TOWN OF SMITHERS
Condensed Questions and Answers of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m.
Council Present: Staff Present: Jim Davidson, Mayor Wallace Mah, Corporate Administrator/CAO Norm Adomeit, Councillor Jason Llewellyn, DCAO Cathryn Bucher, Councillor James Warren, Corporate Administrative Assistant Cress Farrow, Councillor Leslie Ford, Financial Administrator/Collector Bill Goodacre, Councillor Mark Allen, Director of Development Services Andy Howard, Councillor Les Schumacher, Fire Chief Marilyn Stewart, Councillor. Penny Goodacre, Recording Secretary.
Panel Representatives Present: Linda Mangnall, Moderator Malcolm Maxwell, CEO, Northern Health Authority Dr. David Butcher, VP Medicine, Northern Health Authority Debbie Tennant, Medical Laboratory Technologist, Bulkley Valley District Hospital Ron Miller, Manager of Laboratory and X-Ray Services, Bulkley Valley District Hospital Cor van der Meulen, Casual X-Ray Technician, Bulkley Valley District Hospital Dr. Lothar Schaefer, Anesthetist, Bulkley Valley District Hospital.
Media Present: C. Lester, BVLD, and M. Pearson/H. Ramsey, The Interior News. Public Present: 753 signatures, attached to and forming part of these minutes. There was an estimated 800 people present, although not all were given the opportunity to sign in.
SESSION #1 QUESTION AND ANSWER PERIOD 1. Mayor Sharon Hartwell, Village of Telkwa: I and everyone else here want to know what is going to happen to the lab. I sit on the Northwest Regional Hospital District and we signed a “Memorandum of Understanding (MOU)” along with the NHA and other five in the area, and some of the concerns we had in no particular order: funding, moving of equipment, moving of services. We were very opposed to that and we have all those things in the MOU and here we stand tonight. The BVDH is important to all of us in the region and unfortunately Mayor Smith had to leave, she couldn’t put her comments forward. We’re still concerned about 24/7 health care. I’m just here to say I am very distressed at the comments and very disappointed.
2. Mark Adamson, Smithers: My concern is that we are really good at producing babies here and without a surgeon on call, my understanding is there are no deliveries allowed. So if we don’t have a surgeon here all the time, people have to go to other cities to have their babies; which is totally unreasonable. So that is a problem.
Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 2
Another comment, as a society, where the governments made the decision to not be in debt, which I totally support, and to have a balanced budget. And yet, as a society, all we ever do is complain about cuts. You know we are cutting funding for hospitals, highways you name it. But the real problem is: are we willing to pay more taxes to support our hospital? And you have a difficult position, I don’t envy you because you’re given a dollar amount and you have to balance that budget. But maybe as a society we need to look and say “okay, hey let’s all pay a little more taxes if it is directed to a certain place”. So just a comment that we are a very complaining society. Response by Malcolm Maxwell, NHA: I would like to respond, just quickly to the question about obstetrics. But basically, there are quite a number of family physicians and I would ask Dr. Moisey to help me with this. There are quite a number of family physicians who provide obstetrical care, who also have special training in doing c-sections. That is one specific area of surgery. So the problem that can arise though, if the hospital doesn’t have any other surgical activities going on, then the physicians who provide anesthesia don’t have enough chance either, it ceases to become worthwhile for them to continue to provide anesthesia. And they also don’t get a lot of skilled practice at doing it.
So it is important to keep, if you are doing a lot of c-sections in a hospital, even if you have the family physicians doing the sections, you need some surgical activity around, so that you have doctors doing the anesthesia side as well, so that when a lady needs a c-section in a hurry, you have both the G.P. surgeon and the anesthetist to provide that.
3. Brian Northup, Smithers: I would like you to take a message back to your Board, who, I am a little disappointed are not here this evening. You’re undertaking heart surgery to our community. And I believe you that you are trying to do that heart surgery without anesthetic or giving us anesthetic, and kind of hoping that we were asleep. We expect the NHA to lay their cards on the table, tell us what they are going to do, for and with our community and outline that plan thoroughly. Because that has not happened since the inception of the NHA. And when I was on Council, we asked for representation from the NHA and poor Paul Vieira was the only spokesman who attended. We want answers to our questions and we want a clear path of the future for our hospital, it’s our heart.
Response by Malcolm Maxwell, NHA: Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 3
Let me give you the 30 second version of that, because that is fundamentally why I came tonight. And maybe I had too much presentation material. So here is the 30 second version of the future of the BVDH: The BVDH will continue to provide in-patient care for acutely ill people in this community. It will continue to have a radiology service. It will have expanded equipment so that if your radiologist is away or needs to get an image somewhere else, you will have modern technology to do that. It will have expanded skills in obstetrics and surgery in trauma support of your nursing staff, and you have a good nursing staff. You got an old, ugly, scrappy building and I honestly don’t know what to do about it. Because I don’t have enough money coming at me to replace all the old hospitals in northern B.C. but clearly some improvements are needed. I terms of emergency care, we absolutely must have a 24 hour emergency department in a hospital for a community of this size. So all of those things are fundamental to our planning for the future. And Paul, and Suzanne Johnston and David and I, will all be happy to speak to Council or the Health Watch Committee on that. There are many other pieces that I don’t know four years from now which might be the best computer system to buy. But in terms of providing the patient services, medical coverage and the range of care at the hospital, we don’t see a big change from what we see today. Unless we are able to expand some things with more visiting surgeons than we are seeing right now. Okay? My point with respect to the building is simply that I would like to see the patients, the nurses, the physicians, and all the staff that work there every day have something that wasn’t built 45 years ago. The way we do things today is a lot different then how we ran hospital services a long time ago. So what we hear now is staff, trying to work in the emergency department that doesn’t meet their needs as well as it should. I wish we could fix that. With respect to the lab services, hematology and clinical chemistry, all of the services that are required to respond to a physician’s need for information about a patient within 24 hours will be provided in your hospital. There are some microbiology tests that take 2, 3, 4 days to turn around. We will choose the solution for those tests with the following things: with your medical staff, with the pathologist, provides results that meet their needs to provide the best care for the patient. That provide the best result in terms of accuracy, I don’t want the tests to be right 85% of the time if I can have it right 98% of the time. That does incur a cost, cause you can’t ignore it completely, but the first two items will be dealt with first.
