Health Care

ILLNESS IN THE SYSTEM

Critics say the B.C. government’s cuts are dangerous

KEN MACQUEEN October 14 2002
Health Care

ILLNESS IN THE SYSTEM

Critics say the B.C. government’s cuts are dangerous

KEN MACQUEEN October 14 2002

ILLNESS IN THE SYSTEM

Health Care

Critics say the B.C. government’s cuts are dangerous

KEN MACQUEEN

IT’S A CURIOSITY—even by the moun tainous standards of the Kootenay district of southeastern B.C.—but many of the region’s hospitals are built on the high ground. It’s true in the lunch bucket city of Trail, where the imposing Kootenay Boundary Regional Hospital sits eye to eye across the Columbia River from the giant Teck Cominco smelter. It’s true in Nelson, where the bland and slightly decrepit 1950s-era Kootenay Lake Hospital presides over the high-Victorian charm of one of Canada’s sweetest downtowns. It’s true in postcard-pretty Kaslo, where elderly, long-term care patients of the Victorian Hospital tend the ripening tomatoes on a balcony above North Kootenay Lake.

It’s no exaggeration in these places to say people look up to their hospitals. In an increasingly secular world, they are almost consecrated ground. The high drama of a community plays out in these buildings: births and deaths, and much of the fear, hurt and trauma in between. A hospital stands guard. And as the provincial Liberal government discovered at its peril this summer, sometimes a community is obligated to return the favour.

This is literally true in Nelson, a flashpoint of opposition to attempts by the Liberals to reform health-care delivery and to contain its $10-billion annual cost. Pegasis McGauley, a 60-year-old community support worker for the disabled, spent much of the summer in a nylon tent, guarding the hospital’s loading dock to ensure that ventilators and other locally donated equipment weren’t moved away. Her actions were partly symbolic, she concedes, since there’s little left to take. Most capability for emergency and serious surgery, intensive care and internal medicine, was shifted this summer to Trail, an hour away in good weather. Other Kootenay communities saw the acute-care beds in their hospitals close altogether.

Other fellow members of Save Our Services, only one of a number of Nelson-

area groups fighting the cuts, watch the emergency ward. They track the often ugly scramble to find available patient beds, sometimes as far away as Vancouver, Edmonton or Washington State. On a recent afternoon, Klaus and Lee Jarchow closed their photography business early to take a shift monitoring the emergency room. Lee, now 61, suffered a stroke in 1996. Within minutes of her arrival that day she received expert care in the hospital’s intensive care unit. Since July, the former ICU has been used as a staff lunchroom. “I don’t think we pay taxes to have this happen,” she says.

Penny Hanic, a nurse at the hospital since 1975, stops to chat with the Jarchows. Operating room cutbacks have caused her to join a medical exodus from Nelson (she has since moved to Maine). Two surgeons left this summer. Dr. Doug Nottebrock is moving to Kelowna later this month after 14 years as a general practitioner and emergency room physician. The goal of balancing the budget is laudable, he says, but the pace and strategy of change is fraught with risk for patient and doctor. “I’m not prepared to live with that right now,” he says. Nor is Hanic. Shifting services to Trail offers little prospect of real savings, she believes, and has more to do with playing politics: “It’s so not about money.”

But Premier Gordon Campbell is committed to erasing a projected deficit of some $4 billion this fiscal year—and to pursuing an ideological quest for smaller government. Fewer public servants perform fewer publics services, across the spectrum. Nowhere are the political risks higher than the attempt to reform health care—which accounts for 41 cents of every provincial tax dollar. Critics say the spectre of closed nursing homes and emergency services has contributed to a 19-point drop in Liberal support, though at 43 per cent the Liberals remain far ahead of the tiny NDP opposition. Adding to Nelson’s angry sense of isolation are cuts that Mayor Gary Exner says will eliminate one-third of 600 public

sector jobs in local regional offices. “It’s almost like every move they made is punishing rural B.C.,” he says.

Campbell’s campaign prescription to “renew” and “improve” health care became, after his May 2001 election, a crying need to “reduce costs and improve efficiency.” His government increased health spending by $1.1 billion—an amount largely swallowed by salary increases and the costs of a lightning-fast restructuring. It slashed the number of local health authorities to six from an unwieldy 52, and gave them autonomy to make the hard regional decisions. The political pain suffered as a result of health cuts in Ontario and Alberta offered a valuable lesson: amputation without anaesthetic is best done quickly, with someone else’s hand on the saw.

In parts of the Kootenays, wrath is divided between the Liberals and their new creation, the Kelowna-based Interior Health Authority, which administers more than $1 billion for the needs of 722,000 people in a vast swath of hinterland B.C. It was the Liberal campaign platform that promised: “We are going to make sure that people have the care they need, when they need it, where they live.” It was the IHA which designated Trail as the regional hospital.

While the Liberal promise works well for the 7,700 people of Trail, emergency surgery or intensive care is now an hour away for the 9,600 people of Nelson. Further north, it’s two hours away for the 1,100 people of Kaslo, whose hospital’s first-aid-style emergency ward used to stabilize patients for a one-hour trip to Nelson. For hundreds of families living still further north, in tiny communities like Lardeau or Argenta, treatment is three hours away on summer roads.

