Petition put to BC Legislature: restore North Island pathology

Petition put to BC Legislature: restore North Island pathology

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Petition put to BC Legislature: restore North Island pathology

By George Le Masurier

Today North Island MLA Claire Trevena presented a petition signed by over 2,500 people to the BC Legislature that calls for the return of onsite clinical pathologists’ services to the Campbell River Hospital.

The petition, started by the Citizens for Quality Health Care, also asks the province to fund a third general pathologist at the Campbell River Hospital and to conduct an independent investigation into the apparent conflict of interest between the Vancouver Island Health Authority (VIHA) and the Vancouver Island Clinical Pathology Consulting Corporation.

READ MORE: Find our three-part series on North Island pathology services here

Campbell River and Comox Valley doctors and patients have opposed VIHA’s plan to centralize onsite clinical pathologists’ services including interpretation and diagnosis of blood, urine and other fluid samples in Victoria.

Sources have told Decafnation that in Campbell River, where VIHA has already implemented this plan, it has posed significant and sometimes life-threatening dangers to patients and makes the work of lab staff, family physicians and specialists at the local hospital frustrating and difficult.

Campbell River laboratory professionals used to work in concert with easy access to one another for advice. But since VIHA moved clinical pathologists’ services to Victoria, interactions between Campbell River lab technologists and assistants with pathologists at the Vancouver Island Clinical Pathology Consulting Corporation is “formal, remote, delayed and does not meet the needs of medical staff and patients in urgent situations,” the citizens health care group said in a press release this week.

“This delays consultations, decision-making and treatment and is a step backward, not forward in timely and professional patient care,” they said.

The citizens group said it hopes MLAs will take the petition and their concerns seriously and restore clinical pathology services to the Campbell River Hospital and ensure that Island Health provides funding for a third general pathologist in Campbell River.

“The clear message that we have received from the community is that the reduction of local services to North Island patients is not acceptable and we must continue to fight for our rights. What VIHA is doing is a violation of all the promises that were made when the new hospitals were built that there would be an increase and not a decrease in services,” they said.

Noting the VIHA motto — Excellent health and care for everyone, everywhere, every time — the citizens group asked the health authority to take a sober look at the needs of patients and the demands of the front line providers in the community.

“They are the ones who deliver that care, not specialists in Victoria or bureaucrats in a boardroom,” they said.

Citizens for Quality Health Care plans to hold a Town Hall meeting in late January in Campbell River to further inform the public.

Readers can contact the Citizens For Quality Health Care through Lois Jarvis in Campbell River at 250-287-3096, and through Barb Biley in the Comox Valley at 250-338-3149.

 

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Comox Valley to discuss the climate crisis on Wednesday, Nov. 20

Comox Valley to discuss the climate crisis on Wednesday, Nov. 20

Will Cole-Hamilton, a Courtenay city councillor and one of 20,000 Global Climate Leaders  |  Archive photo by George Le Masurier

Comox Valley to discuss the climate crisis on Wednesday, Nov. 20

By George Le Masurier

Scientists tell us that climate change is one of the biggest issues facing humanity but talking about it can be uncomfortable. North American statistics show that most people do not discuss the climate crisis.

This silence makes it hard to build momentum to solve the problem.

The Comox Valley Unitarian Fellowship will join The Climate Reality Project for 24 Hours of Reality: Climate Truth in Action, a day that is about mobilizing a worldwide conversation about the climate crisis and how we solve it on Wednesday, Nov. 20.

Climate Reality Leader volunteers from across the globe will lead presentations and conversations in countries around the world. The presentations will focus on the climate crisis, what it means for us in our everyday lives, and the solutions already in our hands.

Worldwide, more than 20,000 Climate Reality Leaders have been personally trained by Vice President Al Gore to give updated versions of the slideshow made famous in his book An Inconvenient Truth and the subsequent documentary by the same name.

Courtenay City Councillor, Will Cole-Hamilton, is one of those trained by Al Gore and ready to share this critical information with local citizens.

After his presentation, participants will have a chance to form small groups and have facilitated conversations. The purpose of the small group chats is to gain knowledge, build community and find inspiration to face this challenge together and share ideas for taking practical steps for individual and collective action.

Invite your neighbours and friends to talk about climate action. The event will take place from 7 to 9 pm on Wednesday, Nov. 20 at the Comox United Church Hall (250 Beach Drive).

