Category "Staff blog: Medicine Matters"


Former Nfld. premier Brian Peckford wages a new political — and personal — battle in B.C.

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Brian Peckford, the former premier of Newfoundland and Labrador, now lives on Vancouver Island.


He was premier of Newfoundland from 1979 to 1989. Now, as a B.C. resident, Brian Peckford is still game for a political fight. Today he’s taking on Ottawa and Victoria, saying they need to do more to end the shortage of family doctors.

After he retired from politics, Peckford, moved to B.C. in 1993. He’s lived in Nanaimo, Qualicum Beach and now Parksville. And in each community, the shortage of primary care physicians has been getting worse.

Island Health Region surveys show that about 16 per cent of the 50,000 residents of the Oceanside Local Health Area (Parksville and Qualicum Beach) don’t have a family doctor. That’s better than the B.C. average where about 24 per cent of residents don’t have a regular family doctor.

Source: Island Health/Ministry of Health

But the Oceanside area has a surging population of seniors who often have chronic diseases that need continuous medical care.

Peckford’s own doctor, Dr. Hendrik Putter, closed his office a week ago. Ever since he told his 2,000 patients to look for a new doctor, Peckford has been doing just that, to no avail.

To Peckford’s astonishment, Putter arranged for his patients to go to a clinic 74 km away. That’s an illogical proposition, Peckford maintains, since many seniors don’t drive and there is no public transit to the clinic in Courtenay, an hour away. Peckford has also failed to find a doctor willing to take new patients in Nanaimo.

There are about 20 general physicians working in Qualicum and Parksville, but none are taking new patients. Peckford has put his name on waiting lists.

Local news reports in the Qualicum area have suggested a lack of at modern, spacious office space suitable for medical clinics is a major problem in attracting new doctors.

“This is the first time in my 77 years that I’ve been without a family doctor,” Peckford said.

“If I was the premier or the health minister, I’d be coming up with a better battle plan,” he said, noting the Commonwealth Fund has drawn attention to the long waiting times in Canada to see specialists and other studies have also shown Canada’s lower number of doctors compared to other wealthy nations.

In a recent letter to the new federal health minister, Patty Hajdu, Peckford says Ottawa transfers billions in health care payments to the province and he asks if B.C. is meeting its obligations under the Canada Health Act. The Act requires provinces to monitor whether they are meeting the conditions for such federal payments, including access to medical care. He’s asked the federal government to look into whether B.C. is meeting those conditions.

“It seems to me that at the very least, the reasonable accessibility provisions of the Act are being violated as highlighted in my own personal experience on Vancouver Island,” Peckford said in his letter.

“I am only taking this step after I had written the provincial health minister (Adrian Dix) and received an unsatisfactory answer, not from the minister himself but from an employee completely ignoring the main purpose of my letter,” Peckford said, referring to a letter from Thomas Guerrero, ministry executive director of patient and client relations.

Guerrero said Island Health has been trying to recruit a family doctor to Qualicum Beach. He also drew attention to a program designed to recruit and retain physicians. He acknowledged that long term solutions won’t be “of much assistance in addressing your immediate concerns.”

The shortage of family doctors is a major problem across B.C. Health Match B.C., the branch of the Health Employers Association of B.C. that helps recruit physicians from other jurisdictions, has postings for about 900 jobs, believed to be a record high. Of the 900 vacancies, 567 are for family doctors.

A study by B.C. researchers in 2017 showed that the doctor shortage will soon get far worse because 40 per cent of B.C. doctors are at, or near, the age of retirement.

There are 12,960 physicians practicing medicine in B.C. Some 6,616 are family doctors while the rest are specialists, according to the latest annual report of the College of Physicians and Surgeons of B.C. The College used to post a list of doctors taking new patients but stopped last year. It now refers individuals to HealthLink B.C. — accessible by calling 811 by telephone. Nurses who answer calls can refer individuals to various Divisions of Family Practice chapters, lists of walk-in clinics and health resources in their area.

The ministry of health did not respond to a request for a comment.

Twitter: @MedicineMatters


Bank pledges $2 million for Indigenous health care at St. Paul’s Hospital

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Dr. Jeff Reading, the inaugural FNHA Chair in heart health and wellness at St. Paul’s Hospital.

