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BC ELECTION: Longterm care is the big health issue

The NDP now trail the Liberals by just two percentage points in an Angus Reid poll released on Friday. Of course, who knows if those numbers are accurate measurements of voters' intentions? A Mustel Research Group poll released just yesterday had the Liberals, led by Premier Gordon Campbell (right), nine points ahead of the NDP. Simon Fraser political scientist Kennedy Stewart's prediction model has the Liberals winning another majority. []

One of the biggest healthcare issues in the campaign has been longterm care and the number of new longterm care beds created by the government. The NDP -- backed on this claim by the BC Medical Association -- blasted the government for failing to create the 5,000 longterm care beds it promised. The government maintains that it has indeed met that goal despite the fact NDP Carole James said Health Minister George Abbott has admitted they only created 800. []

"It's important for British Columbians to understand that these numbers are part of a bigger story that includes surgical wait times and backlogged emergency rooms," Joyce Jones, the community co-chair of the BC Health Coalition, wrote in an op/ed last month. "A shortage of long-term care beds doesn't just affect seniors and their families. It can also mean that beds needed for surgeries and for patients admitted through the ER are being used by people who are, in turn, waiting for space in long-term facilities."

Longtime NDP health critic Adrian Dix warned the Georgia Straight of what he said would be forthcoming cuts in health funding by the Liberals if they win the election. "This government will use the recession as an excuse to reduce the quality and coverage of public health care, and there will be severe consequences." Health Minister George Abbott told the newspaper Mr Dix's allegations were untrue and pointed out that 90% of new spending budgeted over the next three years will be for healthcare. Tom Bradfield, a Green Party candidate, said his party opposed the Liberals' deregionalization of the regional health authorities that administer healthcare locally. The Green Party would like to see a return to health authorities that are better connected to their communities, he said.

Last month, Premier Gordon Campbell of the Liberal Party promised $20 million in new spending to help HIV-positive residents of the notorious downtown eastside neighbourhood get improved access to antiretroviral therapy. Phillip Banks of the Health Initiative for Men, however, accused Mr Campbell of ignoring the prevalence of HIV/AIDS in the gay community.

The Vancouver Sun endorsed the Liberals but acknowledged "there are some persistent issues." The first issue the newspaper raised was rising health spending. "Then again, no Canadian premier of any political stripe has been able to deal effectively with spiralling health care costs or get a better bang for the dollars spent... Muddling through with incremental improvements is the best that Campbell or any other premier can achieve within the public system."

If you're interested in reading more about the problems the Liberal government has encountered and has created in the healthcare sector, look no further than the latest issue of the BC Hospital Employees' Union magazine The Guardian ().

The BC Health Coalition, which has been a staunch opponent of the Liberal government's on health policy, has published a "Voters’ Guide to Party Platforms on Health Care" comparing the Liberal, NDP and Green Party positions on major issues. [ (PDF)]

You can read the parties' official platforms for yourself here: (PDF), (PDF), .

Meanwhile, Libertarian Party president Paul Geddes told the libertarian magazine the Western Standard his party's position on healthcare. "People are different. We don’t all fit into the 'one-size-fits-all' lowest common denominator government monopoly health plan. Some want more service. Some want less. Some want completely different services... The government should not prevent BC citizens from making private agreements with the health providers of their choice."

And, because it's difficult to resist, we recommend you watch the bizarre anti-Gordon Campbell ad produced by the Canadian Office and Professional Employees Union, entitled "Gordon Campbell Hates You." Find it . And if you enjoy that, don't miss the equally strange "Gordo Five-O" in which Mr Campbell is portrayed as a drunk. The Vancouver Sun it "humorous" -- with the scare quotes. Online .

Photo: Gordon Campbell,

THE INTERVIEW: Astro-doc Bob Thirsk

The first Canadian to live in outer space will be a physician... on bisphosphonates.

This month, Dr Robert Thirsk will begin a six-month stay on the International Space Station when he takes off on board a Russian Soyuz spacecraft on May 27.

I talked to Dr Thirsk about how he became an engineer, then became a doctor, then became a physician. (And even then he wasn't done with his education; he ended up getting an MBA, as well.) He also described one of the many experiments he and his five ISS crewmates will be conducting: they are going to take bisphosphonates to try to counteract the bone demineralization astronauts suffer from in zero gravity.

