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Head Games

Community brings its A-Game to goal of securing a CT scan for Whistler Health Care Centre
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Stu Armstrong's horse is bolting riderless across a field in Pemberton.

Spooked by a bear, she gallops the entire 1.5 kilometres back to the barn, where other riders, recognizing her, go looking for Armstrong.

They find him, feeling as if he's been crash-tackled by three football players. When Sassy Jones started to bolt, his foot slipped from the stirrups. He slid out of the saddle's sweet spot. His mare, a quarterhorse, is built for short bursts of speed. She can hit 30 km/h in three strides. "I realized I'd lost control. I had to make a decision, then and there," he says. Stu decided to let go.

He hit the ground hard enough to leave a crater-hole, bounced, left another divet and decimated a thorn bush with the impact.

Someone gave him a ride back to the barn so he could check on his horse, "a willful stubborn mare" that he spoils guiltlessly and claims he "would never have picked out of a crowd." She marks him, unusually, with her nose, tapping out a pattern across his abdomen, five times. He drives himself to the Pemberton Health Centre, where the emergency doctors immediately put him in a neck brace, on a spinal board, and transport him to Lions Gate for a CT scan.

A CT scan is a computed tomography machine that can generate three-dimensional images inside the body non-invasively through ionizing radiation. It scans soft tissue and bone and can quickly detect fractures, clots, tumours, and bleeds.

Armstrong's accident takes place Sept. 11, 2009. Whistler's brand new CT scan is not scheduled to open until Oct. 23. So, at 4:15 p.m., Stu Armstrong is driven to Lions Gate by ambulance, where he lies in a busy emergency room corridor alone and immobilized in a cervical collar on a rigid backboard, for six hours, before finally being checked in to scan.

His head and neck are given the all-clear. But the CT image reveals something else, a carcenoid tumour in his stomach. "We found this funny looking growth in your lower intestine," he is told at 10:30 p.m., "and it needs to come out pretty quick." Armstrong is booked for surgery, Oct. 22. And then he's left to make his way home, wondering if his horse just saved his life.

 

How can we help?

On Friday, Oct. 23, while Armstrong lies in recovery in Vancouver, the ribbon-cutting ceremony for Whistler's new $2.3 million CT scanner and facility will take place. Although the celebration is bound to be life-affirming, the equipment it hails is not actually likely to be life-saving.

"People have this idea that the CT scan will save lives," says Dr. Annie Gareau, an emergency physician at the Whistler Health Care Centre, who helped build the case to locate the machine in Whistler. "The major trauma, coming off the mountain by helicopter, is going to be diverted immediately to the city. They need to go to the city. They need a hospital. We cannot operate on them. It doesn't change anything in those cases. They wouldn't stop here to have imaging done, because that will just delay their care."

In other words, a CT scan in Whistler wouldn't have helped Dave Sheets.

A local pro skier and fishing guide, 31-year-old Sheets collided with another skier on Blackcomb in 2003. "They were probably the only two guys on the mountain that day that could take each other out," says his friend Chris Quinlan. "The other guy was a football player."

That evening, as friends gathered to support one another and hope Sheets would pull through, a hat was passed around. A few days later, at his memorial, the hat went around again. "This community is amazing like that," says Quinlan, who represented the Dave Sheets Memorial Foundation for four years on the board of the Whistler Health Care Foundation. "If there's a tragedy, the first thing people do is ask, how can we help? What can we do?"

When it became apparent that there was no special tool or diagnostic equipment that would have helped Sheets, his friends still rallied around the legacy fund, hosting annual Three Sheets to the Wind events, raising more than $20,000 for the foundation. "That's the kind of action that happens with a bunch of double A and triple A type personalities," says Quinlan.

 

Improving the system

Double and triple A personalities rally because they tend to play hard themselves.

The Whistler Health Care Centre treats over 23,000 outpatients a year for medical emergencies - an equivalent volume to a medium-sized hospital like the Kootenay Boundary Regional Hospital  in Trail, B.C.

The Whistler clinic is a diagnostic and treatment (D&T) facility, one of a few in the province, and functions as a 15 bed emergency department complete with lab, diagnostic X-ray and ultrasound, nursing and reception, and helipad. It's not a hospital. It is not open 24/7. There are no specialists available except for elective consultation. It has no surgical capability and no admission beds.