Allan Tung

Features of First Nations cultures that help promote their health and wellness will be embedded into the planned new St. Paul’s Hospital, thanks to a $2-million donation from BMO Financial Group.

The pledge, announced Tuesday by the St. Paul’s Foundation, will also be used to further work started in 2015 when the First Nations Health Authority Chair in heart health and wellness was established as a $2.5-million 10-year partnership of the health authority, St. Paul’s and Simon Fraser University.

Grand Chief Edward John said then that it was his 1998 heart attack that was the seed of the program focused on the cardiac health of B.C. First Nations people. His medical experiences helped him understand more about medical gaps for Indigenous Peoples and the need for culturally informed care.

In 2016, Jeff Reading was named the First Nations Chair in heart health and wellness and has led research into issues like the obstacles to timely care for First Nations individuals living in B.C.

Broek Bosma, chief development officer at the St. Paul’s foundation, said Reading will decide how to use the new BMO funds, but the pledge — over an unspecified time period — will be spent on salaries, research and design features in the new hospital. On the third floor of the existing St. Paul’s is an All Nations Sacred Space where First Nations patients can participate in smudging ceremonies and other customary healing practices. The new hospital will also have such features.

Reading has created what is called the first Indigenous Health Education Access Research and Training Centre at St. Paul’s (I-HEART). Its goal is to improve the health of Indigenous people by encouraging healthy diet, exercise and recreation, and by helping individuals manage chronic illnesses like diabetes, obesity, lung and kidney disease.

In 2017, Providence Health Care signed a commitment with the First Nations Health Authority to improve Indigenous health services. The hospital set up a team to advocate for patients. It also helps provide them with traditional items like blankets, foods like bison, salmon, and berries for ceremonies and gatherings, and traditional medicines for healing ceremonies. The hospital also has a rooftop garden with a section for traditional medicinal plants.

Twitter: @MedicineMatters



Often-abused codeine cough syrups to become restricted drugs

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Pharmacist Danny Tam with some of the codeine-containing cough syrups that will require a special type of prescription and will have to be locked up in vaults at pharmacies.

Francis Georgian / PNG

New rules will restrict access to some codeine-based cough syrups because their narcotic ingredient makes them addictive and subject to robberies and abuse.

Cough syrups like Dimetapp-C, Robitussin AC and acetaminophen with codeine are sedating pain relievers that have been marketed for many decades.

But Canadian research has shown adolescents often take them in greater amounts than prescribed in order to get high.

The College of Pharmacists of B.C. said there have been growing concerns about forged prescriptions and pharmacy robberies targeting the codeine formulations. There have also been cases in which such medications have been diverted by health professionals for personal use or to be sold on the street.

The College of Physicians and Surgeons of B.C. says the liquid cough preparations have been too easy to get.

As of Jan. 2, 2020, medications with higher potencies will be reclassified as controlled medications that require special, duplicate prescriptions. Preparations with very low concentrations of codeine will still be available from behind the pharmacy counter.

Dr. Heidi Oetter, the registrar of the College of Physicians and Surgeons, said that apart from being potentially dangerous, codeine cough medications have not been proven effective for anything other than some pain relief.

“The risk is simply too high for something that has no demonstrated benefits,” she said.

Under the new rules, doctors will have to fill out prescriptions on a duplicate pad to help prevent forgeries. Oetter said this should also prompt physicians to “give more deliberate thought” when they are writing such prescriptions. And pharmacies must also store cough syrups with codeine in time-delayed safes along with their other narcotics.

Chris Chiew, general manager of western Canadian pharmacy operations for London Drugs, said that “grab and go” thieves are far less likely to steal from stores with such vaults because they don’t want to wait around for them to unlock.

Chiew said the time delay safes, security cameras and guards in the London Drugs stores are all excellent deterrents. But he agrees with the colleges that other measures to prevent abuse and addiction may also be helpful.

He said that lozenges, drinking water or other fluids, and humid air are all good alternatives to cough syrup.

Because of the opioid epidemic, Health Canada followed the lead of the U.S. Food and Drug Administration and did a safety review of cough and cold products containing opioids like codeine and hydrocodone. It found “limited evidence” linking codeine cough syrups to opioid disorders and other harms in children. It also found, however, that there is little evidence showing any medical effectiveness of the products and so, as a precautionary measure, it advised against the use of such products in those under 18.

