Does Halifax get its own Mayo Clinic?

Liberal Leader Stephen McNeil's remonstrations in the legislature this month condemning a year-old memo from some Capital District Health Authority physicians proposing a new, doctor-driven, private-public, "Mayo Clinic-like" hospital facility in metro were an emblematic example of the sort of backward, stick-in-the-mud attitudes and reactionary, tunnel-vision thinking that keep Nova Scotia an underachieving backwater.

McNeil trotted out the customary boilerplate about defending the sacrosanct public health care system from the evils of profit motive or market accountability, trotting out the old FUD (Fear, Uncertainty and Doubt) about privatization of health care delivery leading to (horrors!) - two-tiered health care, with NDP leader Darrell Dexter chiming in with his labour-union constituency's pet trope about private hospitals and clinics supposedly luring doctors and nurses away from the public system.

The 2006 memo, reportedly authored and signed by Capital Health surgeon Robert Stone, lays out a concept for clinics or centres that "should not be staffed by 'unionized' personnel

It would focus on providing endoscopy; breast health services; prostate therapy; various other diagnostics; orthopedic surgery, other same-day surgeries, and executive preventive health - all procedures that do not require the facilities of a fully-equipped and staffed, acute-care surgical hospital.
For which there is a strong demand that isn't being met in a timely fashion by the current public system, and which helps keep waiting lists long for other, more complex surgeries and treatments.

It's just, plain inefficient and a misuse of scarce resources.

Read the full story here

Decision made by the Commons: Chalk River "open for the public"

The Commons have decided last night to restart Ontario's Chalk River nuclear reactor and resume the production of medical radioisotopes.

Health Minister Tony Clement said this decision balances safety issues at the plant with the urgent need for the product.

The government introduced emergency legislation last night that will compel the plant to restart operations immediately, at least for 120 days.

Atomic Energy of Canada Ltd. shut down the plant for scheduled maintenance last November. The closure was then extended when serious safety concerns were discovered by the Canadian Nuclear Safety Commission, the federal watchdog for the industry.

Last night's bill allows the plant to restart, but suspends the CNSC's oversight of the Chalk River facility.

"A reasonable decision," according to Clement.

The commission made its decisions based on concerns from scientists and engineers over the system used to cool the reactors, and the possibility of a meltdown in an emergency situation.

But Clement said the government's priority is providing the isotopes to patients who need them.

"In terms of balancing that risk with the risk of cancer patients and heart patients who will not be able to get diagnosis or not be able to get therapy, I think the House of Commons made the right decision and approved the startup of the reactor," Clement told CTV's Canada AM today. (click to see video)

He said the government expects the plant to once again be producing usable isotopes within six to eight days.

The bill still needs to be passed by the Senate, which will likely happen today.

Green Party Leader Elizabeth May called for an inquiry into exactly what took place leading up to last night's decision.

She said Prime Minister Stephen Harper turned the reactor shutdown into a partisan issue and undermined Canada's nuclear regulator.

"Yesterday in the House, he attacked the Canadian Nuclear Safety Commission which is the regulatory body that oversees nuclear safety, referring to them as Liberal appointments and charging the Liberal party was getting in the way of people getting their medical isotopes," May told CTV's Canada AM. (click to see video)

"This was a moment for statesmanship, this is when the prime minister should have called on all parties to work together in the interests of Canadians to protect the supply of radioactive isotopes."

She said the situation sets a dangerous precedent for other Canadian communities that host nuclear reactors.

"These are experts in nuclear safety and the chairperson Linda Keen has now been undercut by the prime minister," May said.

"So the next time Canadians living near a nuclear reactor should be concerned if there's a safety defect in a reactor, AECL is going to thumb their nose at the regulator and know the prime minister is going to come to their defence and blame the regulator?"

The Liberals had threatened to refuse to give the bill the unanimous support necessary to bypass the legislative process.

But all of the political parties eventually agreed to fast-track the legislation through the House and Senate.

MPs passed the vote late Tuesday night, with the NDP and Bloc Quebecois backing it.

The Liberal-dominated Senate, which also agreed to stay late, was expected to put the bill to a vote by early today.

CTV

Editor:

"Isn't this political system just great? Although you might not agree with the decision, at least some real decisions are being made!"

