Canadian Medicine

1. H1N1 flu panic. After the virus emerged in late 2008 and early 2009, the panic began. The fall's flu season began with public-health officials and physicians begging people to get vaccinated lest the pandemic turn out to be anything like previous, deadly flu pandemics. Though millions of vaccines were eventually given, a backlash was not far behind: many people spurned the vaccine and some -- unsurprisingly, in retrospect -- began spouting off their H1N1 flu vaccine conspiracy theories. One eccentric Quebecker, whose medical licence was revoked years ago and is now being prosecuted for tax evasion, even called the vaccine a "eugenics weapon," as Canadian Medicine reported back in August. As it turned out, the H1N1 is not nearly the threat it was made out to be. That's not to say it's a walk in the park, of course, but an element of the backlash -- the people who claimed the government was largely covering its behind and the media was blowing the story out of proportion -- turned out to be mostly spot-on.
   
   
2. The recession's impact on contract negotiations. There were many groups far more damaged by the recession than physicians, who have avoided the job losses that plagued the manufacturing industry and, we regret to say, the publishing industry as well. But doctors felt the economic decline, too. In New Brunswick, after the government agreed to a new collective agreement with the province's physicians in late 2008, cabinet ministers realized in the first half of 2009 that the recession would reduce government revenue so severely that they claimed they couldn't honour the agreement. Then-Health Minister Mike Murphy passed legislation that effectively canceled the collective agreement and imposed a two-year freeze in doctors' pay. Physicians threatened to take the government to court and, just as the court date approached, the government relented and the two sides came to a compromise that includes four years of 3.75% raises retroactively into 2008, followed by a two-year freeze from 2012 to 2014. With the recession now technically over but government budgets in no better shape going into 2010 than they were a year ago, the New Brunswick conflagration may prove to be just the first of several conflicts to come across Canada between governments and physicians.
   
   
3. The radioisotope shortage. The Chalk River nuclear plant, responsible for producing about half of the world's supply of the technetium-99 isotope used in many diagnostic imaging exams, was shut down in May for the third time in 18 months over safety concerns after leaks were discovered and it was determined radioactive water was escaping into the Ottawa River. When the plant was shut down in 2007 for similar safety reasons, the government, worried about a world shortage of the isotope, held emergency sessions in the House of Commons and, concerned about the issued an order overriding the nation's nuclear regulatory body's decision to shut the plant down. But by 2009, the safety problems had become so serious that the plant's operators had no choice but to shut down the plant, halting Canada's production of technetium-99. Canada has no backup plan and no other nuclear reactors ready to begin production of the isotope anytime soon, since the construction of two MAPLE reactors was scrapped in 2008 after years of delays and difficulties. Foreign plants supplied Canada and the U.S. as best they could, but the shortage became so severe at times that physicians were threatening to postpone patients' tests. In the summer, Chalk River was said to be ready to come back into service in late 2009. Late 2009 came and went. The latest estimate is that the reactor will come back on-line . We'll believe it when we see it. In the meantime, as nuclear medicine specialists raise alarms about their technetium-99 supply problems, Canada appears to still have no long-term plan to deal with the radioisotope shortage.
   
   
4. The CMA elects Turnbull president. The Canadian Medical Association, which spent the previous two years under the presidencies of privatization advocates Drs Brian Day and Robert Ouellet, elected as its 2010-11 president the so-called left-wing candidate Dr Jeffrey Turnbull, an Ottawa physician with experience caring for the homeless, the addicted and patients living in poverty in Africa. Dr Turnbull has so far tried to play down his political views, just as Drs Day and Ouellet tried not to draw attention to theirs during their time in office, but many physicians privately believe that his election may mark a real departure from the CMA's recent politics. (Canadian Medicine spoke to Dr Turnbull a couple of hours after he was officially confirmed as president-elect. Read the interview transcript here.)
   