Read my Q&A with Dr Thirsk in the latest issue of Parkhurst Exchange magazine or online .

What's in the news: May 6 -- Chaoulli defends himself

Chaoulli strikes back at coroner
At a press conference in Montreal this morning, Dr Jacques Chaoulli (pictured left) rejected coroner Catherine Rudel-Tessier's recent accusations that he had acted improperly in the case of a man who died in the waiting room of a hybrid-public/private urgent-care clinic last year.

Dr Chaoulli's press conference was announced to the media yesterday with the unsubtle title "Coroner Rudel-Tessier is Wrong."

The coroner's report, released to the public in April, criticized Dr Chaoulli for not attempting emergency resuscitation on Jean-Jacques Sauvageau after he slumped over in his waiting-room chair, as Canadian Medicine reported last month.

Today, Dr Chaoulli that conclusion was incorrect. "It is not true that a doctor should start resuscitation procedures on a person presenting all the signs of unquestionable death, a corpse."

Ms Rudel-Tessier and her expert witness, Dr Colette Lachaîne, falsely asserted that doctors should attempt resuscitation up to three hours following cardiorespiratory arrest except in extreme circumstances, Dr Chaoulli said. That regulation applies to police and paramedics, he said -- not to doctors.

"I did not kill him," he Montreal Gazette reporter Charlie Fidelman, despite the fact that he has been accused of no such thing and despite the fact the coroner's report alleged that although Dr Chaoulli should have attempted resuscitation Mr Sauvageau would have died anyway.

Dr Chaoulli accused Ms Rudel-Tessier of impugning his character and unfairly damaging his reputation. "It's clear that, when you're attacked and accused, and in an unjustified way, in every news source, it's clear that damages the image and reputation of the person."

He admitted he should not have left Mr Sauvageau's dead body in the waiting room with the rest of the patients. "But you know, it's always easy to say that afterwards, but it's certainly a lesson I've learned."

In a news release, Dr Chaoulli explained what he believes to be the appropriate response to the death of Mr Sauvageau death, who . "This situation illustrates the need to have all walk-in medical clinics offer the services of a dedicated triage nurse in order to prevent such unfortunate events from occurring again in the future."

Dr Chaoulli's recommendation goes even further than what is likely to be adopted as policy by the Collège des médecins du Québec in response to the coroner's report. Canadian Medicine learned last month that the Collège was considering requiring urgent-care clinics to compel all their doctors and nurses to get CPR training and to keep a defibrillator on hand.

Dr Chaoulli remains under investigation by the Collège to determine whether he acted properly during the Sauvageau incident.

H1N1 flu news update
Yesterday afternoon's counted 165 confirmed cases of H1N1 flu across Canada, with the vast majority found in BC, Alberta, Nova Scotia and Ontario. Today's PHAC numbers aren't out yet, but already we know Ontario has . So far, however, all cases have been mild and zero Canadians have died of the disease.

Canadian scientists in Winnipeg became the first in the world to sequence the flu's genes, Health Minister Leona Aglukkaq and chief public health officer Dr David Butler-Jones announced today. "The world’s knowledge of the H1N1 flu virus has taken a significant step forward thanks to the excellent work done at Canada's National Microbiology Laboratory," said Ms Aglukkaq. []

In China, 27 University of Montreal students were quarantined on Saturday even though none showed any signs of the H1N1 flu. The students' quarantine will end tomorrow morning and they will be permitted to travel to Changchun to take language classes. []

The University of Guelph was the benefactor of some lucky timing in its announcement of the opening of a new Center for Public Health and Zoonoses. [] Coming as it did during a time of global panic over a disease thought to have been initially transmitted from pigs to humans, the school's announcement received more attention than it probably otherwise would have.

Ontario Medical Association's new prez
The OMA has a new president, Dr Suzanne Strasberg.

Dr Strasberg, a family doctor in Toronto, has set out :

1. Focusing funding on the patient;
2. Promoting a healthy lifestyle for all Ontarians;
3. Working with the government to determine and minimize the impact of the Harmonized Sales Tax (HST) on physicians;
4. Ensuring adequate physician input into local health care decision making; and
5. IT and eHealth
In 2007, Dr Strasberg co-authored an op/ed in The Globe and Mail to defend a Canadian Medical Association proposal called Medicare Plus, which called for greater freedom for doctors to practise in the public and private sectors at the same time, among other things. [Canadian Medicine]

Last year Dr Strasberg had a high-profile disagreement with the Coalition of Family Physicians of Ontario (COFP) when she and several other physicians criticized the group (which had endorsed her candidacy for the OMA board of directors) for being "misleading and inaccurate" in its advocacy for a "no" vote against the most recent collective agreement between the OMA and the Ontario government. [Canadian Medicine] The agreement was approved by over 79% of doctors who voted. [Canadian Medicine]

Dr Strasberg's first public announcement was a call for reforms that will ensure every Ontario resident has a family doctor.

