Ocean farming: more food, less land, reduced GHG emissions

Ocean farming: more food, less land, reduced GHG emissions

Image of ocean farming from the Greenwave.org website

Ocean farming: more food, less land, reduced GHG emissions

By Gavin MacRae

The climate crisis will force a shift in where and how we get our calories. Farms in the future will need to produce more food on less land, all while cutting their greenhouse gas emissions.

For Bren Smith, director of the non-profit group Greenwave, this transition means expanding our definition of farming to include the ocean. Smith is the driving force behind the zero-input aquaculture system known as vertical or 3D ocean farming.

The 3D part may sound techy, but Smith says the concept is simple. A grid of ropes extend from anchors on the seafloor to buoys on the ocean surface. A horizontal rope scaffold is fixed off the vertical lines.

Supported by the horizontal ropes, seaweeds grow interspersed with cages for shellfish such as scallops and mussels. Oyster and clams grow in cages below on the seafloor. The resulting symbiosis produces high yields of diverse species on a small ocean footprint.

The farms are thriving ecosystems, Smith says, which create habitat for other marine life, offer coastal protection from storm surges, locally buffer against ocean acidification, and filter nitrogen from fertilizer runoff.

“Fresh water, fertilizer, feed, land, all those things, those inputs, the cost is going to go up in the climate era…. Zero-input food’s going to be the most affordable food on the planet. It’s going to move us to the centre of the plate.”

The cost of entry for 3D ocean farming is low relative to land-based agriculture (US$20-50,000 can bankroll a typical farm). Smith envisions 3D ocean farming as a vibrant new industry displacing extractive industrial fishing and creating jobs on small-scale ocean farms around the world.

 

THE BIRTH OF GREENWAVE

In an earlier life, Smith’s livelihood as a commercial fisher ended with the collapse of the cod fishery in Newfoundland in the 1990s. After a stint at a Northern Canadian fish farm, Smith transitioned to oyster farming off the coast of New York.

Some years later, hurricanes Irene and Sandy left his oyster crop in ruin. At the same time, rising ocean acidification was killing oyster seeds, while warming waters drove lobsters further north. Determined to find a model of aquaculture more resilient to climate change, Smith teamed up with Charles Yarish, a seaweed expert from the University of Connecticut, to develop the 3D ocean farming system.

The result was so successful, Smith co-founded Greenwave to spread the word.

Greenwave’s training program has been inundated, Smith says. “Right now the demand’s too high. We have requests to start farms in 20 countries around the world. It’s just insane, we have a waiting list of 10,000 farmers.”

Despite Greenwave’s success, ocean farming hasn’t yet telegraphed to Vancouver Island – at least under the 3D banner.

But what Vancouver Island does have is a burgeoning interest in kelp farming.

 

IDEAL FOR KELP FARMING

“We’re in a region that has the richest kelp biodiversity in the world.” says Allison Byrne, a kelp researcher at North Island College’s Centre for Applied Research, Technology and Innovation in Campbell River. “We have lots of coastline and lots of capacity in small coastal communities in terms of marine and boating experience that could be applied to the industry. And beyond that there’s a lot of interest, specifically in kelp farming.”

At a seaweed commercialization workshop in Courtenay in June, Byrne says the room was “absolutely packed” with entrepreneurs as well as established fish and shellfish operations looking to diversify.

“There are a lot of companies and individuals that want to push this ahead and are working to do so,” says Byrne. “I think it will look a lot different five years from now, there’ll be a lot more startup farms.”

Another promising ocean farming concept called Integrated Multi-trophic Aquaculture (IMTA) was pioneered on Vancouver Island by Byrne’s former academic supervisor, eminent aquaculture researcher Stephen Cross.

In this arrangement, the waste from a fed species such as a fish or shrimp becomes inputs for other species such as shellfish or seaweeds. Though not yet pursued commercially on Vancouver Island, IMTA and 3D ocean farming share the goal of remediating ocean ecosystems and creating high yields on small footprints.

For ocean farming, and kelp farming in particular, to grow on Vancouver Island, seed and processing facilities are needed, says Byrne.

“We need to reach that critical mass of having enough biomass from multiple different growers to create a demand for processing facilities.”

“I would love to see young entrepreneurs and First Nation-owned businesses take on the industry,” says Byrne, “and I would love to see small and medium sized farms working together, at least at this point, to create a demand for processing.”

 

A MARKET BEYOND KELP

And while forward-thinking chefs have created a boutique culinary demand for seaweeds, there is plenty more market potential for kelp at the grocery store.

Kelp salad greens, chips, sauerkraut, pickles, smoothie cubes, tea, beer, gin, and more could be on the menu.

The largest food market, Smith says, is as a healthy additive to replace the soy ubiquitous in many foods.

Other opportunities for seaweed are for use as animal feed, fertilizers, and for high value compounds extracted for use in pharmaceuticals and cosmetics.

Byrne says the industry needs to continue educating the public on the environmental benefits and economic opportunities of seaweed agriculture. “I think it’s an unfamiliar sector, but once people learn about it, they love it,” she says.

“They’ve done such a good job marketing the concept in New England and on the east coast. But I think we can catch up in the grand scheme of things.”

Gavin MacRae is the assistant editor of The Watershed Sentinel, a publishing partner of Decafnation. Readers can reach him at gavin@watershedsentinel.ca

 

 

 

 

 

 

WHAT IS GREENWAVE AND 3D OCEAN FARMING?

Bren Smith, GreenWave executive director and owner of Thimble Island Ocean Farm, pioneered the development of restorative 3D Ocean Farming. A lifelong commercial fisherman, he was named one of Rolling Stone magazine’s “25 People Shaping the Future” and featured in TIME magazine’s “Best Inventions of 2017”. He is the winner of the Buckminster Fuller Prize and been profiled by CNN, The New Yorker, Wall Street Journal, National Geographic and elsewhere. He is an Ashoka and Echoing Green Climate Fellow and author of Eat Like a Fish: My Adventures as a Fisherman Turned Restorative Ocean Farmer. 

From the Greenwave.org website

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North Island hospital board hesitates to take advocacy role, despite rights and precedent

North Island hospital board hesitates to take advocacy role, despite rights and precedent

Decafnation archive photo by George Le Masurier

North Island hospital board hesitates to take advocacy role, despite rights and precedent

By George Le Masurier

Jim Abram doesn’t have any doubts about his role as a director on the Comox Strathcona Regional Hospital District board. Its crystal clear to him, and he’ll be happy to tell you exactly what he thinks.

“Every director on that board was elected as an advocate for their constituents, so as a board, we’re a collective of advocates. How can we walk away from what our constituents want, what they’re telling us to do?” he told Decafnation this week.