Chiew said he understands Health Canada has also been doing consultations on codeine products that do not require a prescription. It is possible those discussions could end up with a new standard that requires every medication containing codeine — in any format including pills and liquid — to require a prescription. Currently, for example, pharmacists can use their professional judgment to sell, without a prescription, acetaminophen with eight mg of codeine and some caffeine to offset the sedative effect.

A 2018 review of the effectiveness and safety of non-prescription medications containing codeine by the Canadian Agency for Drugs and Technologies in Health found there is evidence that low-dose codeine is effective for pain control or chronic cough when compared with placebo or non-opioid analgesics.

“However, the use of codeine can sometimes be less or similarly effective as non-opioid analgesics, while introducing the adverse effects, such as drowsiness, nausea, and constipation.”

Twitter: @MedicineMatters


Acetaminophen elixir with 8 mg codeine phosphate syrup

PMS-acetaminophen with codeine elixir

Calmylin ACE

Covan syrup


Robitussin AC


Dimetane expectorant C

Teva-cotridin expectorant


Hospital foundation has raised 75 per cent of its pledge for new St. Paul’s

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The Pattison Foundation has made a $75 million donation to fund the Jim Pattison Medical Centre at the new St. Paul’s Hospital. The new facility is described as “a purpose-built, fully-integrated health campus, comprising the entire 18.4-acre site on Station Street in the False Creek Flats.”


The St. Paul’s Foundation has set its sights on raising $225 million toward the cost of a new hospital to be built three kilometres away, on an unused field in the False Creek flats.

With pledges and donations totalling $168 million to date, the foundation is three quarters of the way to completing what’s been called the largest hospital fundraising campaign in Western Canada. The single largest donation was for $75 million from the Pattison Foundation, the philanthropic arm of Vancouver billionaire Jim Pattison‘s empire.

The health care campus will be called the Jim Pattison Medical Centre.

The price tag for the new 12-storey hospital at 1002 Station Street is an ever changing, ever-escalating target, most recently estimated at almost $2 billion. The site, currently a gravel lot atop a former mud flat at the end of False Creek inlet, will be divided into parcels allowing for phased-in construction of buildings. The hospital, a 69-space child daycare centre, outpatient medical clinics, and offices for administrators and researchers are expected to be completed first, by about 2026.

In the second phase of construction, other parcels will be developed for rental housing offered to health care workers, a hotel with kitchenettes for patients seeking care at the hospital as 40 per cent of St. Paul’s patients come from communities outside the Lower Mainland, more offices and a second daycare centre. The initial business plan approved and funded by the government does not cover other structures, only the hospital, according to Providence Health spokesman Shaf Hussain. 

Geotechnical remediation work on the False Creek Flats land that is susceptible to liquefaction has not yet begun. The rezoning hearing, to change the site from industrial to comprehensive development, is October 22 and although construction is not expected to begin for another year, government and hospital leaders maintain the new facility will open in 2026.

While the proportion being raised through philanthropy may appear small, relative to the overall cost, it is ambitious in relation to other health sector fundraising campaigns, according to material gathered by staff of the St. Paul’s Foundation.

For example, the B.C. Children’s Hospital Foundation capital campaign target for its new hospital was $150 million. And the Lion’s Gate Hospital Foundation target for a new medical/surgical centre was $100 million. The Royal Columbian Hospital Foundation capital campaign target for a multiphase redevelopment is also $100 million while the Richmond Hospital Foundation will try to raise up to $50 million for its new building.

All of those projects pale in size when compared to the new St. Paul’s. 

Paul Hollands, the chairman of A&W Food Services of Canada, and chair of the St. Paul’s Foundation fundraising campaign committee said that private donor fundraising will account for about 10 per cent of the total cost of the hospital.

“We came up with this amount of $225 million after looking at other capital campaigns, talking to key leaders and gauging support in the community. It’s a big number but in the coming months, you will hear about some more big and smaller donations. People are seeing how we are trying to do something extraordinary because this is a once in a lifetime opportunity,” he said, referring to the blank canvas the vacant, 18.4-acre site offers.

“Eight or nine years ago we were more modest in our ambitions. But the fact that we’ve had this very long gestation period means we’ve been able to crystallize our desire to create something really special.”

The existing 6.7 acre St. Paul’s site has already been listed and is expected to yield at least $800 million. Taxpayers will fund the remaining amount of the new hospital construction.

