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This Issue Is Dedicated to the Memory of Karen Pilgrim

Update from the Chair

First I must apologize for delay in publishing our fourth newsletter. Jeanette, our newsletter editor, has experienced many health-related problems in her family and has had to relinquish her position. We would like to thank Jeanette for her valuable contribution to the VoHCA organization and hope her life becomes more bearable.

Toronto Chapter
The Toronto Chapter is up and running as you will see in the article included in this issue. VoHCA will be using the experience in setting up the Toronto chapter to come up with guidelines for setting up other chapters. Members in Quebec, Newfoundland and Alberta have expressed interest in setting up chapters.
 

Election.The VoHCA AGM was held in Kingston and the following directors were elected: -

Chairman..................................Gord Lever
Secretary.....................Annette Strassburger
Treasurer..............................Sharon Clarke
Director Strategy.................Cathy Richards
Director Toronto Chapter..........Peter Evans

Krop Protest
On June 3, 1999 three directors attended the protest on behalf of Dr Krop at the CPSO office in Toronto. Representatives from more than a dozen health-care related groups took part. The directors took the opportunity of promoting the VoHCA cause during the protest and also at a subsequent press conference at Queen's Park. The CPSO disciplined Dr Krop but did not take his licence away. He will appeal the decision to the Supreme Court.
 

Media Attention
Several VoHCA members were featured in articles in major Newspapers. Eric Pilgrim was featured in a Toronto Star article and Janet McDonough article in the Globe and Mail on superbugs in our hospitals. VoHCA was also mentioned in the Globe and Mail article on sexual abuse of patients by doctors. Janet will also be featured in a TVO documentary on superbugs.
 

Health Professions Act Review
The main thrusts of VoHCA executive are the Regulated Health Professions Act review and the inquiry into how the CPSO handles complaints. Please refer to the articles in this newsletter. It is now a golden opportunity to present the views of VoHCA members on the issues related to these reviews. Members are encouraged to send in their comments on both topics.
 

Competent Malpractice Lawyers
We are in the process of compiling a list of lawyers competent in the field of medical malpractice. If you can recommend one, please let us know. Also, we are building up a confidential list of doctors to avoid, please contact us.

Site on the "Information" page may be of interest in the interim.

Membership Renewal
VoHCA is now into its second year of operation and ask members to complete the membership renewal form and return along with the appropriate fee. Unfortunately we made a mistake in assuming we could register as a charitable organization. To meet the requirements we would not be able to lobby for the changes we think should be made. In this so called democracy, charitable status limits your lobbying to a maximum 10% of your total effort. The executive felt it was more important to work toward change rather than be limited by the rules applied to charitable organizations. We apologize for any inconvenience this may cause.
 

Thank you
Eric Pilgrim, Jobar Inc., and Plastics Canada for your generous donation to cover the cost of this newsletter.
 

Access To Records Around The World
As part of our efforts to prepare a thorough submission for the Health Profession's Review Board, we are compiling a database on the level of access to health care records from other countries around the world. It is our hope that the present Canadian system, will be shown to be completely inadequate in comparison with almost any other country.

In order to perform this comparison, we need your help in getting input from others around the world. We would like you to send the survey included in this newsletter to anyone (friends, relatives, email buddies, anyone who owes you a favor) in any other part of the world. Anyone can fill in this questionnaire. It does not require having had serious health problems. The steps are simple:

1. Determine who to send this questionnaire to

2. Send the questionnaire. If you would like to email it, please send an email to me at

"innovacan@hotmail.com" and I will send you an electronic copy of the survey.

3. Ensure that the respondents return the questionnaires Thanks so much in advance for your help with this.

        Cathy.

Even simpler, If you are reading this online, click on survey below.

Records Survey

Five Year Review of the Regulated Health Professions Act (RHPA)

After more than a years delay, the RHPA is finally up for review. VoHCA has been accepted to make a submission with the deadline being the end of the year. A subcommittee consisting of Peter Evans, Annette Strassburger and Gord Lever has been formed to formulate the submission. We will also be using the expertise of George Belza in preparing the submission. Members with access to the Internet may want to check out the Council's website at www.hprac.org where the public consultation document can be seen. A copy of the letter sent to VoHCA is included in the newsletter.

The RHPA came into effect on 31 December, 1993 and regulates those who work in the 23 regulated health professions, including the CPSO. The Act covers more than 220,000 people belonging to the regulated Colleges. The function of the Colleges is to set standards and to ensure they comply with the RHPA and related laws.