4. Phil LePage, Smithers: I have a whole pile of questions, but given the line up, I’ll keep it to just one. Mr. Maxwell you have a slide that shows you anticipate 15-20% more hospital Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 4
care visits in the north. I would like you to take that to Gordon Campbell and show him, that as a result of that, we need 15-20% more funding in the north, not 15-20% more cuts. You cannot balance your budget by cutting the guts out of the north. In a crappy year, 2002, this valley provided $61 million in stumpage revenue alone to the south. Response by Malcolm Maxwell, NHA: Just so that you understand, NHA like other health authorities in other parts of B.C., we get a budget to work with. It is adjusted in various ways, but our Board has looked at what the issues are and we are putting forward arguments based on the different health status of northerners. And it gets to be a lengthy argument given all of the different views in the province on how health care dollars should be divided up. But we are very concerned that the health status of northerners be recognized in the allocation of health dollars. P. LePage: we would like to hear that message loud and clear sent to Gordon Campbell. Thank you.
5. Carol Warren, New Hazelton I would like to address the issue of mental health care in our area. My son was recently hospitalized in Smithers here, waiting a place, a bed in Terrace. But Terrace closed down because they only had one psychiatrist, and they are supposed to be our regional psychiatric health care. My son was transferred to Prince George but to add insult to injury, because he was not serious enough to be committed, he was not able to be transferred by ambulance, so we took him there. Today he was discharged from Prince George and we have to get him home again. I want to know what is going to be done about securing some mental health care for our families and relatives. And I also want to know what is being done to educate and train our nurses here in the hospital, because they are not prepared to act as a designated facility nurse for mental patients. They need training and it is frustrating, so they can feel safe and our family members can be taken care of in our community. Response by Malcolm Maxwell, NHA: Thank you, about, one of the areas of care that we are clearly inadequate in is where we have raised it, based on the advice that we have had from the medical staff in the region. We have only about half of the number of psychiatrics that we should have to meet the basic needs that we see out there. We do have some family physicians who have an interest in psychiatry pitching in but psychiatry is our most pressing recruit for positions at the moment. The position that left Terrace was recruited to Cape Breton, Nova Scotia to a large regional hospital there. We are doing, advertising nationally and internationally, and have pushed psychiatry back to the top of our recruitment priorities in the north. But what we are left with, without enough psychiatrists, is Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 5
when someone is acutely ill then they can be managed perhaps in their community hospital for a little while. But exactly as you say, the nursing staff don’t have the skills and are handling many other needs. Family physicians are not well prepared to manage that care and carry out their other responsibilities. And we’re left with a situation of trying to manage referrals to either, if it is in the east to Dawson Creek or to Prince George. To manage those patients and when we can’t do that, then the BC Bed Line will help us find a place in the south. But there is a very dire shortage of psychiatrists in the north; we don’t have adequate care capacity there. I’m very sorry for the experience you had with your son, that’s not, the health system shouldn’t operate that way and it didn’t meet your needs.
I have asked our staff to have some discussions with BC Ambulance so we understand what the patient transport issue is there as well. I am not happen with the way that service is.
6. Jane Peruniac, Bulkley Valley I am not a redneck and I don’t drink and I use my seat belt. I have a few comments that I would like to make and I really do have questions at the end. One of the things that I would like to comment on here, looking at the website, and looking at the government’s announcement of the investments they have made in health care in the north, I would like to review them.
I would like to start in Prince George, a $50 million investment in the Prince George Hospital; I’m not going to quibble about that. That’s going into the training of northern doctors and their own M.R.I, machine, I will not quibble with that. I think that we as Bulkley Valley residents will benefit from that investment. Let’s move over to the west; let’s look at Terrace. Terrace renal dialysis centre, okay I won’t quibble with that either. We have a lot of people we know who are driving to Prince George weekly to get renal dialysis. I think that is a good investment.
Now, let’s move on to Kitimat. Let’s talk about Kitimat as the centre of northern British Columbia, has a brand new $30 million hospital in Kitimat, which is one hour from Terrace, from a major hospital and another hour from Prince Rupert. What a wise and brilliant investment. What about a $15 million upgrade to that hospital and a $15 million upgrade to the Smithers hospital?
Let’s move on to Smithers now. What did we get? We got a $300,000 seismic upgrade. Oh cut me a break! Who in this room, who in this room can tell me the last time that Smithers suffered from a major earthquake? Who can tell me, the memory in this room goes back 100 years. Did they get their “S’s” in San Francisco and Smithers mixed up? I mean that is absolutely disgusting and let me tell you why I am personally so disgusted by it. It says that we get no diagnostic equipment here and I had to use the Smithers Hospital in a way I Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 6
never expected a year ago.
I had to go in there with a brain problem, and in my small circle of people that I know, four others had the same experience. I had to go in there and the diagnostic ability of the doctors, if you have a brain problem here in this town is the following: Do you know where you are? Do you know what the date it is? Do you know who the Prime Minister of Canada is? Do you know who the President of the Unites States is? Do you know these things and if you do, then the doctors know two very important things: 1) you’re alive and 2) your brain seems to be working. Why you are seeing in triplicate nobody knows. They don’t understand it and are not sure. And what happens next?
Well, next you are loaded onto a stretcher in the back of an ambulance and you have a two-hour ride from hell to Terrace to the closest CAT Scan machine. And if you weren’t injured when you got into that ambulance, believe me you are injured by the time you arrive.
You’re talking time when it comes to brain injury, you are talking seconds, you’re talking minutes and all four people, I can tell you, all had to be MEDEVACed out. And we all lived thank goodness to tell the tale. But where did we have to go? We had to go down south, all of us, that’s the truth.
So now I have two questions that I want to ask you. One is, whether the NHA will write an extremely detailed and serious letter to NAV Canada, which is thinking of cutting back services at our airport. Those services are needed for our 190 MEDEVACs flights that our servicing us. Without them we die.
My next point I have, my next question that I mean seriously, this is not a joke. I mean, will the NHA, and I will come to a meeting and put this motion forward if I need to. Can we formally ask to adopt St. Paul’s Hospital into the NHA because that is our hospital that services us, that is what has happened with these cuts. That is where we go to save our lives, that is where we go to get diagnostic services. The doctors in this hospital are over worked trying to diagnose things with no equipment, except that they get a seismic upgrade. Isn’t it nice to have an emergency room that has new paint, that is wonderful, but what the heck does it do for the rest of us, who are injured and they can’t tell us why? And we’re not mad, we are scared, we are really scared.
I have one more thing; this is a promise I am asking for you, I’m asking a promise. If you are finding it very difficult to stand up to the government need to balance its budget. If you as the NHA are feeling weak in the knees and it is really getting difficult, I want you to promise that you will call on us. Because we will march, we will lock ourselves to the hospital door, we will do what’s required, we are not wimps and we are ready to stand. So you call on us, I want that promise. Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 7
Response by Malcolm Maxwell, NHA: I was thinking by the sounds of things, we should get a cement truck and some bricks and start working on a new one. I would like to comment on a number of the points made.
