News

Ming Quon was at home, standing under a warm shower late on Jan. 24, 2007, when a sudden, sharp pain in his head nearly knocked him over.

He yelled for his wife, May Quon. Just a few hours earlier, he had been doing the cha-cha-cha with her at a dance class.

By 11 p.m., he couldn't make it to bed; he was staggering, his face as white as a sheet of paper.

"I usually don't have headaches, I knew something was wrong," Mr. Quon, 55, said in an interview from his home in York Region, north of Toronto.

"It felt sharp and extremely achy."

An ambulance pulled up to the front steps of their suburban brick house. Mr. Quon, who teaches electrical technology at a community college, was taken to York Central Hospital, where he was diagnosed with a subarachnoid hemorrhage, caused by a ruptured aneurysm.

But that was only the beginning of his troubles.

More bad news was to come: No Ontario hospital that provides neurosurgery could take him.

Unwittingly, Mr. Quon found himself smack in the middle of a health-care shortage, one that has forced 164 patients with broken necks, burst aneurysms and other types of bleeding in or outside of the brain to Michigan and New York State hospitals since April, 2006.

That includes 69 patients sent so far in fiscal 2007-2008, according to Health Ministry figures.

Although Ontario has the worst problem by far, it is not alone.

British Columbia has sent four patients with spinal-cord injuries to Washington State hospitals for care from May to September, 2007, though the recruitment of more staff and opening of new beds have helped alleviate the problem. Saskatchewan has sent patients to neighbouring provinces, including Alberta, for specialized neurosurgical services.

In Ontario, patients face barriers to receiving care at every turn.

There is limited access to teleradiology and operating-room time. There are too few intensive-care beds, a short supply of neurosurgically trained intensive-care nurses to staff them and too few neurosurgeons.

For Mr. Quon, it was "a scary thing," said his wife, a registered nurse who works at an insurance company.

Ms. Quon said her husband spent about 15 hours in emergency as staff worked to find a hospital that performs neurosurgery.

Bruce Harber, York Central Hospital's president and chief executive officer, could not comment on the case, due to patient confidentiality.

But he wrote in an e-mail: "We at York Central Hospital work closely with CritiCall [an emergency-referral service for physicians] to ensure that these patients are transferred to the most appropriate and available regional centre."

When Mr. Quon was finally referred to a Buffalo hospital, his wife raced home to grab passports, threw on a pair of slacks, forgetting to change out of the pajama top she was still wearing.

Treatment at Millard Fillmore Gates Circle Hospital came in the form of neurosurgery about 17 hours after Mr. Quon suffered his subarachnoid hemorrhage.

He underwent a craniotomy, an operation to open the skull, then had a small metal clothespin-like clip placed on the aneurysm's neck, to halt its blood supply.

He also had two endovascular coil embolizations, a minimally invasive procedure where a long, thin tube is inserted into the femoral artery near the groin, up to the aneurysm.

Small platinum coils then fill the aneurysm to prevent it from further expansion and rupture.

Michael P. Hughes, vice-president of public relations and government affairs for Kaleida Health, which includes Millard Fillmore Gates Circle Hospital, could not speak about Mr. Quon's case, due to patient confidentiality, but said his institution is seeing an increasing number of Canadian patients.

"I'm glad he had a positive outcome," Mr. Hughes said.

Chris Wallace, head of the division of neurosurgery at Toronto Western Hospital (part of the University Health Network), said in Mr. Quon's case the wait to obtain neurosurgery did not make a difference to his outcome because he did not have a second cerebral hemorrhage.

"He's very brave and so is his wife," said Dr. Wallace, a neurosurgeon who has seen Mr. Quon since he returned from Buffalo.

"I'd be crying if the delay had led to a worse result. In this instance, it didn't."

In an effort to stem the tide of patients being sent to U.S. hospitals, the University Health Network has been provided an additional $4.1-million by the Ontario government to do 100 more neurosurgical cases by October, 2008.

