A Winnipeg brain surgeon, who was hired five years ago to establish a groundbreaking epilepsy program, has decided to leave Manitoba because he says the province has failed to fulfil its promise to fund it.
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Posted: 7:00 PM Sep. 22, 2021
Last week a young neurosurgeon informed me he was leaving Winnipeg for greener pastures. When I first met him, he was thrilled to be recruited to run an epilepsy surgery program. That was five years ago. The program was never funded and he finally had enough of waiting to do the work he came here to do.
Dr. Demitre Serletis says he has no choice but to move to the U.S. in the new year.
His departure is the latest in a list of problems plaguing the province’s health-care system, from hospitals having to send ICU patients out of province to nursing shortages and a backlog of more than 100,000 postponed surgeries and procedures.
The neurosurgeon hopes that speaking up about the adult epilepsy surgery program may motivate the province to act.
"It's an important cause close to my heart," said Serletis, who specializes in neuroengineering. He led the formation of a multidisciplinary team that developed a proposal for comprehensive pediatric and adult epilepsy services. He was honoured by Doctors Manitoba this year for his work, which has helped to recruit other specialists to Manitoba.
Serletis said he was hired to replace a pediatric neurosurgeon who had left, and to bring in a strong mandate for developing an epilepsy surgery program.
"... In the last five and a half years, we have made significant improvements.” – Dr. Demitre Serletis
"It's not typically the case that we have to start from scratch and build a program. But the higher leadership said, 'let's start with a surgeon' after having had at least a dozen neurologists over the years leave the province," he said Wednesday.
By starting with a surgeon, "it gives some reassurance to neurologists that there might be a commitment towards actually developing a program like this," said Serletis. Epilepsy is a unique specialty that's like a "team sport" that requires a neurosurgeon, neurologists, radiologists, electroencephalogram (EEG) technicians and dedicated nurses, he said. When he arrived, the adult epilepsy unit was located on an orthopedic ward where nurses weren't trained in seizure management. On the pediatric side, the last neurologists who specialized in epilepsy had left the province, he said.
"I came in that context and in the last five and a half years, we have made significant improvements," he said. "This is a team sport and what I did was catalyze this into a common movement with a comprehensive proposal," he said.
"The capital came in from private donors and from government who responded favourably to a comprehensive plan, but there was no mention of any further development or support from leadership," said Serletis.
"I don't want to give the sense that the epilepsy program didn't develop," he said. "I was able to deliver some of the surgeries that have never been done in this province," he said. If the operating funds had been in place, Winnipeg could've been a "great centre of excellence" instead of having to now send adults out of province for epilepsy surgery.
"I know everybody is equally frustrated. It's not just myself," the neurosurgeon said.
"We estimated in our proposal that there must be over 6,000 patients who would be eligible for surgery, and there's about 19,000 patients with epilepsy in the Winnipeg Regional Health Region. These numbers are staggering," Serletis said.
"We had delivered all of these statistics to leadership," he said. "Epilepsy surgery is one of the most cost-effective strategies in modern times. That's not an overstatement… Provincial programs have been able to recuperate the costs within two to three years of this type of investment," Serletis said.
"I know everybody is equally frustrated. It's not just myself.” – Dr. Demitre Serletis
"The capital funding for the adult program was approved but the operating costs were not. And in that time frame they lost a number of neurologists," he said.
"It's a lost opportunity. I genuinely feel it would have done very well. Where we're situated in central Canada, there's a large population of underserved patients."
Serletis said he doesn't know where or why the program's operating funds from Shared Health got hung up.
"The funny thing is, they're the ones who asked for it. That's what I was hired to do."
Shared Health said it won't comment on Serletis's departure, but noted "staffing turnover in and of itself is not unusual." When asked about the fate of the adult epilepsy surgery program, a spokesperson said in an email they've announced an expanded adult epilepsy monitoring unit that "underscores our commitment to improving neurology services in our province, which includes a long-term plan to develop an adult surgical program."
“It's a lost opportunity. I genuinely feel it would have done very well. Where we're situated in central Canada, there's a large population of underserved patients.” – Dr. Demitre Serletis
In the new year, Serletis will be at Cleveland Clinic, a state-of-the-art epilepsy centre.
"If things had moved ahead, I don't know that we would have taken this opportunity, to be honest," he said.
"We have our kids in schools and we loved Winnipeg. It's a fantastic city. Fantastic hockey team. We're Jets fans for life," said the doctor who moved to Winnipeg from Arkansas.
"I'm very excited to be going, but it's very bittersweet. I have really high hopes that this type of program will continue."
Manitoba could be saving a lot of money and grief if, like many other provinces, it had an adult epilepsy surgery program, said Dr. Dan Roberts, an ICU doctor who is the acting co-head of neurology at the Health Sciences Centre.
"A surgical intervention in somebody like that often will control the seizures, or (end) them and they can come off medications and it's a completely different life for them." – ICU Dr. Dan Roberts
"Imagine if you're a 25-year-old person with epilepsy and you're on four or five medications, you're seizing every day or two and you're occasionally developing uncontrolled seizures, and have to be admitted to hospital or an ICU," Roberts said.
"You can't work. You can't drive a car. You can't be truly independent and often family members have to devote a lot of time to the care of these individuals," he said. Most people with epilepsy respond to one or two medications and they can get along reasonably well, but some don't, said Roberts.
"A surgical intervention in somebody like that often will control the seizures, or (end) them and they can come off medications and it's a completely different life for them," said Roberts.
Provinces like Saskatchewan that have adult epilepsy surgery programs are set up to serve their own populations, the ICU doctor said.
"It's always much harder for patients in Manitoba to access surgical programs like this, or transplant programs, in other provinces," he said.
"The waits can be tremendously long or they actually never access it. We've got a 10-year backlog of cases, even if we had a program."
After 20 years of reporting on the growing diversity of people calling Manitoba home, Carol moved to the legislature bureau in early 2020.