It seems perfectly clear to Abram that the board should advocate for health care issues like complete pathology services, but not every director sees it that way.

Abram made a motion at the board’s November meeting to send a second letter to BC Premier John Horgan and the Vancouver Island Health Authority (VIHA) reconfirming the board’s “strong support” for maintaining fully functioning pathology services at North Island hospitals.

Provincial Health Minister Adrian Dix did not respond to the board’s first letter of support sent in May.

VIHA, sometimes referred to as Island Health, is attempting to centralize many North Island health care services in Victoria. Earlier this year, it moved all onsite clinical pathologists’ services from the Campbell River Hospital to doctors in Victoria, a change the health authority intends to make at the Comox Valley Hospital next year.

Abram’s motion, which eventually passed, triggered a discussion about whether it is appropriate for the hospital board to advocate on health care issues, and whether the board should expand its interests into other areas of health care, such as facilities and medical services for seniors.

The board discussed this issue at its 2018 strategic planning session and in February of 2019 passed a motion that it recognized “the important role for communities and regions to advocate for health care services and programs through local municipalities and regional districts.”

But several directors said they still aren’t comfortable in a wider advocacy role and that the issue raises questions the board hasn’t yet answered for itself.

Hospital Board Chair Charlie Cornfield, a Campbell River city councillor, was one of those.

“I would like to comment on the business of advocacy,” he said at the Nov. 7 meeting. “Because this board was very clear (in the past) that we deal with acute care. And that advocacy issues around … operational issues are best dealt with by the community itself.”

That makes no sense to Abram, who represents the Discovery Islands and mainland inlets within electoral area C of the Strathcona Regional District.

“That’s an antiquated attitude to what’s going on in today’s world,” he said. “We’re advocates on everything else in local government. We’re there to represent the public. We can’t get stuck on an old concept. It’s habit. It’s historical. If people don’t recognize that things have changed, then there’s a problem.”

However, the board does have a recent history of advocacy.

When VIHA proposed building one regional hospital for the North Island, the board originally supported the idea. But later the board reversed its position and advocated for two hospitals, which caused many difficult and divisive conversations. And the board also took a unanimous vote two years ago for free parking at the hospital and most recently to restore pathology services in Campbell River.

There was enough hesitation among directors about advocating more actively and broadly about health care issues at the Nov.7 meeting that they deferred the topic to a future strategic planning session.

 

OTHER DIRECTORS WEIGH IN

After the 2018 municipal elections, several new directors joined the hospital board. Decafnation recently asked several new Comox Valley directors serving on the hospital board whether they felt advocacy was an appropriate role.

Courtenay Councillor Wendy Morin said she’s just getting up to speed on the board’s mandate, history and responsibilities.

“I know (advocacy) is a question the board will be exploring. As we pay 40 percent of hospital capital funding, I think we do have some role in advocacy, but I am still unclear as to how broad this should be,” she told Decafnation. “I think there is a problem if we were promised certain services and amenities during the implementation of the new hospitals, and those promises have not been fulfilled. I think we need to investigate and see what role we have in advocating for those.”

Electoral Area A Director Daniel Arbour said the board does have an advocacy role to the extent that it spends millions of dollars on health infrastructure.

He said the hospital board is primarily charged with raising tax monies to pay for hospitals, which “tends to be a lot of money.”

“Those hospitals are nothing without the health services that occur in them, and they are impacted by the “health ecosystem” as well,” he told Decafnation.

“While I would not argue for health care operations to be downloaded from the province, to me it is clear that we are a natural channel for local constituents to bring forward concerns and opportunities for improving health delivery. There are also questions as to whether we should be involved beyond just hospitals. Those questions may be explored at our strategic session next year,” he said.

Comox Councillor Nicole Minions said she thinks the 23-member board representing over a dozen diverse communities, should take an advocacy role, especially in extraordinary situations like the centralization of services, such as pathology, “that could negatively affect the health and care of our communities residents.”

But she doesn’t think the board should step into the operation of the two campus hospitals.

“However, as our taxpayers pay 40 per cent of capital costs, it is important to ask questions, listen to concerned residents and advocate to our province to find the right healthcare solution,” she told Decafnation. “As a council member in a community with an average age over 50, health care is important to our residents.
Abram says advocacy is “what we’re here for.”

“Our constituents don’t get to meet face to face and talk with VIHA or government officials, we do,” he said. “I can’t in good conscience go to board meetings and not advocate for the public.”

 

CAN HOSPITAL BOARD’S LEGALLY ADVOCATE?

The Comox Strathcona Hospital District has historically operated on the presumption that its only, or at least, primary role is to fund select capital projects.

By Oct. 31 of every year, the hospital board advises VIHA of its recommended annual funding allocation for equipment or project under $1.5 million in the next year, subject to final approval of its budget on March 31.

Then, by Jan. 31, VIHA tells the hospital board how they will distribute spending of those funds by equipment and projects.

The board also considers funding major projects proposed by VIHAS that cost more than $1.5 million, before finalizing its tax requisition for the next year.

That appears to comport with the BC Hospital District Act (1996), which states the purpose of regional hospital districts “is to establish, acquire, construct, reconstruct, enlarge, operate and maintain hospitals and hospital facilities. And it further requires boards “to exercise and perform the other powers and duties prescribed under this Act as and when required.”

And the Act goes on to state that the letters patent incorporating a district under this Act must specify the following: the powers, duties and obligations of the district in addition to those specified in this Act,” and “other provisions and conditions the Lieutenant Governor in Council considers proper and necessary.”

The Act does not address the role of advocacy by a board, neither requiring it or prohibiting it, although the Act does, perhaps oddly, include “operate” as one of the board’s purposes.

 

WHAT DO OUR LETTERS PATENT SPECIFY?

On Dec. 8, 1967, Lieutenant Governor George Peakes signed the original letters patent that created the Comox Strathcona Hospital District. Dan Campbell was the Minister of Health Services and Hospital Insurance at the time.

Section 9 of that document states that the duties and obligations of the hospital district include those in the hospital act, but also:

“… These Letters Patent, and in addition the District shall establish a Regional Hospital Advisory Committee as soon as possible. The said Committee shall, when requested by the Board, review the hospital projects proposed by the boards of management of the hospitals in the district and recommend priorities and revisions thereto if deemed necessary, and shall also recommend regional programmes for the establishment and improvement of hospitals and hospital facilities in the District for presentation to the Board and to the British Columbia Hospital Insurance Service for Approval.”

To date, the hospital board has not established an advisory committee.

But Section 9 does seem to open the door for a wide range of health care advocacy.