Contact climatecomoxvalley@gmail.com for more information.

 

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Hospital district board debates advocacy role, doesn’t back off on retaining NI pathology

Hospital district board debates advocacy role, doesn’t back off on retaining NI pathology

BC Premier John Horgan helped break ground for 126 new publicly funded long-term care and hospice beds to be built by Golden Life Management Corp at Cliffe Avenue and 29th Street in Courtenay. The event was unrelated to the regional hospital board meeting  |  George Le Masurier photo

Hospital district board debates advocacy role, doesn’t back off on retaining NI pathology

By George Le Masurier

Should the Comox Strathcona Regional Hospital District advocate for health care services on behalf of its constituents? Or is the district’s role limited to funding 40 percent of selected capital projects proposed by the Vancouver Island Health Authority and levying appropriate taxes?

That question arose at this week’s meeting of the hospital district board during debate about whether to send a follow-up letter to Health Minister Adrian Dix. The minister has not responded to a previous letter that advocated for maintaining onsite clinical pathologist’s services in the North Island.

At the direction of the CSHD board in April, Chair Charlie Cornfield wrote to Dix and VIHA’s board Chair Leah Hollins. In that May 3 letter, Cornfield called removing onsite clinical pathologist’s services “yet another reduction in health care services for communities in the northern region.”

“On behalf of the CSRHD board, I am requesting that Island Health revisit and cancel the contract with VICPCC for laboratory services and … request that Island Health retain and expand, with appropriate funding, pathological laboratory services at the North Island Hospital campuses.”

VIHA did respond to Cornfield’s letter. They sent Dr. David Roberston to address the issue with the board in September.

Director Jim Abram, who represents the Discovery Islands-Mainland Inlets area, made a motion to send a second letter to the health minister to “reconfirm our strong support” for onsite pathology services and a third pathologist at the Campbell River Hospital, and to “fully utilize our capital investment in both hospitals.”

A reworded motion was eventually passed unanimously but not before several directors questioned whether the board should advocate over what they called “operational” issues.

Board Chair Cornfield said he thought “advocacy around operation issues are best dealt with by the public.”

And Campbell River Mayor Andy Adams, also a hospital board director, said he was “uncomfortable” with the board playing an advocacy role. And Comox Valley Area A Director Daniel Arbour said he had “questions around advocacy.”

But Abram and Oyster Bay Director Brenda Leigh tied advocacy in this case to a capital issue.

“I think advocacy is the best use of our hospital board,” Abram said. “We spent $267 million for fully functional laboratories.”

Leigh added that “when you don’t get a letter back in eight months, it’s time to knock on doors.”

In the end, the directors did not back off the advocacy they expressed in their May 3 letter and voted unanimously to send a follow up letter to Health Minister Dix.

The approved motion:

“That the Comox Strathcona Regional Hospital District write to the Premier and Island Health to reconfirm the board’s strong support for maintaining fully functioning local pathology services at the North Island Hospitals in Courtenay and Campbell River in support of optimum health outcomes for the hospital district and to fully utilize the board’s capital investments at both hospitals.”

The provincial Hospital District Act is silent on the issue of advocacy.

 

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Jesse Ketler, first woman to chair the Comox Valley Regional District Board

Jesse Ketler, first woman to chair the Comox Valley Regional District Board

Jesse Ketler, Cumberland Councillor, CVRD Director and Board Chair

Jesse Ketler, first woman to chair the Comox Valley Regional District Board

By George Le Masurier

Cumberland Councillor Jesse Ketler this week became the first woman to chair the Comox Valley Regional District since its inception in 2008.

All 12 of the past chairs have been five different males. Two of them — Bruce Jolliffe and Edwin Grieve — each held the post for four consecutive terms.

Ketler defeated two male opponents — David Frisch and Edwin Grieve — to win the annual November election of board officers.

Arzeena Hamir was elected vice-chair for the second consecutive year. The only other woman elected to the vice-chair position was former Comox councillor Patti Fletcher, who previously held the post in 2012.

In her speech to directors before the vote, Ketler touched on a variety of issues including fiscal responsibility, equality of power and climate change.

“On equitability. With seats at the board based on population and majority rules, the feeling of equity and balance can be elusive,” she said. “As a member of the board with the smallest population, I acknowledge how important it is to be heard. And I know that the best decisions come out of healthy debate where all sides are given a voice. I will endeavour to allow for fulsome, respectful debate of the important issues we face. And I feel that as presiding member, I can bring a neutral lens to some of our more contentious challenges.”

