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iverglas

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Member since: 2001
Number of posts: 38,549

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I hope people actually read your link re Canadian wait times

The context is:

Posted on June 25, 2009
Response to the Senator accusing Canada of having "staggering" wait times from Canadian Surgeon and Hospital Executive Dr. David Zelt

By Dr. David Zelt
The Kingston Whig Standard
6/24/09

Dr. David Zelt, chief of staff and vice-president, medical administration, at Kingston General Hospital, sent the following reply to McConnell.

and what he said was:

Your researchers have taken data and interpreted it incorrectly, with the result that your information is inaccurate.

Your statement to the Senate: “Today, the average wait time for (hip replacement) surgery at KGH is about 196 days.” In fact, our actual average hip replacement wait time is 91 days — less than half of what you stated.

Your statement to the Senate: “What about knee replacements? Well, at Kingston General, the average wait time is 340 days, or almost a year from the moment that the doctor says you need a new knee.” In fact, our average wait time for knee replacements is 109 days.

Three months' wait for a surgery for a non-life-threatening condition, from referral to surgery? When it is available to every resident of the province on equal footing? Is someone actually concerned about this?

I took my partner to the ER just before midnight on a Saturday night a couple of years ago because symptoms he was describing sounded to me like a retinal detachment. I was right. After two hours there and very complete examination, he was told to report to the eye clinic at the hospital in our city that is the designated in-patient eye surgery facility the next morning. He was admitted and had to wait all day for the surgery, because on a Sunday only two ORs were operating and he got bumped by every car accident and emergency caesarian section that came along. All in all, it was about 19 hours from ER arrival to surgery. It was emergency surgery, needed immediately to preserve his eye, and it was done immediately, and the wait time was mainly associated with it happening at midnight on a Saturday.

More from your link:

Your statement to the Senate: “And for cardiac bypass surgery, patients in Ontario are told they may have to wait six months for a surgery that Americans can often get right away.” In fact, the median wait time for cardiac surgery in Ontario is 16 days (32 days at KGH).

That is the median time. Half waited longer, half waited less time. Again, if the situation is an emergency, it is treated as such, and surgery is essentially immediate.

I'm wondering what your point was, too.

As I sit here with my third cast on the leg I broke just over three weeks ago, having had attention (ambulance, three consults, 3 sets of xrays, plaster cast) first in the ER, then a consult week later to decide whether to have surgery, then the surgery a week later to install a plate and screws and put on another temporary cast, then a consult a week later to examine the wound and replace the cast, then this week another set of xrays and maybe one of those air cast things ...

I was really quite pissed about spending nearly 8 hours in the ER the first time. Apparently I made the mistake of breaking my leg the same day half the city broke or dislocated something; two life-threatening orthopaedic emergencies, even (whatever they might be), I was told when I finally got pissy, while I and everybody else were waiting. And frankly I'm pissed about the two-week wait for surgery, when I was told at the ER it would be within a week. But really.

So far it has cost me $45 for a medically-necessary ambulance trip (waived if I were low-income or otherwise eligible), several taxi fares, and a total of maybe $50 for prescriptions. And a little under $100 for a private wheelchair rental for two months. I'll have a few more taxi fares for a few more hospital visits before it's over. So, about $400 out of pocket all told, all for incidentals.

I paid $750 last year for Ontario health insurance, at tax time, because I'm high-income. (That's the second-highest level; the previous year I paid the top rate, $900. The scale ranges from 0 for low-income to $900; people receiving social assistance and seniors also receive drug coverage.)


editing to note: I have these out of pocket expenses because I'm self-employed and do not purchase any supplemental insurance. If I worked for the government or an employer of any significant size, I would have private supplemental group insurance which would cover my prescriptions, taxis and wheelchair rental, possibly with some sort of annual deductible which would not be significant.

human groups have all sorts of taboos and traditions about their dead members

I imagine most US jurisdictions have some kind of law equivalent to the provision in the Criminal Code of Canada against offering indignities to a dead body. And the same sort of requirement that the representative of the deceased make appropriate arrangements for disposal of the body.