One, it does really concern me when I look at some of the capital expenditures that I’ve seen. We have a mix of old and new hospitals across northern B.C. that, I’d be lying to you if I told you all of it makes sense to me because not all of it does. I can tell you that we’ve tried to review over the last year and a half, because we’ve had a team of architects, engineers, and electrical engineers, tramp through every one of those hospitals and look for electrical, mechanical, and other problems. And they will work with the Regional Hospital Districts to try and identify what the monies that have contributed from the communities to the Regional Hospital District and the money that we have for capital. We do want to make the very best decisions we can because we got a lot of hospitals that need improvement and we’ve got some that need replacement.
Another comment I would like to make is, it is always difficult when people have to travel for care. We can reduce that some; we can keep more patients in the north that have been kept in the north in the past. But keep in mind that also communities the size of Kamloops and Kelowna and Prince George, which have more medical specialists and I will still have to send about one patient in five or six to the teaching hospitals in the south. It is not convenient, and sometimes it is costly and sometimes it is frightening but the technology we have in modern medicine can also do a lot of wonderful things for people but it can only do them in some of those centers. So we can bring some care back to the north, and we should do it where we can. But we can’t bring 95% admissions back to our community hospital.
7. Ghia Labonte, Bulkley Valley I would like to know if our local M.L.A. Dennis MacKay is in the room? I think it is a public disgrace that he has not attended this meeting, unless he happens to be hooked up to intravenous in our public hospital.
Personally I would like to say that as we have all seen with the government lately and all their advertisement campaign, which I might add could have been spent in health care, stats can be skewed any way you want them to be skewed. So to put stock in your lovely power point presentation, really doesn’t cut it. What we do and what we say are two different things.
And my questions is: with your stats, you say that the lab could send out quite easily, based on costs and the needs of consulting physicians, some of the labs could be sent out. Have you ever had your labs lost, every time they got sent out? You would understand that, yes maybe you don’t need them in 24 hours but within a 6 week period might be nice! Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 8
I would also like to say that the stats, your stats say they can be sent out, but the staff of our lab tests, who I choose to believe, for obvious reasons. They do more labs here than they do in Terrace. And so my question then is: were you insinuating that our lab can’t get their results right 85% of the time and that they should be getting them right 98% of the time?
I would also like to say about your stats, our life expectancy is shorter and perhaps, I might suggest to you, it is not because we are all drunk drivers slaloming around moose, but it is because there is not a hospital on every street corner like there is in the lower mainland. And having worked in the lower mainland as an emergency care worker, I know that sometimes the difference between life and death is because we are within 10 minutes of a hospital.
Response by Malcolm Maxwell, NHA:
Let’s be clear about what I said there, if it wasn’t clear or if I offended anybody, I am sorry but here are some things that are true. I thought you wanted the information. One of the reasons that you very badly need an emergency care capability in your hospital is if somebody says, well what is different from BVDH than a small hospital in the south? One of the things is different is that is sees more patients who suffered in motor vehicle accidents. (Audience: because they travel more.) Of course they travel more. They travel 4 or 6 hours. So as a function of where we live, we are exposed to a lot more risks of accident injury. It is also true of the employment that we have. But I’m simply trying to make the case that the Bulkley Valley could use a hospital.
8. Mandi Ayers, Lab Tech, Smithers I take great offense that you say we only get it right 85% of the time. If you look back over our CMPT’s we are well over 85%, we are like 98% over the last 5 years.
My second comment is you said the decisions to move will be made by the pathologist. We pay for our pathology services, we pay a lot of money and we don’t have it. They are supposed to provide 3 visits to us a year, education to us, we don’t have it. So why do they get to have a say in that?
So my question is where do you get your statistics from? And we would all like to see those statistics that you say, that this microbiology lab is not accurate.
Response by Malcolm Maxwell, NHA:
What I said was in choosing where to provide lab services we will look at three things: 1) quality; 2) turn around time so that the physician gets the tests when they need it; and 3) costs. And we have to be guided mostly by the first two. Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 9
It is generally true and it is true, in northern B.C. as well, CMPT scores are lower in smaller centers than they are in larger centers cause it is harder to do. But that doesn’t mean that we cannot have accessible service in smaller centers, we can.
But I simply want to make the point that when we talk about lab and imaging services, they are not there principally for convenience, they are not there principally for employment, they are not there principally because it is nice. They are there to help your physicians have the best information they can get, when they need it, to provide care for the patients. So that’s why we are trying to create decision making processes that are aimed at meeting standards and meeting the physician’s need for test information. We don’t do it on a lot of other bases.
9. Public question – If I may just prior to that Madame, if I could throw a couple of questions towards Mr. Maxwell. Certainly since privatization of the Ministry of Highways in 1988, the road conditions have significantly worsened; I would suggest that that has created an increase in health care costs. Because there has been an increased number of accidents as a result of that. Do you think that it may be possible that if the government were to return to government maintenance of the highways, that would help to improve winter time road conditions, thereby reducing accidents.
And can you also tell us, do you happen to know if the pampered little rich boy Gordon Campbell wears his seatbelt when he drives in Hawaii?
SESSION #2
10. Amy Copland, Smithers I am a local mother from Smithers. It really seems to me that there are all sorts of problems facing us in terms of money, plain and simple. My suggestion to you is that you have to get more efficient and more innovative, that simple. We hear about people, we didn’t see org charts in this meeting. Apparently, people were shown org charts in the last meeting with all sorts of high paid executive positions up to the $200,000 range. My suggestion is less of that and more innovative programs in our hospital. Response by Malcolm Maxwell, NHA: Can I comment on that? Amy Copland, Smithers Yes. Response by Malcolm Maxwell, NHA: When the six health authorities, provincial health services authority and the five geographic ones were formed, the one in the north had the highest Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 10
administrative costs in B.C. And it also had the highest support service costs. Today we have the third highest admin support costs and we have moved between $7.5-8 million out of administration and out of support services and into nursing, medicine, and laboratory technology. Because we, and I am quite happy to provide you with the reports that show this. Its not easy, we continue to try and do more of that. There isn’t enough money to do all of the things that we want to do in the health system but we are trying as hard as we can to squeeze the organization of the budget that we got, to try to spend as much of the money as we can on direct services and will continue to do that. Amy Copland, Smithers My real question is, and I have a tonne of questions, let me tell you, a tonne of them. Like, why was I MEDEVACed with my two year old when he had a piece of chicken stuck in his throat all the way to Vancouver? Costing me $1,000, costing taxpayers around $10,000, when you could buy a $12,000 scope to reach down his throat and get the piece of chicken out? That’s not my question though. Those types of things just don’t make sense to me. My real question is: it seems in the last couple of years talking to people in the health care profession in this town, we are teetering on the brink of becoming a diagnostic and treatment centre. Which is a serious down grade for us for our hospital from what it is now. It means that women can’t have children in this hospital. It means that people who are seriously injured get packed into the back of an ambulance and put on those roads to add to that big bar graph of statistics about motor vehicle accidents in the north. Or we get stuck on an airplane and we have to wait on a tarmac for 24 hours until NAV Canada decides to send a weather report.