Indeed, an expert neurosurgery panel report done on the shortage of neurosurgical services and authored by James Rutka, chairman of the division of neurosurgery at the University of Toronto, made 21 recommendations to the Ontario government in late December.

That 84-page report recommended a two-phase approach: allocating additional neurosurgical services to one hospital to address emergency out-of-country transfers immediately, and increasing capacity in more centres in Ontario.

Alan Hudson, head of Ontario's waiting-time strategy and a former hospital president and neurosurgeon himself, struck the panel when he heard of the neurosurgical service shortage.

When told of Mr. Quon's case, Dr. Hudson said: "We've given some fairly detailed advice to the government for exactly this reason. We're looking forward to the government's response to the expert panel report."

Health Minister George Smitherman's press secretary, Laurel Ostfield, said "the government is currently awaiting further advice from the team who drafted the report on the best way to use the recommendations in our combined efforts to improve patient care for Ontarians."

Over the past three years, she said the government's track record has been to implement 80 per cent of recommendations received from expert panel reports.

As for Ms. Quon, she and her husband are not angry, "just very disappointed."

There were all sorts of problems to deal with upon their return, including threatening calls and notes from bill collectors, hounding her to pay various U.S. hospital bills.

The Ontario Health Insurance Plan, which covers all costs of emergency surgery and the hospital stay, has since dealt with the matter.

In all, Ms. Quon said her husband's treatment, including surgery costs, diagnostic imaging and a hospital stay of more than a month, was about $250,000 (U.S.), according to a Health Ministry letter she received.

That doesn't include the costs she absorbed - $5,000 out of pocket to stay in a Buffalo hotel for more than a month, which is not covered by OHIP.

When they returned, it was difficult to get back into the health-care system.

She said the province should have a designated person who deals with patients who receive out-of-country care so things run smoothly upon their return.

Mr. Quon, meanwhile, has yet to return to work. He has trouble with short-term memory, is easily distracted and frustrated.

He has little memory of what happened after the subarachnoid hemorrhage, other than the initial pain he felt in the shower and sketchy images of nurses walking U.S. hospital hallways.

"It was hard on my family. The mental anguish and all that," Mr. Quon said.

"For me, I was just delighted to be down there."

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'ALARMING TREND' OF PATIENT TRANSFERS

James Rutka, chairman of the division of neurosurgery at the University of Toronto, was appointed by the provincial government to head the expert neurosurgery panel. In his just released report, Dr. Rutka noted there was an "alarming trend" of sending Ontarians out of province for neurosurgery care.

"It is poor patient care to transfer people who need emergency care out of province or to make anyone who needs neurosurgery wait longer than they should and risk doing them harm," Dr. Rutka wrote in his 84-page report. Transferring patients out of province should only be done in exceptional circumstances, he said.

Some observations in the

report:

About 65 neurosurgeons provide neurosurgery each year to more than 30,700 Ontarians in 13 hospitals in larger urban areas.

Neurosurgical conditions are a major cause of disability, morbidity and mortality that results in high costs to individuals, their families and society.

Dr. Rutka made 21 recommendations to fix the problem, including:

The heads of 13 hospital neurosurgical units should develop clear and simple criteria for determining when a patient needs a neurosurgical consultation and may need to be transferred to a neurosurgical unit. As well, they should develop a simple protocol for looking after minor head injuries in the emergency room. This information should be provided to every hospital in Ontario and posted in emergency rooms.

Hospitals with Level 3 and 4 (the most acute) neurosurgical units should dedicate resources, including operating rooms, equipment and staff for unplanned emergency cases.

Neurosurgical centres should provide updated bed information to CritiCall (an emergency-referral service for physicians) electronically at least twice daily.

The Ontario government should increase its full-time neurosurgeon-to-population ratio from 1 per 187,077 to the more appropriate level of 1 per 150,000. If that ratio were accepted, 15 additional neurosurgeons would be required.

Lisa Priest