But it's not just the volume of patients moving through the clinic that sets the Whistler Health Care Centre apart. It's the trauma acuity. Dr. Gareau, who was previously trauma director at VGH, says, "The trauma acuity is comparable to Royal Columbia Hospital, a major urban hospital in New Westminster. So to us physicians, it made sense that we should have a CT scan here."

Gareau explains that local physicians, in family practice and at the emergency clinic, saw on average 60 cases a month in which a CT scan would have helped their practice of medicine.

She reams off commonplace scenarios in which the tool would be deployed - the classic winter head injury, where a young snowboarder from Ontario, a new seasonal resident, smacks his head in the park and comes into the clinic, groggy and dazed.

An on-site CT scan would enable a Whistler-based physician to make sure that the kid is not part of the "Natasha Richardson" percentage, suffering from an undiagnosed brain bleed that will later prove fatal.

Without the Whistler-based CT scan, the physician's choices are twofold: send the snowboarder home, most likely to a housing situation where his roommates can't be counted on to monitor him responsibly, or send him to Vancouver for a CT scan.

He's not a high-priority patient, so if they send him for a scan, he'll wait an hour or more for an ambulance, make the two hour ambulance trip, sit in emergency for hours, finally get his five-minute scan and receive the "all-clear" diagnosis.

There is no ambulance service to bring him back to Whistler. By this stage, as it was for Stu Armstrong, it's likely after 10 p.m. He doesn't have a support network in town yet. He still has a headache, concussion, nausea, and he has been discharged in the city because there's nothing wrong with him. He starts hitching back to Whistler because he's missed the last bus and he can't afford the cab-fare.

"Those are the ones we're going to help," Gareau says. The concussion that might be hiding an intra-cranial bleed. The possible neck fracture that requires up to six hours in a neck collar and spinal board to eliminate definitively as a diagnosis. The 10 days in a wrist-cast as a precautionary measure, because fractures to the scaphoid bone, almost impossible to see on an X-ray, are easier to diagnose 10 days later. The cautions from a doctor that can pretty much end a vacation: "you might have a fracture and you can't risk it."

Gareau's colleage, Dr. Fern Von der Porten, authored a research paper in 2007 that showed a substantial number of head injuries treated at the clinic, according to the Canadian CT Head Guidelines, should have had CT scans. And they did not.

Gareau clarifies, "Those guidelines were designed for facilities that have a CT scan. But it was still frightening that in so many cases we were not going to the standard of care that a hospital or D&T centre with a CT scan would provide.

"People have this idea that the CT scan will save lives," she reiterates. "But the more common scenario is these people - we will keep them in the community, we will save them the transport down." And that will keep the emergency transport available for the major trauma, when it happens.

 

Sechelt set precedent

Whistler's experienced emergency physicians built the case for the CT scan, and even though more than half of clinic attendees are from out of province and thus potentially generate revenue for Vancouver Coastal Health (VCH) from other insurers and HBOs, there was still no money in the provincial coffers.

Whistler Mayor Ken Melamed sits on the Sea to Sky Regional Health District board, a subcommittee of the SLRD, which ultimately funded $1.3 million towards the CT scan from the regional tax base. (Typically, the regional health district board will contribute 40 per cent of capital costs for this kind of project, matched by 60 per cent provincial funding through VCH.)

Melamed says, "Vancouver Coastal Health simply said, we've got no money in the budget. They have a process for capital expenditure and there's a long list of capital upgrades throughout the region." A CT scan for Whistler was not on that list.

Vancouver Coastal Health is the provincial agency responsible for providing health care and services to the 1 million residents of greater Vancouver, Sea to Sky, the Sunshine Coast and the Central Coast.

What VCH did have was a precedent on the Sunshine Coast, in which the Sechelt community and health care foundation had fundraised the entire costs for a CT scan. Says Melamed, "So that model was offered to the regional health district and the decision was made to try and pursue that option."

The community would have to raise the entire sum - for the machine and the construction of an extension to the clinic, and VCH would allocate budget for the operating costs from April 2009 at $200,000 a year.