Ketler said she’s aware of the financial impact CVRD decisions have on constituents.

“I myself am a single parent of two young children and I live with my share of financial insecurity,” she told directors. “I have been a member of the Comox Valley Coalition to End Homelessness since its inception and I am entering my second term as the Village appointee to our Homelessness and Affordable Housing Committee. I know how even $50 a month can have a big impact on a family and I do not take decisions on tax increases or user fees increases, lightly.”

And, in a statement released by the CVRD, Ketler said she wants to contribute to “solutions that bring people together.”

“The board has heard the community’s concerns around affordability, climate change, and reconciliation with First Nation people and has reflected these in our priorities,” Ketler said.

 

PREVIOUS BOARD CHAIRS

Note: Vice chairs in parentheses

2008 — Fred Bates, Feb. 15 to Nov. 31 (no vice chair)
2009 — Fred Bates — (no vice chair)
2010 — Gregory T. Phelps (Edwin Grieve)
2011 — Edwin Grieve (Paul Ives)
2012 — Edwin Grieve (Patti Fletcher)
2013 — Edwin Grieve (Jon Ambler)
2014 — Edwin Grieve (Jon Ambler)
2015 — Bruce Jolliffe (Manno Theos)
2016 — Bruce Jolliffe (Ken Grant)
2017 — Bruce Jolliffe (Bob Wells)
2018 –– Bruce Jolliffe, Jan to Nov. (Bob Wells)
2019 — Bob Wells (Arzeena Hamir)

 

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More News
As VIHA moves toward medical centralization, North Island worries about risks to public

As VIHA moves toward medical centralization, North Island worries about risks to public

As VIHA moves toward medical centralization, North Island worries about risks to public

By George Le Masurier
 
As goes your pathology, so goes your medicine
— Dr. William Osler, Canadian physician and co-founder of Johns Hopkins Hospital

 

Last in a series of articles examining the state of patholgy services on the North Island

When the Vancouver Island Health Authority ordered the discontinuation of onsite clinical pathologists’ services at the Campbell River Hospital, there was an overwhelming and immediate protest by surgeons, lab technologists and assistants, elected officials and the general public.

VIHA initially responded by ignoring the community’s concerns. Then leaders in the organization made presentations to the Campbell River City Council and the Comox Strathcona Regional Hospital District board that promoted the benefits of a specialist-based and centralized system for clinical pathologist’s services.

READ MORE: Previous stories in this series

Those presentations, which also indirectly dismissed the concerns of general pathologist Dr. Aref Tabarsi and the Campbell River community, have caused some confusion at the regional hospital board.

The board has maintained its support for restoring onsite clinical pathologist’s services at Campbell River. In April it voted to write the Minister of Health and the chair of the VIHA board of directors to oppose the reduction in onsite pathologist’s services to the North Island.

But a presentation in September by Dr. David Robertson, a VIHA executive whose portfolio includes laboratory services, seemed to muddy the formerly clear waters of directors’ understanding. The hospital district board meets again this week (Thursday, Nov. 7), and will undoubtedly take up the issue.

So, let’s break it down.

 

THE CORE ISSUE, SUMMARIZED

Major hospitals in metropolitan centers serving large populations in close proximity have always attracted the most medical specialists. There are simply more patients to justify their practices, and there are also highly specialized services, like open heart surgery and organ transplantation that are best performed in a few centres in the province.

Small community hospitals in rural areas with much less dense populations have traditionally relied on more broadly trained medical doctors in most fields. The majority of cases for rural doctors do not require specialist knowledge, and doctors practicing in smaller communities generally like the variety of their work.

This organically developed system has also been true in the field of pathology.

General pathologists are licensed by the College of Physicians and Surgeons of BC to practice in all the areas of clinical pathology, such as microbiology, chemistry and hematology. When cases come along that require more specialized knowledge in one of those fields, general pathologists in Campbell River and the Comox Valley have always consulted with their colleagues in the big cities.

“This is a very serious issue, and we can make it difficult on VIHA if they don’t listen to what people and the board are saying,”  — hospital board director Jim Abram

VIHA, however, wants to change this system. It doesn’t want any more general pathologists in any of its hospitals. It prefers to hire only specialists in the field and centralize them in a hub.