 

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Smit Field owners, neighbours, CVRD rural directors clash over testing of drag racing cars

Smit Field owners, neighbours, CVRD rural directors clash over testing of drag racing cars

Dan Annand a co-owner of Smit Field on Forbidden Plateau Road  |  George Le Masurier photos

Smit Field owners, neighbours, CVRD rural directors clash over testing of drag racing cars

By George Le Masurier

Does the Comox Valley want to allow the testing and tuning of drag racing cars in a rural residential neighborhood along Forbidden Plateau Road next to Nymph Falls Nature Park? Directors of the Comox Valley Regional District’s three rural electoral areas will answer that question at their next meeting, on Dec. 9.

But it won’t be an easy decision. The case involves neighbourhood concerns about noise, pollution and forest fires, a defiant property owner and a federally regulated airport.

For the past three years, the Vanisle Airfield Society Inc. has tested and tuned their drag racing cars at a 50-acre Forbidden Plateau Road property owned by Dan Annand and Kevin Griessel in contravention of Comox Valley Regional District zoning bylaws.

The property is zoned RU20, which allows several non-residential uses, such as sawmills and dog kennels, but does not allow drag racing or the testing of drag racing cars.

However, the property also contains Smit Field, a private airport registered by Transport Canada with 1,200 feet of concrete runway where the Vanisle Society has been holding its test and tune events.

The CVRD shut down the car club’s activity this summer after some area residents complained.

Now the society has applied for a three-year temporary use permit that would allow up to 50 car owners to test their racing cars over three days, three times per year beginning next May.

Vanisle Society spokesperson Ken Pederson says there is no other site with comparable amenities for car owners on Vancouver Island. Members of the society just “want to have fun,” he says, and tune their cars before entering races.

That hasn’t swayed concerned residents, who say they initially complained about the noise because the cars reach high decibel levels that they say can be heard at homes up to two kilometers away.

But since hearing from the Smit Field owners, and suffering social media harassments from members or supporters of the drag car society, the residents now fear the property owners plan to grow the site into a major event venue and that the drag racing car events will become permanent.

Temporary use permits can be issued for up to three years, and are renewable.

And that, they say, intensifies additional ongoing concerns about air and ground pollution and forest fires.

But principal owner Dan Annand told Decafnation this week that he has no plans to create more large-scale public events on his property, although he does currently host Jeepapalooza, which in its second year last summer drew 700 owners of off-road vehicles.

And if the CVRD Electoral Services Commission doesn’t approve the Vanisle Society’s temporary use permit, a defiant Annand says he might continue to allow the testing of drag cars anyway because he believes the regional district doesn’t have the authority to regulate how he uses his property.

Annand has also hinted that he might turn Smit Field back into a “full-blown airport,” with fly-in gatherings for pilots that could attract more participants and make more noise and pollution than either the drag car testing and Jeepapalooza events.

Plus, he says, he would stop allowing other public service uses of his property.

The following five sections break down this complicated story:

  1. What is Smit Field
  2. Why have neighbors complained
  3. Who is the Vanisle Airfield Society
  4. Dan Annand’s frustrations
  5. What is the CVRD recommending

 

Aerial view of Smit Field courtesy of Transport Canada

WHAT IS SMIT FIELD?

Bert Smit and Dan Annand, who shared a love for flying, have co-owned the 50-acre Smite Field property for many years. Smit owned the property as early as 1977 and obtained classification as a registered aerodrome through Transport Canada sometime in the early 1980s.

The airfield features a grass runway 66 feet wide by 2,663 feet long at the base of the Beaufort Mountains forming Forbidden Plateau and Mt. Washington.

In recent years, Annand has covered 36 by 1,200 feet of the runway with concrete. The drag racing cars use roughly 325 feet of it to test single cars and sometimes side by side.

Smit died on March 3, 2010 when his homebuilt two-seater Jodel aircraft crashed in a forested area just below Forbidden Plateau. Witnesses to the crash say Smit was doing acrobatic maneuvers when a wing appeared to break away.

The airfield is rarely used. As a private aerodrome, pilots must call Annand by phone to request permission to land. Annand has two hangars on the property, one that houses his own Cessna 180 taildragger airplane.

But when Smit and Annand, and others, used the airfield more frequently, Annand said “there were a lot more noise complaints” than there has been recently about testing drag racing cars.

As a result of those previous complaints, Annand changed the circuit pattern for arriving aircraft to approach the runway from over the Puntledge River rather than over residential areas.

A media relations officer for Transport Canada told Decafnation that the federal agency “does not issue an approval to the aerodrome but rather validates the data provided so that it can be published in the Canada Flight Supplement,” which is information for pilots.

Transport Canada does not issue approvals to the aerodrome on the use of runways. It is the responsibility of the aerodrome operator to ensure that the aerodrome is operated safely and to notify Transport Canada of any changes to the flight supplement information.

Annand has not yet notified Transport Canada that he hard-surfaced a portion of the listed runway with concrete or that he plans to extend it to 3,000 feet.

Burned rubber from drag car testing on the Smit Field runway

WHY NEIGHBORS HAVE COMPLAINED

Residents along Forbidden Plateau Road started complaining to the Comox Valley Regional District by Sept. 16, 2017. They say the noise from revving high-performance drag racing engines is deafening in Nymph Falls park and at homes within about two kilometers of the airfield.

Dylan DeGagne was the first neighbor to go public with a complaint. He told the Comox Valley Record last May that while paddleboarding on the Puntledge River near the BC Hydro dam at Comox Lake, “he could hear the cars roaring.”

DeGagne started a petition on Change.org to stop the activity. He immediately became the target of social media intimidation. He has now sold his house and is in the process of transferring to Victoria.

But other residents who spoke to Decafnation on the promise of anonymity, say they have also complained to the regional district. All of these sources purchased their properties before the dragster testing began. They say the noise since 2017 has affected their ability to enjoy their properties and potentially their long-term property values.

They have requested anonymity because of the threats issued through social media posts by either members or supporters of the Vanisle Airfield Society.

Screenshots of two previously public, now private Facebook pages include this post: “Yea, people complain its (sic) too loud. The noise isn’t going away, because I’ll make continuous passes on there (sic) street at 2am if need be, so get over the noise.”

And this reply: “I’ll just put a 353 Detroit in the box of my truck running flat out all night lol.”

Residents say they knew before they purchased their properties that there was an airfield nearby, but not that testing of drag racing cars would occur.

Their complaints include adverse market value impacts to their property, safety concerns to cyclists along Forbidden Plateau Road, forest fire risk, negative impacts to users of Nymph Falls park and wildlife, contravention of CVRD zoning bylaws and “an incongruence with climate change policies” (unnecessary pollution and carbon emissions from fossil fuels).

They say during the most recent Jeepapalooza event, some of the 700 campers set off fireworks during one of the driest periods of the summer.

