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Heart surgery shakeup pledged

Minister plans quick fix for beleaguered program

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MANITOBA'S heart surgery program is going under the knife for a complete overhaul, Health Minister Dave Chomiak vowed yesterday.

In an interview on the heels of reports that two more patients in Winnipeg have died waiting for heart surgery, Chomiak promised to act on the recommendations of an independent review that is due within weeks.

"This is a golden opportunity to say, 'That's it,' " Chomiak said. "I'm not just fooling around.

"There have been problems with the structure of cardiac care for 20 to 25 years and I have said we'll move on those structural changes. Period."

Manitoba's heart program has been plagued by institutional rivalry and bitter infighting for years. It has been difficult to recruit surgeons and the program has suffered as a result.

The overhaul is expected to finally end decades of rivalry over surgeons and cases between the Health Sciences Centre and St. Boniface General Hospital. Heart care may still be delivered at the two hospitals, but the program would have administrative independence from both.

There have been five deaths of patients waiting for heart surgery since last July. Three of the deaths were reported last winter, triggering the minister's decision to order an independent review.

The two latest deaths occurred since the review was ordered last winter, and they make the overhaul even more imperative, the health minister said.

Normally, there should only be two deaths a year of people waiting for heart surgery, based on the number of surgeries -- 1,200 -- performed annually in the province.

One of the two patients, a woman, died after being bumped three times in a week following her admission to hospital for an urgent heart condition.

The other death involved a patient who it was determined did not need surgery immediately, but who died at home suddenly without warning.

Two steps will be taken almost right away, Chomiak said.

One of the two surgeons from Halifax who has been flying occasionally to Winnipeg since the winter to help cut through a backlog of cases will be moving here permanently. Dr. John Lee will keep flying in to do surgery from his home in Halifax throughout August, but in September he is expected to hang his shingle in Winnipeg.

Lee and another surgeon from Halifax performed 48 surgeries in Winnipeg this winter and spring, cutting the waiting list from 150 down to 99 patients by June.

And Chomiak said measures will be taken to reduce bumping, the practice of repeatedly postponing surgery when more serious cases come up.

"I've asked the Winnipeg Regional Health Authority to put into place whatever mechanism they can so this does not happen. There will be some bumping, but repeated bumping should not be tolerated," Chomiak said.

The review Chomiak is vowing to act on is being headed up by Edmonton heart surgeon Dr. Arvind Koshal.

Koshal said yesterday in an interview he's confident he can fix the heart surgery program here so that it becomes one of the best in Canada.

That would mean no needless deaths, he said. However, there will always be some deaths on any heart surgery waiting list, he added.

"We've looked at everything, and the report is almost done. It's 45 pages and it's not pie in the sky, and if they implement it you will have a very good system in Manitoba," Koshal said.

He said the kinds of solutions he will recommend to Chomiak aren't new.

In fact, they are part of a series of reports commissioned by governments in the 1990s on cardiac care problems in Winnipeg, including a watershed report by Queen's Bench Justice Murray Sinclair that followed an inquest -- the longest in Canadian history -- into the deaths of children after heart surgery.

Apart from the Sinclair report, the documents were left to gather dust, which is the main reason the heart program is in such trouble now, the doctor said.

"Fortunately, this time the minister said he will implement this report," Koshal said.

The key is to streamline the system so waiting lists are managed better, and to address every other aspect of care, from diagnosis to recovery, he said.

"There are some very good people there, but you need a system that allows everybody to perform at their top level."

Sources inside the system say heart care in Manitoba is a political minefield known for bitter tensions among doctors and other health-care professionals. For years, the program's reputation spoiled its chances for recruiting top doctors.

Once the program is fixed, doctors will want to come to Winnipeg, Koshal promised.

He suggested the current system also lacks the co-ordination needed to foster public confidence and quality of care, key factors that will also change.

"The main focus of this report is that it is patient-focused; that is the most important thing about this report -- it will cater to patients and their families," Koshal said.

Chomiak said yesterday he'll follow the doctor's orders to the letter.

"What I'm telling you is I am going to implement whatever Dr. Koshal says. If he says one site, one program, I'll implement that. If he says three sites, three programs, I'll implement that," Chomiak said.

Koshal is a key member of the Edmonton program, a heart-care institute that does more heart transplants than any centre in Canada and has succeeded in cutting its mortality rates by streamlining its operations.

Koshal put together a team of heart experts from Alberta and the Ottawa Heart Institute to write the prescription to reconstruct the program here, he said.

"What we are going to suggest is very similar to what has happened in other areas of Canada, including ours," Koshal said.

Koshal's report is due before the end of August.

alexandra.paul@freepress.mb.ca

Republished from the Winnipeg Free Press print edition August 2, 2003 $sourceSection$sourcePage

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