"I wonder though, who's going to pay the bill if there's going to be a meltdown!"

Related articles:

Isotopes Chalk river: production could start very soon

Breaking news: federal government to legislate temporary production of radio isotope at Chalk River

St. Joseph's Health Care to receive scarce medical isotope today

AECL blunder choked supply of key isotope

Ontario reactor shutdown forces cancellation of cancer tests worldwide

Manitoba college closes applications for Registered Nurse program

At Manitoba's Red River College, the waiting list for nurses who want to upgrade their skills has become so long that the school is no longer accepting new applications from them.

The college has sent out letters to Licensed Practical Nurse applicants indicating it had suspended accepting applications from LPNs to the accelerated RN program, which takes about two years.

Some nurses have already been on the waiting list for over 5 years.

Twenty-five LPNs are on the waiting list for the college's accelerated RN program, so no more will be allowed to apply, at least for now, said Louise Gordon, spokeswoman for nursing programs at the college.

"It's simply because we don't believe it's fair to have people wait for that long," she said, noting the waiting list is about five years long.

Goverment promises 100 more places

As reported on Monday, some Manitoba LPNs, frustrated by the wait, are opting to upgrade at Northland College in Minnesota, despite obstacles including higher cost, certification exams and a requirement to attend classes in the U.S. about two days a week.

Health Minister Theresa Oswald said the NDP has committed to opening 100 new spaces for students of nursing.

"We're, on one level, quite delighted that there are lots of people that want to be nurses in Manitoba. It's, on one level, a good problem to have, rather than clamouring for human resources," she said.

"But certainly we know that for every particular program that we created quite recently at Red River, for LPNs to upgrade to RNs, that there is a waiting list that is not satisfactory to people."

However, where those spots will open and for which nursing programs has yet to be determined.

CBC News

Related article:

Nurses in Manitoba moving south to improve skills

Double Dippin' Doctors

Clinic doctors got $500,000 in public funds, but walk-ins must pay for basic visits!

Doctors working at the private Copeman Healthcare Centre in downtown Vancouver received nearly $500,000 in fees charged to the public last year, though the clinic is also charging its 1,500 patients to use its services.

The top grosser in public funds was Tasha Bienert, a family physician at the clinic, who got $158,727 from the Medical Services Plan. Psychiatrist Kevin Kjernisted was paid $120,568. Another psychiatrist, Diane McIntosh, received $118,079. Corporate medical director Peter House made $43,110 while family physician Beth Donaldson got $39,466.

The payments are recorded in the Medical Services Commission's annual financial report for the year ended March 31, 2007. Two other Copeman clinic doctors, Michael Koehle and Mark Gelfer, do not appear in the records. Nor for that matter does clinic founder and CEO Don Copeman, a businessman who once took pre-medicine courses.

It is unclear from the report how much of the fees paid to the various Copeman doctors was for work performed at the clinic, and how much was for work they may have done elsewhere. But medical director House says, "Nobody at Copeman works outside the clinic. We used to."

Besides whatever public money flows to Copeman clinic staff, the centre also charges patients a fee before they can see a doctor. To be seen costs $3,900 for the first year, plus $2,900 for each year after that. That's up from $3,500 for the first year and $2,300 annually since the last reporting in May 2006.

Under the Medicare Protection Act, doctors who have "opted-in" and receive payments under the public Medical Services Plan may not charge a patient for any service normally paid for through public insurance. How then, are Copeman doctors charging twice?

Decision in secret

In late November the government's Medical Services Commission, which oversees payments under the MSP program, ruled after an 18-month investigation that the private clinic on Vancouver's Hornby Street is operating legally, but it remains unclear how that decision was made.

"They refused to provide any reasoning for the decision," says Adrian Dix, the NDP health care critic. "They are denying people their right to know anything about it."

A health ministry spokesperson says it is "frustrating," but section 49 of the Medicare Protection Act says the government can't talk about the commission's ruling. She says Health Minister George Abbott has said the section needs to be reviewed, but meanwhile any answers about the ruling would have to come from the Copeman clinic.

Copeman's medical director House says all he's seen is a two-page letter from the commission that says everything is okay with how the clinic does business. "I don't have the report, no. It wasn't sent to me. I don't know if it was sent to Mr. Copeman."