“Why should we accept the devaluation of our homes, and the risk, to support other people’s hobbies,” one resident told Decafnation.

The concerned residents don’t see the Jeepapalooza and drag car testing events as separate issues.

“It’s not separate for us,” a resident told Decafnation. “The point is, where is this headed? The land owner has poured more than $200,000 into this property without without any approvals. He’s not doing it for three weekends a year that he says doesn’t generate any income for him. There’s a longer-term vision here.”

And they dispute Annand’s claim that the drag car testing events are just for his friends.

“Our complaint was filed only after we discovered that the test and tune events were being advertised on two Facebook pages, totalling more than 3,000 followers.

“This is not strictly a family and friends event,” the source told Decafnation. “All Vancouver Island and BC drag car owners now think there’s a drag strip in the Comox Valley.”

And they have no confidence so far that the CVRD can control these events through a temporary use permit. The regional district does not have a bylaw compliance officer to monitor such permits. It relies on a complaint-driven system.

The concerned neighbours do not understand the purpose of the CVRD’s recommendation to approve a one-year temporary use permit. The staff report suggests that one year would serve as a trial and give staff time to evaluate the events.

“But there’s no objective criteria mentioned how they would evaluate the events,” a resident said. “We already know it doesn’t work. What will they do, planners will drive around in their cars to see how loud it is?”

Concerned neighbors generally feel the CVRD recommendation disregards their concerns, the environment, the park and existing zoning bylaws.

 

Facebook Post showing cars lined up for testing at Smit Field

WHO IS THE VANISLE AIRFIELD SOCIETY

Comox Valley and Vancouver Island drag racing enthusiasts say they just want a safe place to test and tune their cars.

The Vanisle Airfield Society was formed in January of 2015 after approaching the co-owner of the Smit Field, Dan Annand. They formed the society in order to get insurance coverage, and are the official applicant for the temporary use permit.

“We want to do it right. We’re trying to make it safe for everybody,” Ken Pederson, a society spokesperson told Decafnation.

Prior they located at Smit Field, owners used to test their cars on the Comox Logging Road near Royston or on the lower sections of the Mt. Washington road, which was neither legal or safe.

The group has since purchased an expensive set of lights of the type used to start drag racing events and timing equipment to provide instant, printed feedback on driver response times.

In drag racing, a set of lights similar to street lights illuminate down from red to yellow to green. The driver to most quickly accelerate his car has a considerable advantage.

According to Pederson the test and tune events are really about tuning the driver, not the car. Smit Field is not used for drag racing where cars and drivers compete against each other side-by-side.

“Ninety-nine percent of drag races are won or lost at the starting line,” Pederson told Decafnation this week. “That’s why we need a place to practice. It’s more about tuning the drivers’ reaction time.”

Pederson says there are no other places to practice on Vancouver Island that appeal to his group of members. They tried Saratoga Speedway but the straightaway was too short for the faster cars and they could only get five hours of time. It takes two to three hours to set up their lights and timing equipment, so there wasn’t enough time to warrant the cost of renting the track.

And the Island’s other drag racing sites like Port McNeill and Western Speedway near Victoria don’t allow test and tune events. Drivers say they need the practice team to justify expensive trips to drag races, especially those off the Island.

Pederson says 35 of the 42 cars owned by members that might practice at Smit Filed are street legal.

And, he says, a suggestion to reduce the tuning events at Smit Field to one day, rather than three, won’t appeal to the society’s members. The society charges $700 for an annual membership, which pays for the portable toilets and food sold during events as well as the debt for purchasing the lighting equipment.

“Three one-day events don’t make it worthwhile,” he said.

Pederson said the society hopes to purchase carbon credits to offset the burning of fossil fuels before the CVRD’s electoral directors meet Dec. 9 to decide the issue.

“We’re trying to show we’re not a bunch of hillbillies. We want to do this properly,” he said.

Smit Field co-owner Dan Annand at the site of salmon habitat restoration on the Puntledge River near his property

PROPERTY OWNER DAN ANNAND

Dan Annand has co-owned the Forbidden Plateau Road property for over 20 years. He originally partnered with owner Bert Smit. When Smit died in 2010, Annand took on a new partner, neighbor Kevin Grissel, whose name appears on the title.

Annand says he’s not trying to become another Saratoga Speedway.

“It’s just friends having fun. I could do it every weekend if I wanted,” he told Decafnation this week. “Because of the hassle with the CVRD, I might invite a few friends up here with cars anyway, whether it (temporary use permit) passes or not.”

He says many of the drag car owners in the Vanisle Airfield Society are friends, whose parents were friends with his parents. And they share a love of racing, which he used to do 50 years ago, and flying. Three of the car owners own airplanes.

Annand is a member of the pioneering Piercy family and his wife’s family, the Picketts, were early settlers on Denman, Hornby and Cumberland.

“I probably have 500 relatives in Courtenay alone,” he says.

He doesn’t charge the drag car society or the Jeepapalooza organizers any rental fee. He has offered his property for free as long as the groups raise money for charity.

“That’s what it’s all about,” he says. “If they didn’t raise money for charity they wouldn’t be allowed out here.”

Between the testing of drag racing cars and Jeepapalooza, Annand says $80,000 has been donated to cancer-related non-profits in the last two years, including sending a family to Hawaii through the Help Fill A Dream Foundation, and donations to the local Hospice Society.

But he says the airfield could make money by promoting fly-in events to pilots around BC and beyond.

“If this doesn’t go through, I’ll hard surface the whole runway and start having airshows and fly-ins,” he said.

Annand says the increased air traffic would cause more noise and more pollution than a whole year of drag car testing.

“The stupid part is that the drag cars burn on a 14-1 air to gas ratio. They burn clean. Aircraft burn lead-based fuel. One plane releases more carbon than all the cars on an entire weekend,” he said. “One airshow here would create 10 times more pollution in the air than a whole year of cars.”

And he disputes the claim that any of the events have exploded fireworks. There are two water tanker trucks on the property, so he believes the risk of a fire is next to nothing.

Annand also points to all of the other benefits he offers free of charge to the Comox Valley community.

He allows the military search and rescue squadron to have their year-end party on the property, usually landing a helicopter. He allows the Courtenay Rod and Gun Club and the Department of Fisheries to use his property to stage gravel for a Puntledge River salmon enhancement project in an area called Reach B.

Mountain biking groups use his property to access trails up to the top of the Forbidden Plateau, and have recently rebuilt a bridge using Smit Field access. Mountain search and rescue teams use his site for marshalling and as a launch point for training exercises.

Annand also built a parking lot for access to Barbers Hole, and says he plows snow from neighbors driveways every winter.