   
5. Alberta's deregionalization plan courts controversy. In 2008, the Alberta government decided to scrap the regional health authority model for healthcare administration used most everywhere across Canada, and reverted to a centralized system in which a government-appointed "superboard" of directors supervises healthcare administration across the entire province. (You can read my June 2008 article in the National Review of Medicine on that decision .) The new set-up was supposed to cut costs and standardize good practices across Alberta, but in 2009 it was found that wait times had actually lengthened for emergency care, surgeries and longterm care placements. In December, government officials quietly admitted that the health system might exceed its 2009-10 budget by over $1 billion. New Brunswick also moved to a deregionalized model in 2009, cutting its eight regions down to just two. There, too, the government quickly ran into difficulties. French-speaking Acadians have against New Brunswick claiming the reform took away their control of healthcare in their communities. At one time, not long ago, deregionalization was a popular concept in some health-policy circles, even if not everybody agreed on all the details. The events of 2009 may make some of the reformists think twice.
   
   
6. Ontario health minister resigns over eHealth spending scandal. In early October, David Caplan (right) was forced out after months of revelations demonstrated all sorts of inappropriate procurement and spending practices by the government's eHealth agency. Many if not most of the issues began when George Smitherman was minister, but he managed to get out of the tough health portfolio before the scandal came to light and now has a bright political future ahead of him as the likely next mayor of Toronto. Mr Caplan was replaced by Children and Youth Services Minister Deb Matthews.
   
   
7. Newfoundland breast-cancer pathology inquiry takes down health minister. Four months after the Cameron Inquiry released its findings into the reasons why more than a thousand women in Newfoundland and Labrador may have had faulty breast-cancer hormone test results -- "The whole of the health system, to varying degrees, can be said to have failed the... patients," Justice Margaret Cameron said -- and a cover-up attempt was exposed, Health Minister Ross Wiseman was swapped to the business portfolio. Business Minister Paul Oram took over. The Newfoundland pathology problems were just the tip of the iceberg in terms of Canadian pathology errors, however. Nearly half the provinces have encountered major pathology problems in the last two years, as in early 2008.
   
   
8. Brian Day sues BC over private-care ban. Former Canadian Medical Association president Dr Brian Day filed a bold lawsuit against the government of British Columbia, claiming the province's Medicare Protection Act violates the Charter of Rights and Freedoms by forbidding patients from seeking medical care in the private sector. The lawsuit may turn out to be the first heard in court of all the lawsuits being prepared across Canada that will attempt to extend the Supreme Court of Canada's logic in the seminal 2005 Chaoulli case beyond Quebec. (The Chaoulli case pitted a physician against the province of Quebec; Dr Jacques Chaoulli came out victorious, and whole sections of Quebec's medical insurance laws were declared void, opening an opportunity for private medical insurance for medically necessary care.)
   
   
9. Americans idolize and demonize Canadian healthcare. It's like the 90s all over again. Canada's "socialized" healthcare system: good or evil? That became a major point of contention in the United States this year as Barack Obama's Democratic Party continues to try to pass legislation to overhaul (or at least reform, or maybe just tweak...) the country's health-insurance industry and finally provide universal health insurance. As of this writing, however, the bill is still held up in the Senate. And, as of this writing, Canada's system has not been represented accurately even once in the United States.
   
   
10. Medicine goes green. As 2009 closes with the Copenhagen conference on climate change and greenhouse-gas emissions raging on across the Atlantic, it's become clear that environmentalism has become an increasingly important concern in the medical community. Doctors are, more and more often, trying to make their practices more environmentally friendly, and, more importantly perhaps, they are being more vocal in public on the connection between climate change and health. One sign of the growth of the movement occurred early in the year when the preeminent doctors' environmentalist lobby group, the Canadian Association of Physicians for the Environment (CAPE), announced it , up from just 400 a year and a half prior. Gideon Forman, CAPE's executive director, updated Canadian Medicine earlier this month: "Our growth has levelled off somewhat (perhaps because of the recession) but we've still grown about 10% since your article and are now up at 4,400 members." This year also saw the launch of MediClim.com, a new website created by a Toronto physician to track the health effects of weather conditions, and a major protest over uranium exploration in Quebec that saw over 20 physicians from a small town threaten to quit their jobs.
    

