Canadian Medicine

The controversy about the shutdown of the Chalk River nuclear plant (pictured above), and its repercussions on physicians' access to radioisotopes produced there for their diagnostic imaging machines, is gaining steam.

Calling the halt in production of radioisotopes as a result of the Chalk River nuclear plant leak and shutdown "what may well be the country's worst medical crisis in decades," London Free Press columnist Greg Weston blasted the current government and governments past for failing to protect Canadian patients from the risk a shutdown represents.

Dr Jean-Luc Urbain, the president of the Canadian Association of Nuclear Medicine, told Mr Weston, "This is an absolute catastrophe, the worst possible scenario you could imagine." By next week, Dr Urbain said, up to 3,000 Canadian patients per day may have to have their diagnostic imaging canceled for lack of isotopes. "If you cannot make a diagnosis, you cannot prescribe treatments," he said. "The situation is really, really dire."

Already, 70 bone scans were canceled in Saskatoon as the health region rations its resources in anticipation of the shortage.

"We'll be okay for this week and next week," Dawn-Marie King, the director of clinical operations for medical imaging at the University Health Network, Mount Sinai and Women's College hospitals, said. "If it does go into a month, weeks three and four and beyond will be an issue."

The London Free Press's Mr Weston asked Health Minister Leona Aglukkaq's office what the plan is. He got back a message from Natural Resources Minister Lisa Raitt that said, in part, that she had "led a discussion with... government and industry representatives in isotope-producing countries to address this issue and to encourage immediate collaboration." Well, Mr Weston wasn't about to take her word for it. "We contacted many of those key international players," he wrote, "and let's just say that if Raitt's gabfest had any effect at all, we couldn't find anyone who noticed."

A Toronto Star editorial enumerated the fruits of the government's international negotiations "to co-ordinate reactor maintenance schedules in order to ensure that facilities are not taken out of service simultaneously." The current status of the five reactors worldwide that produce the needed radioisotopes? Four are shut down for repairs, reportedly. "So much for collaboration," the Star sighed.

And the news keeps getting worse. A spokesman for Atomic Energy Limited of Canada, which runs the plant, said the repairs will take over one month, but the National Post heard from an engineer who works at Chalk River that even eight months would be surprisingly fast for repairs to be completed. Another engineer, who used to work at Chalk River and is now employed by the federal government, told the Post, "Sounds to me as if good ol' NRU is gone for good." Several repair scenarios could place the shutdown at as long as two to six years, reporter David Akin wrote.

In the meantime, a South African company called NTP Radioisotopes has come forward to offer to help provide supplies for the US and Canada. Some have suggested paying to use McMaster's nuclear reactor to fill in for Chalk River, but nothing appears to have come of that idea yet.

But the shortage is already becoming a hot political issue, with Liberal health critic Dr Carolyn Bennett excoriating the government for its failure to prepare for this eventuality. "This government has no plan to deal with another isotope crisis... Is there a plan to deal with a month-long shutdown at Chalk River? Can this government offer any hope to Canadians that they have a strategy to ensure Canada continues to be a world-leader in nuclear medicine? Based on the government’s handling of this file, the answer to each of these questions is a resounding 'no'."

Of course, the overdependence on Chalk River was a problem when Dr Bennett and the Liberals were in power, too. Longstanding plans to build two new reactors, called MAPLE, never got off the ground and then were cancelled by the government last year when problems with the design turned out to be serious. However, MDS Nordion, the company that distributes the radioisotopes produced at Chalk River, issued a statement the other day that implied they were unhappy with the government's "unilateral" decision to scrap MAPLE and that they believe "the completion of the MAPLE project is the best alternative to provide long-term global isotope supply." []

What next? At this point, with much of the political side of the debate apparently focused on finger-pointing, it's anybody's guess. But it seems increasingly certain that many, many Canadian patients' tests will be postponed as a result of the Chalk River shutdown.

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Ontario MDs anxious about financial matters
Recession aside, two recent events have some Ontario physicians concerned about financial matters.

The first matter of concern is the Ontario government's sudden decision last month to suspend new hiring in capitation-model practices such as Family Health Teams. (See the comments below this article for an update on this story.)