Can you tell me, is it in the plan of the NHA to turn our hospital into a diagnostic and treatment centre? That’s my question.
Response by Malcolm Maxwell, NHA: No.
Amy Copland, Smithers Okay, what is your plan for our hospital? And can I see it in writing?
Response by Malcolm Maxwell, NHA: Actually, you can have a copy of this presentation.
Amy Copland, Smithers Not this presentation. I want one about my hospital.
Response by Malcolm Maxwell, NHA: Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 11
Yes, that was about your hospital. Let me just touch on a few things here.
Amy Copland, Smithers I don’t think so.
Response by Malcolm Maxwell, NHA: Our expectation is that if you look at how many patients are going to be admitted to the Smithers hospital in three years from now or four years from now, we think it is going to be about the same as today. Because what we are trying to do, these things actually don’t bounce around very rapidly, unless you take a service out of the community.
So here’s what we expect to do. We expect your physicians, your medical staff is just about full with the number of physicians they told us they need. We plan to invest in well over $1 million in diagnostic imaging, so that you have the kind of digital imaging system that Cor correctly identified as being necessary.
We intend to see, and the reason why we are spending money on nursing training and education the way we are is that when someone comes to the Emergency Department here with a heart attack, they should be greeted by a nurse who has Advanced Cardiac Life Support and some of those patients will require monitoring and post nursing care which is why we are paying for monitors this year. We expect that women will not only continue to have low-risk deliveries here, but that women will need emergency Cesarean sections here, and we’re very concerned…
Amy Copland: So they need a surgeon.
Response by Malcolm Maxwell, NHA: Actually what they need is an anesthetist because you have a number of family physicians who could do the surgical side of the C-section.
Amy Copland: Because you dropped the standards a couple of years ago.
Response by Malcolm Maxwell, NHA: No. If you had two surgeons here you would still have family physicians doing c- sections, because two people can’t provide constant coverage. Family physicians trained in c-section delivery provide a wonderfully reliable service for a community. The purpose of this is not the G.P. surgeons.. Who’s running the anesthesia machine? If we’re not successful in ensuring that you have visiting surgeons, and possibly a resident surgeon, you need someone to have the anesthetist side… Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 12
Dr. Schaeffer: We’ve got quite a few. We’ve got two.
Malcolm Maxwell: And as long as there’s surgical need, so they can do their skills, they will be around the odd time when you need them for a c-section. So we’re concerned to see that the surgical service is here to provide access, but also to make sure there’s anesthesia work, so that you have both anesthetists and family physicians doing c-sections for the O.B. service. Those are things that you can easily expect as being necessary and part of the future of the hospital.
Amy Copland: So what I’ve heard you say is that our hospital is not going to be turned into a diagnostic treatment centre.
Malcolm Maxwell: Absolutely.
Amy Copland: Is there timeline on that or does that expire at the end of fiscal? Do you have 5- year plan or a 10-year plan or…
Malcolm Maxwell: I would wager that I’ll be willing to retire before you need to worry about it. I’ve worked in Nova Scotia and the Yukon and Northern Alberta and here. I have never seen or heard anyone who was responsible and knowledgeable in the provision of rural health care – a physician, a nurse, or anyone else suggest that a community of this size with the kind of travel times you face to a larger centre, could operate without the following things. We must have an emergency department that has physicians and well-trained nurses available 24 hours a day, 7 days a week. We must have an in-patient nursing unit where nurses have good skills and they can deal with emergencies. This is the toughest job in all of nursing. They have to deal with medical patients. They have to deal with surgical patients, when you have surgical patients. They have to be good obstetrical nurses. They’ve got kids coming in. They have to have reasonable pediatric nursing skills and when things don’t work as well as they should, they have to be psych nurses as well. We have to a lot to support nurses who practice in hospitals of this size. But if someone has suggested to you that there isn’t a future for the Bulkley Valley District Hospital, they are either worrying where they shouldn’t be worrying or they’re fibbing. Because it isn’t true. There must be a hospital here and it must do the things that I’ve described.
Amy Copland: Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 13
So we have some work to do to make it the best hospital it can be and that’s your job.
Malcolm Maxwell: Well.. I think you do have some work to do, but I think it’s our job. There are things that we can do, but I’ve never seen a really good hospital that didn’t have good links with its community and good support there as well.
Amy Copland: … excellent by this show of…
Malcolm Maxwell: I think there’s wonderful support for your hospital here. I think it’s a good thing. Give yourselves a round of applause. You know you should.
Sheri Howard: I have a couple of comments and I know it’s one question and I promise I won’t take a long time. No disrespect sir, you made a very nice speech, very flowery, but honestly I don’t’ think very many of us here are crazy or that we need a foot specialist. I don’t’ think that’s our concern tonight. Maybe I’m wrong, but hardly ever, but…
Malcolm Maxwell: Wish I could say the same.
11. Sheri Howard: I’m kind of a black and white person. I’m not really a grey person, so what I’d like to know and just bring to your attention is the fact that my daughter was just in the hospital not very long ago and admitted for close to a week. I was appalled at the services that were up there. Just appalled. And they don’t even take into consideration the two main features that we’re talking about tonight. And I swore that I was going to make something happen of that and unfortunately, I never got around to it yet, but now is the time. You know, if you’re a parent of a child that’s in a hospital for a week, you need to eat. If you’re there day and night, you need to eat and look at me, I like to eat. And I can’t even get a sandwich in that place. You can’t get a meal, oh other than the fact that you could wait for three days and go down to the cafeteria, that’s what they call it, to a machine and have a meal from last night’s dinner that’s been in a cooler all night. Do you think that that’s what you want after you’ve been dealing with the stuff that goes on with kids. No thank you, it’s not. All of these other features you’re talking about are really important and what I want to know, and like I said because I am a black and white person. It’s all dollars and cents from what I can gather and it’s not that you’re disagreeing that we need this, or that you think Kitimat or Terrace or Prince Rupert is a better place to put it, but how much money is it going to cost? I for one am sure that I could dig into my Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 14
pocket and come up with the money to go strictly to that. This is a community that can raise money on the turn… You would not believe how much money this community can raise and as much as some of us say that we don’t have any money for all these things, we can find money to support something that’s as near and dear to our hearts as this cause obviously is and I’m sure everybody here was shocked at the turnout which Amy’s already mentioned. How much money is it going to take from each one of us to save it? Is it ten dollars, twenty dollars, a hundred, a thousand, because there are people who want to donate money to things that are really important, if they know about them and if you don’t tell us, some of us have blinders on as well and we don’t know, so we need to know that.