Honorable mention
This year marked the explosion in popularity of the smartphone -- the predecessor to the age of truly portable computing. Smartphones, especially the iPhone and the BlackBerry, have rapidly gained popularity among doctors and residents who use them to access information in the exam room or on the run. The next step is Apple's highly anticipated Tablet computer -- a sort of cross between a laptop and an iPhone -- which is due in 2010 and which we are willing to wager will be convenient and powerful that it will cement the role that portable computing will have in medical practice in the future.

Informant feels betrayed over terms of CMA’s $500k offer

For two years, at the FBI’s behest and with a promise of more than $1 million in reward money, an American man infiltrated the secretive anti-abortion terrorist network that backed the elusive sniper James Kopp -- the man who murdered an American physician and allegedly shot three Canadian doctors who performed abortions.

In 2001, the informant, who now lives under the assumed name Jack Steele, discovered where Mr. Kopp was hiding out in France. Mr. Kopp was arrested, brought back to the United States, found guilty of murdering Buffalo obstetrician Barnett Slepian, and sentenced to life in prison with no chance of parole.

The FBI eventually passed along its share of the reward: US$700,000. To this day, however, now nearly seven years since Mr. Kopp’s conviction, the US$547,000 Canadian portion of the reward -- up to $500,000 of which would have come from the Canadian Medical Association -- has never been paid.

When Mr. Steele was approached by the FBI in 1999, he says they promised him $1.2 to $1.3 million for his help -- the total of the American and Canadian rewards -- but they didn’t mention that the CMA had set conditions on its reward.

“There were some limited conditions on the reward -- namely, that the information had to lead to a conviction in the cases concerning the specified doctors [the three Canadians: Garson Romalis, Hugh Short, Jack Fainman] and any arrests in these cases had to have been made by June 1, 2003,” the CMA said in a statement. “None of these conditions were met.”

After Mr. Kopp was put away for life, Canadian authorities reportedly had enough evidence to be satisfied that the danger to abortion providers was gone. BC and Manitoba never filed charges, and Ontario dropped its charges last May. Canadian officials never sought to extradite or try Mr. Kopp in Canada. Mr. Steele feels they “deceived” him.

The Canadian task force is “conveniently using Kopp’s U.S. murder conviction to avoid paying a half-million-dollar reward,” accuses Jim Popkin, a retired NBC News investigative reporter who’s supporting Mr. Steele. “Now that Kopp is off the streets, and Canadian doctors are safe, the task force’s work magically is done. But the tipster who saved the day has been forgotten, victim to a legal technicality.”

“I did the physical footwork of over two years to catch him,” Mr. Steele says. He wore a wire, participated in vandalizing U.S. abortion clinics with criminals, and managed to track down the man widely accepted to have been responsible for shooting three Canadian physicians in their homes. He says the FBI told him that would be sufficient to claim the CMA’s reward. He only learned after the fact that it was not.

Image: FBI

Protect your patients by letting the pros protect your computers

On the morning of August 14, a 20-foot-long piece of concrete fell from the third floor of a suburban Toronto office building where several large group practices are located and smashed into the ground below, luckily not injuring anyone. City inspectors, concerned about other pieces falling as well, immediately evacuated and cordoned off the entire building.

You might think this would spell disaster to the building’s two Family Health Teams and to the one preparing to move in in eight days. Without their records and computers and phones, how would they care for their patients? How would they even let patients know the building was closed? How would they refer patients appropriately until the building reopened?

Thanks to a cleverly planned, remotely hosted computer system, none of those problems turned out to be insurmountable, says Dr. Michelle Greiver, a family physician and researcher who was among the doctors who had to scramble to adapt when they learned their relocation plans might have to be put on hold.

Read the rest of this article in the latest issue of Parkhurst Exchange or .