“If this TUP gets turned down, all of that goes away,” he said. “The skinny of it is, I’ll stop all public access and all the benefits and the donations to charity go away. Shame on the three neighbors who can shut this all down. The CVRD should represent the majority. It’s no longer a democracy.”

Annand said he went door-to-door asking neighbors about the drag car noise. He says 91 people said they were in favor of it, and some even help volunteer during the events. He believes only three or four neighbors have complained.

Annand says he’s “done just about everything we can to reduce noise.”

“It’s noisy, no question. But we’re asking for 24 hours total per year. If you can’t put up with that then … really?” he said. “I’ve just about had enough of the CVRD. If it doesn’t pass, I’ll go to a full-blown airport. I’m going to do that anyway.”

 

CVRD’S RECOMMENDATION

Since notifying Annand and the Vanisle Airfield Society that they were contravening Comox Valley Regional District bylaws, planners have met with him and representatives of the Vanisle Airfield Society, and separately with a group of concerned neighbors.

At the Nov. 4 Electoral Services Commission, CVRD staff presented a report that recommended approving a temporary use permit for one year that would allow three, three-day test and tune events for a maximum of 30 cars and 15 campsites.

Staff have recommended allowing car owners to only practice from 10 am to 4 pm on Saturday and 10.30 to 3.30 on Sunday.

The report notes that the test and tune events comply with CVRD’s noise bylaw, which restricts hours but does not regulate decibel levels.

The report said the bylaw compliance department did a full review and determined the past drag car test and tune events were not lawful.

Staff said that noise from the events could not be controlled, but the conditions of the permit were designed to minimize neighbourhood disruption.

 

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Petition put to BC Legislature: restore North Island pathology

North Island MLA Claire Trevena presented a petition signed by over 2,500 people to the BC Legislature Nov. 20 that calls for the return of onsite clinical pathologists’ services to the Campbell River Hospital and to investigate possible conflicts of interest within Island Health

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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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VIHA’S pathology plan: What’s at stake for patient care, lab technologists and assistants

VIHA’S pathology plan: What’s at stake for patient care, lab technologists and assistants

VIHA’S pathology plan: What’s at stake for patient care, lab technologists and assistants

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

 

The second in a series of articles examining the state of pathology services on the North Island

Imagine you are the Campbell River parent of a four-year-old boy who has been feeling tired for the past few days. Suddenly, in the morning, you notice he has a stiff neck and a high fever.

You take him to the Campbell River Hospital emergency room. Cerebrospinal fluid (CSF) is drawn by the ER physician or the pediatrician. The specimen is sent to the lab, but because microbiology was removed from the CR lab, the technologist hasn’t done a gram stain on a CSF for more than a year. She knows what’s at stake; this is a very serious situation.

The clock is ticking and minutes can make the difference between life and death.

Now, how would you prefer this scenario continues to play out:

Option A: The lab technologist sees Haemophilus bacteria and she brings the slide to the office of the general pathologist who is working onsite, and they discuss the findings. A few minutes later the pathologist and pediatrician, who know each other and work together regularly, discuss the next steps and antibiotic choices.

You will likely be with your child on a helicopter in short order. And you didn’t even think to bring your toothbrush when you left home this morning.

Option B: The lab technologist changes microscopes to the one that has the camera mounted on it. After logging in and opening up numerous computer programs, some photos of the sample are taken.

Then the technologist phones the Royal Jubilee laboratory to find another technologist to help her. Policies dictate that since she hasn’t done a CSF in a year, she can’t report the result on her own. She sends the photos to her colleague in Victoria. That colleague phones or emails back to agree with her findings.

Then she emails the photos to four specialized microbiology pathologists. One of those four is on call and that specialist pathologist is looking after the entire Vancouver Island that day, not just your son.

The specialist has no responsibility to inform the technologist that the photos were received and whether they are being acted on. When time permits, the specialist will call the ER physician to discuss the case.

Later in her shift, the technologist hears the helicopter landing on the pad. She hopes the Victoria-based pathologist acted on the email and that the helicopter is there for your little boy and not some other patient.

The onsite pathologist might notice the helicopter, too, but will have no idea why it is there because the technologist was prohibited from discussing your son’s case with him. He could have contributed to the timely care of your son, but VIHA’s policies took him out of the loop.

 

TIMELY RESULTS, LESS WORRY

For most people, the period of uncertainty before definitively knowing their diagnosis is the most worrisome, perhaps even the most traumatic. Psychology studies show that once a person knows the facts of their condition, they are on their way to acceptance and better physical and mental health.

So the quicker people can get results from their blood tests or biopsies, the sooner they can start dealing with their medical condition and get on the road to recovery.

But the Vancouver Island Health Authority, which has the greatest influence over the health care experiences of Island residents, is on a path to limit patient’s choice to Option, B by centralizing all clinical pathologist’s services in Victoria.

VIHA has forbid general pathologists in Campbell River from doing any clinical pathology work, such as diagnosing blood-related diseases (hematopathology), providing oversight of body fluid levels of substances such as cholesterol and hormones (chemistry), and the identification of infectious organisms (microbiology).

That change has caused long delays in reporting diagnoses, frustrated doctors and unnecessarily extended periods of worry for patients.

Comox Valley general pathologist Dr. Chris Bellamy

​And while it is true that “samples have been and will continue to be collected and analyzed at both North Island Hospital campuses,” according to a VIHA response to Decafnation, that doesn’t mean onsite general pathologists will be authorized to make diagnoses.

Clinical pathology specimens (blood, urine, stools) will continue to be collected locally, and, apart from microbiology specimens (which are all sent to Victoria) they will, for the most part and for now, continue to be analysed locally.

But based on changes made at the Campbell River Hospital laboratory and planned for the Comox Valley next year, these specimens are not and will not be reviewed by a local pathologist.

“I will absolutely guarantee that this shift will result in the further erosion of technologists locally and will be bad for patient care in this area,” Dr. Chris Bellamy, a 30-year Comox Valley general pathologist, told Decafnation.

 

TECHS: HEART OF THE LAB

Big changes have been looming over North Island laboratories for a while, but when VIHA abruptly shut down all clinical pathologists’ services in Campbell River on April 1, with just four days notice, no one’s daily life was more disrupted than the workforce of medical laboratory technologists and assistants.

Ask any respected pathologist, and they will tell you that technologists and assistants are the heart and soul of a pathology laboratory.

Assistants greet patients, draw blood, prepare specimens for technologists and perform the shipping and receiving of samples at North Island laboratories.

Technologists spend the majority of their time analyzing and reporting the sample results on blood, urine and body fluids. They prepare specimens for pathologists through a process called histology, the means of getting samples from surgery into slides a pathologist can read through a microscope and make diagnoses. In small labs, such as Port Hardy, they also perform assistant duties.

