Di s patche s | healthcare and we’re working with suppliers.” In contrast, in Ogdensburg, Dr. Jarrett sells easy availability: “Quick convenient access is really what we have to offer.” Or, as Laura Shea, director of community relations and planning at ClaxtonHepburn, puts it: “If you’re able to trade money for time, we can help with that.” In two days from referral, a patient can undergo a scan in the 40-slice CT Scanner (CATscan). Costs range between US$800 and $1,200; chest scan costs a little more than $1,000. An MRI of the brain, a common test, costs about $1,700 with a similarly short wait time. “I speak to an awful lot of Canadians who say they’re willing to spend that money as compared to waiting three or six months to get something like a CATScan that their family doctor has recommended,” says Dr. Jarrett. “I also speak to Canadian patients who say ‘I don’t want to spend the money and I’d rather wait.’” Dr. Eden-Walker doesn’t disagree with buying speedy service. In the Canadian system, he says, if a person’s spinal disc/ disk is crushing a nerve, an MRI scan is not difficult to schedule. If it’s back or neck pain, it can be a wait of months. “If I were the person and had $1,000 to spend on the procedure, yes, I’d do that.” He’s seen his patients head to Quebec for a fast scan. Why? Part of the reason is that many orthopedic surgeons will see patients only after they have had a required scan, he says. “Prompt-pay” patients at Claxton-Hepburn – those who are treated there must pay as services are rendered – get a 15 percent discount which, Dr. Jarrett readily explains, helps the hospital’s cash flow. In contrast, in Canada, people not covered by OHIP may pay double the OHIP rates. Med-Team Clinic charges $32 to see a family doctor for possible bronchitis which, for someone without OHIP would cost close to $60. Claxton-Hepburn, a full-service regional hospital, has 153 beds and more than 40 physicians, a cancer centre and a burns unit. Doctors refer complex cancer surgery, neurosurgery or invasive cardiology workups to such centres as to Syracuse; Burlington (Vermont), Boston and Manhattan. At Claxton-Hepburn, a patient can swiftly move from diagnosis to treatment, Ms Shea says. A woman, for example, can get a mammogram within two days. If it’s abnormal, she’s called back next day to have additional pictures taken. If need be, 32
within another day, she has a biopsy. If the biopsy indicates she has cancer, referral is made to an oncologist within a week. It takes one or two days to start radiation therapy and about seven business days to begin chemotherapy. Costs, which vary patient to patient, are close to US$75,000 plus physician fees of $9,000 for prostate
Claxton-Hepburn Medical Center.
“we’ve had embassy people who have come d own here with abdom inal pain and other sy mptom s. They got here and we diagnosed appendicitis – at least two cases of embassy pe ople whose appendix we re moved on an em ergency basis the same day.”
cancer treatment. Breast cancer treatment costs $34,000 plus $7,500 for physician fees. By comparison, the Ottawa Hospital’s three campuses average 42 days from booking breast surgery to its completion, Queensway-Carleton averages 38 days and Montfort Hospital averages 29 days – all well under the 84-day provincial target. General surgical wait times have many factors. It’s possible that the already fragile supplies could be affected by a new world-wide shortage of medical isotopes. It was precipitated by a leak discovered in May at the aged National Research Universal reactor at Chalk River Laboratories – the third shutdown in two years. Canada depends on it for 80 to 85 percent of its Molybdenum-99 supply, which is then refined at Kanata’s MDS Nordion facility into Technetium-99m. Technetium is used in nearly 80 percent of all nuclear medicine scans. Not only is Chalk River’s re-opening delayed until spring 2010,
but the Dutch Patten Reactor, another Moly-99 producer, is due to go offline for six months of scheduled servicing starting in the first quarter of 2010. “We’ve been able to survive by incredibly hard work by our technologists and clinical colleagues and by changing process and practice to maximize the use of the medical isotopes we have”, says Dr. Sandy McEwan. He chairs the department of oncology at the University of Alberta, served as past president of the Society of Nuclear Medicine in the U.S. and was named special adviser on medical isotopes to Federal Health Minister Leona Aglukkaq. “Is this sustainable over the long term? Probably not. Can we learn from what we’ve done to give us a medium-term approach to this? Probably yes,” says Dr. McEwan. Carol Sawka, of Cancer Care Ontario, says surveyed regions could find “no evidence of a negative impact on cancer patients to be scanned as they need.” A combination of predicting supplies, substituting tests using a disseminated list and Ontario’s decision to allow fluoride PETscans to be used for patients’ bone scans rather than research – the one scan for which there really is no substitute – has allowed us to keep pace with patient demand.” Dr. McEwan agrees. “At the moment, we don’t have alternative tests for infection for the kidney, for lung scanning, for sentinel mode imaging (looking at the lymph node that drains the breast for cancer), liver and gastroenterological bleed studies. Ministry of Health spokesman David Jensen says: “There has been no significant backlog of patients for diagnostic procedures reported to the ministry. Ontario has been able to manage existing patients with a reduced allocation of medical isotopes through its medical isotope disruption plan. Ontarians are not being referred to the United States because demand is currently being met in Ontario.” Ontario is also underwriting a clinical trial of sodium fluoride (18F) that might be able to do bone scans on up to 2,000 patients. Fast approvals for sodium fluoride for bone scans, says Health Canada, has made these scans available at the the University of Sherbrooke Hospital in Quebec, McMaster University and the Cross Cancer Institute in Alberta. Provincial and the federal governments Continued on page 67 FALL 09 | OCT–NOV–DEC