More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here.
Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins.
"They rushed me over to Detroit, did the whole closing of the tunnel," said Eric Bialkowski, 47, of the heart attack he had on March 14, 2007, in Windsor, Ont. "It was like Disneyworld customer service."
While other provinces have sent patients out of country - British Columbia has sent 75 pregnant women or their babies to Washington State since February, 2007 - nowhere is the problem as acute as in Ontario.
At least 188 neurosurgery patients and 421 emergency cardiac patients have been sent to the United States from Ontario since the 2003-2004 fiscal year to Feb. 21 this year. Add to that 25 women with high-risk pregnancies sent south of the border in 2007.
Although Queen's Park says it is ensuring patients receive emergency care when they need it, Progressive Conservative health critic Elizabeth Witmer says it reflects poor planning.
That is particularly the case with neurosurgery, she said, noting that four reports since 2003 have predicted a looming shortage.
"This province and the number of people going outside for care - it's increasing in every area," Ms. Witmer said.
"I definitely believe that it is very bad planning. ...We're simply unable to meet the demand, but we don't even know what the demand is."
Tom Closson, the Ontario Hospital Association's president and chief executive officer, said 30 per cent of Ontario's hospital medical beds are currently occupied by patients awaiting more appropriate placements, such as assisted living centres, a nursing home, a rehabilitation facility or even their own homes with proper home-care supports.
That squeezes the system at both ends: Patients in intensive care units whose condition improves cannot get into step-down units, and some emergency patients can't get a bed at all, he said, adding that "everything is jam-packed at the moment."
A method for determining the right mix of beds and health services required in Ontario needs to be developed, he said, noting that that task has not been undertaken on a provincial basis for a decade.
Laurel Ostfield, press secretary to provincial Health Minister George Smitherman, said that in emergencies, where the patient goes becomes a clinical decision.
It is preferable for someone with a heart attack in Windsor to be sent to Detroit, a few kilometres away, rather than on a long ride to London, Ont.
When demand has peaked, government has responded, she said. It struck a neurosurgery expert panel to study the problem and $4.1-million has been provided to stem the tide of U.S. neurosurgery patients.
As well, stand-alone angioplasty services were created in Windsor in May.
Canadian Medical Association president Brian Day said he couldn't speak about the Ontario problem, but noted this country is the last in the Organization for Economic Co-operation and Development to finance hospitals with global budgets.
Under that model, patients - and often doctors - are sometimes viewed as a financial drain.
"We keep coming back to the same root cause," Dr. Day said in a telephone interview from Ottawa. "The health system is not consumer-focused."
Patients first learn of the problem when they are critically ill.
Jennifer Walmsley went to Headwaters Health Care Centre in Orangeville in October and was diagnosed with a cerebral hemorrhage due to a ruptured aneurysm. That acute-care hospital does not have neurosurgery and no Ontario hospital that does could take her. She was then rushed to a Buffalo hospital.
Headwater's chief of staff, Jeff McKinnon, said three neurosurgery patients have been sent to Buffalo in the past year. Others have gone to Toronto, Mississauga, Hamilton and London.
Radiologist Louise Keevil said Headwaters has an arrangement with neurosurgeons at other Ontario hospitals to send electronic images for their assessment, but "the limiting factor is availability of beds in their hospital.
"The physicians are very accommodating but their hands are tied by availability of service."
Kaukab Usman had a heart attack after a gym workout in Windsor on Dec. 9. She was rushed to hospital and given clot-bursting drugs.
When they failed, she was sent to Henry Ford Hospital in Detroit, where she had angioplasty on one clogged artery and two stents inserted.
"It was a miracle for me to be alive," Ms. Usman said in a telephone interview from Somerset, New Jersey, where she is recuperating.
Aaron Kugelmass, director of the cardiac catheterization laboratory at Henry Ford Hospital, said a system is in place to get these patients the care they need expeditiously.
"We try to make their length of stay in the U.S. as short as possible," said Dr. Kugelmass, associate division chief of cardiology. "If they are stable for discharge, we discharge them to home in Windsor, with clear follow-up plans."
Cross-border emergency health care should become less frequent when Amr Morsi, an interventional cardiologist currently in Orlando, Florida, comes to work at Hotel-Dieu Grace Hospital in Windsor in April; a second interventional cardiologist is to come on board there by end of year.
When the program is fully functional, Dr. Morsi expects Hotel-Dieu Grace to be able to do 500 angioplasties a year.
"The idea of starting the program in Windsor is that we will be able to do more of the angioplasty procedures in Windsor without having to send them to Detroit or London," said the Toronto native who did his cardiology training at the University of Toronto.
"It will take some time to decrease the numbers entirely, but that certainly is the long term plan."
Mr. Bialkowski of Lakeshore, a town east of Windsor, had angioplasty and received four stents. The stents, typically made of self-expanding, stainless steel mesh, were placed at the site of the fully blocked artery to keep it open.
The price to treat him, including a two-day hospital stay in March, 2007, was $40,826.21 (U.S.) With a 35 per cent discount from Henry Ford Hospital, the bill to the Ontario Health Insurance Plan tallied $26,537.03 (U.S.), according to a health ministry document, a copy of which was sent to Mr. Bialkowski.
The father of six, a human resources manager for a manufacturing company based in Windsor, is back at the gym and feels great. It didn't matter where he received the lifesaving care, he said, just so long as he obtained it.
"I guess the Canadian government took care of me," he said.
globeandmail.com: Why Ontario keeps sending patients south
Why Ontario keeps sending patients south
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