We just don't like it. We don't even mandate post mortem organ donation.

Now, granted, generally nobody can sue for defamation of a dead person, say. Our laws/norms tend to relate to the body itself. But there are long-standing customs, expressed in sayings like "do not speak ill of the dead", that do reflect our feeling that deceased members of our groups still have a sort of honorary membership.

Basically, we don't like the idea of our own bodies or memories being mistreated, so we don't like to see it being done to others'.

I'm a genealogy hound. I've run across evidence of ancestors of mine being posthumously baptised by proxy by some Mormon. (There are websites where people post family trees, and those associated with the giant Mormon/Ancestry.com octopus include a space to record each person's status in that regard that someone not in the know might not notice.) I think it's disgusting.

I would call it disrespect rather than desecration. It is simply disrespectful to the person who was, and yes, we do still "respect" deceased persons, to impose a choice on them that they never made.

I'm a lucky atheist, myself. Some years ago, my former church (the United Church of Canada, pretty much the most progressive Christian church on the planet) obtained an undertaking from the Mormons that they would not do posthumous proxy baptisms of people baptised in the UCC. I was baptised as an infant, of course, so I'm shielded from Mormon intervention.

... Of course, after reading a bit here about how they are not honouring their undertaking in respect of Jews, maybe I should not be so sanguine ...

All in all, though, yes: these posthumous proxy baptisms are every bit as disrespectful as desecrating graves, and yes, we human beings and our groups quite reasonably frown on the latter kind of disrespect and so quite reasonably frown on the former as well.

you are making a false statement

you discussed banning me permanently at an offsite forum that excluded another host


The offsite forum DID NOT EXCLUDE ANY HOST. I quickly set up the offsite forum to avoid having to PM and reply to PMs from four other people in order to discuss any issue that arose in the group. I sent the link to the four other hosts. Three of them (all but redqueen) posted in that forum in the short time it was used.

That was all.

AFTER Neoma removed me as co-host of the Feminists group AND banned me from posting in the group, I

(a) "banned" Neoma from the off-site forum as a symbolic little move that gave me a wee chuckle of satisfaction

and then immediately

(b) closed the forum to further posting by ANYONE (by requiring registration in order to post, and closing the forum to registrations)

which was the appropriate thing to do because I WAS NO LONGER A HOST OF THE FEMINISTS GROUP and so the forum which I had created for hosts of the feminists group, and to which I had access, could no longer be used for discussions among hosts.


On the general question here:

Would you really, really have preferred that discussion about you be conducted in the Hosts forum at DU?

Even if so, do you speak for everyone whom hosts of a forum/group might want to discuss by name in relation to their activities in the group? I can answer that, since I can speak for myself: no, you don't.

Do you object to hosts of groups/forums discussing matters that fall within their hosting functions by DU PMs?

what came after the Underground Railroad?

African-Americans who came to Canada -- their history has not been well told in Canada, and is likely even less known in the US.

http://www.thestar.com/living/article/1129556--black-history-month-the-unknown-story-toronto-s-first-black-postman

Black History Month: The unknown story Toronto’s first black postman

When Albert Jackson showed up for his first day of work as a mailman, on May 17, 1882, the other letter carriers refused to show him the rounds. The reason: He was black.

... Toronto’s black community was galvanized into action and supported Jackson, a former child slave from the United States who had escaped to Canada along the Underground Railroad.

They were determined to see Jackson working his mail route and took their demands to John A. Macdonald, the prime minister. It was an election year, and they were heard. Wanting to please black voters, Macdonald intervened.

... Albert Calvin Jackson was born in Milford, Del., around 1856. His father was a free man but his mother, Ann Maria Jackson, was a slave, making Jackson and his eight siblings slaves as well.