Twitter: @MedicineMatters


Physicians need to do a better job of protecting patient files: B.C. privacy commissioner

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BC Information and Privacy Commissioner Michael McEvoy.


Doctors’ offices regularly breach patients’ privacy so clinics across B.C. must do more to protect the information in their possession, says a report released Wednesday by the Office of the Information and Privacy Commissioner for British Columbia (OIPC).

The audit and compliance report is based on 22 randomly selected medical clinics where at least five doctors worked. The audit sought to find out whether clinics and their staff are meeting legal obligations under the Personal Information Protection Act (PIPA). The act dictates how private organizations collect, use and disclose personal information.

Medical clinics were chosen for the review because of the massive amount of sensitive personal information they collect and because relative to other private sector organizations, physicians’ offices, medical clinics and labs “account for the largest number of complaints and breach files received by the OIPC over the past five years.”

The scope of the review did not entail a physical inspection of electronic medical records systems, patient files storage systems or actual visits to the clinics. Rather, designated staff at the clinics answered questions and provided written material.

Even without a physical inspection of such clinics, the review discovered numerous problems with the way clinics handled patient information. Many lacked a designated privacy officer, put insufficient resources into privacy procedures and failed to stay abreast of technological advances that would help protect information.

The compliance review report says although there’s an inherently strong bond of trust between doctors and patients, the “troubling reality” is that privacy issues occur regularly in the medical field and the privacy commissioner routinely hears complaints about privacy breaches. Such breaches include accidental disclosures by email, files stolen from doctors’ vehicles, and computer systems that are compromised.

“The harms caused by these breaches can be very serious, leaving victims vulnerable to everything from damaged relationships to humiliation, financial loss and more.”

Michael McEvoy, B.C.’s information and privacy commissioner, said the compliance audit focused on medical clinics because of the large volume and sensitivity of the personal information they collect.

“The results show that while some clinics were complying with their obligations, many have work to do when it comes to improving their privacy practices. There is no question about the intense demands medical professionals face. However, respecting and protecting patients’ private information is critically important.

“Doctors and staff at clinics not only owe it to their patients to do their utmost to build and maintain strong privacy programs, but they are also legally obligated to abide by privacy legislation. I hope that the focus of this report underscores the need for clinics to address gaps in how they protect this sensitive personal information and my office’s willingness to assist them in doing so.”

The report has 16 recommendations aimed at helping clinics address the gaps in their privacy management programs, building better policies and safeguards, and ensuring they provide adequate notification about the purposes of collecting personal information online. The report recommends that clinics develop more robust privacy protocols, better responses to breaches, improved monitoring to ensure compliance and prevent breaches, provide more training for staff, and use more caution when collecting and sharing information online.

More to come.

Twitter: @MedicineMatters


Real benefits to stenting multiple blocked arteries, not just the one that caused a heart attack, study says

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Unblocking additional plaque or cholesterol-clogged coronary arteries with stents after a heart attack — instead of just the one that caused the heart attack — leads to a reduction in the risk of dying or having another heart attack, a multinational study involving B.C. experts and patients shows.

Experts predict the “landmark” study will have immediate implications for heart attack patients as interventional cardiologists will now stent additional coronary arteries with significant narrowing (more than 70 per cent) instead of just the culprit artery that caused the heart attack. There are three major coronary arteries and when heart attack patients have one blocked artery, it is not unusual to see blockages in the others, referred to as multi-vessel coronary artery disease.

The study began in 2013 at hospitals in 31 countries, predominately in Europe and North America. It was published in the New England Journal of Medicine and was presented as a late-breaking session at the World Congress of Cardiology in France.

The COMPLETE study, as it is called, involved 4,041 patients (200 in Vancouver) who were followed for about three years. All patients got stents in the culprit arteries as an emergency rescue measure. But in one arm of the study, half were then released from the hospital and prescribed the usual post-angioplasty medications while in the other study arm, patients had their other blocked arteries stented in what is called complete revascularization, either at the same time as the heart attack causing culprit stenting or within 45 days.

Participants in the COMPLETE trial

Deaths from heart disease, further heart attacks or related to the medical procedure occurred in 179 patients (8.9 per cent) in the complete revascularization group, compared to 339 (16.7 per cent) of those who had only one stent put in.