Before April 1, 2019, these Campbell River laboratory workers had a tremendous resource available to them that lightened the burden of their day-to-day responsibilities: access to onsite general pathologists.

When VHIA stopped Dr. Aref Tabarsi and Dr. Leia from practicing clinical pathology, they were also prohibited from discussing clinical cases with the technologists.

“Community doctors and technologists highly value having a pathologist onsite. Everyday, techs bring problems to a pathologist to solve, to give them the answers they require,” Bellamy said. “The alternative VIHA model is to have techls call Victoria, leave voicemails, communicate via email and chase down the clinical pathologists in Victoria to get their answers.

“The technologists are already stretched to the limit with workload and simply do not have the time for this convoluted and time-consuming chain of communication.”

In a letter sent to VHIA protesting the closure of onsite clinical pathologist services in Campbell River, 11 technologists said the health authority was asking them to do more with less when their workload was already at its breaking point.

“We used to be able to walk down the hall and ask for help. (We) have on many occasions brought slides to Dr. Tabarsi and Dr. Leia and they have always taken the time to go through it with us. This is valuable education that all staff will lose. When we send a slide off site, we lose the feedback and knowledge of the patient’s clinical situation. This information is valuable to the education of staff and we are feeling a huge loss,” the letter states.

In a similar letter, 28 of Campbell River’s lab assistants said they feel that “adding additional duties like querying complicated testing requirements, contacting south Island on-call pathologists and the constant follow-up with patients and physicians not only is incredibly time consuming, but also an inappropriate duty for our scope of practice. Lab assistants are constantly being pushed into roles out of their pay grade and scope of practice due to technician shortages.”

The assistants also said that some blood samples require patients from more remote places like Sayward, Kyuquot, Cormorant Island and other outreach communities to travel to Campbell River to have blood collected.

“Having Dr. Tabarsi and Dr. Leia upstairs to approve or not approve tests in a timely manner, while the patient is here waiting, was such an asset to the lab staff, patients and physicians.”

 

STAFF SHORTAGE MADE WORSE

It’s a fact that the entire province of BC suffers from a shortage of lab technologists and assistants, but the situation is worse under the Vancouver Island Health Authority.

“The reorganization of microbiology and now onsite clinical pathologists’ services has destabilized the workforce,” Dr. Chris Bellamy, one of three general pathologists at the Comox Valley Hospital, told Decafnation.

After the St. Joseph’s laboratory team moved to the new Comox Valley Hospital, eight of the 10 lab microbiology technologists quit because of the new working environment. Both hospitals run consistently with multiple open tech positions. Campbell River usually has four to five unfilled shifts every day, a third or more of the total staffing level.

The shortage is so acute in Campbell River that the lab is close to not being able to operate 24/7.

Campbell River general pathologist Dr. Aref Tabarsi

Dr. Aref Tabarsi, one of two general pathologists onsite in Campbell River, said at the end of an 8.5 hour shift, technologists and assistants frequently cannot leave until a casual qualified technologist is found to replace them. This usually resorts in long hours, somewhat unexpectedly.

And it’s been made worse, say technologists, because seven years ago VIHA centralized the staffing of vacant shifts to an office in Victoria.

Bellamy and Tabarsi have seen some good technologists quit their ‘regular’ jobs to work as ‘casuals’ so they can take more control over their work hours and workplace environment.

VIHA could address the tech shortage and retain experienced technologists and assistants, Bellamy says, by creating more full-time jobs, and fewer part-time ones.

And, he says, VIHA should put to rest the threat of a Section 54 implementation.

According to sources working within VIHA who did not want to be named, the health authority is likely to institute a “Section 54,” or some other job disruption as part of its march toward centralization of services in Victoria.

Section 54 of the BC Labour Relations Code allows VIHA employees to be laid off and then rehired by way of a line-picking system. The rumoured threat of Section 54 has been rampant among VIHA laboratory workers for two years, according to Decafnation’s sources.

North Island hospitals have also lost one of their most effective recruiting devices.

The former St. Joseph’s General Hospital laboratories hosted lab technologist practicum positions from BCIT from 2006 until the new hospital opened in 2017. The labs often hired their students after graduation.

But BCIT discontinued the program when VIHA decided to move microbiology out of North Island laboratories and centralize it in Victoria. BCIT has a rule that students must be able to complete their 38-week practicum without having to relocate, which they would have had to do to get microbiology training at Royal Jubilee Hospital in Victoria.

The Comox Valley lab has recently resumed taking practicum students from the College of New Caledonia and Southern Alberta Institute of Technology.

 

WHAT’S AT STAKE

Pathologists don’t just oversee the measurement of your cholesterol level or conduct an autopsy to determine how a person died. They play an active role in modern medicine that prevents diseases from worsening and that help keep people alive.

According to the Mayo Clinic, “It is estimated 60 to 70 percent of all decisions regarding a patient’s diagnosis, treatment, hospital admission, and discharge are based on the results of the tests medical laboratory scientists perform.”

But despite what VIHA says publicly, its actions have significantly overloaded lab technologists and reduced the availability of onsite clinical pathologist’s services on the North Island.

How has VIHA’s disruption of Vancouver Island laboratories affected patients? Here are a few case examples.

Two weeks ago on a Friday afternoon this scenario occurred in the Comox Valley Hospital: A bone marrow examination had to be done extremely urgently, and it was possibly a life saving necessity. This is a surgical procedure — boring into the patient’s pelvis for a sample — that only general pathologists provide at CVH.

Fortunately there was a general pathologist onsite, who dropped less urgent work, did the procedure and gave a diagnosis that helped the patient’s internal medicine doctor to target medical treatment within a few hours.

Sources told Decafnation that if the diagnosis had waited any longer, say until Monday, it’s likely the patient would have died.

Jim Abrams, the Discovery Islands-Mainland Inlets director on the regional hospital board has experienced the need for onsite general pathologists first-hand.

Before Campbell River lost the authority to do clinical pathology onsite, he had surgery during which the surgeon needed to know immediately if a piece of tissue was malignant. Fortunately, Campbell River lab had an onsite general pathologist that day who could still do an urgent diagnosis.

And how are the Victoria labs coping with all the work they have centralized to themselves so far?

Decafnation has learned that a high-profile person recently complained to the Provincial Lab Agency that he had been waiting six weeks for a skin biopsy. And it recently took 25 days to get a final report on a woman’s breast biopsy collected up-Island.

In their letter to VIHA, the Campbell River laboratory assistants related an example of how the transfer of clinical pathology work to Victoria has created long delays in turn around time, even for sensitive tests.