When Ann Maria’s eldest two sons, James and Richard, were sold, she pleaded with her husband to run away and spare their other children a similar fate, writes Frost. But he grew depressed and insane over the loss of his boys and died grief-stricken.

In 1858, Ann Maria and her seven other children, the youngest of whom was Albert, escaped to Philadelphia, where African-American abolitionist William Still ran a station of the Underground Railroad, helping fugitive slaves on their journey north to freedom.

It's a longish article and an interesting read. At present, there is a move to name one of the lanes that run between city blocks in that part of Toronto after Albert Jackson. The Jackson family's history is part of the history of that neighbourhood (an area about 6 blocks by 6 blocks in downtown Toronto where I and all of my siblings have lived at various times, and where none of us could afford to live now).

This is a documentary about the Pennsylvania man who recorded the Jackson family's details as they travelled north:

http://www.toronto.com/article/712256--underground-railroad-conductor-william-still-chronicled-in-new-documentary

Google toronto underground railroad for quite a lot of interesting historical info.

There are Underground Railroad Museums in Toronto and Windsor, Ontario:
http://www.toronto.com/article/710983--black-history-month-explore-toronto-s-underground-railroad-history


The Toronto Archives has some interesting documentation:

http://www.toronto.ca/archives/blackhistory.htm

This is one of several such petitions presented to City Council in the 1840s.Council enacted a by-law in 1840 enabling it to license travelling theatrical groups and circuses, and on at least one occasion, in July 1843, Council refused to let a circus perform without assurances that it would not sing songs or perform acts that would be insulting to “the gentlemen of colour” of the city.


http://www.heritagetoronto.org/discover-toronto/photos/willliam-peyton-hubbard-black-history-month

Born in Toronto to parents who had been freed from slavery in Virginia, William Peyton Hubbard became this city's first Black elected politician and one of its most influential elected officials. A baker, cab driver, and businessman, Hubbard was first elected to City Council in 1894. At a time when Black Torontonians were barred from some Toronto hotels and restaurants, he won another 13 consecutive yearly elections, and became Toronto's second most powerful elected official, at times serving as acting Mayor. A passionate and sharp debater, Hubbard was an influential advocate for fairness, efficiency, and democracy in government, and a key supporter of public control of electricity and water supplies. Among other roles, Hubbard also served for 40 years as a Board member of the House of Industry, a municipal charity assisting Toronto's poor.


Black Canadians elsewhere (many of whom descended from earlier refugees, in the post-US revolution years) did not all fare so well; the story of Africville in Nova Scotia is a permanent and ongoing blot on Canadian history:

http://www.stolenfromafricville.com/about-africville/


(edited post to fix a link)

break a leg! ... but only if you have a universal single public payer health insurance plan ;)

Ten days ago, I slipped and fell. Why did evolution make us walk upright, and then make us so incapable of doing it properly and give us such fragile little things to do it on? I've sprained ankles more times than I could count, broken my left fifth metatarsal twice (falling off a sidewalk curb and the edge of a driveway) -- not to mention other broken bones associated with gravity -- and now snapped my right tibula a couple of inches above the ankle joint.

I heard the snap and felt my foot point in an unnatural direction under me as I went down, and I couldn't get up. Fortunately I had on high loose boots, so I got that one off and waited a few minutes for the co-vivant to come back to where I was, an outdoor storage room attached to the garage. He tried to help me up but I felt my ankle waver and I dropped back to the floor. It's winter here, and the entry to the room was blocked by an immovable parked car and snow and ice. There was just no way to get me up and out without proper assistance. So he called an ambulance.

The paramedics arrived first and did the usual paramedic stuff, blood pressure and blood oxygen and questions. Had I hit my head? No, nothing but the foot at all. Was I coming into the room or going out? I don't remember. Does that happen often? The question confused me, but then I got it. No, no! it's just that I'd been in and out of the room 50 times in the past two hours carrying boxes out and I don't remember which way I was going this time (15 minutes ago, by then). I don't seem to have dropped anything and from the direction I'm facing, I was coming in.

