Commentary By Jerry O’Hanley
The provision of on-Island vascular surgery for Islanders has languished far too long in the hands of various bureaucratic institutions. The latest salvo was a trial balloon floated by the Physician Resource Planning Committee to recommend that these services be relocated on a permanent basis somehow to Halifax.
The bureaucracies were faced with a dilemma when Dr. Peter Midgley indicated to them that sustainable vascular surgery on P.E.I. would require two surgeons, a seemingly generous compromise when most call groups these days are one in four. The response was to initiate an impact analysis — a primarily monetary exercise. The analysis showed that a two-person scenario similar to that proposed by Dr. Midgley was substantially less expensive than off-Island care.
Presumably this answer was not the one that was wanted, so it was massaged and repeated and discussed at various tables, but the economic conclusion remained inescapable. The question then remains as to how after these many months in limbo that the Physician Resource Planning Committee could arrive at an opposing position. The rationale that the Department of Surgery at Queen Elizabeth Hospital at their meeting just before Christmas was given was that two on-Island vascular surgeons, while in no way an economic problem, would be concerning in terms of competence and sustainability.
The competence argument goes something like this — the more a surgeon does, the better are patient outcomes.
The argument sounds good, but holds no water when tested directly, particularly when the ill effects of prolonged wait times are considered.
If the assumption that competence is solely a volume issue were true, we should send everyone with a health problem to Toronto or New York. Vascular surgery (along with many other treatments here) has ranked very well against national standards for many decades.
The larger, more salient, competence issue involves the rest of us. Vascular surgery patients demand our very best attention.
When we do not attend them in their operative period, we lose the opportunity to hone our skills in anesthesia, perioperative medical and nursing management, respiratory therapy, and a host of other hospital functions. Indeed our resource management services, including our governmental planning committees, lose the chance to sharpen their management skills without the whetstone of vascular surgery. Without vascular surgery, no doubt their job is easier, but unlikely better.
Patient outcomes are decidedly the primary issue. I am told that we saw in the result of off-Island vascular surgery when we were without this service some years ago — our amputation rate rose. Health care delayed is health care denied. The current arrangement is insecure and causes substantial treatment delay.
Like Moncton, which no longer wishes to receive Island vascular patients, Halifax has no vested interest or contract in their care long term. So, as proposed, we will tender our regrets that Island vascular patients will have less timely access to limb-saving surgery away, but their amputations can be provided relatively quickly at home. Possibly cheaper. Decidedly substandard. Utterly stunned.
The sustainability argument is also flawed. Dr. Midgley has indicated that he believes the service can be maintained on-Island with a partner. Dr. Ken Grant provided this service on P.E.I. by himself with the help of his colleagues, particularly Drs. Ashby, Cottreau and Cox, for the better part of his life has endorsed this idea and has actively lobbied for its adoption.
Surely Dr. Midgley and Dr. Grant are in the best position to devise a workable, sustainable plan. Government has not yet seen fit to do them the courtesy of trying this logical proposal.
Speculations about feasibility by committees composed of people far removed from the care of these patients are risky, lightweight grounds for decision-making versus the recommendation of those most deeply involved. Islanders deserve that opportunity for better care.
I believe the Physician Resource Planning Board decision is a test of the political waters. If the response is less than vocal, then Health P.E.I. will recommend to Treasury Board and ultimately cabinet the decision be ratified. I believe that now is the time for Islanders to let the ultimate decision-makers know that they are wholeheartedly in favor of the provision of two on-Island vascular surgeons to care for them, at least on a trial basis.
Jerry O’Hanley, M.D. is a Charlottetown physician