"I am looking forward to working with Dr. Suzanne Strasberg and to continuing to develop the vital relationship I have with the OMA," Ontario Health Minister David Caplan. "I would also like to thank the Association's outgoing president Dr. Ken Arnold for his leadership during a crucial year in the partnership between doctors and our government."

If Mr Caplan and Dr Strasberg can indeed develop a working partnership, it will be a major improvement over the animus that existed for years in Ontario between Mr Caplan's predecessor, George Smitherman, and the province's medical community.

Sékaly to leave for the US
One of the country's most accomplished HIV/AIDS researchers, University of Montreal's Rafick-Pierre Sékaly, has been lured away from Canada by a Florida research institute. "The offer was the dream of any scientist," he said. "I'd have been crazy not to take it." More than half of his staff of 40 researchers will leave Montreal with him.

Dr Sékaly and other researchers bemoaned Canada's inability to provide the same sort of funding for scientific research that the United States can. According to CBC News, Dr Sékaly will have a research budget in Flordia that's twice as large as his budget was in Montreal.

Lessons in euthanasia
Australian physician Philip Nitschke gave a workshop on euthanasia to nearly 100 people in England.

Read PE online
The May issue of Parkhurst Exchange is in the mail now, but there's no need to wait until the hard copy arrives: check it out online .

Provincial elections take precedence over federal politicking

One of the major fallacies commonly held about the Canadian healthcare "system" is that there is such a thing in the singular. The truth of the matter is that beyond providing funding and assessing some apparently arbitrary nominal fines for violations of the Canada Health Act, the federal government has little influence in creating or implementing the health policies that affect the majority of Canadians. Canada has health systems, plural. Counting each province's ministry of health plus Ottawa's administration of healthcare for First Nations, soldiers, veterans and prisoners, there are fourteen distinct systems.

Nevertheless, there is often much talk during federal election campaigns about threats to medicare or efforts to kickstart healthcare reform when instead those matters pertain to provincial politics. Perhaps because the characters are seen as more colourful or perhaps because the rhetoric is more inspiring, federal politicians tend to overshadow their provincial counterparts.

This is the case at the moment. While the chattering classes jaw about whether Liberal leader Michael Ignatieff will attempt to topple the government sooner rather than later and whether Prime Minister Stephen Harper will work with the NDP or the Bloc Québcécois to keep his Conservatives in power, two provincial elections of significant consequence are coming up.

British Columbia's campaign is in its last stages and voting ends next Tuesday, May 12. The NDP's numbers are surprisingly high considering where they were several months ago, but the incumbent Liberals still hold a small lead in the polls. The Liberals have had some tumultuous years in terms of health policy, what with the Insite safe-injection controversy and a recently begun battle against Canadian Medical Association past-president Dr Brian Day over the constitutionality of denying patients full rights to use private health facilities.

On the other coast, the writ was dropped in Nova Scotia, triggering a June 9 election in which the Progressive Conservatives will attempt to either hold on to their minority government status or gain a majority in the legislature, while the NDP will attempt to leapfrog past the Tories to become the governing party. During the campaign Canadian Medicine expects to see the Conservatives forced to defend their healthcare record, which consists of an ambitious review of the entire system ("transformational system-wide realignment" was the catchphrase) conducted over a year ago but little substantive progress made in practice so far. The Tories did, however, manage to successfully negotiate an interesting collective agreement with the province's physicians a year ago this month, which may help lay the groundwork for future reforms.

Stay tuned. Canadian Medicine will endeavour to bring you the most important news on the health-related aspects of the two election campaigns.

Meanwhile, tell us your opinions of the campaigns on the coasts. Will the Liberals prevail in BC? Will the NDP defeat the Conservatives in Nova Scotia? What results would be of the most benefit to doctors, their patients, and the province's healthcare systems as a whole?

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