The underlying objectives of the RHPA are:

- to protect the public from harm

- to promote high quality care

- to make the regulated health professions accountable to the public

- to give patient/client access to health-care professions of their choice

- to achieve equality by making all regulated health professions adhere to the same purposes
and public interest principles; and

- to treat individual patients/clients and health professionals in an equitable manner.

The Review will determine whether the RHPA has generated a regulatory system that is effective, efficient, flexible and fair. From the experiences of VoHCA members we will try to show that in the case of the CPSO it has not met its objectives, particularly with regard to points one, three and six.
 

What we need to do to make our submission as effective as possible.
We need each member who has made a complaint to the CPSO to supply us with the following information:

A two page maximum summary of the problem that caused the complaint to be made. Copies of the correspondence between the complainant and the CPSO (names can be blanked out if so desired). These will be compiled as an appendix to our submission. A copy of the relevant medical documents will also be required but will only be referenced in the submission. Any other information such as appeals to the health Professions Board. Annette Strassburger will be coordinating this part of our submission and can be contacted through the VoHCA office. Because of time limitations, we need this information as soon as possible. An outline sheet is attached for each member to complete. If you need assistance in completing your form, please call the VoHCA office. The Toronto Chapter will also help prepare the summaries of the Toronto members.

Another appendix will include an update of the statistics prepared by Georgina Hunter showing the abysmally low rate of referrals of complaints to discipline in by the CPSO.
 

Review of How CPSO Handles Patients Complaints
The person at the Ministry now coordinating the CPSO review is Marilyn Wang, (416) 327-6402.
I recently spoke to her and was informed that the situation at present is as follows:
The Ministry is currently working on a Request for Proposal to tender out the review to an independent body. However, because it is the first time the Ministry has ordered such a review it is taking longer than originally forecast. The CPSO has brought up the issue of confidentiality regarding the complainant and doctor involved and this appears to be the main issue still left to be resolved. This we feel is largely a delaying tactic by the CPSO as the Act clearly shows that the information can be made available to the Ministry and hence the reviewer. I also asked how the independent reviewer would know who has a problem with the CPSO and suggested VoHCA should be included on the list of contacts be given to the independent reviewer. Ms Wang agreed, so if you wish to have your complaint reviewed please contact us.

FUTURE MEETINGS

Toronto Chapter

Wednesday, 15 September, 1999 7 p.m. in Toronto City Hall, Nathan Phillips Square Committee
Room #2- second floor

Guest Speaker Marilou Mcphedran, Lawyer

"Do Ontario's Patients need a Bill of Rights."

Marilou McPhedran is the Toronto Lawyer who headed the task force on sexual abuse of patients eight years ago.

According to an article by Lisa Priest in the Toronto Star, June 13,1999, Ms McPhedran is so disturbed by the current doctors disciplinary system, she's launching a new probe - for free."patients seem to have nowhere to go. The CPSO doesn't seem to listen, and the government doesn't seem to listen"

All members and anyone else interested in Canada's health-care system are urged to attend. Kingston members interesting in attending should contact the VoHCA office at 389-5599

Kingston Chapter

29 September, 1999, 7:30 pm, Ogwanada Resource Centre, Portsmouth Ave
                    "End of Summer Update"

23 November, 1999, 7:30 pm, Ogwanada Resource Centre, Portsmouth Ave.
                     Topic to be advised.
 
 

TORONTO CHAPTER HIGHLIGHTS

The Toronto Chapter is up and running. Its Steering Committee meets regularly and is promoting VoHCA membership through public meetings and media exposure opportunities as they arise.

Lisa Priest, award winning journalist and author of "Operating In the Dark -The Accountability Crisis In Canada's Health Care System" was guest speaker at a well attended Spring meeting held at Hart House, University of Toronto. Her talk was informative and very well received the book is also well worth reading.

In late May, we followed up with another lively public session This time the agenda centered around a video presentation featuring Georgina Hunter and VoHCA's Wendy Gorst. Georgina's so sad story of losing her young baby through gross medical mismanagement, her criticism of the CPSO for not even disciplining the doctor involved, and her claim that she is not alone in receiving such treatment, really hit the mark and stimulated considerable discussion Peggy Hartley and Bill Morris reinforced the video presentation with their own poignant, personal stories. VoHCA members left the meeting with the clear recognition that they were indeed not alone and optimistic that VoHCA is going to do some good.

