Chaoulli strikes back at coroner
At a press conference in Montreal this morning, Dr Jacques Chaoulli (pictured left) rejected coroner Catherine Rudel-Tessier's recent accusations that he had acted improperly in the case of a man who died in the waiting room of a hybrid-public/private urgent-care clinic last year.
Dr Chaoulli's press conference was announced to the media yesterday with the unsubtle title "Coroner Rudel-Tessier is Wrong."
The coroner's report, released to the public in April, criticized Dr Chaoulli for not attempting emergency resuscitation on Jean-Jacques Sauvageau after he slumped over in his waiting-room chair, as Canadian Medicine reported last month.
Today, Dr Chaoulli said that conclusion was incorrect. "It is not true that a doctor should start resuscitation procedures on a person presenting all the signs of unquestionable death, a corpse."
Ms Rudel-Tessier and her expert witness, Dr Colette Lachaîne, falsely asserted that doctors should attempt resuscitation up to three hours following cardiorespiratory arrest except in extreme circumstances, Dr Chaoulli said. That regulation applies to police and paramedics, he said -- not to doctors.
"I did not kill him," he told Montreal Gazette reporter Charlie Fidelman, despite the fact that he has been accused of no such thing and despite the fact the coroner's report alleged that although Dr Chaoulli should have attempted resuscitation Mr Sauvageau would have died anyway.
Dr Chaoulli accused Ms Rudel-Tessier of impugning his character and unfairly damaging his reputation. "It's clear that, when you're attacked and accused, and in an unjustified way, in every news source, it's clear that damages the image and reputation of the person."
He admitted he should not have left Mr Sauvageau's dead body in the waiting room with the rest of the patients. "But you know, it's always easy to say that afterwards, but it's certainly a lesson I've learned."
In a news release, Dr Chaoulli explained what he believes to be the appropriate response to the death of Mr Sauvageau death, who should have been cared for immediately. "This situation illustrates the need to have all walk-in medical clinics offer the services of a dedicated triage nurse in order to prevent such unfortunate events from occurring again in the future."
Dr Chaoulli's recommendation goes even further than what is likely to be adopted as policy by the Collège des médecins du Québec in response to the coroner's report. Canadian Medicine learned last month that the Collège was considering requiring urgent-care clinics to compel all their doctors and nurses to get CPR training and to keep a defibrillator on hand.
Dr Chaoulli remains under investigation by the Collège to determine whether he acted properly during the Sauvageau incident.
H1N1 flu news update
Yesterday afternoon's Public Health Agency of Canada update counted 165 confirmed cases of H1N1 flu across Canada, with the vast majority found in BC, Alberta, Nova Scotia and Ontario. Today's PHAC numbers aren't out yet, but already we know Ontario has identified 13 more cases. So far, however, all cases have been mild and zero Canadians have died of the disease.
Canadian scientists in Winnipeg became the first in the world to sequence the flu's genes, Health Minister Leona Aglukkaq and chief public health officer Dr David Butler-Jones announced today. "The world’s knowledge of the H1N1 flu virus has taken a significant step forward thanks to the excellent work done at Canada's National Microbiology Laboratory," said Ms Aglukkaq. [PHAC news release] [Globe and Mail]
In China, 27 University of Montreal students were quarantined on Saturday even though none showed any signs of the H1N1 flu. The students' quarantine will end tomorrow morning and they will be permitted to travel to Changchun to take language classes. [Canadian Press]
The University of Guelph was the benefactor of some lucky timing in its announcement of the opening of a new Center for Public Health and Zoonoses. [U of Guelph news release] Coming as it did during a time of global panic over a disease thought to have been initially transmitted from pigs to humans, the school's announcement received more attention than it probably otherwise would have. [Guelph Mercury]
Ontario Medical Association's new prez
The OMA has a new president, Dr Suzanne Strasberg.
Dr Strasberg, a family doctor in Toronto, has set out five areas she'd like to work on during her presidency:1. Focusing funding on the patient;
In 2007, Dr Strasberg co-authored an op/ed in The Globe and Mail to defend a Canadian Medical Association proposal called Medicare Plus, which called for greater freedom for doctors to practise in the public and private sectors at the same time, among other things. [Canadian Medicine]
2. Promoting a healthy lifestyle for all Ontarians;
3. Working with the government to determine and minimize the impact of the Harmonized Sales Tax (HST) on physicians;
4. Ensuring adequate physician input into local health care decision making; and
5. IT and eHealth
Last year Dr Strasberg had a high-profile disagreement with the Coalition of Family Physicians of Ontario (COFP) when she and several other physicians criticized the group (which had endorsed her candidacy for the OMA board of directors) for being "misleading and inaccurate" in its advocacy for a "no" vote against the most recent collective agreement between the OMA and the Ontario government. [Canadian Medicine] The agreement was approved by over 79% of doctors who voted. [Canadian Medicine]
Dr Strasberg's first public announcement was a call for reforms that will ensure every Ontario resident has a family doctor. [OMA news release]
"I am looking forward to working with Dr. Suzanne Strasberg and to continuing to develop the vital relationship I have with the OMA," said Ontario Health Minister David Caplan. "I would also like to thank the Association's outgoing president Dr. Ken Arnold for his leadership during a crucial year in the partnership between doctors and our government."