After a median followup of three years, the risk of a second heart attack or death from heart disease occurred in 7.8 per cent of the patients who had complete revascularization while it was 10.5 per cent in those who got one stent.

“In the past, the gestalt was you do an immediate angioplasty to open the culprit blocked artery and then do less with the other ones, put patients on meds and monitor them instead of fixing the additional blockages at the same time or right after,” said Dr. David Wood, the Vancouver co-principal investigator and director of the Vancouver General Hospital Cardiac Catheterization Lab.

“But in this study, the results show that doing more stenting, even within the first 45 days after the heart attack, was beneficial. There was a 26 per cent reduction in the patients’ risk of dying or having another heart attack.”

Dr. David Wood and Dr. John Cairns at Vancouver General Hospital. The pair participated in the COMPLETE trial, focusing on the effect of stenting additional arteries of heart attack victiims. Photo: Arlen Redekop/Postmedia

Arlen Redekop /


Dr. Shamir Mehta, the principal investigator of the study led by McMaster University and Hamilton Health Sciences, said the data shows that there are benefits to clearing all the arteries and no major downside to the additional procedures.

“Given its large size, international scope and focus on patient-centred outcomes, the COMPLETE trial will change how doctors treat this condition and prevent many thousands of recurrent heart attacks globally every year,” said Mehta, an interventional cardiologist and a senior scientist at the Population Health Research Institute.

Dr. John Cairns, a Vancouver cardiologist who is the former dean of UBC medical school and a study collaborator said: “(Additional) blockages should be fixed in the first 45 days after a patient’s initial heart attack.”

Leslie Carey was one of the trial participants. In 2015, the Burnaby resident had a heart attack while riding a bus to work,

Carey’s chest pains were so severe that he got off the bus and called 911. Paramedics quickly attended to him in a nearby parking lot, whisking him off to VGH.

Life was stressful at the time but his health was pretty good, or so he thought.

“I didn’t have high blood pressure or diabetes but I was taking meds on and off for cholesterol,” said the 58-year old marine administrator for the Royal Vancouver Yacht Club.

Right after a coronary artery was stented, Carey said he felt so much better. His chest pain was gone. Since he was randomly assigned to the trial arm of patients who would get further treatment, he then had another stent inserted into another partly blocked artery. And months later, yet another stent was added so he now has three stents propping open his major coronary arteries.

“I’m fully wired now,” said Carey.

About 20,000 B.C. residents have diagnostic angiograms and angioplasties — usually with stents — each year and another 2,000 have open heart surgery, which is indicated for more serious cases and for patients with diseases like diabetes, according to a Cardiac Services B.C. provincial registry.

Leslie Carey had a heart attack while on a bus to work at Royal Vancouver Yacht Club and had three stents put in. Photo: Arlen Redekop/Postmedia

Arlen Redekop /


Mehta said patients who had angioplasties were on the right medications to reduce their risk of a heart attack. No one should jump to the conclusion that the medications weren’t effective.

“We don’t know if the same benefit of angioplasty would be there if they were not on the medication. The angioplasty can be considered as an add-on to the medications to prevent further events.”

Mehta, Cairns and Wood agreed that doing more angioplasties on patients with heart attacks is not going to overburden the Canadian health care system. A future study may look at the economics of “front-loading” angioplasties and Cairns said he thinks there could be some cost efficiencies in addition to health benefits.

“We are well equipped in Canada to perform the additional procedures, particularly since the trial shows they can be done any time within 45 days of the index (first) heart attack,” said Mehta.

The median age of trial participants was about 62 and 80 per cent were male. Study authors said that is because more men have large heart attacks.  About 50 per cent of study participants had high blood pressure and 40 per cent were smokers. Just under 40 per cent had high cholesterol.

The study cost over $14 million; $3 million came from the Canadian Institutes of Health Research and just over $11 million from Boston Scientific and AstraZeneca. The companies had no role in trial design, analysis or manuscript writing, according to the authors.

Twitter: @MedicineMatters


False Creek private surgery clinic sold to Toronto equity company

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Dr. Amin Javer and his team perform sinus surgery on a patient at False Creek Healthcare Centre in Vancouver.

Arlen Redekop / PNG

A Toronto private-equity company has bought False Creek Healthcare Centre in Vancouver, one of B.C.’s first private surgery and diagnostic facilities.