Two of our members, Eric Pilgrim and Janet McDonough, have been highlighted in major newspaper articles over the last little while. Both lost their spouses under tragic circumstances and their stories were prominently featured if anyone missed these articles and wishes to obtain a copy, please call Peter Evans at (416) 530-2677. Janet will also be featured In a TVO program on superbugs in our hospitals.

We are presently preparing for our next public meeting (15 September) and have lined up a very interesting guest speaker, Marilou McPhedran, Lawyer. See meeting announcement for more details. We will also be updating everyone on VoHCA's proposals on reform of the Regulated Health Professions Act currently being worked on.......so plan to attend!! Toronto members will be contacted with meeting details once finalized.

Sexual Misconduct and the College of Physicians and Surgeons or Ontario (CPSO)

According to several recent high profile reports in the Toronto Star and Globe and Mail the CPSO is equally pathetic in dealing with sexual complaints as with medical ones. With the passage of the Regulated Health Professionals Act in 1993 there is supposedly a zero tolerance rule in effect. However, the CPSO has done little to enforce it.

A 1992 Canada Health Monitor survey found almost one in ten women over the age or 15 had been sexually harassed or abused by a physician in Ontario either during an examination or consultation. Of course, the CPSO calls these figures outrageous, stating it is less than I percent.

Several articles in the Toronto Star about a Peterborough psychiatrist illustrate well how the CPSO does all in its power to protect abusive doctors. The psychiatrist, who sexually abused at least five of his patients between 1975 and 1992, is finally behind bars after pleading guilty to professional misconduct. The CPSO stripped the doctor of his licence to practice medicine almost seven years after the first official complaint against him, even though Ontario has some of the toughest legislation in Canada regarding sex between patients and doctors. This time lag as we all know is completely unacceptable yet the CPSO continues to get away with it.

The Peterborough police officer investigating the case described the doctor's watchdog (CPSO) like "secret service".

The Star report showed that in 1998 the CPSO investigated 38 new complaints of sexual misconduct - while another 128 were carried over from previous years. The CPSO when asked how long it takes to resolve a sexual misconduct complaint against a doctor stated it does not track that kind of information. I think we all can guess why.

Between 1993 and 1996, according to the Globe, a verdict of guilty was found in 40 cases of sexual abuse but only 23 licences were suspended. One doctor's licence was suspended for only 90 days even though the courts had found him guilty of sexual assault. A search carried out by the Star found that of the 36 doctors who handed in or had their medical licenses revoked for sexual misconduct by the CPSO since 1991, only four were fined - $5000 each. A fifth promised to pay $10,000 toward survivor counseling if requested. As well as seldom being fined, doctors found guilty rarely have to pay costs.

Where is the justice?

Superbugs - a Growing Threat in Our hospitals.

A recent article in the Globe and Mail stated that last year in Ontario an estimated 50-100 deaths were caused by the superbug methicillin-resistant staphylococcus aureus (MRSA). TItis bacterium is resistant to all but one antibiotic, The widespread misuse of antibiotics over the last twenty to thirty years has lead to the emergence of stronger, and more resistant strains of bacteria. Vancomycin-resistant enterococcus, (VRE) is a bacterium that is already resistant to every known antibiotic. It is feared that the latter may transfer its Vancomycin-resistant genes to the more virulent MRSA. This would put medicine back into the dark ages.

The cost of treating patients with MRSA is around $ 15-20,000, so if a major outbreak did occur it would be very costly to the health-care system.

Recently the only burn's unit in the Toronto area had to be closed down because of the presence of a superbug.

One point being debated is whether or not the general public should be informed if a hospital has an out break of one of the superbugs. It appears that most hospitals do not want to reveal if they have such a problem. I think most VoHCA members would agree that the public should be informed - just ask member Janet McDonough whose husband died tragically from contracting MSRA in Princess Margaret Hospital in Toronto.

Of all the professionals to voice their opinions in the Globe and Mail investigation, the only one to make any sense was by microbiologist Dr Alison McGeer of Mount Sinai Hospital who stated: "The truth is that the more you look for it the more you will find it. No hospital really wants to talk about it because if we talk about what's going on we're admitting we have a problem and people will worry that we're not a good hospital. But if no one knows it is going on, you can't fix it"

Health-care Fraud by MD's

The Ontario government has served notice at last that it is payback time for any doctor caught ripping off the health-care system.

A Kingston area GP has been charged with defrauding the system of about $600,000 from the Ontario Health Insurance Plan for services never performed. The new proceeds-of-crime laws will be applied, so if a doctor used $20,000 as a deposit for a house now worth $200,000, then that asset can now be liquidated and the$200,000 will be forfeited.