So far, where it has been implemented in Campbell River and, to a lesser extent in Nanaimo, this has “destabilized” the workforce of laboratory technologists and assistants, who were already in short supply and felt overworked.

How? By adding hours of extra steps trying to communicate with specialized clinical pathologists located far away from them instead of the general pathologist down the hall. And it has added the stress of not getting instant feedback on whether their work was right for the case, and removed the learning experience of daily personal conversations about their shared profession.

And the change is also concerning for local surgeons and internists who rely heavily on onsite clinical pathologists who they know and trust for a quick turnaround of diagnoses. It’s a change VIHA plans to make at the Comox Valley Hospital sometime next year.

Dr. Paul Herselman, an ER doctor and former Chief of Staff at the new Comox Valley Hospital who now practices dermatology, said it’s always been easy to pick up the phone and call local pathologists that he knows.

“It will be a huge loss for me not having someone I know to talk to and come to a reasonable agreement on a diagnosis,” he told Decafnation. “A lot of medicine is about interpersonal relationships.”

The change affects patients who will wait and worry longer for the results of their tests. And there are concerns about maintaining the integrity of some samples from the North Island during multi-hour-long transport to Victoria.

And, finally, elected officials and the taxpayers they represent are concerned that the North Island isn’t getting the fully functional acute care hospitals for which they paid $267 million, and continue to pay for 40 percent of ongoing capital costs.

 

SPECIALIST-MODEL, GOOD OR BAD

Dr. Roberston has painted a picture of the medical world moving toward a specialist-based and centralized method of care. But there are 42 general pathologists — like all the current pathologist on the North Island — throughout BC, mostly in the Interior, the North and on Vancouver Island.

After trying a specialist-based model in Alberta some years ago that imploded, that province is now promoting and training general pathologists as a pivotal part of their future lab system.

The latest (2017) Provincial Plan for Integrated Lab Services in Alberta developed by the Health Quality Council of Alberta, says there is only one strategy for pathologists:

“Develop a provincial strategy with the Departments of Laboratory Medicine and Pathology at the University of Calgary and University of Alberta to address the shortage of general pathologists who are key to the regional laboratories and their support of small rural sites in Alberta.”

Dr. Chris Bellamy in the lab

Alberta has recently followed through with this recommendation, significantly increasing the number of training positions in general pathology.

“So this idea that everyone is going to a specialized model is false,” Dr. Chris Bellamy, a general pathologist practicing in the Comox Valley for the past 30 years.

In 2005, the Interior Health Authority decided to send all of the Okanagan region’s anatomical pathologists’ services to Ottawa, which the local doctors fought against. It turned into a total disaster, says Bellamy who has been involved in province-level health care policy since the early 2000s.

Most of the Okanagan pathologists resigned and the area has never fully recovered, Bellamy says, although, Interior Health, with difficulty, has recently hired back some general pathologists.

But the specialist-model does work well in the Lower Mainland.

Twenty-five years ago, the Fraser Health Authority hired only general pathologists. Now they have both clinical and anatomical pathologists, and the clinical pathology specialists are constantly travelling among Lower Mainland hospitals.

“This doesn’t happen on Vancouver Island,” Bellamy said. “We do not see Victoria clinical pathologists ever come to the Comox Valley, Campbell River or Port Hardy.”

Bellamy said there are specific circumstances why it works in the Vancouver area that don’t exist on the Island.

“I understand the trends and that things change. But it has to be handled carefully,” Bellamy said. “If a system is working, then don’t try to fix it.”

He said there needs to be dialogue to make transitions smooth and effective.

“VIHA is trying to do this way too quickly. Why force out pathologists if what they’re doing is enabling the system to function at a high level?” he said.

 

HOSPITAL BOARD VS. VIHA

While VIHA is responsible for delivering health care to Vancouver Island residents, local hospital boards, such as the 23-member Comox Strathcona Regional Hospital District (CSRHD) board, also play a key role.

The hospital board pays 40 percent of the capital costs for facilities and equipment of the Comox Valley and Campbell River hospitals, the Cumberland hospital laundry facility and several small hospitals and clinics in remote parts of the region.

Hospital boards also advocate to VIHA, the Ministry of Health and the provincial government on behalf of citizens for maintaining and improving regionally available health care services.