Nelson ambulance paramedic Brian

Levin speaks of the all-important first hour when treatment for accident or illness can make a life-or-death difference. “No matter how you slice it around here,” he says, “your golden hour is shot.” Dr. Grant Falck, a Nelson general practitioner and anesthesiologist, walks a visitor through the Kootenay Lake emergency department, quiet this morning, and the former ICU, where three staff members on break sip coffee. Packing a desperately ill person off to Trail, he points out, is frightening for the patient and leaves emergency doctors

Campbell wants to erase a projected deficit of some $4 billion—and pursue an ideological quest for smaller government

fearing lawsuits. “We’re actually just waiting for some disaster to occur to emphasize the point of how dangerous the situation is,” Falck says. The entire hospital medical staff has signed a petition calling the changes “unsafe and unsustainable.” In Kaslo, Vivienne Jennings, 77, and her husband Jim, 74, breeze through their local hospital, visiting old friends in the bright, cheerful extended-care rooms. They’ve given countless volunteer hours to their tiny hospital, accepting that any serious emergency would be handled in Nelson. The prospect of now living two hours from any substantial medical services frightens and angers them. Even so, it’s hard to reconcile the Jennings, and their kind, gentle ways, with Jim’s recent blistering letter to the premier. “I am definitely concerned for your soul,” he wrote Campbell. “First John 3:15 tells us that no murderer can enter the Kingdom of Heaven, and you are on the road to becoming a murderer through your health-care policies.”

HORROR STORIES FROM THE KOOTENAYS

Nelson-area residents say their safety is jeopardized by provincial health reforms that gutted services at their city hospital, and shifted most emergency care and surgery an hour away to Trail. Murray Ramsden, CEO for the provincially created Interior Health Authority, says regionalized services result in better care at lower cost. Getting patients to hospital will always be a challenge, he says: “Rural B.C. has got mountain ranges and vast geographical areas.” Still, recent medical emergencies have shaken the faith of many in their health-care system. Some examples:

■ This is a devastating year for Fred Fenkner, 70. The Nelson resident was recovering from triple bypass heart surgery when he suffered a stroke in March. Months later he was diagnosed with bone cancer. In mid-July, while in Kootenay Lake Hospital in Nelson, he developed an abscess in his groin. He was flown by air ambulance to Kelowna for surgery. Less than 24 hours later, he was returned to Nelson, a trip of more than seven hours involving transfers to three different ambulances en route. In Nelson he was transferred to a fourth ambulance for the hospital in Trail. Some 12 hours later, he was bounced back to Nelson.

“I’m disgusted with the whole thing,” says Fenkner, who believes the surgery could have been handled at Kootenay Lake prior to the cutbacks. “I think this is a hard-nosed bottom-line government,” says his wife Della at his hospital bedside in Nelson. “It lacks compassion. People like Fred, they treat him like a

sack of oats that can be moved from one storage room to another, wherever the cost can be cheapest.” He has since been moved to a long-term facility in Rossland, almost 90 minutes from their home, because there were no available beds in Nelson.

■ Karen Mackie watched in horror on a July morning when her one-year-old son Jayson swallowed a nickel, began to choke and turned blue. She flipped him upside down, pounded on his back, and apparently knocked the coin from his trachea to his esophagus. With the immediate danger past,

she rushed to Kootenay Lake Hospital some 20 minutes away, to be told neither Nelson nor Trail had the capability to help. She and Jayson were flown by air ambulance to the children’s hospital in Vancouver at a cost, she was later told, of $5,000. There, some 13 hours after the incident, doctors attempted but failed to retrieve the coin, which had moved safely into Jayson’s digestive tract. Children swallow things all the time, says Mackie. But, she adds, “My child was in some danger and it wasn’t able to be handled up here, and my question is, why?”

■ On Sept. 5, Tanya Harmen, 50, of the tiny Kootenay community of Thrums, was in a devastating crash northwest of Nelson and Trail. She and the woman in the other vehicle were taken to Nelson, where they were stabilized and transported to Trail. The severity of Harmen’s injuries resulted in her transfer, first to Spokane, Wash., and finally to Seattle. IHA spokesman Drew Edwards says such severe injuries have always necessitated transfer to a major trauma hospital, and that, among other considerations, Spokane was the closest with the facilities needed.

Harmen’s relatives wonder why she wasn’t moved immediately to Kelowna or Vancouver, rather than being bounced from hospital to hospital. Her treatment in the U.S. could last months, and will cost “huge American dollars,” says her sister-in-law Nadine Hatherly. “It defeats the purpose of centralization of services by sending people to the U.S.” Hatherly says the incident has caused her and her husband to consider moving from the Nelson area to a community with a full-service hospital.

The decision to designate Trail as the regional centre was based on clinical realities: more specialists working in a more modern facility, according to Murray Ramsden, CEO of the health authority. “Yes, on one hand they are not geographically centred, but they do have that infrastructure to support carrying out that responsibility as a regional hospital,” he says. Are residents more or less safe since the changes? “That’s a very hard question to answer,” he says. Funding levels varied widely throughout the regions. Now, he says, “we know we are treating all our health-care services equally, effectively

and we are expecting them to achieve high standards of patient care.”

Critics say the decision was tainted by political realities. The smelting giant Teck Comineo, Trail’s dominant employer, is a generous donor to the local hospital, and to the provincial Liberals. Teck companies gave more than $63,000 to the party last year, and company chairman Norman Keevil has Campbell’s ear as a member of his B.C. Progress Board, a private-sector economic advisory group. Such speculation is dismissed as “paranoia” by Blair Suffredine, a Nelson lawyer and first-term Liberal MLA. While he is “not very happy” that surgery moved to Trail, the election promise of health care “where you live”

must be tempered by economic reality, he says. “Taken to its logical extreme that would mean a hospital on every corner.” The definition of that promise may yet be determined in court. Nelson’s Save Our Services is suing the province and the health authority, seeking an injunction on the grounds the reforms violate federal standards of accessible health care. Campbell says the restructuring ensures exactly that—access to a system “that will be sustainable for the future.” In communities like Nelson, though, there’s little faith in political prescriptions from distant Victoria. It’s the hospital on the hill they trust. It’s doctors, not politicians, who hold the higher ground. PÎ1