Malcolm Maxwell: Okay. One of our toughest problems is that there’s .. Dr. Schaefer I think brought this out nicely. We want to see the doctors in your community have access to the tools they need to provide good care and one of the most expensive areas of medicine is diagnostic imaging. So, we set aside funds to acquire a new mammography machine…
Sheri Howard: Have you ever had a mammogram?
Malcolm Maxwell: There are some experiences I haven’t had.
Sheri Howard: It’s one of those things you could probably go awhile without having a brand new machine.
Malcolm Maxwell: But beyond the mammography machine, if you remember Cor’s presentation, there is an awful lot of money that is required to put in place the kind of diagnostic imaging service that we really would like to see in Smithers. I would be more than happy to meet with medical staff here, as we do when we try to priorize equipment anyway, but if there are people in the community that would like fundraising tasks, the Health Watch Committee and the medical staff are good vehicles locally for some discussion and more than happy to provide a list of things that have been identified by our clinical staff and medical staff here to say here are things that the hospital needs and that the community can contribute, then they can get here sooner than otherwise.
Sheri Howard: Okay, but that’s not really answering what my point was.
Linda Mangnall: Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 15
What was your question Sheri?
Sheri Howard: Deb probably could tell us. How much money do we all need to put in because we’re coming up short, if that’s what you’re saying I think. And this is a community that says we’re open for business and if you do this to us, we won’t be.
Malcolm Maxwell: Well first off, your hospital is going to be open and doing the things that I described regardless. What you can do, if you wish to, is some pieces of equipment… I think Cor said it was 7 years as an objective for a digital service. Well I think that kind of thing can be done in 4 or 5 years, but all of the other communities have needs as well as Smithers. We get some money from the Province, the Feds chucked hundreds of millions of dollars at lab and imaging equipment, but the amount that gets to us at the end of the line is some, it helps, but it’s not enough, so my point… The overall expenditure in Smithers over the next four or five years to create the kind of x-ray department that we’ve talked about, in Cor’s presentation and Dr. Schaefer’s remarks and mine, is a couple of million dollars and we recognize that the largest part of that will have to come through Northern Health’s sort of capital allocation, but Fort St. John has needs, Fort St. James has needs. Everybody has needs. If the community, if there’s a group in the community to take on a piece or parcel of that and cause it to happen more early, if that’s the question somebody has, we’re more than happy to work and share what we think needs to be done.
Sheri Howard: Can I interrupt you for a second? Kitimat received a microbiology system and they were told to return it, so apparently, even if money has been given by this community, it’s not always accepted by the NHA.
Malcolm Maxwell: I met with the Directors of the Max Lange Foundation and they said well please tell us the mechanism to set aside what are the greatest needs for capital equipment? And what we said is we talked to staff in the hospitals and medical staff and set priorities. There are, sometimes it’s lab equipment, sometimes it’s imaging equipment, but for the discussion on microbiology, that wouldn’t be my first place to put the money.
Sheri Howard: The thing with equipment, was that it was to be purchased for Rupert and Terrace. But Kitimat already had the equipment.
Male Voice: Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 16
… Kitimat. It was a gift.
Sheri Howard: … and that’s money well spent, when Kitimat does more than Terrace. Smithers does more than Prince Rupert. But it doesn’t matter.
Malcolm Maxwell: So if you look at microbiology as an example. There are a number of services like this where there isn’t enough money to do all of the things in all of the places, so how do you make the decisions?
Unidentified Member of the Audience: Put it where the workload is.
Malcolm Maxwell: We talked to the pathologists, the physicians that use the test results and not all of the choices are going to positive ones in everybody’s eyes, but the choices will do the following things. They’ll meet standards for patient care and they’ll satisfy the physicians who have to use the tests and the pathologists who are responsible for the standards of the tests that good medical care and good test results have been provided and that’s the only way they can make those decisions.
Sheri Howard: Even if it costs more money? Because it’s going to cost the money to buy the equipment for Terrace when Kitimat already has it, why would you not allow Kitimat to do Terrace’s work?
Malcolm Maxwell: One of the things that I have asked the medical committee and the technical committee that is reviewing microbiology services to do is the arguments that were brought forward, and they’re not new arguments because the technologists from the labs in the northwest have been through this a couple of times – those were not new points, but I said go back over it, review the cost information, the travel time, and the standards to make sure that we’ve got the right answer.
Sheri Howard: My original question was not that. I just had to interrupt about the equipment being unaccepted by the NHA. The purchasing stores department of the BVDH was transferred to Prince George Regional Hospital in early 2003, supposedly to save valuable healthcare dollars. This restructuring has been a painful process, as always is the case. It has been a year since this restructuring and Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 17
has the NHA evaluated the cost savings particularly at BVDH and secondly, will these numbers be made public?
Malcolm Maxwell: I don’t have numbers that are specific to BVDH with me. We have saved in excess of one million dollars from purchasing. Some of those changes were difficult ones, some of them caused additional work for staff in the various hospitals. Some of the changes, when we made them, took a considerable period of time to work as well as what was there before. Why? Because we have a fixed amount of money to provide care with in the North and even though it isn’t great fun sometimes, what we are trying to do is take, of the money we have, we want to spend it on nurses, we want to spend it on drugs, we want to spend it on physiotherapists and if we can make the support services side of the business - laundry, housekeeping, food services, catering, ordering – if we can make that cheaper, then that money doesn’t go anywhere but to pay nurses, pay for drugs, pay for services, and we’re squeezing that and sometimes we make changes and we have to go back and correct them because they didn’t work quite the way we planned. Other times they work quite well. But we are looking at that constantly because we want to move money from non-clinical work to clinical work.
Sheri Howard: So those figures are there and they will be made public to this place right here. Smithers wants to know. Are the figures there and you will give us the figures that we are saving money.
Sharon Hartwell, Mayor, Village of Telkwa and Chair, Northwest Regional Hospital District: We are awaiting a letter from you, there has been a letter sent out, waiting for your contribution list for our Hospital District for your funding criteria for the coming year. We are going to balance our budget, or set our budget in the next 2 ½ weeks and we can’t do that until we have the funding requirement from you. You spoke earlier about where is the money going to come from? We are committed to coming up with our portion of the funds for what is needed for our hospital and hospitals in this area. When are we going to see the list so that we can match it with you so that we can come up with what we need for the Smithers hospital, Houston, Rupert, Kitimat, and the rest of them all the way to the Queen Charlottes?