“One example to clarify the issue is that a few weeks ago there was a patient with a requisition full of tests that were not in the Test Information Guide. The assistant Googled them and found they were querying Leukemia and Scleroderma. She was very busy in the outpatient area and had no tools at her disposal to know how to enter the tests. The assistant called the on-call pathologist in Victoria to ask for advice on what to order and if they needed approval. The on-call pathologist told the assistant to email the requisition and they would look into it.

“The patient returned two times that day, obviously worried about her health and anxious to hear back from us. The lab staff recommended the patient go home and a staff member would call her when we hear back. This was over three weeks ago now, and still no response. We are now left with an incredibly unsatisifed and scared patient, an upset family physician, a lab and its staff looking incompetent, all the while, there is a pathologist right upstairs wanting to support our community.”

Even Campbell River City Council members have experienced a slow down in getting test results.

At a July 22 council meeting, Councillor Michele Babchuk said she was currently waiting for pathology results. Her family doctor told her to expect that the results would take two to three weeks, “which is an anxious time for some of us. This is something that did not happen in the past.”

And Campbell River Mayor Andy Adams said he had waited nine days for a biopsy result from Victoria that VIHA admitted should take only three to four days. “So something is not working,” he said.

Campbell River general pathologist Tabarsi says the turnaround time for urgent cases has slowed dramatically since VIHA took away onsite clinical pathologist’s services.

“It isn’t safe or good service now,” he said. “If it’s a test for iron deficiency, the longer wait times are not a significant issue. If it’s a test for breast cancer or cerebrospinal fluid infection, it is critical.”

Next: What are the potential solutions and what are Comox Valley and Campbell River elected officials doing to alleviate the problem.

 

 

 

 

 

 

 

 

 

 

 

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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More Health Care | Latest Feature

Petition put to BC Legislature: restore North Island pathology

North Island MLA Claire Trevena presented a petition signed by over 2,500 people to the BC Legislature Nov. 20 that calls for the return of onsite clinical pathologists’ services to the Campbell River Hospital and to investigate possible conflicts of interest within Island Health

Patients, lab staff suffer from reduced pathology services at North Island hospitals

If Island Health executives get their way, the new Comox Valley Hospital could lose all of its onsite clinical pathologist services sometime next year, a move that area doctors and elected officials believe will further diminish patient care on the North Island. It’s already happened in Campbell River and wait times for results are getting longer

Patients, lab staff suffer from reduced pathology services at North Island hospitals

Patients, lab staff suffer from reduced pathology services at North Island hospitals

Patients, lab staff suffer from reduced pathology services at North Island hospitals

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

 

First in a series about medical laboratory services available on the North Island

If Island Health executives get their way, the new Comox Valley Hospital could lose all of its onsite clinical pathologist services sometime next year, a move that area doctors and elected officials believe will further diminish patient care on the North Island.

The Vancouver Island Health Authority has already sanctioned the transfer of clinical pathologist services from the Campbell River Hospital (CRH) laboratory to specialists at Royal Jubilee and Victoria General hospitals.

This has created longer wait times in Campbell River for results from urgent and emergent blood tests and cancer diagnoses, and it has added hours of extra work onto overburdened lab technologists and assistants, who were already stressed due to constant multiple staff vacancies.

EDITOR’S NOTE: Reading the definitions in the right-hand sidebar will enable a better understanding of some technical aspects of this story.

According to the community group Citizens for Quality Health Care, the change has made the relationship between pathologists and lab techs “estranged and awkward.”

“Both pathologists and technologists are demoralized and traumatized in this demeaning situation created by VIHA, which has also made our lab unsustainable into the future with an ever-increasing population,” the group said in a presentation to the Campbell River City Council.

The transfer of work has also absorbed funding that could have been used to hire a third general pathologist in Campbell River, a position that Dr. Aref Tabarsi, one of the two current Campbell River general pathologists, believes is essential to the continued safe operation of the laboratory.

The experienced general pathologist team from the former St. Joseph’s General Hospital, now located at the new VIHA-managed hospital on Lerwick Road, have so far been immune to these changes. But when their contract expires next March, Bellamy fears that the Comox Valley Hospital will also lose its onsite clinical pathologist work to Victoria.

Dr. David Robertson, VIHA’s executive medical director for laboratory services, told the Campbell River City Council in July that these changes are part of the health authority’s long-term strategy to hire pathology specialists, rather than general pathologists, and centralize them in Victoria.

 

HOSPITAL BOARD UNHAPPY

None of this has pleased the North Island medical community or local elected officials who expected fully functional laboratories when they committed taxpayers to fund about $267 million of the two hospital’s construction costs.

Multiple North Island organizations, groups and individuals have recently spoken in opposition to Island Health’s reorganization of the two hospital’s laboratories. Among them: the Comox Strathcona Regional Hospital District board, Campbell River City Council, 75 local doctors and dozens of lab technologists and lab assistants.

And they all agree on the need for a third pathologist in Campbell River.

After fighting for years with Island Health over a long list of issues — flawed planning, pay parking, a poorly designed helicopter pad, public-private partnerships, overcapacity issues and losing microbiology lab services before the new hospitals even opened in 2014 — some hospital board directors have had enough.

“We’re all getting sick and tired of fighting VIHA every step of the way,” Discovery Islands-Mainland Inlets director Jim Abram told Decafnation this week. “Why do citizens have to keep fighting a superfluous government agency?”

Echoing those sentiments, Oyster Bay Director Brenda Leigh believes North Island taxpayers have been short-changed.

Dr. Chris Bellamy

“It is very disturbing that Island Health is continuing to try to downsize the services we were promised when we put forward our 40 percent investment for the NI Hospitals,” she told Decafnation.

​But so far, that opposition has not persuaded Island Health to restore clinical pathology services to the North Island or to abandon its vision of consolidating clinical pathology into the purview of a group of specialists in Victoria.

How and why VIHA got to the point of eliminating such critical laboratory services in Campbell River and soon in the Comox Valley is complicated, but the net result is easy to understand, according to 30-year Comox Valley general pathologist Dr. Chris Bellamy.

“The public should recognize how integral a laboratory is to a hospital,” he told Decafnation. “If you don’t have a functional lab, you don’t have a proper acute care hospital.”

 

WHAT’S GOING ON, IN A NUTSHELL

Island Health plans to consolidate clinical pathologist services so that each sub-area of the field — microbiology, chemistry and hematology — will be handled by a group of Victoria pathologists who have specialized in one of those areas. VIHA considers this as a better model than the current one, which relies on general pathologists in smaller community hospitals.

While all pathologists spend five years in training, general pathology specialists receive competency in all areas of the field. Clinical pathology specialists go deeper into a single area of the field, but do not achieve competency in the other areas.

That is why most hospitals in communities outside of the province’s metropolitan cities employ general pathologists, and have them working at their full scope of practice.