The ambulance guys couldn't get the stretcher in the door, so I was going to have to get out some other way. The good luck was that the room contained the detritus of various of my family's households, and we've all broken bones, so there were three pairs of crutches within arm's reach. The guys hoisted me upright expertly, I hobbled on crutches about 20 feet to the stretcher, and they loaded me in.

I reported my pain en route as about 3 out of 10. Amazingly, just not hugely painful. Arrived at the hospital about 2 pm (we'd been directed to the one I consider my local hospital, the ER where we always go when under our own steam), and I waited a half hour in the ambulance intake area to be triaged to ER, then promptly got xrayed and transferred to a hospital stretcher in the plaster room across the hall. Around 4 pm, a doctor looked at my leg and pronounced it broken. Then we waited. Around 6 pm, an ortho resident examined me and ordered more xrays, and came back and said somebody would see me in about 20 minutes.

At ten to eight I was bored out of my freaking skull from being left waiting in a room with no idea what I was waiting for, and decided to stop being the cheerful, chatty model patient I had been until then, and the co-vivant wheeled me outside for a smoke. I left a note on my pillow saying I would be back at 8:05. Of course "they" came to see me while I was gone, as everyone who saw me come back told me. So I wheeled myself out to the desk and kicked up a fuss. My co-vivant (as we had told a nurse hours before) had not had any insulin all day (he had been in the same ER twice two years ago in diabetic ketoacidosis and come thisclose to dying), I had waited six hours for I did not know what, and I'd had enough. Well, we had had the misfortune of being there on the busiest ortho day they'd had all year. There were people lining the halls. My immediate thought (and the co-vivant's, he mentioned after) was to turn to the hallway full of people and say "Hands up everybody who has been here since 2 pm." But I restrained myself.

So they agreed to have the co-vivant register so he could get his insulin, which he got promptly, and we went back to the room to wait. Before too long the senior ortho resident came in, explained my fracture, explained the risks of surgery/no surgery, plastered my leg, and got my consent to surgery, and said I would get a call from the "walking wounded" service, ha ha, for the day surgery appointment in the next week. And sent me for one more set of xrays. It was almost 10 pm when we left and got a taxi home ... where I hauled myself up the five steps to the front porch and in the door and down the hall on my bum, and was finally able to hoist myself into an arm chair. Not an ounce of weight was to go on the foot for 6 weeks.

That was Thursday. Next day I got a call. But not for surgery; for my follow-up appointment at the fracture clinic. I didn't want a follow-up appointment. But there was apparently no way around this. So a few days later, I hauled myself on my bum down the steps to a taxi and got to hospital for a 10 am appointment. At 10:45 I pitched another fit. Evidently they had told everybody who had been at the ER when I was to show up at 10 am that day. I said I was leaving, they said I shouldn't do that as I had a broken leg. Duh. I got seen at 11:45.

This time, it was Dr. Bigwig Ortho Surgeon ... who couldn't bring himself to advise me whether to have or not have the surgery -- inserting a plate and screws to hold the fibula together and ensure that the broken off lower part did not interfere in the ankle joint, which is the real problem. Apparently the sticky outy pointy bit of the bone doesn't bother them. This is one of the most common injuries known to orthopedics. I keep getting "smoking, bone healing, tsk tsk, blah blah". Yeah, well, alcohol and caffeine, tsk tsk too, and I don't do them. And I smoke whether you do the surgery or not. (Although I am cutting down - the patch is no good since it's the nicotine that is the problem. And I'm eating the most bone-healthy diet imaginable.)

