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Doctors frustrated with VCHA priorities

Decision to concentrate facilities in Squamish ignores numbers at north end of corridor

The Vancouver Coastal Health Authority is planning for 2020, but according to a group of concerned doctors the conclusions reached by the steering committee don’t reflect the growing need for emergency diagnostic services and sports medicine in Whistler and north Sea to Sky corridor.

"The Vancouver Coastal Health Authority wants to have the status quo for Whistler and Pemberton, and they want to expand services in Squamish – that’s what it boils down to," said Dr. Adam Kendall, an emergency room doctor at the Whistler Health Care Centre and member of the 2010 Whistler Medical Staff Committee.

What that means is there are no plans by the VCHA to significantly improve the level of medical services offered in Whistler.

The original recommendations from the VCHA, the Health Service Plan for Acute Services Sea to Sky Corridor, were questioned by several doctors at a presentation at the end of June, and in a letter from Dr. Bruce Mohr. Dr. Mohr was the Medical Director for the Whistler Health Care Centre, but recently stepped down from that position.

In response, the VCHA amended its original recommendations slightly to allow for some improvements in Whistler and Pemberton, but Kendall and other doctors believe they still fall short of what’s needed.

"It’s not like we’re asking for a new hospital here in Whistler, but the medical community ultimately wanted to see enhanced diagnostic services in Whistler," said Kendall.

But if the VCHA, which administers health care facilities throughout the Lower Mainland and the Sunshine Coast, decides that the Squamish General Hospital is inadequate to house expanded services, Kendall would like to see that hospital built in Whistler. "It just makes more sense to do it in Whistler (rather) than Squamish," he added.

The VCHA planners do recognize the fact that the largest growth in population and visitor numbers will happen in the north part of the corridor, as well as the fact that Whistler’s emergency room visits are more than Pemberton and Squamish combined. By 2009-2010, VCHA is projecting more than 26,800 emergency room visits per year in Whistler, compared to 17,050 for Squamish and 6,750 for Pemberton. They also project that the Whistler Health Care Centre (WHCC) will perform about 21,000 X-Ray exams, compared to 10,200 in Squamish and 2,500 in Pemberton.

Still, the VCHA consultants recommended expanding inpatient and day surgery capacity at Squamish General Hospital, as well as an ambulatory care program, improved emergency room capacity, expanded radiology (such as mammography and CT scan), and more beds.

For Pemberton, minor renovations are recommended to increase the lab, improve patient flow and address infection control issues. For Whistler, the short-term recommendations include creating a space for a CT scan, and in the long-term creating more emergency room capacity.

Kendall points out that all of the services proposed for Squamish are already offered at Lions Gate Hospital, just 45 minutes down the highway, and that the Squamish hospital is already underutilized – several years ago, there was even a possibility that the SGH was going to be closed.

"That doesn’t help anyone in the north corridor, and that’s where the majority of growth is going to be," said Kendall.

According to VCHA spokesperson Viviana Zanocco, the organization is constantly re-evaluating how to spend its limited capital budget, and is committed to ensuring that higher priority upgrades happen first.

The WHCC had an expansion just two years ago, she added, and will likely receive money for future expansions. In the short-term the VCHA money was needed to double the size of Lions Gate Hospital’s emergency room facilities, to upgrade the hospital in Sechelt, and improve the functionality of the Squamish hospital. The budget for that upgrade is just $400,000 and will focus on making the emergency area more prominent, improving the flow of patients through the hospital, and adding one observation bed. More funding will be needed before that upgrade can begin.

On a long-term basis, the VCHA is waiting to see what comes out of planning for the Olympics.

"They will need a better facility up there, and infrastructure for the Games," said Zanocco. "The federal, provincial and local governments will be working on that, including ourselves, and we expect the Olympic Committee to pay for some upgrades. Hopefully we would be able to contribute something as well, like add some money to make any temporary (health care) facilities from the Games more permanent."

But Kendall says VCHA is basing its decisions on demographics and population numbers, and by doing so it is missing the fact that the WHCC is one of the busiest hospitals in B.C. when it comes to treating trauma. In fact, WHCC is second only to New Westminster’s Royal Columbian Hospital. Dr. Les Vertesi, who authored a study on the WHCC, said: "In other words, compared to the Royal Columbian Hospital, one of the busiest trauma centres in the province, during its busy season the WHCC handles a similar level of acuity of trauma load in approximately half the numbers. The load must be handled with no consultant backup, no inpatient resources, and with only basic X-ray imaging capability."

Because of the nature of tourism and recreation in Whistler, the WHCC handles a steady stream of injuries – sometimes as many as 150 patients in a day during the winter months. The most serious trauma cases are sent by ambulance and helicopter to Lions Gate and Vancouver General, while the WHCC treats everything else.

"There’s a lot demographics don’t take into account, and that’s the very high acuity level here," said Kendall. "There are very young people, but they’re smashing themselves up quite significantly. And we’re having to deal with that in large numbers, and with less emergency resources than a big city hospital has."

One priority identified by local doctors and acknowledged by the VCHA is the need for a CT-scan in Whistler to provide diagnosis for head injuries. However, nobody can give the local medical community a timeframe for acquiring the equipment.

Rather than wait, Kendall and other doctors believe the only solution for Whistler – if the VCHA is committed to the course of action it has laid out – is to create a public-private diagnostic facility in Whistler, with a CT-scan, ultrasound and MRI, as well as sports medicine centre with a surgical facility. The facility would be limited to treating extremity injuries, such as torn ligaments and broken bones, which are common in Whistler, and would also include occupational therapy, kinesiology and physiotherapy components.

According to Kendall, most local doctors back the idea of expanding diagnostic and treatment capabilities at the Whistler Health Care Centre, although there is less agreement over the creation of a public/private partnership.

"I can’t speak for all doctors… but when the (2010 Whistler Medical Staff Committee) put a report together in 2004, we had a vision for Whistler being a centre of excellence for sports medicine and for trauma care. Because we do see so much stuff here," he said.

"We’re not saying the current level of care is substandard by any means, but we should be providing state-of-the-art diagnostic services for patients and right now we can’t provide that diagnostic component for them."

Several businesses are interested in pursuing a public-private partnership to build that centre in Whistler. Not only would the facility treat residents, which Kendall says will be a priority, but it will also serve tourists. If they get injured on their vacation they won’t have to go to Vancouver or cut their trips short to get treatment for certain injuries, including surgery to mend torn ligaments.

Having the centre in Whistler will keep seniors in the community, prevent unnecessary referrals to Vancouver hospitals for diagnosis, and will open the possibility of medical tourism to Whistler. People could come to Whistler to have surgeries covered, which will benefit the local economy and health care centre.

Rather than wait for the VCHA to make a decision on capital spending – a new tower in Richmond and expanded hospital in Sechelt are on the top of the list – Kendall and the 2010 Whistler Medical Staff Committee are hoping to work with the municipality to get support for a public-private project they hope will be a legacy of hosting the 2010 Games.

In addition, Kendall hopes someone from the staff committee will be part of whatever committee ultimately decides what is to be done with Lot 1/Lot 9. The area, which is adjacent to the WHCC, was slated to house the 2010 Paralympic Arena but that facility may go to Squamish.