after hearing about Richardson’s death, the McCrackens wondered if Morgan was really as OK as she seemed. After all, Richardson had been talking and lucid immediately after her fatal injury. When they went upstairs to kiss Morgan good night, she complained of a headache. “Because of Natasha, we called the pediatrician immediately. And by the time I got off the phone with him, Morgan was sobbing, her head hurt so much,” McCracken says.

The McCrackens took Morgan to the emergency room at LakeWest Hospital in neighboring Willoughby, where doctors ordered a CT scan and immediately put Morgan on a helicopter to Rainbow Babies and Children’s Hospital in Cleveland, with her father by her side. “I knew it was bad when she had to get there by helicopter in six minutes, instead of the 30 minutes it would have taken to get to Cleveland in an ambulance,” McCracken said.

When the helicopter arrived at Rainbow, the McCrackens were greeted by Dr. Alan Cohen, the hospital’s chief of pediatric neurosurgery. He whisked Morgan into the operating room, pausing for a moment to tell McCracken that his daughter had the same injury as Richardson: an epidural hematoma.

McCracken remembers standing in the emergency room, feeling like the life had just been sucked out of him. “My heart sank,” he says. “It just sank.”

Unlike Richardson’s, Morgan’s story has a happy ending.


Australia: Melbourne public hospital lied over waiting lists

THE Royal Women's Hospital has been systematically lying about its surgery waiting list for almost a decade, says a damning report that has forced the Government to overhaul Victoria's hospital funding system. Health Minister Daniel Andrews yesterday apologised to patients who waited months longer for surgery than the Women's has claimed since the late 1990s. He said an independent audit — commissioned after The Age earlier this month revealed the hospital had incorrectly reported data to the Government — confirmed the creation of a "second waiting list" that was disguising the hospital's real performance.

About 180 patients waiting for semi-urgent surgery every year waited an average of 95 days longer than the hospital was reporting, the audit found. This occurred in the context of inadequate scrutiny at the executive level. The finding comes after The Age revealed allegations last May that hospitals were manipulating data to meet benchmarks for bonus funding. Mr Andrews consistently denied the practice was taking place and refused to investigate.

In response to the audit's finding, Mr Andrews yesterday announced that:

* A long-standing $40 million bonus funding pool used to reward hospital performance would be scrapped.

* Six hospitals would be audited without warning every year.

* Patients would be notified in writing if their waiting-list status changed, so they could challenge any discrepancies.

Mr Andrews said he was furious about the audit results and put all Victorian hospital boards on notice that data manipulation was unacceptable. "Health services are accountable for their data and there is an expectation that they record and report it accurately," he said.

The audit of the Royal Women's Hospital found that although staff spoke of "two waiting lists" in front of senior and executive management, executives claimed they knew nothing of it. A "data-entry instruction sheet" revealed that when patients neared a benchmark for how long they should wait, they were put on a secret list, which effectively stopped the clock.

The Government rewards most hospitals with bonus funding if they meet performance benchmarks, but the Royal Women's is not on this list. Mr Andrews said it had previously been on the list and that data manipulation appeared to be a long-standing practice potentially motivated by the incentives. He said he had appointed a delegate to the board of the Royal Women's to ensure the fraud was eliminated. The secretary of the Department of Human Services had received the report and would take legal advice on what action could be taken against those involved, he said.

Royal Women's chief executive Dale Fisher said she had ordered a clinical review to establish whether patient care was affected by the list rorting. She said that, "on the face of it", there was no effect on patients because the list manipulation did not change the booking date of an operation, only the report of the patient's waiting time. "The people got treated at the next available opportunity," she said.

But Ms Fisher admitted it might have hurt the hospital's gynaecological department. "That's one of the disappointing things … that it did compromise our view of demand in gynaecology," she said. "We could have strategically allocated more resources." She said "appropriate disciplinary action" would be taken against staff involved in the practice. This could range from counselling to sacking — but no one had yet lost their job.

Ms Fisher defended her management of the hospital, saying there was no reason the executive team would have spotted the practice, because it was designed to "iron out" the kinds of peaks and troughs that drew management attention. "I am pleased that we found the problem and fixed the problem," she said.

But Ms Fisher said she may never have realised the seriousness of the issue if it was not for a report in The Age this month about waiting-list fraud in unnamed hospitals — a month after she knew about the list problem at her own hospital. "When I found this … I viewed it as a management problem that we needed to fix. The level of seriousness was raised as a result of that article … It was the issue of possible fraud (that) raised the level of seriousness." The hospital will centralise training of staff to get greater control over data reporting, and its internal auditors have been asked "to make sure we're not missing anything else".

The Victorian president of the Australian Medical Association, Doug Travis, welcomed the decision to scrap the bonus pool, saying it would allow hospitals to focus on patient care. "There has been a culture in Victorian hospitals to hit your (key performance indicators) no matter what," he said. "Our community needs to be assured that hospital funds and resources are directed where they are needed."

Shadow health minister Helen Shardey said the Government's response was inadequate because six random audits a year would allow a major hospital to go three years without being audited. "There should be an immediate independent audit of all hospital waiting lists," she said.


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