Health care crisis in the Valley

Patients and doctor speak to some of the struggles accessing health care outside the Columbia Valley

A letter in the Pioneer February 14th from an Invermere doctor claiming Alberta has become harder and harder for patients to access has opened a flood of response. Between letters to the editor, cheers, online comments, and personal stories, the anecdotes are pouring in on how the medical system is breaking down between B.C. and Alberta.

Dr. Gareth Mannheimer, Invermere District Hospital chief of staff, has been working in Invermere for the past 10 years. The Pioneer reached out to Dr. Mannheimer to focus in on this issue and find out what has been happening locally as it relates to Alberta health and the figurative wall rising between the borders.

Dr. Mannheimer says he has seen, without question, a “progression of attrition of access to the facilities in Alberta.” He says what started out as a shutdown to services such as cancer imaging has expanded to include non-emergency surgeries, specialist appointments and more.

“Those barriers have slowly gotten higher and higher and really just quite difficult to navigate,” Dr. Mannheimer reflects. “It affects absolutely every aspect of medical care that we have.”

It is not a total shut-down to services; it is more that it has become “unpredictable” whether a patient will be allowed to cross the border or not for care.

“Certainly we are seeing more and more referrals bounce back because they simply do not treat B.C. patients. This is true for spinal surgery, this is true for many eye emergencies, this is certainly true for cardiac surgery, and it’s become very unpredictable of who they will and won’t treat.”

More patients are now being sent to Kelowna instead of Calgary. Dr. Mannheimer makes clear this is not a question of competency within B.C., praising his colleagues in Kelowna. It is more a question of convenience for Valley residents to be sent either three hours away to Calgary, or over two mountain passes and twice the driving time to Kelowna.

“Patients in the East Kootenays’ proximity to Calgary is such that it really just makes sense. It makes sense for patients themselves. It makes sense for patient’s families, for patient’s support structures. It makes follow-up after these acute interventions more sensible,” he says. “Patients should really have the most appropriate care available, closest to where they live.”

The Pioneer reached out to Alberta Health Services (AHS) to inquire about the challenge B.C. patients are having in accessing medical care in Alberta. While a media spokesperson said they had no one available for an interview, media relations officer Don Stewart emailed a statement on behalf of AHSs.

“We know that many patients from outside Alberta receive elective – or non-urgent – care at Alberta Health Services (AHS) facilities, including patients who have services available in their home province, as well as those who may be unable to receive specialist care in their home province. AHS does not have a policy restricting care for out-of-province patients,” he wrote.

Mr. Stewart said last year AHS provided care for almost 9,440 patients from outside Alberta, while AHS acute care hospitals often operate at or near 100 per cent capacity.

“Individual services or providers responsible for their practice make decisions that allow them to appropriately manage their waitlists,” Mr. Stewart continues. “The practice of re-directing interior B.C. residents to Kelowna General Hospital for cardiac surgery has been established for nearly one year. It is an agreed practice between leadership at Interior Health, the Kelowna General Hospital Cardiac Program and Foothills Medical Centre.”

He says that agreement was struck for several reasons, including Kelowna’s well-established cardiac program that has unused capacity to provide care, and the nearly 400-patient waitlist at Foothills when the agreement was struck.

“While patients may want to drive a few less hours, both Alberta and B.C. residents deserve the most timely care and this practice is in place to ensure that happens,” Mr. Stewart concludes.

Some Valley residents have been models of the system working well, getting the timeliest service when they need it. Dianne Peterson is one such example. It was 4:30 in the morning on December 16th, 2017, and Ms. Peterson woke with a start. The day before, she had trouble breathing; feeling almost like an elephant was crushing her. She didn’t consider what the breathing trouble may be a symptom of, and went about her day. Now she was awake and knew something was wrong. When she felt a shock run from her throat down her arm, she realized it was a heart attack. Fifteen minutes later she was out the door of her Wilmer home and in the Invermere & District Hospital’s emergency ward. After she was stabilized, she began listening to what was going on around her.

“I heard the doctor talking ‘Kelowna’,” she recalls. Lying in her hospital bed, Ms. Peterson, a self-confessed stubborn woman, called out that there was no way that was happening.

“Now I can talk, and I said, ‘I’m not going to Kelowna’.”

Ms. Peterson has a daughter who lives in Calgary, and another just an hour outside the city, so she wanted to be transferred to where her support system was located. But besides that, she had heard cautionary tales of Valley patients who were scheduled to go to Kelowna but got stuck in Cranbrook because of poor air conditions for fixed wing air transport to move patients from one hospital to another.