In a memo to employees obtained by Postmedia, the owner of the facility and four others in Canada — Centric Health — says the deal is expected to close at the end of September. The buyer is Kensington Capital Advisers.

Doctors and patients can expect a “business as usual” transition followed by an improvement in facilities and quality of care, according to Kirk Hamilton, vice-president of Kensington. The company, which describes itself as an investor in “alternative assets” bought the clinics in Vancouver, Calgary, Winnipeg, Toronto and Mississauga for $35 million. The clinics will be owned by the Kensington Private Equity Fund.

False Creek was opened in the late 1990s by an entrepreneurial Vancouver anesthesiologist, Dr. Mark Godley. In 2011, he sold the Vancouver centre and a sister facility in Winnipeg to Centric Health for $24 million.

The surgical clinics have apparently been a drag on Centric’s financial bottom line. In the memo to employees, David Murphy, the Centric CEO, said the “bittersweet” transaction is the culmination of a year-long review to improve the company’s financial health.

The decision was made “that the most viable path forward was to divest some of our businesses and pursue a more focused strategy built around our seniors’ pharmacy business.”

Murphy nevertheless told employees the growth potential for the private surgery business is “immense” and that Kensington is “the right owner for this business” as it is committed to increasing investment in each of the surgical sites.

“I am confident they will partner with you to help this business realize its tremendous growth potential.”

In B.C., changing government policies initiated by the NDP have been destabilizing the private surgery business. There is the uncertain outcome of the continuing B.C. trial into the constitutionality of paying privately for expedited surgery in such clinics. Closing arguments in the three-year-long trial will not be made before the fall and a judge’s decision is not expected until sometime in 2020.

Murphy mentioned B.C.’s political and legal situation in the company’s latest quarterly report in which Centric cites risks in the private surgery business, including the B.C. trial and NDP government policies.

Asked about the wisdom of buying a private surgery centre in B.C., Hamilton said in an email: “The acquisition includes multiple facilities across Canada and isn’t limited to False Creek. Currently, the False Creek facility does not provide any services to the B.C. government. However, we would be open to providing similar patient services to the B.C. government in the future.”

He was referring to the fact that for many years, health authorities have paid several private clinics to help clear backlogs of scheduled surgeries. But most private clinics also take patients willing to pay out of pocket for expedited surgery, something the government maintains is illegal.

Last fall, the government introduced so-called compliance letters. Surgeons who do any work at private clinics that have contracts with health authorities must sign statements promising they won’t do medically necessary work in both the public and private systems. If they refuse, they could be banned from doing publicly funded operations at private clinics that have contracts with health authorities.

Vancouver Coastal Health has contracted out elective surgery cases to the False Creek clinic in the past, but last year, Health Minister Adrian Dix instructed VCH to sever its contract with False Creek because an audit showed some patients were paying privately to get expedited access, contrary to provincial law.

Twitter: @MedicineMatters


Surgeons in B.C. get fee increase for operations on obese patients

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Dr. Kathleen Ross, president of Doctors of B.C.

Custom Photography / PNG

Some B.C. surgeons who operate on extremely obese patients are being paid a 25 per cent surcharge because surgeries on such patients often take longer and are riskier.

The change came into effect a few months ago for some physicians and will soon kick in for more medical specialists.

It came about after a survey three years ago showed that obese patients were falling through cracks. All but a handful of the B.C. surgeons who responded said they had delayed or declined to perform elective surgery on patients with a body mass index, or BMI, higher than 38. Four in five surgeons said they had delayed or declined to perform surgery over concerns about complications in patients with a BMI of 30 to 34.

Some patients have accused physicians of being biased against them.

Doctors of B.C. and the Ministry of Health have been working to solve the problem. General surgeons and anesthesiologists were the first to negotiate surcharges meant to compensate for added risks and time involved in treating obese patients. Gynecologists/obstetricians are also expected to get a surcharge soon.

Dr. Kathleen Ross, the new president of Doctors of B.C., said the government didn’t come up with extra money. Instead, money was reallocated from what’s called the available amount given to sections of physicians. Within sections like anesthesiology, fees shrunk for some procedures to allow for the surcharge which is referred to as a “BMI modifier.”

Although obesity is typically defined as a BMI over 30, the premium only applies for operations on patients with a BMI over 35. Several other provinces offer surgeons a premium.