If Mr Caplan and Dr Strasberg can indeed develop a working partnership, it will be a major improvement over the animus that existed for years in Ontario between Mr Caplan's predecessor, George Smitherman, and the province's medical community.
Sékaly to leave for the US
One of the country's most accomplished HIV/AIDS researchers, University of Montreal's Rafick-Pierre Sékaly, has been lured away from Canada by a Florida research institute. "The offer was the dream of any scientist," he said. "I'd have been crazy not to take it." More than half of his staff of 40 researchers will leave Montreal with him. [Montreal Gazette]
Dr Sékaly and other researchers bemoaned Canada's inability to provide the same sort of funding for scientific research that the United States can. According to CBC News, Dr Sékaly will have a research budget in Flordia that's twice as large as his budget was in Montreal. [CBC News]
Lessons in euthanasia
Australian physician Philip Nitschke gave a workshop on euthanasia to nearly 100 people in England. [BBC News]
Read PE online
The May issue of Parkhurst Exchange is in the mail now, but there's no need to wait until the hard copy arrives: check it out online here.
Latest headlines
Wednesday, 6 May, 2009
What's in the news: May 6 -- Chaoulli defends himself
Tuesday, 5 May, 2009
Provincial elections take precedence over federal politicking
One of the major fallacies commonly held about the Canadian healthcare "system" is that there is such a thing in the singular. The truth of the matter is that beyond providing funding and assessing some apparently arbitrary nominal fines for violations of the Canada Health Act, the federal government has little influence in creating or implementing the health policies that affect the majority of Canadians. Canada has health systems, plural. Counting each province's ministry of health plus Ottawa's administration of healthcare for First Nations, soldiers, veterans and prisoners, there are fourteen distinct systems.
Nevertheless, there is often much talk during federal election campaigns about threats to medicare or efforts to kickstart healthcare reform when instead those matters pertain to provincial politics. Perhaps because the characters are seen as more colourful or perhaps because the rhetoric is more inspiring, federal politicians tend to overshadow their provincial counterparts.
This is the case at the moment. While the chattering classes jaw about whether Liberal leader Michael Ignatieff will attempt to topple the government sooner rather than later and whether Prime Minister Stephen Harper will work with the NDP or the Bloc Québcécois to keep his Conservatives in power, two provincial elections of significant consequence are coming up.
British Columbia's campaign is in its last stages and voting ends next Tuesday, May 12. The NDP's numbers are surprisingly high considering where they were several months ago, but the incumbent Liberals still hold a small lead in the polls. The Liberals have had some tumultuous years in terms of health policy, what with the Insite safe-injection controversy and a recently begun battle against Canadian Medical Association past-president Dr Brian Day over the constitutionality of denying patients full rights to use private health facilities.
On the other coast, the writ was dropped earlier today in Nova Scotia, triggering a June 9 election in which the Progressive Conservatives will attempt to either hold on to their minority government status or gain a majority in the legislature, while the NDP will attempt to leapfrog past the Tories to become the governing party. During the campaign Canadian Medicine expects to see the Conservatives forced to defend their healthcare record, which consists of an ambitious review of the entire system ("transformational system-wide realignment" was the catchphrase) conducted over a year ago but little substantive progress made in practice so far. The Tories did, however, manage to successfully negotiate an interesting collective agreement with the province's physicians a year ago this month, which may help lay the groundwork for future reforms.
Stay tuned. Canadian Medicine will endeavour to bring you the most important news on the health-related aspects of the two election campaigns.
Meanwhile, tell us your opinions of the campaigns on the coasts. Will the Liberals prevail in BC? Will the NDP defeat the Conservatives in Nova Scotia? What results would be of the most benefit to doctors, their patients, and the province's healthcare systems as a whole?
New URL, same great medical news source
Canadian Medicine is now located at CanadianMedicineNews.com.
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Friday, 1 May, 2009
FLU NEWS: The don't-call-it-swine-flu flu in Canada
As of Friday afternoon the Public Health Agency of Canada's official count listed 51 confirmed cases of the H1N1 flu (more on the nomenclature later).
All the cases have so far been mild and everyone who's been infected in Canada has recovered. The number of confirmed cases, however, has been rising every day.
Update: As of May 5, there were 165 confirmed cases across the country, with most in BC, Alberta, Nova Scotia and Ontario.
WHAT YOU SHOULD KNOW
Physicians trying to stay abreast of all the information about the virus may have read Canadian Medicine's summary earlier this week, "What Canadian doctors need to know about swine flu".
Last night, the Public Health Agency of Canada released several sets of interim guidelines, including a document to help direct clinicians in ambulatory care settings. The guidelines include advice for doctors on screening, triage, infection control precautions, and safety guidelines for doctors on how to protect themselves while examining patients.
More information for physicians and other healthcare professionals -- including infection control measures for hospitals and acute-care facilities, case reports, public health response guidance, and more -- is available on the PHAC's H1N1 page.