The campaign also targets patients benefitting from a thriving black market of illegal health cards

Health-care fraud in Ontario has been estimated as high as $300 million a year so the $6 million that the police estimate they will recover is peanuts when compared to what is being bilked.

In the US the crackdown was initiated in 1993 where fraudulent Medicare claims are estimated at $12 billion a year. Medical professionals are going to jail in record numbers. An Illinois psychologist was sentenced to five years in jail for submitting 11,000 false claims to Medicare. In 1997 the US attorney's office prosecuted 552 criminal cases of health-care fraud up from 166 in 1993. In Florida, of 345 cars prosecuted between 1993-97, 85% were convicted.
 

Cyclospora - Hits Toronto Area

Have you ever experienced stomach cramps, explosive diarrhea, vomiting, extreme fatigue after eating fresh fruit. Chances are it is because of the presence of a parasite such as cyclospora. It is believed that the fruit or vegetables become infected from human fecal matter present in water used for irrigation in Central and South American countries.

This summer an outbreak occurred in the Toronto area although the source was not identified.

Recommendation: Wash the produce thoroughly with soapy water (although there is considerable evidence that this will be only partially remove the parasite). Cooking will kill the pest but that is not possible for vegetables such as lettuce. Ionizing radiation has been shown in the US to be effective in dealing with the parasites but its use is meeting resistance by some environmentalist.
 

Helicobacter Pylori Present in Some Well Waters

The bacterium H. Pylon has been shown to be present in about 40% of the well water in Pennsylvania. This bacterium is the cause of most ulcers and stomach cancers and burrows its way into the stomach lining. Because it protects itself very well from the stomach acidity by secreting an alkaline coating, it can survive for decades. It can be treated effectively with a mix of two or three antibiotics.

A species of the bacterium that contains the cagA gene is particularly dangerous. A study in Italy showed that people less than 40 years of age had three times the normal risk of stomach cancer when the infecting bacterium carried that specific gene. Of 105 young patients who originally complained of heart burn, but were later found to have stomach cancer, more than 70% were infected with that type of H. Pylori.

Recommendation: If your water supply is not treated, have it tested regularly for bacteria and other microorganism.
 

Dangerous Reactions to Prescription Drugs

A recent study by the Health Information Partnership in Kingston showed that more than 16,000 patients a year in Ontario had bad reactions to drugs their doctors prescribed for them and about 680 die annually from "adverse drug reactions". However, it is not classified as malpractice or negligence. These figures may be low as a study carried out by University of Toronto indicated that about 10,000 deaths in Canada per year were caused by adverse reactions to drugs.

The number of people dying from aspirin and other NSAIDs (such as Ibuprofen) in the USA (16,500) was almost the same as the number of people who died from AIDS (16,685), according to a recent report in the New England Journal of Medicine. This makes it the fifteen highest cause of death in the USA.

Another study looking at all prescription drugs concluded that bad reactions to prescription drugs is now the 5th leading cause of death in North America after heart disease, cancer, strokes and accidents.

Grapefruit juice is also known to effect a significant number of common prescription drugs. For example, the level in the blood of the cholesterol lowering drugs such as Mevacor and Zocor stream can be elevated fifteen times after drinking grapefruit juice. This can increase the risk of rhabdomyolysis, a skeletal muscle wasting disease, significantly. Other drugs that are known to react with grapefruit juice are antihistamines such as Seldane or Hismanal and certain drugs used to treat hypertension. Always read the information that comes with your drugs.

Thomas Edison at the beginning of the century stated: "The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet, and in the cause and prevention of disease". How wrong he was.

Recommendation: Avoid taking drugs if you can.
 

Measuring Effectiveness of Health-care

We are often told by our politician's that Canada has the best health-care system in the world. My question to them is "how do you measure the effectiveness of a health-care system?" I have not seen much thought given to this question. Although the amount of money spent does have some influence, it is not the only factor.

If longevity is used as the marker then clearly the most spent per capita does not guarantee you the top spot. The USA with the highest per capita expenditure on health-care is way down the pecking order when it comes to longevity. The Japanese with much less spending are usually first or very close to the top which intrigues me having lived there for several years. I have spent many hours comparing the Japanese to Canadians to try to explain why they live on average longer than we do. I think by comparing lifestyles in different countries we can learn a lot about the important factors that affect health.