Malcolm Maxwell: You’ll see it before your meeting Sharon because we were actually working on some of that this morning. One of the biggest difficulties there, the equipment side is fairly easy for us because we can simply speak with medical staff, nurses, technologists and develop requests on major equipment from that. The harder part is that Northern Health received about 4 ½ to 5 months ago now, several thousands of pages of assessment of electrical/mechanical building Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 18
systems in all of the hospitals and it’s taking us some time to work through that and, as I described a few minutes ago, we’re very concerned that when we come to you with requests on buildings that we’re making the right and the best request. So what we’ve tried to do is to provide, as I think you’ve seen, a preliminary list and said here’s a range of things we see as priorities. We need to refine this and get back to you. The limiting factor for us is trying to pull together the huge number of changes, improvements, age-related problems in the many hospitals and facilities we have and work with our Regional Hospital District partners so that we’re giving them the best information we have about – you guys have the same problems as we do, you have a limited number of dollars. You want to make sure you’re making the best use of them and we’ve got to give you the information that’s helpful to you in doing that. Sharon Hartwell: Mr. Maxwell that doesn’t answer the question. We have identified…
Malcolm Maxwell:
Well you’ll have it in advance of your meeting.
Sharon Hartwell: But the people here want to know where the money’s coming from. We have committed at the Hospital District our portion of the funding for what is required in our area and we’re waiting for an answer from you, saying where’s your matching dollars? We’re coming up with our share. You’re saying can you come up with the money? We can come up with our end. When are you going to come up with yours and identify these needs as expressed here tonight.
Malcolm Maxwell:
Here’s where we get our money from. We get a block grant of $5.5 million from the Province for the whole region. In addition to that, because there is a deal between the Federal government and the Provincial governments to fund medical equipment, we get a couple of million more there. Aside from that, the only access Northern Health has to capital dollars is to go into the operating budget to pay for capital or basically borrow money to pay for capital which is the same thing. So we need… when I say we need to priorize Sharon, that’s specifically what I mean and where the money would come from to match is out of our capital budget.
Sharon Hartwell: I understand what you’re saying but what the Hospital District is saying is we are not going to match those dollars unless you come to the table with dollars, so we’re going to reduce our budget accordingly, which isn’t helping anybody in the room, so we’re still awaiting information for our budget meeting on the 19th. Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 19
Malcolm Maxwell:
As I said Sharon we’re working at providing that to you in time for your meeting because we know you’ve got a different budget cycle than we do.
Debbie Tennant: But I do have a comment. May I make a comment? There is a document called Patients First 2002. You can find it on the Internet if you just go to search and put in Patients First 2002. The government has written this document. There are several recommendations involved in that and one of the recommendations is that the CEOs sign a performance agreement with the government. So the Health Authorities do have that. There is also a recommendation that realistic consequences be addressed to help regions that do not reach these targets. The targets, there are access standards. Mr. Maxwell was not lying when he says that we will probably have a hospital here. What that hospital looks like and how many beds it actually has, that is yet to be determined. Hazelton, in talking to Dr. Peter Newberry, Hazelton actually is set back from the NHA. What they found was that the NHA wanted to reduce their hospital to 4 beds, so Dr. Newberry said, you know, that’s not what we’re here for. We’ve been here in the community for a hundred years and we were also the initiators of the Rural Medicine Program, but the NHA didn’t want to recognize any of that. But I would encourage you to go online and look at Patients First 2002. It’s a lengthy document and it looks very flowery when you first look at it, but if you read into it you can actually find quite a bit of information. Thank you. Malcolm Maxwell:
I would like to answer that. When I arrived at Northern Health I went to Hazelton. I met with Dr. Peter Newberry. The hospital in Hazelton has a distinguished record as a place where young physicians and other young health professionals have gone to learn. Northern Health worked with the United Church in developing an affiliation agreement with the Hazelton hospital. We admire the Hazelton hospital. It’s one of the first sites in British Columbia that has an inter-professional training program – one of only four places in British Columbia that does that. I’m not sure what information my friend had, but it isn’t correct and our agreement with Hazelton specifies that and in fact they continue to do the things they were doing before regionalization.
Roger Benham: I am married to a nurse and I am acutely aware that the nurses here are at the point of breaking up. They are totally loaded up to the limit. You talk about finding more money for nurses and I see the possibility that if one nurse (my wife works at Bulkley Lodge) if one nurse leaves for whatever reason, there’s going to be serious damage. That’s one point. Another point – you talk about over the next five years, you project 15% growth and you call that static? Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 20
Malcolm Maxwell: No. What I said was relative to how often people in the south go to hospital, people in northern B.C. will be there 15% more often and some of that has to do with distance, some of …
Roger Benham: What about growth of the community population?
Malcolm Maxwell: Yes. The forecast we have shows some growth in population but we also expect northerners to use hospital services more than the south.
Roger Benham: We’ll have a growth in population. If we had had the growth that was being dreamed about a couple of years ago over the ski hill, we could have had a doubling of the population of Smithers within 5 years. Luckily, from the health point of view it didn’t happen, but it was on the cards. And there are still people here who dream about making a wonderful Ski Smithers up in the hill. You have another item which you just passed over. You talked about, you mentioned psychiatry. There’s no psychiatrist, and yet you are proposing to bring into the Bulkley Lodge, I believe, 15 people from Riverview, 18. You’re going to have psychiatric patients without a psychiatrist. I presume that if that’s the case you can just keep them drugged out of their minds all the time. But, some of the nurses are going to have to deal with these people when they go bonkers and there are serious concerns about that. Are we addressing that?
Malcolm Maxwell: I can tell you a little bit about that. We’ve already done that in a couple of locations in the north and actually the transfer of beds and nurses so that we can provide care for people in our own communities with chronic mental illnesses is a good thing. It does for some people require some medical support, but for many of these folks they need a care environment that’s stable, a place where they can have some contact with their own communities and their own family.
In one or two of the cases where we’ve seen people come back from the south – I’m not talking about people who are sort of acutely or suddenly mental ill, I’m talking about people who have had mental health problems in their life for many years. Some of these folks, when they left the Riverview facility were able to return part time to the community, but they need a stable housing environment. They need some support and they need some care. We have also – this is actually one of the areas where resources are being transferred to the various health regions - the Interior, the Island, the North, and we’re actually getting more capacity and often direct number of patients coming as we’re getting the Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 21
resources to provide care for. One of the things that that means is elderly in our communities who may have Alzheimer’s disease and a small proportion of people with Alzheimer’s disease need a whole lot of care. We will have a lot more capacity in our communities to meet their needs. I think…
Roger Benham: … night shift – only one nurse. So, if you’ve got a problem with a psychiatric patient, that nurse is tied, then what happens to the whole of the rest of the Bulkley Lodge? Seniors will be affected.
Malcolm Maxwell: I think if you look at the groups and the needs of people that are coming to those units, as I say, it’s not people who would be admitted to a hospital emergency department or an acute psychiatric unit. That’s not the intent. One of the things that I do agree with you on though is that for people who do need psychiatric care, who need a psychiatrist as opposed to a family physician or psychiatric nurse, we don’t have nearly enough services and our medical staff has told us that the recruitment of additional psychiatrists is our most pressing regional need overall at the moment and we do have I think only about half the number of psychiatrists in northern B.C. that we should have going forward.