VACCINE NEWS
Dr Marie-Paule Kieny, the director of the WHO's Initiative for Vaccine Research, estimates that it will be four to six months before an effective vaccine can be developed and delivered, according to the Toronto Star. She said the seasonal flu vaccine does not appear to protect against the H1N1 virus.
THE POLITICAL FLU
Just as physicians and nurses have kept busy of late examining and assuaging sniffling patients, so too have our representatives in the provinces and in Ottawa busied themselves with monitoring the disease, preparing an appropriate response, and politicking.
Federal Health Minister Leona Aglukkaq, who was seen as an inexperienced selection for the cabinet seat because her previous experience was as health minister of a territory with just one hospital, has largely escaped criticism and has even earned some praise. She consulted opposition health critics Dr Carolyn Bennett, of the Liberals, and Judy Wasylycia-Leis, of the NDP, about her decisions, and she's deftly deferred to her in-house medical experts like chief public health officer Dr David Butler-Jones on technical questions. The Globe and Mail commented that she "gracefully survive[d] her first day in the eye of the storm" earlier this week and quoted Jan Kasperski, CEO of the Ontario College of Family Physicians, lauding Ms Aglukkaq. "Her calm vigilance now strikes us as exactly the right approach," a Montreal Gazette editorial said. Ms Aglukkaq brushed off criticisms of her as being inexperienced. "I was at the territorial-provincial-federal table when we put the pandemic plan together for the country... That plan that we developed in partnership with the provinces and the territories is now in effect and working quite well in my opinion."
Ms Aglukkaq told The Globe and Mail, "In situations like this, it's very important to put aside party politics and be talking with my opposition critics, updating and briefing them on matters of this nature." That sentiment reminded me of the comments Dr Aaron Johnston, a BC family doctor who worked in Nunavut, emailed me when Ms Aglukkaq was first appointed health minister last October. "[A]lthough Leona is a Conservative MP her background is as an MLA in a consensus parliament rather than a partisan parliament," he wrote, "and perhaps that will be of some use to her in this minority government situation."
Not everyone was quite so impressed, however. Maclean's reporter Aaron Wherry called Ms Aglukkaq's performance this week "a minor revelation" but tempered that by adding "[i]f only, it seems, because she would seem for now to understand how poorly prepared to manage a worldwide health crisis she —- or anyone —- may be." Mostly, Mr Wherry was struck by her openness to working with the opposition and willingness to admit a mistake given how infrequent it is to "see someone behaving like something other than a self-aggrandizing outlet for utter nonsense, let alone freely admitting one’s own limitations." Her answer to one question seemed lacking to him. "But if it lacked in substance, it lacked equally in ill intent."
Meanwhile, Rick Mercer irreverently twittered, "The real tragedy? If the swine flu becomes a pandemic Canadians may have no choice but to find out who Canada's Health Minister is."
THE VIRUS'S NAME
A closing note on terminology, for those of you who were wondering about my "don't-call-it-swine-flu flu" coinage in the headline. Swine flu is out, thanks to lobbying efforts by Big Pork and thanks to trade and business worries from government officials.
The World Health Organization is now calling the disease influenza A(H1NI), which, though it doesn't have quite the same visceral ring to it as did swine, is certainly more accurate considering no pigs are sick with the virus and it cannot be spread by eating pork. (The name change may also help save some pigs from being exterminated, as has happened in Egypt.)
The virus has been described in some journalists' shorthand and elsewhere as the Mexican flu. Even Prime Minister Stephen Harper was caught using the phrasing. The Mexican flu usage, however, has been assailed on multiple fronts. One free-trade critic told the Toronto Star that Mexico is not alone in the blame for the hazardous conditions at pig farms that are suspected by some of spreading the virus. "You might call this the 'NAFTA flu,'" said Common Frontiers coordinator Rick Arnold, alleging that multinational corporations took advantage of lax regulatory conditions in Mexico. Others -- with a rationale less political than realistic -- have similarly suggested calling it the North American flu.
Craig MacFarlane, a lecturer in the Carleton University department of law and sociology PhD candidate, made a different argument for not calling it the Mexican flu. "Those of us who study animals know that there is a strong connection between the treatment and representation of animals and other forms of human discrimination," he wrote on his blog Theoria yesterday. Calling the disease the Mexican flu amounts to a slur on Mexicans, he argued. "Carol Adams (The Sexual Politics of Meat) has profitably explored the relationship between sexism and animal use; Charles Patterson (Eternal Treblinka) and Boria Sax (Animals in the Third Reich) have pointed out the connection between industrial agriculture and the Holocaust; and Marjorie Spiegel (The Dreaded Comparison: Human and Animal Slavery) has looked at the connection between racism and animal use. And, of course, Upton Sinclair’s The Jungle should not be forgotten."
Of course, plenty of people haven't been able to resist making light of the serious situation, suggesting names like "Fox News Fever", "Bacon Lung", or, along the same lines as Mr MacFarlane's analysis, "The Xenophobic Flu".