The news prompted the Coalition of Family Physicians of Ontario (COFP) to release an "urgent notice" to all doctors in the province. "With the present freeze by Government, new doctors poised to enter the medical work force are being forced to put their plans on hold and reconsider their options. Likewise, established doctors, who have made significant financial investments in setting up as a FHN/FHT/FHO/FHG, now face uncertainty and potentially devastating losses."

Health ministry officials have said the suspension is temporary and should be lifted within several weeks.

The second issue is the amount of money the Ontario Medical Association owes in rent on a property it is no longer using.

The figure is a staggering $6.1 million per year in rent for the University Avenue office space the OMA was using before moving in early April to a new location on Bloor Street.

The COFP -- long a critic of the OMA -- has eagerly jumped at this opportunity to criticize the association. In the , COFP president Dr Douglas Mark called the lease problem a "fiasco." "Although the OMA has laid the blame on the economy as the culprit, it should have been cautious precisely because of the poor economy rather than leasing new premises prior to securing a tenant for the old site."

Dr Mark's assessment of the OMA's likely next move is dire. "What are the implications for you in all this? It strikes us that the OMA seems to lack fiscal accountability to its members, and may simply pass on related additional costs to you directly, by means of an increase in OMA dues. It is empowered to do so by the OMA Dues Act of 1991, which is how it raises its revenue, without any mandated regard to its actual fiscal performance. Alternatively, it may choose to simply cut some programs to finance the shortfall. Both of these choices will have a negative impact on you."

Dr Mark encouraged physicians to write to their OMA reps and recently inaugurated OMA president Suzanne Strasberg.

Nuclear medicine worries as key nuclear plant shut down again
The Ottawa-area Chalk River nuclear power plant, which is responsible for producing more than half of the world's supply of a vital radioisotope used in as many as 90% of diagnostic imaging procedures, has been shut down for repairs for the second time in the last 18 months.

The plant was shut down after radioactive heavy water was discovered to be leaking out of the facility. Similar leaks were discovered in December and necessitated a three-day shutdown for repairs. [Canadian Medicine]

There are now fears, once again, that too few radioisotopes will be available to physicians and radiological appointments could be canceled, as happened in late 2007 when the plant was last closed for an extended period of time.

"We'll be good for the next week, but the next three weeks will be really difficult after that," Dr Doug Abrams, the president of the Canadian Society of Nuclear Medicine, told the Canadian Press. "It's really going to depend on what other sources can be tapped from Europe."

The threat of a debilitating shortage grew so great in 2007 that the federal Parliament passed emergency legislation ordering the plant to reopen despite safety concerns. [Canadian Medicine] Not long after, then-Natural Resources Minister Gary Lunn fired Linda Keen, the head of the Canadian Nuclear Safety Commission, after she voiced concern about the wisdom of restarting the Chalk River plant without the required safeguards yet in place.

H1N1 flu news: a round-up
As of May 15, there were 496 confirmed cases of the H1N1 virus in Canada, with more than half in Ontario and BC. One death has been attributed to the disease, that of a 39-year-old woman in northern Alberta who had not travelled to Mexico and whose flu-infected mother, whom she presumably caught the virus from, had not been to Mexico either. It was difficult, however, for doctors to determine to what extent the flu had been a factor in her death; she had preexisting medical problems.

Four hospital employees at University Health Network facilities in Toronto have been diagnosed with the H1N1 flu.

Remember the news earlier this month that Canada was the first country to decode the H1N1 virus's genes? [Canadian Medicine] It turns out that was somewhat less than true. Canadian scientists were the first to genetically sequence a Canadian sample of the virus and a Mexican sample, but CDC scientists in the United States were the first to decode the virus's genes. Dr Frank Plummer, the director general of the National Microbiology Laboratory in Winnipeg that was said to have made the purported breakthrough, told the Canadian Press that Health Minister Leona Aglukkaq "misspoke." He added that Health Canada's press release "mistunderstood" the distinction "in their enthusiasms for the findings."