As it turns out, Ms. Peterson did not need to put her foot down to demand a transfer to Calgary. Vancouver was too far away for the urgent care she needed, and it appeared she was not going to be able to get transferred to Kelowna quickly enough either. Paramedics settled her in an ambulance to head for the airport in Fairmont Hot Springs, where a plane was set to pick her up and rush her to Calgary. A bit more bad luck was in store for Ms. Peterson, however, when they arrived to the Fairmont airport and discovered the plane was not there. It turned out the pilot was unable to land at the local airport and had headed on to Cranbrook. So, paramedics raced her – “lights and siren all the way” – to the regional airport, where she was promptly flown to Foothills. By 3:30 p.m. the same day, Ms. Peterson was in recovery. The specialist at Foothills told her that the system worked well in her case, that it was ‘perfect’ in terms of getting to the hospital and getting her on the operating table in a timely fashion.

The cardio team ambulance attendant told Ms. Peterson her textbook response time does not happen often.

“Most times, you’re sitting in Invermere or Cranbrook for days waiting for transport (to Kelowna),’ Ms. Peterson recalls him telling her. “My case is what they want to have happen, but sadly it doesn’t.”

Ms. Peterson was lucky with the order and speed of her care, and has also not had issues going back to Alberta for other appointments. Just last month, she tells the Pioneer, she had a test for another health issue in our neighbouring province.“Patients need to be sent to where they can get the fastest help,” says Ms. Peterson, echoing Dr. Mannheimer’s sentiment. “There’s something wrong with our system.”

Indeed, others have not had such a ‘textbook’ experience. Lil Steinwand is a retired nurse, so she knows plenty about the health care system and the importance of critical care patients being treated fast. So when her husband Don had a heart attack in January 2018, he was quickly brought to the Invermere & District Hospital emergency department. The problems started after that. The attending doctor called for a transfer to a higher-level care facility. It took seven and a half hours from the time he arrived at Invermere’s emergency room until the time he was handed over to a specialized response team tasked with driving him to Foothills hospital in Calgary. By the time the team arrived with Mr. Steinwand to Calgary, it had been almost 11 hours. Mr. Steinwand was left with 10 per cent of his heart capacity because of this lengthy timeline.

“We in the East Kootenays have been let down and ignored by the Provincial health System,” Ms. Steinwand wrote in a letter to the Patient Care Quality Review Boards. “Canada is a first world country and should give and receive first class care for all.”

The Steinwands are looking for a change in the policy to transferring critically ill people to a higher level of care.

“There was no reason for it to take 11 hours for him to get there,” Ms. Steinwand said to the Pioneer. “It’s just not right.”

She has written formal complaints to the Interior Health patient care quality office, the Provincial Health Services patient care quality review board, and BC Ambulance Service. So far, they have not received a satisfactory answer to their complaints of why exactly it took so long to get Mr. Steinwand the care he needed in Calgary.

Mr. Steinwand feels frustrated at the lack of response from authorities, saying they are getting the “run-around” from Interior Health and BC Ambulance. His quality of life has gone way down as a result of the wait time too.

“My life went from very active to almost an invalid,” says Mr. Steinwand .

Dr. Mannheimer agrees transportation to higher-care facilities is a big issue, though somewhat aside from the Alberta wall currently under discussion. If patients are transported to Kelowna, there are challenges getting them there with a strained air transport system. Once they are there, there is no way for patients to get back home once they are discharged from a hospital. If patients are transferred across provincial lines, there are transportation considerations between B.C. and Alberta ambulance systems. And given our rural setting, there is not always the correct transportation available at our fingertips. In Mr. Steinwand’s case, a specialist needed to travel from Fernie to accompany him from Invermere to Calgary, which added a significant amount of time to the transfer.

Dr. Mannheimer speculates that the issue between B.C. and Alberta is more a political one than a medical one. He says if Valley patients are struggling to access the care they need, to reach out to their primary care provider. He also suggests if problems are related to accessing cross-border care, to reach out to political representatives as well.

“Physicians are very aware of this problem, and physicians are working incredibly hard to try and fix it. But without a fire and the various political structures, this problem is not going to be fixable.”

Doug Clovechok, MLA for Columbia River-Revelstoke, agrees. He urges patients to reach out to his office with their stories so he can add it to the growing stack of evidence to bring before the minister of health.

“We want people to tell us,” Mr. Clovechok told the Pioneer. “I’m the gun, and they’re the bullets. I can’t fight for them if I don’t have the bullets.”

Mr. Clovechok’s office shared several stories they have heard from constituents already, adding ammunition to the arsenal. For example, there is a senior citizen in the Columbia River – Revelstoke whose physician recommended him for spinal surgery. The constituent would like to go to Calgary since they have adult children living there; his spouse would be able to stay with their family in Calgary during the surgery and recovery. Further, he knows he will need at least four pre-surgery appointments/consultations with the surgeon. The surgeon in Calgary denied the physician’s referral, and noted that they must go to a surgeon in their own province/region. This means that the constituent must travel to Kelowna for surgery and all their consultations/appointments (seven hours each way, plus two nights hotel at his expense).

To share your story with our MLA, email Doug.Clovechok.MLA@leg.bc.ca, or call his constituency office at 1-250-432-2300.

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