 

The first campaign

In 2006, the Whistler Health Care Foundation officially geared up for the CT campaign.

They'd already been lobbying behind the scenes for several years to get to "go" status, and had funded teleradiology throughout the corridor, enabling the transmission of X-ray, CT and MRI imagery to be transmitted electronically for consultation and interpretation.

Their goal, based on initial costs provided by VCH, was to raise $1,270,000 by April 2007.

Explains Melamed, "VCH went to their quantity surveying process, gave us cost estimates and were very clear that we needed to fundraise 100 per cent of the costs. They wouldn't take the risk of going ahead with just part of the money raised. So after they gave us the price estimates, we raised the money."

The Whistler Blackcomb Foundation launched the campaign with a gift of $275,000.

Recalls Garry Watson, who served on the Whistler Health Care Foundation Board, "That was the kick off. It was a great show of good faith and a confidence builder, and then it started to fall into place. One couple walked in and said, we'll give $25,000, just don't use our names. Someone else gave $50,000. Someone else gave $40,000."

The Whistler Health Care Foundation pledged almost $100,000 in monies they had been quietly squirreling away in preparation for the campaign. The Squamish and Pemberton Health Care Foundations pledged $95,000 and $29,000 respectively.

The regional health district committed to its 40 per cent share of the project cost - $509,000.

A majority of Whistler's physicians donated between $500 and $1,000 each, as a show of support for the project. Debbie and Hugh Smythe and David Greenfield and Anne Parent made substantial contributions.

Barb Mathews donated $40,000 in memory of her father, Dave Mathews.

The Houssian Family Foundation gave $50,000. Kary and Geordie Trusler, the Royal Bank, the Ken Downey Foundation, Dean Alexander, Andy Szocs, the American Friends of Whistler and several anonymous contributors made donations of more than $10,000.

Community groups including the Whistler Firefighters, Winterpride, WORCA, Senior Men's and Women's Hockey, Whistler Rotary, local coffeehouses and other informal groups found their own ways to contribute to the campaign.

The Whistler Health Care Foundation's "dream team," led by Sue Adams, produced two Indulge fundraising Galas at the Westin, at which the community raised $125,000.

Garry Watson says he was bowled over by the response. "I'm not a fundraiser. I find it hard to go out and fundraise." Nevertheless, as the campaign got close to its deadline, Watson placed a call to David McLean, the chairman of CN Rail. "He's had a place here from year one. We chatted about old times, and he said: Leave it with me and I'll see what I can do."

Three days later, Watson came home and his partner, Anne Popma said, "There's a message for you from David McLean."

Oh good, thought Watson.

"He said he thinks he can do $100,000."

"I said, 'Now, don't you joke with me, Annie,'" recalls Watson. "That was a real capper."

And across the finish line they landed, with a $50,000 donation from Whistler resident Jim Duncan, a former investment banker who has been coming to Whistler since 1968.

It might have been the most spectacular speed fundraising success ever.

 

Re-financing

And then, the goal-posts were moved.

Says Ken Melamed, "The construction climate was in a period of escalation. We raised the money, then it went out to tender and the costs were higher. We had to reopen the campaign. The donors were losing their faith and confidence in the project."

The campaign was short almost a million dollars.

Trudi Beutel, Public Affairs Officer for Vancouver Coastal Health explains, "The project costs went up when we received the new unit."

On July 18 2008, Olympic sponsor GE announced they would donate a state of the art 64-slice CT scan, the Lightspeed VCT, to the Whistler Health Care Centre in advance of the Games, and it would remain in the community after the event.

The gifted scanner, a "Cadillac" compared to the second-hand eight-slice machine the campaign was initially built around, was air-cooled, not water-cooled and required additional mechanical services, twice the usual number of piles and a substantial structural slab to ensure there would no vibration in the room impacting the machine.

Says Melamed, "One of the extraordinary facts about this story is that the Olympics did provide the opportunity to do this. The original CT scan cost only $500,000. But it also goes back to the frustration of nailing down the costs. The construction estimates just kept going up and ate into the potential savings of getting the scanner for free."