Roger Benham:
I’ll just end with a somewhat political note and that is we were promised by the Liberal government before they got into power in this province that they would increase their spending on health services and I kind of feel that we haven’t actually achieved that.
Joanne Voss, Smithers: I have a number of concerns about our hospital from using the little plastic cups for water so that the nurses have to run forever to fill them up, to the lack of psychiatric facilities for people – a safe room. We have talked about it and been promised it for a number of years and have nothing, but I’m still really, really confused and maybe it’s the grey hair, I don’t know, but we’re talking about losing further services in our hospital and you told us that it depends on whether we have a surgeon, whether we have enough nursing staff, and whether or not we have an anesthetist to continue our hospital at the same level that it’s at right now. My concern is that the more that you decrease – we laid off nurses. Nurses left town. There is no other place for them to go. If we cut services so that we can’t offer the same level, we’re not going to have the anesthetist. Malcolm Maxwell: So, let me touch on this another time. My expectation – our plan – what we’ve talked to the physicians regionally in the northwest and the community about is how many doctors are needed, what services are needed? We do not expect to Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 22
see the Bulkley Valley District Hospital discontinue obstetrics or pediatrics or surgical care. Our expectation is quite the opposite. We expect, when we try to understand what’s going to be needed in the health system based on what we get from the medical staff and so on, is that five years from now the Bulkley Valley District Hospital will be doing the things that it’s doing today: the 24-hour emergency will be there, obstetrics will be there. That’s what we’re planning for. That’s what we’re buying equipment for and that’s what we’re training nurses for. I am concerned about the age of the building. I think the staff face handicaps there. I am concerned about the cost of some of the equipment we need, not because of cost, but because many communities have needs and if you look at something like digital imaging, it’s a big challenge, but it’s a challenge that needs to be met because the hospitals need that kind of capability. So, all I can say is that we’re not foreseeing any of this…. Joanne Voss: What are you doing to ensure that we don’t lose anything more? That is why we’re here tonight and we’re not hearing anything from you. I’m hearing from you basically that it’s up to our medical staff to ensure that surgeons come into town. I think our medical staff have their private practices, they man the emergency room admirably and I don’t see that the NHA is really supporting us. Malcolm Maxwell: When I say we have to draw upon our physicians, they do need to refer patients, they do need to be satisfied with the service, so it would be quite wrong for us to try and recruit physicians or move physicians or encourage them to go from one place to another…
Joanne Voss: If we don’t have any services here, they have to refer the patients somewhere else.
Malcolm Maxwell:
My point is that it does mean a partnership between ourselves, in terms of providing the space and resources and doing advertising and doing recruitment, the physicians here in the community identifying – do you want an orthopedic surgeon coming in doing some arthroscopy, doing some procedures or that sort? So, the medical staff here have identified – Dr. Schaefer described a number of visiting services that they thought would be helpful and we take that forward into discussions with the Medical Advisory Committee in the northwest, with the surgeons at other centres, and try to encourage that to happen.
Joanne Voss: But you’re not promising or you’re not willing to help us to help our physicians to do that.
Malcolm Maxwell: Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 23
Certainly we are. That’s what I’m saying.
Joanne Voss:
Well, another thing in writing.
Karen Kingston: I’d like to clarify a point regarding Hazelton. I’ve worked there in the past. I’m a Smithers’ resident. I’ve had a discussion with Dr. Phil Muir. My understanding is that in Hazelton the hospital was slated to be closed and that what happened was that the hospital administration, deciding that that wasn’t the route they wanted to take, reinstated a Hospital Board, the way they used to run things and then negotiated an agreement directly with the Ministry of Health. My understanding is that they are no longer part of the NHA, but that they are independent. They have an independently-negotiated contract with the Ministry of Health and they run it in a very unique manner.
Malcolm Maxwell: I can explain a little bit about that. When the government created the health regions that exist now, there were a number of hospitals that were run by, for the most part, denominational organizations. The United Church had, I think, three and then various Catholic healthcare organizations existed and there’s a number of others as well.
So what was done was the Province provided the funds to operate those hospitals to the Health Authority that they sat within, so we received the funds for the operation of the Hazelton hospital and because they are owned by the United Church, the United Church appoints a Board that deals with that hospital and appoints Dr. Muir as the Administrator and we worked with Dr. Muir and that Board to write a funding agreement, so that we provide the funds for Hazelton hospital and they agree to work with us on various – like we share I.T. resources and support services and so on. So they are a little different from other community hospitals because they were specifically owned by the United Church. Their funding flows through Northern Health subject to that agreement.
The history of the Wrinch Hospital as a teaching centre, I think, goes back for many years, but the funding arrangements – I sat at the kitchen table in the Wrinch Hospital with Dr. Muir and a number of other folks and we worked out an agreement and subsequently it was ratified by the United Church and our Board about 18 months ago.
Katia Bischof: I’m also an R.N. working at the Bulkley Lodge. I am a resident of Smithers. I’m also a mother. Regarding the microbiology, I wanted to express something that some people in the room might not be aware of and that is how I see our standards really dropping. One of the things that B.C. Children’s Hospital, for Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 24
example, is trying to achieve is to reduce the use of antibiotics and one of the things that will automatically happen when our microbiology will take longer to process is that especially children will get antibiotics just because it might be positive, and also, furthermore, afterwards the children’s antibiotics may need to be changed. That actually does not apply to children. A couple of other things – so that’s actually regionalization could be really beneficial because people regionally could set standards, or provincially set standards. I really feel that is only being used when it is to an advantage in a financial way. On the other hand, if it is more beneficial not to think regionally, that’s the way it is usually supported. Regarding the Bulkley Lodge where I have a position right now – there’s a few comments. One is that the community raised quite a few funds to expand the Bulkley Lodge and why is it that the Health Authority can change admission criteria for long-term care, so that it’s very hard for seniors to get admitted? Then, on top of that, people that actually were qualified, based on those criteria, don’t actually get a bed assigned. They get respite status because the official beds, or the beds that they would get admitted to, are actually closed. How can seniors with the most complex medical conditions be taken care of by less and less trained staff? To imagine contracting out direct care to long-term care residents is catastrophical. I have heard you say that you are supporting R.N.’s and to my knowledge there were at least two positions deleted in the BVDH and the home care nursing hours which would be supporting the closer to home, have actually been reduced, so I don’t feel as supported by the Health Authority as I would like to.
Malcolm Maxwell:
There are a number of points there. The one on nursing staffing – one of the things that we did do this year is we wanted to look at nursing staffing in all of our hospitals, so we felt that the only person who could do that and do it well was a nurse, so we used a senior, experienced nurse to work with the nurses in each of the hospitals to review staffing and at the end of that process, we did make some changes. We increased staffing in a couple of locations. One of the issues that came up in your hospital here was that from time to time you had a nurse working by herself in the emergency department which wasn’t a good situation and we want to make changes so that that person has more backup available to them. And in some cases we saw staffing levels could be decreased or we could see a mix of R.N.’s and L.P.N.’s.