My understanding from the outset was that I needed the surgery. So, with 30 seconds remaining to decide my own fate and no input from him, I said surgery. He left me to have my cast cut and bandaged together, to save time on surgery day. I changed my mind and decided to go with coming back for the next one-week appointment, so I wheeled out to the desk in the waiting room. The clerk wanted my appointment slip and my green card. I didn't know what an appointment slip was, and I had never been given a green card (it's the hospital registration card you get when you register at ER, but nobody gave me one). She said I had to have a green card or they wouldn't have seen me. I announced to the waiting room at large that I . did . not . have . a . green . card. She retreated back to the consultation area, and behold, out came Dr. Bigwig Ortho Surgeon, saying I really needed to have the surgery. I suspect I had been pegged as difficult and it took being more difficult to get somewhere.

So next came the pre-op interview - by phone at the appointed time; they knew better than to make me come back. Then the call to give me the date next week; I call the morning before to get the exact time. It will have been nearly two weeks between injury and surgery and I am really not happy about that. Recovery time is extended accordingly: six weeks from surgery before the leg can be used at all. Six weeks stuck in the 40 feet between the living room couch where I sleep and the home office where I work. Fortunately, there's a bathroom in between. But the shower is upstairs. That isn't happening anytime soon.

Surgery is at the hospital in another part of town where ortho day surgery is done, which is also where I have had several eye surgeries. (It has no ER or inpatient services.) I will have either a general anaesthetic or sedatives plus an epidural. Sedatives don't sedate me, but general anaesthetics are to be avoided if possible ... I'll be having a serious chat with the anaesthesiologist.

The hospital systems in medium and large cities in Ontario are completely integrated, and some hospitals in each city are very specialized; in Toronto, e.g., there are two that handle particular cancer treatments for the entire area. (Hospitals here are publicly operated, but this is not an essential feature of a single payer system. It just makes the health system infinitely more efficient and less expensive to operate.) My mother and sister, who live north of Toronto, both had to go to the superlative Princess Margaret in downtown Toronto for radiation therapy, because they had the misfortune to get cancer a year or two before their regional hospital got the radiation therapy facilities needed to serve the burgeoning bedroom communities in the area -- but there was a free shuttle bus service from their hospital to the Toronto one for radiation patients.

So that's my report from the trenches of the public health insurance system. The usual Ontarian pissed off about ER wait times and now a little pissed off about surgery wait times.

But: out of pocket $15 so far for a Percocet prescription. (The public plan here doesn't cover drugs and I don't have an employer-based or other supplemental plan and am not a senior or low-income. I didn't like the Percocet, and have been taking Tylenol 2s and 3s donated by my mum, a senior who gets her prescriptions for $2.) And about $40 for taxis, and another $40 on the day of surgery. And $80 to rent a wheelchair for two months (which a supplemental plan would have covered if I had one). I may have to pay extra to get a fibreglas rather than plaster cast; that was the case 20 years ago when the ER doc didn't want to charge me $100 for that even though I wanted to pay it, and ended up deciding I didn't need a cast for the metatarsal. Not an option this time.

Just after I did this to myself, we were watching a US television channel and saw an ad for health insurance -- obviously aimed at the segment of the uninsured demographic there that consists of young people who choose not to have insurance. A skier tumbling downhill, with each injury and its cost shown on screen. The one like mine was shown as $10,000.

One other thing that might be worth noting about our health system, although unrelated to insurance. The co-vivant and I are not married, and for next of kin purposes in medical situations are treated as spouses. The same is true of same-sex couples, married or not, and this is also the case for all varieties of spouses for virtually every other purpose in Canadian society: taxes, immigration, pensions, inheritance, etc. At one point I was covered under his employer-based supplemental health plan, and he would be covered under mine if I had bought into a private plan for the self-employed. Which is beginning to look like a good idea. Although really, I'm looking at a grand total of maybe $300 in taxis and prescriptions and equipment rentals, which might not be more than the deductible for some plans.

Now just don't get us Canadians started on the parking fees at hospitals. Ask one of us about our health care experiences, and you will always hear the same thing: "... but it cost me X to park." And the Canadian Medical Association Journal has just taken up that cause:
http://www.thestar.com/news/canada/politics/article/1100874--cohn-why-hospital-ceos-can-t-feel-your-parking-pain
-- because essentially, this does amount to a "user fee". Of course, those of us not driving would still be stuck with the taxi fares ...