BMI is calculated based on a person’s height and weight. For example, a woman who is five-foot-eight and weighs 270 pounds would have a BMI of 41.0.

Body Mass Index Primer; Source: U.S. National Library of Medicine

“This is in recognition of the fact that in obese patients, there may be more complications and areas of the body are more difficult to access,” Ross said. “Operations are more technically complex.”

Dr. Stephen Kaye, an obstetrician/gynecologist, said obesity affects all of patient treatment, making the initial evaluation, the surgery and post-operative care more complex.

Obese patients can have higher rates of infections, require longer hospital stays and more hospital readmissions. It takes longer to prepare obese patients for surgery, including getting them in position on larger operating room tables. Getting them sedated takes longer, said Kaye, who is co-president of the Doctors of B.C. section of obstetrics and gynecologists.

“Specialized equipment and retractors are required in order to visualize and reach the surgical site,” he said. “When operating on the abdomen and pelvis, for example, the distance between the skin surface and the abdominal contents is increased by the thickness of the fat of the abdominal wall.

“These are high-risk patients and increasingly, the care of these patients is being concentrated in the hands of a fewer number of physicians who are willing to accept the patients and have the expertise or who work in hospitals that have greater resources to provide such care,” Kaye said.

In the case of a hysterectomy, for example, the $654 fee paid to a gynecologist/obstetrician would rise by $72 for every 15 minutes beyond the standard two hours. For anesthesiologists sedating hysterectomy patients, the fee would be billed at $38 minutes for every 15 minutes but the BMI modifier would add an extra $20 for every 15 minutes beyond the two-hour typical surgery time.

Some anesthesiologists and other surgical specialists are paid through contracts so their compensation would be structured differently.

Dr. Curtis Smecher, an anesthesiologist at Abbotsford Hospital and president of the B.C. Anesthesiologists Society, said that in the last round of negotiations, each section of physicians was given a pot of money to distribute for pressing needs and the BMI bonus was a high priority for doctors in his area.

“It’s a bit like shuffling deck chairs,” he said about the reallocation, adding that he won’t be surprised if orthopedic surgeons are next to seek the premium since surgeries like joint replacements are far more difficult in obese patients.

Anesthesiologists say their management of obese patients is more complex because of thicker necks, chests, and abdomens in such patients who often have sleep apnea and reduced lung and heart function, which can affect airway management and ventilation during anesthesia.

Physician services cost taxpayers almost $5 billion a year. Ross would not disclose how funds are being shuffled around to pay the premiums, but in the latest Physician Master Agreement with the government, there was also some shifting of funds to address disparities between physician groups. For example, cataract fees to ophthalmologists were reduced about 18 per cent, from $425 a year to $350.

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Ballsy participants sought for Vancouver testicle study

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Dr. Ryan Flannigan inside VGH’s Robert Ho research building in Vancouver. Dr. Flannigan is leading a study on a new way to treat scrotum pain. Photo: Arlen Redekop/Postmedia

Arlen Redekop / PNG

Males who suffer debilitating scrotal pain can now sign up for a new study using an old but reformulated numbing medication with lidocaine.

Nearly five per cent of males can suffer so much that mere walking can be painful if they have chronic pain in their testicles and scrotum, the latter of which are the sacs of skin surrounding the testicles.

Dr. Ryan Flannigan, a Vancouver General Hospital urologist who is the director of the male infertility and sexual medicine research program at the University of B.C., said that he has seen up to 100 men with chronic scrotum pain in the last six months alone. Some patients come from as far away as the Northwest Territories. But many men don’t bother to seek medical attention because, as Flannigan points out, males are generally more reluctant than women to go to doctors and more inclined to brush off medical concerns.

Flannigan, who specializes in testicular and penile abnormalities, said testicular pain is described by patients as either constant aching or episodes of sharp pain.

The scrotal pain condition occurs in a range of ages — from teenagers to men in their ’60s — but it most commonly affects those in their 20s and 30s, Flannigan said.

While conventional treatment has involved injecting a lidocaine anesthetic into the spermatic cord to help numb pain, it is temporary relief for only up to four hours. So in the new study, soon to enrol 20 patients, lidocaine will be reformulated into a polymer paste that is designed for a slow, more sustained release, over seven to 14 days.