Jim Duncan was frustrated. "I almost didn't stick with it. I have been very frustrated with the costs of these projects here in Whistler. I gave the money because I thought Whistler needed a CT scanner. But it was hard to continue when the costs spiraled out of control. I stuck with it, but I nearly didn't."

Marnie Simon, who had chaired the campaign for the Health Care Foundation is, by her own admission, "a bit of a bulldog." Did she think about giving up? "Maybe. For a minute. But then I got so angry. Too much work had been done. Too many people had helped. And I still had the passion, even if it was in the form of anger. You just have to be tenacious with things like this."

So she sank her teeth in.

Recalls Chris Quinlan, "Marnie Simon was awesome. She fought all the way. The designers and initial project managers were so far off-base and she just fought them. I wouldn't want to cross her."

Simon and Watson and the board of the Health Care Foundation went back to the Sea to Sky Regional Health District and asked them to re-open their contribution.

Says Melamed, "They came up with a creative analysis on the funding role of the regional health district, and convinced us it was a worthwhile investment to increase our share. The regional health district can amortize that funding over such a large tax base, so it was not felt to be too significant. We were so far down the road, there was so much agreement on the need for this diagnostic tool, and it was just a matter of understanding the impacts on the tax base."

The administrator at the Regional District, Paul Edgington, crunched the numbers and the Sea to Sky Regional Health District board voted to increase their initial $509,000 contribution by another $700,000, to keep the project on the rails.

"We finally convinced VCH," says Melamed, "that we had done as much as we could on our side, and they would have to take it on."

 

For the whole corridor

In total, $2,297,601 was raised for the Whistler Health Care Centre's new CT scan, with over $1 million coming in private donations through Whistler Health Care Foundation, the Squamish Health Care Foundation and the Pemberton Health Care Foundation, and the remaining cash being provided by the regional health district from community taxpayers.

For Marnie Simon, a retired surgical nurse and health administrator who has been hailed as the driving force behind the CT scan campaign, Oct. 23 has been a long time coming.  "It was a rocky road. But it is critical equipment. And now we have it. This is not for the Whistler Health Care Centre. It's for the whole corridor. And it's a huge accomplishment for our community."

And though the ribbon-cutting will be a relief, with "the battles over, except for who gets the accolades at the end," Simon hopes to really celebrate the community's success at the Whistler Health Care Foundation's final Indulge fundraiser at the Westin Hotel and Spa on Nov. 28 2009.

"That fundraiser is our real opportunity to finally celebrate the operation of the CT scanner and to honour the donors who stuck with the cause," she says. "The money was raised incredibly quickly, but it just sat there for three years. So it's our chance to say thank you to them for seeing us through."

 

Dave's work is done

Chris Quinlan was meant to be on a surfing trip this week, but he cancelled so he could attend the ribbon-cutting. He says there haven't been any fundraisers for the Dave Sheets Memorial Foundation lately. The CT campaign was a success. More than $20,000 was raised in Dave Sheets' name. "It's pretty much an accomplished goal. We still get together on the anniversary of his death and go for a ski and have a shot in his honour. But I think Dave's work is done."

At the Indulge helm, Sue Adams isn't quite ready to close the book. "With this major project finished, the Whistler Health Care Foundation is getting ready to reposition. We want to launch them on their way, with this final Indulge Gala, and leave the foundation well-prepared to embark on their new vision." The foundation's next funding mission is to outfit the clinic and ambulances with monitoring equipment for critically ill patients.

The need for the Whistler Health Care Foundation is as strong as ever. The Vancouver Coastal Health region has a $15 million budget deficit, the Whistler Health Care Clinic will see another 23,000 outpatients pass through its doors this year, and even the new CT scan will operate in a cost-contained environment.

So, the corridor's health care champions can't hang up their superhero capes yet. Still, they're more than entitled to enjoy a toast to the moment. A glass of champagne. And maybe, a celebratory doughnut.

 

 

The ribbon-cutting for the new CT scan will take place on the second floor of the Whistler Health Care Centre in the multi-purpose room at 11 a.m., Friday, Oct. 23. At the point this story was filed, Vancouver Coastal Health was still deciding who would cut the ribbon and Ministry of Health was deciding to whom the naming rights for the extension would go.

 

 



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