Carla Zilkowsky:
I am an emergency nurse and I work downstairs by myself. I don’t have any backup.
Malcolm Maxwell: Do you think that’s a good thing? Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 25
Carla Zilkowsky: No. When is it going to be changed? It’s been booked solid and I’ve had to look after cardiac patients…
Malcolm Maxwell:
One of the things that came out of that review was just the problem that you described, so what I’ve been told is…. We think the staffing needs to be changed because you working down there by yourself isn’t a good thing. Tracy, have you got a comment on that.
Carla Zilkowsky: No. Don’t put her on the spot.
Malcolm Maxwell: I don’t actually set the staffing schedule for her. The truth is Suzanne told me that we’re doing something recently soon on it – before summer. September 1st.
Unidentified Speaker: What’s the holdup?
Carla Zilkowsky:
I hope no one has a heart attack until September. What is the plan? Are there going to be two emergency nurses or a floater from 11 to 7, what is the plan.
Malcolm Maxwell: Good questions and I don’t have all of the 7 day shifts in my head. The point I wanted to bring home to you is you had an issue that you clearly felt something needed to be done about it. The point I was trying to make is that we’re trying to do something about it.
Unidentified Voice:
September’s a long ways away.
Carla Zilkowsky: … called the RCMP and actually they have actually come. I’ve had a couple of guys that were, you know… and I’m by myself.
Unidentified Speaker:
I’m not a nurse, however I know both at the Lodge and at the Hospital – they Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 26
find it very hard to have their concerns heard and dealt with. They’re always passed along. Talk to the Administrator. Talk to the WCB. Talk to … and we never did get answers. If you don’t get answers…. you just get put through to another department.
Malcolm Maxwell: The answer I have for you tonight is that we will have an additional physician in place by September, so … The situation sat there for a considerable period of time until Northern Health had a chance to try to do a staffing comparison, try to hear some of the concerns and try to respond to them.
Unidentified Speaker: We’re concerned. Why are you waiting until September to do something about it?
Linda Mangnall: Is there a possibility of making that change earlier than September?
Malcolm Maxwell:
I’d be more than happy to go back to the nursing staff on that, but as the nurses here will know their rotations, their requirements, to set time for change, their rights to positions, but I’m not keen to see… I don’t want to see a situation where nurses are …
Carla Zilkowsky: Summer is the most… we have tourism, we have people coming in and out all the time in emergency. We have cardiac problems… Do I go overtime? Is that what you want me to do? … another six hours because I have to sit there with my patients?
Malcolm Maxwell:
No. The work is plenty hard enough without people doing a bunch of extra overtime.
Simone Towner:
My name is Simone Towner and I’ve lived here for 23 years. I have five children, two of whom I’ve been fighting to get a diagnosis for 3 to 4 years. I’ve heard from Elizabeth Tuomi after many, many phone calls trying to find some place to take my children to have them assessed and diagnosed, so that they can get back to school and get on with their lives. I’ve had all of the same flowery answers that you’ve kind of been giving tonight. It’s not good enough. It simply isn’t good enough. My children are suffering and nobody is paying attention and nobody is helping. I don’t live in Vancouver. I will gladly take them Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 27
to Vancouver for an assessment, but we can’t get in. And I don’t understand why as a taxpayer and a citizen, why we’re punished for living here. It’s absurd. I don’t need an answer from you because I’ve had all the form letters that I can possibly stand. I want help for my children. I’m so bloody incensed that you’re sending people up here from Riverside and I can’t even get my kids out for an assessment.
Mandi Ayers: Just one quick question. It’s just a yes or no answer. My name is Mandi Ayers and I work in the lab at the hospital. Are you moving microbiology to Terrace? Yes or no?
Malcolm Maxwell:
The answer that I’ll give you is that we will make the decisions on moving microbiology or adding services to this hospital or any other hospital based on the input of health professionals, not based on the input of the Province or other kinds of discussion, so the microbiology service will either stay, based on the judgment of pathologists, the medical staff, and input from lab techs on what produces the best result for the patient and that’s the only basis we’re going to make those decisions on.
Unidentified Speaker: I think your experts fooled you.
Malcolm Maxwell:
Could you be specific with me about what that is?
Cindy Savage My name is Cindy Savage and I work at home and I’m hearing from the staff and the community that there is a gag order on staff at the Lodge and they’re afraid for their jobs and I applaud Debbie for standing up because her job is on the line for being here, so are they going to be able to speak freely about the things we need?
Malcolm Maxwell:
The only policy that we have with respect to communications and our staff is that if they are asked to speak on an issue that’s in their program or area, they check with their supervisor to see if anybody else is dealing with it…
Unidentified Speaker: There are cutbacks everywhere else. How come your management is not taking any of the cutbacks. Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 28
Malcolm Maxwell:
We’ve reduced management support costs in Northern Health faster than any other Health Authority. We’ve gone from being the highest as the percentage of our budget in B.C. to the third highest.
Les Schumacher: I just want to say one thing. I probably shouldn’t but the woman that was here in the last meeting who said she had a brain injury. Fantastic speech. A lot of preparation and prepared to say something. I came here prepared to say absolutely nothing, to listen to what was said. And after listening to her, she asked for a promise. I’d like to see a promise from the Northern Health Authority. My attitude is that the promise she should have asked for was that if you can’t do anything for the northern people, and the people of Smithers, promise to resign. Thank you.
Malcolm Maxwell:
Look folks there’s something I want you to keep in mind. Really. Seriously. It’s fine if you’re frustrated with some things in the system and you want to point the finger at me because I get paid a good buck. But there’s something I’d like to keep in mind. Most of the managers who work in Northern Health work out of one of our facilities in one of our communities. Most of them are nurses, physiotherapists, occupational therapists, physicians and most of them… So, I would only ask you to consider that many of the folks that are working on these issues, and trying to stretch the dollars that are there to provide good services in your communities, are people who spend a good part of their life working on patient care, working on care for the elderly. They are good people who have spent a good chunk of their life in healthcare. They work very hard at what they’re doing. They’re doing the very best they can. Whether or not you think that of me is a different matter, but I would ask you to keep that in mind.
ADJOURNMENT
17. The meeting adjourned at 9:13 p.m.
______Marilyn Stewart Notes of the Public Meeting of Health Services – Bulkley Valley District Hospital held in the Ferguson Room, Hudson Bay Lodge, 3251 Highway 16, Smithers, B.C., on Tuesday, March 2, 2004, at 5:30 p.m. Page 29
Councillor
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