Dr Margaret Chan, the Canadian-trained physician who's currently the director general of the World Health Organization and the woman at the head of the global response to the H1N1 outbreak, was profiled in the New York Times earlier this month. "[I]t all started," the article explained, "because her boyfriend decided to move to Canada."

Aiming for faster breast cancer diagnoses
Princess Margaret Hospital announced it will offer same-day breast cancer diagnoses. "The vision for this groundbreaking initiative is that when completely
operational, women and men suspected of having breast cancer will be able to
receive all their tests, diagnosis and treatment plan in one day at Princess
Margaret Hospital."

Sask. radiologist review finds 'concerns'
Saskatchewan health officials will hold a news conference today to elaborate on the hints they gave yesterday about "identified concerns related to significant clinical differences of opinion in the interpretation of diagnostic images in the [Sunrise] region" stemming from an investigation of an as-yet-unnamed radiologist.

Ontario will allow non-doctors to prescribe, order exams
New legislation proposed in Ontario means nurse practitioners and physiotherapists will be able to order diagnostic imaging exams, midwives will be permitted to draw blood, and pharmacists will be allowed to renew prescriptions at their discretion. You can read the full text of the bill, if you're so inclined, at the Legislative Assembly of Ontario's website. []

MORE NEWS FROM ACROSS CANADA
Ontario aims for all-electronic prescribing by 2012.

Newfoundland and Labrador nurses, still mired in what appears to be an ever-worsening dispute with the provincial government (and, perhaps, in an increasingly personal dispute with Premier Danny Williams), have said they will refuse to work overtime beginning today. The nurses' union has referred to the impasse as a lockout, while the government has called it a strike.
Update, Wednesday, May 20: The union and the government reached an agreement early this morning after negotiations overnight lasted until 5am. Nurses will receive a pay increase of a minimum of 21.5%.

Orthopedic surgeons in Prince George, BC, refused to add more non-urgent patients to their wait lists unless they are granted more OR time. "We're not being provided with the resources we need, and it makes no sense to us to keep adding to the never-ending list," said Dr Michael Moran, the head of the six-doctor team.

Dr Brian Day appeared in commercials produced by the advocacy group Conservatives for Patients' Rights, which is lobbying against reforms in the United States that would increase the government's role in the healthcare market. The Canadian Health Coalition has doggedly pursued its fight against Dr Day across the border, writing a letter to President Barack Obama. "It remains shocking to us that Dr. Day, a past president of the CMA, is participating in a campaign to de-rail the efforts of the American people to secure their right to health care by misrepresenting the facts about Canada. This is a breach of fundamental ethical obligations of the medical profession, namely, a commitment to best evidence and avoidance of conflict of interest." The letter ended with a personal message to Mr Obama from the coalition's Michael McBane. "We wish you every success in your efforts to reform America’s health care system for the benefit of all your citizens. If we can at any time share with you or your team the benefits of our excellent system, we would be happy to do so." [ (PDF)]

A Canadian researcher, Konan Michel Yao, was charged with smuggling biological material into US. Mr Yao was on his way from his old job at the National Microbiology Lab, in Winnipeg, to a new post at the US National Institutes of Health's Biodefense Research Laboratory, in Maryland, when he was caught with 22 vials, including samples of genetic material from the Ebola virus. He told police he didn't want to start his work from scratch at his new job.

Surgeons performed the first surgery on a fetus ever in Canada, at Toronto's Hospital for Sick Children. []

Alberta Health Minister Ron Liepert introduced legislation that would allow the province to sue convicts for crime-related healthcare costs. "Our caucus does not believe taxpayers should have to foot the health care costs of someone who commits a crime," Mr Liepert told CTV News. "We need to send a message that we are going to make you pay if you get involved in criminal activity." []

The Manitoba Nurses Union said it will ask the provincial government to outlaw the practice employed by the quarterly magazine of the College of Registered Nurses of Manitoba, RN Journal, of publishing the names of drug-addicted nurses. "These nurses are ill. We go a long way in this province to protect personal health information and in my mind this is treating nurses like second-class citizens," said union president Sandi Mowat.

Wondering how to get your pediatric patients to eat better? Follow the example of their schools: lock 'em up.

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