If one was to compare the two countries on factors believed to be important then one would expect Canadians to live longer. We live in a huge uncrowded country with some of the cleanest water and air in the world (so we are told), two very important factors in the health of a nation. It has been well documented that nothing has more effect on increasing the longevity of people in developing countries than providing them with clean water. The Japanese on the other hand live in one of the most crowded spaces on earth. About 13 times as many people live in Japan as live in Ontario, in a space one sixth the size. One would assume that in crowded places it is less healthy because bugs and diseases can be passed on much more easily. Accommodations are much smaller, again allowing germs to spread more readily. Sewage and garbage disposal are major problems (they always laugh when they hear there is no space in Canada to bury garbage?). Also, the stress levels in cities like Tokyo is extremely high - try commuting to work on the subway for several hours each way each day in the peak periods. In terms of natural resources, Japan is a poor country compared to Canada, its only real resource being its people. This also contributes to a more stressed out society than Canada. Another interesting fact is the smoking rate in Japan is about twice that of Canada.

Then why do Japanese live longer?

The answer I think is exercise and diet.

During my two year stay in Japan I was encouraged to exercise every day at the company facilities. At the time of our return to Canada both my wife and I were the finest we~ve ever been without an ounce of fat on either of us. The food in Japan is incredible - always fresh and low in fat. Lots of seafood, soy-based products, noodles, fresh fruit and vegetable, and of course rice, are eaten daily. One other product which is consumed in huge quantities is green tea which has recently been shown to be very good for your health. The area we lived in, Shizisoka, is famous for its green tea and its citizens drink two or three times as much as the rest of Japan. The area has the lowest cancer rates in Japan and particularly striking is the lung cancer rate which is less than half of the rest of Japan even though the smoking rate is about the same. Compared to Canada this area has only about 1/3 of the lung cancer rate of Canada even though their smoking rate is double.

I often wonder why the Canadian Cancer Society does not do more to publish this type of information. Recent studies have shown that green tea can have a protective effect against lung and other cancers and while I prefer people not to smoke, I think they should be encouraged to consume foods that may reduce their cancer risk.

The question of crowdedness also intrigues me. Some studies have shown that crowdedness may be good for you. One study showed that children from large families are on average healthier than from smaller ones. The explanation is that the kids are more likely to be exposed to a wider variety of germs in larger families and thus build up their resistance to disease. Perhaps we are too occupied with cleanliness as shown by the new antibacterial products that are appearing daily on our supermarket shelves. In the long term what will be their effect on the health of our society?

Gord Lever
 
 

If you have any comments about the articles in this issue or would like to submit a health-related article, please contact VoHCA.

Patient Pulse
is Published by VoHCA
Voices on Health-care Concerns and Accountability
Box 27018 Gardiners P0
Kingston ON K7M 8W4
Tel:(613)389-0916
Fax: (613)3894739

Global Survey to Patient's Rights to Their Medical Records

Thank you for agreeing to complete this survey about your experience with a health care system outside Canada and the US. One of the largest complaints of our group, a patients' advocacy group in Canada, is that our members have limited access to their own medical records. In order to get copy of records, one must go to the medical institution, put tabs on pages that are to be photocopied and then pay per page for someone else to photocopy the records.

We had a woman from France join our group who told us of a wonderful system in France where the doctor wrote his/her notes on carbon paper in triplicate. He/she kept a copy, as did the patient, and one was sent to the government. We are attempting to understand what Systems are in place in other countries So that we can prepare a compelling argument asking for change in the reporting system in Canada.

The survey should take five minutes to complete. Please return the completed survey in the following ways:

1. Email: innovacan@hotmail.con
2. Fax: (613)389-4739
3. Mail: Box 27018 Gardiners P0 Kingston ON K7M 8W4 Canada
    or click on   Records Survey

In which country have you received medical attention?

What level of care did you receive? Please mark and X beside all that apply.

I visited a family doctor
I visited a specialist
I stayed in a hospital
Other:

After this visit, what sons of records did you get? Please mark an X beside all that apply.

I immediately received a copy of the doctor's notes
I was sent a copy of the doctor's notes
I received a summary of the doctor's notes
I received a very detailed invoice outlining every medical expense
I received a high level invoice with only summary expenses
I received no documentation

Did you request this documentation, or does it go automatically to all patients?

Do you have any other generic comments about your access to your own health care records in this country?

Do you know from others what the procedure is? Are patients entitled to see their records and is it easy to do?

Are records given immediately after visits or are they only sent if asked for?
 

How did you pay for this use of the medical system?

It is covered by a medicare type program
I paid for it
My insurance company paid for it
Other:

How would you describe the medical system in this country?

Mainly medicare
Two tiered system, part government run, part privately run
Mainly privatized system

 

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