Copeman did not return calls. Nor did general manager Susan Rafter respond to an e-mail requesting details of the ruling.

However, in an interview with a reporter from The Tyee at the outset of the Medical Service Commission's review of the clinic, Copeman made clear what his arguments (crafted with the help of lawyers who'd written related legislation elsewhere) would be: the fees are for extra services the clinic provides, not for seeing a doctor.

The fees give members access to services like annual health screening, personal coaching, counselling, diet advice and fitness consultation that aren't covered under the public MSP program. As the clinic's website put it, "The fees for these enhanced medical services are bundled by the centre and made available to each client for a simple, annual fee."

Pay for access

The NDP's Dix isn't buying the argument Copeman is selling. "People aren't paying for those services, and everyone knows it," he says. "You're paying for the right to see a family doctor."

What the clinic is charging for is at the crux of the question. Under British Columbia law it is illegal to charge for access to a doctor for anything that would be covered by MSP. As the Health ministry's website explains: "The Medicare Protection Act protects patients from being charged an extra amount for physicians' services that are benefits of MSP." They can charge for all kinds of medically unnecessary things, but if the doctors are going to work in the public system, they have to provide any service covered by MSP to anyone who asks. If someone refuses to pay the fees, the doctor still has to see him or her.

So if Copeman is charging for the extra services and not for access to a doctor, it should be possible to make an appointment at the clinic for something covered under MSP without paying any fee.

When I ask Copeman's House what happens if someone walks in with a fever or some other condition where a visit would be covered by MSP, he says, "We don't refuse anybody, but that's not our business. . . . We're not a walk-in clinic."

Copeman doctors would treat the person, he says, and there would be no charge. "No, we don't charge a fee for that," he says. "We in our clinic do not charge our patients for any medically insurable service that's available in the province. . . . Doctors don't charge patients at Copeman Healthcare Centre for anything except non-insured services."

Members only

But if House is correct, Copeman officials have failed to explain the policy to the people who actually book appointments. When this reporter called the clinic's main phone line last week to ask about making an appointment, the reception person said, "You do have to be a member." It is possible for non-members to get in to see a doctor, she says, but there's a fee of $175. Even if you don't want any extras.

Told about the response, House says, "No, it's not quite so easy, because that's not what we're about."

Whatever the clinic is doing appears to be fine with the government, and House says the commission's approval shows people should stop worrying about the clinic. "We have a business that complies with the Medicare Protection Act of British Columbia, and that's been proven," he says. "We've gone through a two-year process. There's no smoking gun here."

Fan of American system

At a time when the public health care system suffers from several threats, there are bigger issues than the clinic, House says. "It's ridiculous. You can quote me on that. It's a ridiculous topic for debate," he says. "The story's dead, except in people who don't want to believe it. They believe in conspiracies, and the media fans that."

The best source of health information, adds the clinic's top doctor, is the Fraser Institute, which House says is "unfairly labeled as a right-wing think tank."

The bigger problems with the public health care system include chronic under funding and a shortage of physicians, he says, adding that there isn't enough emphasis on illness prevention to help people take care of themselves before they get sick.

For such shortcomings, the doctor offers a cure. "The American health care system is where you're going to get excellence," House says. "We're the only developed country that doesn't have a private and public system running in parallel. . . . Everything else we do besides healthcare is a free market."

He says, "We're not a threat to the health care system and we're not a solution to the health care system. We're an option."

Copeman eyes expansion

Dix says the Copeman clinic does pose a real threat to public health care. If it is allowed to get away with charging patients for access to a doctor, the practice will expand in a hurry. Doctors will be available to those who can afford to pay, and others will have to make do in a deteriorating public system, he says.

"It will be harder to find a family doctor and there will be more extra billing," Dix predicts.

The NDP will fight the decision, he says, starting with figuring out how it was made. "I'm reviewing all options legal and otherwise, freedom of information options, so we can see what was done here."

With Abbott and the federal government refusing to take action against the Copeman clinic, they are practically inviting expansion, he says.

Copeman himself has said in the past he plans to have 40 clinics across Canada within five years. If so, many more Canadians could be asked to open their wallets before their doctors will open the door.

The Tyee