I paid $750 for my coverage last year, which is calculated and paid on my income tax return, being in the second-highest income bracket for the Ontario premium calculation. (I assume that since I claim the co-vivant as a dependant this covers him too; I've never thought about it. He just has his own card.) The scale here goes like this:
under $25K: 0
$25 - 36K: $300
$48 - 72K: $600
over $200K: $900
(with various calculations in between those brackets)


For anyone interested, this is what my leg looks like. This isn't my leg. It is a leg on an internet site that looks like mine. I wasn't given a copy of my xrays, to show my family doctor or for any other reason, because anybody who needs to see my xrays has access to my medical records electronically. Canada is behind every other jurisdiction in the world in getting the whole electronic medical records thing going ... except the US, of course. But my community clinic, where I go for primary health care, is wired and my doc there has access to everything that happens in connection with my health card.

http://www.medical-definitions.com/images/broken-fibula. jpg



We in Canada didn't get a universal plan overnight. It was incremental: first in one province, then nationally for hospital care, then nationally with loopholes for doctors to opt out and charge extra. It took decades to get what we have now, which is under constant threat from efforts to privatize one thing or another -- and of course is constantly affected by right-wing governments' funding cuts. But if I had picked another day to slip and fall (and I have to say there seemed to be an inordinate number of dislocated shoulders in the ER that day), I likely wouldn't be complaining at all.

I never read the lounge ...

but I looked in tonight and just thought my little sister's story might buck you up.

She was diagnosed with stage III rectal cancer at age 42 -- a lifelong non-smoking vegetarian. That was nearly 3 years ago. First the colostomy, then the chemo, then the radiation, then the surgery, then the colostomy reversal -- a little over a year for the entire process. And she is completely good to go. No indication of any further cancer. It's a beatable one. Not that everyone will beat it and there's no guarantee you will, I don't mean to be flippant. But we found it can help a little to hear the good stories when you suddenly find yourself dropped in it.

My mum was diagnosed with lymphoma at almost exactly the same time. Her chemo and radiation (surgery wasn't possible) paralleled my sister's, a few weeks later throughout the process. Hers may recur, but she's good for now.

For several weeks, I was the only one who knew about my sister (apart from her partner), as she decided to keep it from my mum and brothers, and then flatly refused to discuss any of it with anybody, and just got on with it and that was it. The day I came in from out of town and went with my mum to the hospital for her first biopsy, and my sister was there for her first chemo down the hall, and I was looking after her kid in the cafeteria and running back and forth making up excuses to my mum for why I had wandered off and why my sister couldn't come to drive her home and trying to make sure they didn't cross paths accidentally ... I finally swore the nurses to secrecy and told them what was up, so they didn't decide I was an insane and neglectful daughter ... Anyhow, my sister decided to break the news to my mum later that day, and what a relief that was! But I'll tell ya, that was a tough year.

Everybody does it differently. My sister, with her everybody-shut-up approach, was one extreme. I don't know that I'd go the same way; I am bad enough with this broken leg, just a whiner. If talking about it helps how you feel, it's good you can do that. And if hearing about people who have gone through and come out the other end (maybe not the best metaphor for rectal cancer, hmm) ... well, my family would be glad if that helped a little.

why don't you take your allegation of dishonesty

and, oh, like, prove it or something.

My REASON was that I was posting a picture of a leg in a cast and an xray showing the kind of fracture I have just suffered. Since I was not claiming to post a picture of MY leg in a cast or an xray of MY leg, I had NO REASON to disclaim anything.

What if they were copyrighted pictures I borrowed?

God almighty, look around you. This is DU. How long do you think it would take me to find 50 copyrighted pictures being borrowed here?

Class?

Let me know when you see some at this place. I'll throw a party.

I gather you might want to retract some of that. Feel free.
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