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Corridor partners rally for orthopedic care

VCH to decide by April 30 if retiring knee surgeon will be replaced
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out on a limb Dr. Bruce Mohr, chief of medical staff at the Whistler Health Care Centre, is among those making a case for enhanced orthopedic care in the corridor. Photo by Alison Taylor

The Sea to Sky corridor needs another Dr. Pat McConkey, mending the worn-out and weary knees of many a skier and snowboarder.

That's the message from a chorus of community voices, from Whistler's mayor to the president and chief operating officer of Whistler Blackcomb and many doctors and physiotherapists in between. They are appealing to the region's health authority on the eve of the renowned knee doctor's retirement.

There appear to be no plans to replace the local knee surgeon, operating out of the Squamish General Hospital, leaving the corridor's orthopedic work to Dr. Alexandra Brooks-Hill.

But just one orthopedic surgeon servicing the corridor could mean longer wait times for residents and guests and a patchy continuity of care in orthopedics, as city surgeons rotate in to help cover the care. It could also squash the dreams of some in the medical community of seeing the corridor become a centre of rural excellence in orthopedics

"We're in danger of actually stepping backwards," said Dr. Bruce Mohr, chief of the medical staff at the Whistler Health Care Centre, which saw almost 8,200 orthopedic injuries last year — 43 per cent of all emergency room visits.

Backwards isn't an option for community partners.

Even if it costs more.

Vancouver Coastal Health (VCH) benefits financially from the Whistler Health Care Centre to the tune of more than $1 million annually.

That's a fact not lost on Whistler's mayor.

"Vancouver Coastal Health don't like to spend money in the corridor, they currently get paid quite a bit of money (from the corridor) especially the (clinic) which is a bit of a cash cow for them," said Nancy Wilhelm-Morden at an emergency meeting of the Sea to Sky Regional Hospital District (SSRHD) on Monday called to address this issue of succession planning in orthopedics.

After writing a letter to VCH earlier this month, specifically addressing Dr. McConkey's retirement, among other things, Wilhelm-Morden met with the top brass at VCH including the health authority's CEO and the director for this region to express her concerns in person.

"Of course, as a personal injury lawyer I see the issue first hand because many of my clients are on a waitlist for orthopedic surgery of one type or another, and I think to a person, each of my clients would say they'd much rather have that kind of orthopedic surgery conducted out of Squamish General Hospital by a doctor who will not only be conducting the surgery, but following up with them," said the mayor. "So there's a whole consistency of care, there's the provision of local services. It is very much a quality of life issue."

Squamish councillor Patricia Heintzman convened the hospital district emergency meeting Monday.

"I wanted to make sure we talked about it and perhaps put a resolution forward expressing our concern and our desire to maintain the standard as it is currently," Heintzman said.

"It's an essentially important service in that patients don't need to travel to the city for care and surgeries and consultations."

The motion, which passed unanimously, called for maintaining two orthopedic surgeons in the Sea to Sky corridor. That resolution will be part of the united response leading into Friday's VCH/Sea to Sky Local Governance Liaison Group's meeting at the hospital in Squamish.

The Sea to Sky medical community argues that more than 94 per cent of orthopedic injuries could be managed at the Squamish General Hospital.

During a six-week period in 2008 for example, 200 patients travelled out of the corridor for surgeries that could have been reasonably managed locally. More than a quarter of the patients, 62, were Sea to Sky residents.

With the high volume of bone, joint and muscle related injuries coming out of Whistler alone, VCH could designate the Squamish hospital as a regional centre of sport and extremity trauma surgery.

But it will cost.

Replacing Dr. McConkey alone will cost between $100,000 to $150,000. McConkey uses a less expensive method to perform knee ligament reconstructions; any replacement of his will use a more expensive technique.

VCH's decision is expected by April 30.

In an emailed statement this week, VCH public affairs officer Trudi Beutel said:

"We hope to have a model of care developed for the delivery of orthopedic services along the Sea to Sky corridor later this spring...

"Among other things, the model will aim to maximize existing operating room capacity, resource and manpower at both Squamish General Hospital and Lions Gate Hospital. It will also provide a solution that recognizes the opportunities/limitations present at the existing hospital sites in order to provide higher levels of care."

Whistler's Dr. Mohr is not optimistic.

"We're not too encouraged with what they're going to come back with," he said.

"We are concerned that April 30 we're not going to see a replacement plan."

Whistler Blackcomb has also waded into the fray. This is the first time in president and COO Dave Brownlie's memory that the company has written to the health authority about an issue — a sign of the level of concern community-wide.

"We're an active, healthy outdoor community, both in our recreational activity, and also in a lot of the world that people are involved in around here," said Brownlie. "So having access to the diagnostic side and then ultimately the surgery side is just so critical in getting people back up and out both at work and in play in the corridor.

"We all know the challenges out there and certainly increased budgets are a problem, but the service levels should not be going backwards. I think as a corridor we provide a significant contribution to health care through the tax base we have here so I think it's important to at least maintain what we currently have."

Dr. Mohr is also rallying to have a full-time orthopedic technician at the Whistler centre to assist with casting, splinting and equipment fitting.

Not only will it improve patient flow during peak hours, he said, the technician can also improve the quality of care and efficiency. Ultimately this position could transition into supporting an expanded orthopedic focus within the corridor and be a link to setting up a program in Squamish.

The position could be funded by sales of orthopedic equipment and through a follow up clinic at the health centre where out of country patients would be charged a fee. Patients now see a family doctor for follow up.

The ultimate goal, according to the Sea to Sky Senior Management Team, is to see the "provision of orthopedic services become a centre of rural excellence that will likely include a strong research component."

Mohr said they haven't done a lot of grumbling and complaining in the past. The Whistler centre is a goldmine of sorts — 22.2 per cent of its budget is funded by out of country patients. Compare that to seven per cent at Squamish and just four per cent at Lions Gate. And yet it is still just a clinic, not even open 24 hours a day.

"It's a five-star destination resort and they're largely getting by without having a hospital here, without having surgery here," said Mohr.

"They can't view it as another small town in B.C."

— with files from Cathryn Atkinson