In a recent presentation to the regional hospital board, Robertson indicated that VIHA was headed toward a specialist-based model for clinical pathology on Vancouver Island that it claims will be more efficient and get better results.

General pathologists disagree.

“You don’t need a Phd in math to teach high school algebra,” Bellamy said.

He and Tabarsi say most of the work at community hospitals does not require a specialist. But they always have and will continue to consult with specialists in Victoria, Vancouver and elsewhere when they encounter difficult or rare cases.

“Why not build on what works and is already in place,” Bellamy said. “General pathologists are still viable in the Comox Valley and Campbell River. We’re not denying doctors or patients access to specialized care. I highly respect the professional opinions of the anatomical and clinical pathologists in Victoria. I’ll always reach out when it’s needed, but not always to the Victoria specialist. Sometimes to specialists at Vancouver General, the BC Cancer Agency or Children’s Hospital, whoever is the best qualified for the case.

“Why restrict pathologists from providing the best care available?”

 

HOW WE GOT HERE

In the early 2000s, a specialist microbiology pathologist from Alberta — who had been through a health care disaster in 1996 after 40 percent of the province’s clinical pathologists were laid off along with nearly 60 percent of lab technologists — came to VIHA with the idea that all microbiology on the Island could be handled in Victoria on a 24/7 basis.

In order to handle such a huge additional volume of specimens, the microbiologist proposed an expensive, automated robotic system located in Victoria. It was claimed the system would save money on staffing and that it could be operated remotely by microbiology technologists in hospitals outside Victoria, thereby retaining local microbiology expertise, infrastructure and jobs in hospitals outside Victoria.

The VIHA executive and Board of Directors bought into the concept and the technology — despite some misgivings from the microbiologists — but it never delivered as promised.

“The automated system and its promised benefits was a pipe dream. In fact, it had the reverse effect,” Bellamy said.

But the idea of consolidating areas of clinical pathology took root in Victoria.

VIHA eventually moved ahead with plans to consolidate all Vancouver Island medical microbiology services in Victoria, and it did so despite cautionary notes in a 2011 independent review of its proposal.

 

CAMPBELL RIVER SUFFERS

In 2006, Dr. Aref Tabarsi took a telephone call from a Victoria pathologist who demanded that some Campbell River work be sent to Victoria.

“I was told to send my bone marrow work (hematology) to Victoria or Victoria would demand to review all of my work,” Tabarsi told Decafnation. “So, what could I do? I ‘gave’ the work to Victoria.”

Soon after the transfer, Victoria hired an additional hematopathologist.

Dr. Aref Tabarsi

Later that same year, while Tabarsi was on vacation, a Victoria department head demanded the Campbell River laboratory send all of its outpatient blood work to Victoria. But Tabarsi was called, returned to the hospital and stepped in front of the courier truck and made the driver unload CR samples from the truck.

For nine years prior to 2013, Tabarsi oversaw the quality of Campbell River’s laboratory. In terms of physical work, oversight consisted of reviewing the technologist’s documentation that includes graphs showing the machines had been calibrated accurately and that test results coincided with the calibrations.

But in 2013, the division heads of clinical pathology in Victoria, who later incorporated themselves with a group called the Vancouver Island Clinical Pathology Consulting Corporation, assumed Tabarsi’s laboratory oversight responsibilities. They did it, he says, without any prior notice or consultation, and without giving him any recourse.

In practical terms that meant the Campbell River technologist’s quality control documents were sent to Victoria once a month for review and signatures.

“At the time, I wondered why — since all pathologists were on a fixed salary — Victoria wanted to take on this extra work,” Tabarsi said.

Some months later, VIHA negotiated new contracts for all of its pathologists based on a workload model. Under the new contracts, the more work a pathologist performed, the more they were paid.

“The mystery was solved,” Tabarsi said.

As a result, the funding of 0.4 full-time-equivalent work assigned to the oversight function of the total 0.7 FTE allocated for all clinical pathology work performed in the Campbell River lab was lost. That proved critical to preventing Campbell River from hiring a third pathologist, which Tabarsi says is necessary for the safe operation of the lab, Tabarsi said,

Pathologists get seven weeks of vacation a year, plus two weeks for professional education. That means more than a third of every year (18 weeks) there is only a single onsite pathologist on duty.

“It’s not safe,” Tabarsi said. “One pathologist doesn’t have a colleague to consult with, every malignant case has to be signed by two pathologists, and just the sheer volume of work can’t be done by one person in a clinically acceptable time frame. In addition, the chances of mistakes are higher.”

 

VIHA STATEMENT

VIHA told Decafnation that it works within the network of laboratories across Vancouver Island that form the Island-wide Department of Pathology and Laboratory Medicine.

“Our network of laboratories includes 13 acute laboratory testing sites each with a collection station and 25 standalone collection stations. We also contract with a number of publicly funded laboratory physicians groups, including the pathologists at both North Island Hospital campuses, on a contracted basis to create an integrated model of service delivery.

“Like other trends in health care, changing technology, increasing complexity, and recruitment challenges all impact the delivery of care. Island Health is closely following these trends, including taking advantage of technological improvements to provide equitable access to specialized pathology care for all of our communities, including those on the North Island,” the VIHA statement said.

 

VIHA FLIP-FLOP

After stripping the Campbell River lab of its clinical pathologist’s work this year, VIHA still appears uncertain about how to move forward.

Some history:

In 2017, the three Comox Valley general pathologists, Dr. Chris Bellamy, Dr. Wayne Donn and Dr. S. Giobbie, started echoing Tabarsi’s concerns, and it appeared that VIHA was listening. Because on Feb. 26, 2018, the health authority issued a memo that under new two-year contracts all clinical pathology work would go back to Campbell River and the Comox Valley.

“I relaxed. VIHA was saying Comox Valley and Campbell River would have a larger voice. The new Island Health CEO (Kathy MacNeill) was doing things right,” Tabarsi said.

However, less than a year later, on Jan. 3, 2019, VIHA extended the current pathologists’ contracts for an additional year, into 2020. That meant Vancouver Island Clinical Pathology Consulting Corporation’s contract for North Island clinical pathology work could not be terminated, and nothing would change.

Then, on March 27 of this year, Robertson notified Campbell River pathologists to stop doing all clinical pathology on April 1. He said that work would now be done by the doctors in the Vancouver Island Clinical Pathologists Consulting Corporation located in Victoria.

Yet, just this week, the Island Health media relations department sent a statement to Decafnation that said, in part, “Island Health has made no decision on the future of clinical pathology consultation services for communities in Campbell River or the Comox Valley.”

Next: How centralization of clinical pathology has exacerbated staffing shortages and increased workloads, and what’s at stake for patients.

 

 

 

 

 

 

 

 

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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