“Now it appears that Island Health is favouring private profit, not patient care, as a good use of our public investment,”hospital board director Brenda Leigh

At its April 2019 meeting, the CSRHD board voted unanimously in favor of a motion by Discovery Islands-Mainland Inlets director Jim Abram to request that Health Minister Adrian Dix cancel contracts with the private group of pathology providers in Victoria, called the Vancouver Island Clinical Pathologists Consulting Group.

Abram’s motion said that cancelling the Victoria contract would reinstate onsite clinical pathologist services to the Campbell River Hospital and would justify hiring a third pathologist.

Unstated, but indirectly implied in Abram’s motion, was the sustaining of current pathologists’ services at the Comox Valley Hospital.

Director Abram says North Island residents “paid for a full-blown pathology departments and they should have them.”

“This is a very serious issue, and we can make it difficult on VIHA if they don’t listen to what people and the board are saying,” he told Decafnation.

Abram said no matter how many graphs VIHA tries to manipulate, “their agenda is not the same as ours.”

Board Chair Charlie Cornfield wrote a letter on May 3 to Health Minister Adrian Dix and VIHA board Chair Leah Hollins to state that the North Island expects a fully functioning pathology laboratory.

“I am requesting that Island Health revisit and cancel the contract with VICPCC (Vancouver Island Clinical Pathology Consulting Corporation) for laboratory services and engage with the local pathologists regarding these services within our hospitals,” Cornfield wrote. “The board does not support any reductions in local healthcare services.”

Oyster Bay Director Brenda Leigh has been more direct. She calls the outsourcing an attack on local general pathology services.

“The manner in which the Campbell River and Comox Valley labs are being targeted for privatization and outsourcing right after our hospital projects have been completed is a betrayal of our trust that we would get what we paid for in our capital builds,” Leigh told Decafnation. “Now it appears that Island Health is favouring private profit, not patient care, as a good use of our public investment.”

Leigh praised Tabarsi for “heroically” standing up against VIHA.

Director Abram agrees.

“I’m extremely disappointed in people’s opinion when they suggest Aref (Dr. Tabarsi) isn’t the expert,” Abram said. “If he says it needs to be done, he’s the guy to listen to because he knows what he’s talking about. When Aref speaks, he’s telling the truth.”

 

WHAT’S NEXT?

VIHA has centralized microbiology in Victoria. It intends to do the same with clinical pathologist’s services. It has already centralized several other non-medical functions in Victoria, including such basic systems as filling vacant shifts for all categories of hospital employees with a robo-call system of contacting casual workers.

Next on VIHA’s centralization agenda could be radiology, because its modern digital technology makes it easy to share across long distances.

Except, medical sources tell Decafnation that the growing field of interventional radiology — draining an abcess, for example — can’t be done without a radiologists onsite. Or, the patient would have to be transferred to where the radiologist is located.

But the solution for pathology is more pressing.

“There should be three medical/health care hubs on Vancouver Island — Victoria, Nanaimo and the north, either Comox Valley or Campbell River, with Victoria having some additional specialized testing facilities,” Bellamy said.

“There’s a high risk for the public with a single Victoria hub,” he said.

 

 

 

 

 

 

 

DEFINITION OF TERMS
USED IN THIS SERIES 

 

VIHA is the acronym for the Vancouver Island Health Authority, sometimes also referred to as Island Health

Anatomical pathology deals with tissue biopsies, such as biopsies from breast, colon, skin and liver.

Clinical pathology deals with body fluid such as blood, urine and spinal fluid, and includes three areas of specialization:

Hematopathology assesses the blood for diseases related directly to blood, such as anemia, blood transfusion issues and leukemia.

Chemistry deals with measuring and interpreting levels of particles and substances such as hormones, cholesterol, sugar and electrolytes in the body fluid.

Microbiology deals with the identification of the infectious organisms.

General pathologists are medical specialists who study an additional five years in all areas of pathology.

Clinical pathologists are medical specialists who study the same additional five years but in only one of the areas of specialization.

Medical Laboratory Assistants (MLA’s) are employees who greet patients, draw blood, prepare specimens for technologists, and perform the shipping and receiving of samples

Medical Laboratory Technologists (MLT’s) are employees who spend the majority of their time analyzing and reporting the sample results on blood, urine, swabs, body fluids etc. They also prepare specimens for pathologists. At very small sites, they also perform MLA duties as part of their job

 

 

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