The needlepoke through the skin at the top of the scrotum into the spermatic cord can be uncomfortable but Flannigan said he tells patients “it’s like a visit to the dentist when the freezing goes in.”

In a study that will soon enrol participants who suffer from severe scrotum pain, Dr. Ryan Flannigan will be injecting a newly formulated solution of a numbing agent designed to provide longer relief. Photo: Arlen Redekop/Postmedia

Arlen Redekop /


The paste, developed by a UBC spinoff company called Sustained Therapeutics (which is funding the study), will be injected into tissues, not blood vessels. Flannigan said the polymer material will “naturally break down” as it is metabolized.

Besides lidocaine-based injections, other treatments that may be tried include anti-inflammatories, steroids, and sometimes even surgery to cut nerves that are transmitting the pain. Physiotherapy can also help when the pain originates in another area of the body and is referred to the testicles.

Preclinical trials in animals at UBC affirmed the safety and proof of concept behind the intervention. Now the goal of the Phase 1 trial in humans will be to determine a safe and effective dose.

Flannigan said common causes of the condition include a blow to the testicle area, a previous infection in the area, inflammation in the spermatic cord that stores and carries sperm, and nerves pinched during hernia repair or a previous vasectomy. Pain can also be caused by enlarged veins in the scrotum, cysts, or kidney stones. The cause remains unknown in nearly half of cases.

Flannigan said men from around B.C. — or even outside the province — will be considered for the trial. To register an interest, males should contact the clinical trials unit at the Vancouver Prostate Centre or call 604-875-5675.

Twitter: @MedicineMatters





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New leader for B.C. Cancer agency is a prestigious oncologist and researcher

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Dr. Kim Chi has been named the new leader of the B.C. Cancer agency.


Dr. Kim Nguyen Chi, a renowned prostate cancer researcher and highly respected oncologist, will take over as head of the B.C. Cancer agency on July 1.

He is the first visible minority leader since the agency was established 45 years ago.

Chi, who went to medical school at the University of Ottawa, succeeds Dr. Malcolm Moore who announced four months ago that he would be leaving his post about a year early. Moore said he was moving back to Toronto for personal and professional reasons. The typical duration of such leadership positions is five years but the agency has had trouble keeping leaders. Dr. Max Coppes stayed in the job for two years and Dr. David Levy stayed just 18 months.

Chi came to B.C. in 1996 to do an oncology fellowship at BC Cancer, following an internal medicine residency in Ottawa.

BC Cancer has had a high churn rate for leaders and it has been criticized for too often choosing Americans over Canadians, and out of province experts over local ones.

In a press release, the agency says Chi understands the “intricacies of patient care and operations based on his current role as B.C. Cancer’s Director of Clinical Research and Medical Director for the Vancouver Centre.”

Chi has an interest in developing biomarkers and new treatments for those with the most advanced form of prostate cancer. He was a lead and collaborating author on some recently published studies on new drug treatments for men with metastatic prostate cancer.

Chi said he’s honoured to take over.

“As I step forward now, I do so with the profound understanding that B.C. Cancer is not about one person or one leader, it is about our tremendous history of achievement — of world-class research and knowledge translation and unparalleled patient care — made possible by the collective will of all of our clinicians, researchers and staff. I am proud to be the one who will take us forward in building on that legacy.”

Health Minister Adrian Dix called Chi an excellent choice.

“He understands firsthand the worlds of medical oncology and cancer research, but he also knows where B.C. Cancer has come from and where the opportunities lie to leverage the investments the B.C. government has made in cancer care to improve the lives of patients in every corner of our province.” 

Chi started at the B.C. Cancer agency 20 years ago. He says the bond between patients and physicians is nowhere stronger than in cancer care “where you are helping a person navigate one of the most serious issues they will ever face.”

Chi’s official title will be Chief Medical Officer and head of B.C. Cancer as well as vice-president of the Provincial Health Services Authority, to which the cancer agency is accountable.

Chi takes over during a time of relative calm. That had not been the case in the past decade or two. Scientists and clinicians have in the past cited concerns about poor staff morale, long patient waiting times and inadequate government funding.

The B.C. government’s latest budget included increased funding for the cancer agency, earmarked for increased cancer-related surgeries, diagnostic imaging, expanded positron emission tomography and computerized tomography scans, and chemotherapy demands.

More to come…..

Twitter: @MedicineMatters

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