He didn’t connect the dots, but a Nelson physician left people at a health care forum this week wondering about the relationship between cuts to Kootenay Lake Hospital over the last decade and the facility’s performance on the Fraser Institute’s latest report card.
Dr. Raz Moola’s presentation pointed to a number of indicators where the local hospital scored significantly better or worse than the rest of the province.
Moola, one of Nelson’s two obstetricians, noted they did very well in minimizing the rate of Caesarean sections based on 2008-09 data, the most recent available. Kootenay Lake Hospital ranked seventh out of 52 in BC.
“I’d like to think that nobody is having a Caesarean section unless they need it, but there’s huge differences from 25 per cent in our hospital to upwards of 40 per cent in other communities,” he told the audience.
Kootenay Lake Hospital was also ranked first in the rate of vaginal births that occurred in mothers who previously delivered by Caesarean section.
“It’s an indication of comfort level among midwives, family physicians, and obstetricians,” he said. “Many organizations suggest this is a marker of good quality health care.”
However, obstetrics is the only kind of inpatient surgery offered at the local hospital, which Moola says probably makes it one of a kind.
“As far as I can tell, we’re the only hospital in BC and probably the nation where you have full service obstetrical/gynecological service and nothing else when it comes to surgery. From my view, this is not the right kind of balance you need to say you have a healthy community.”
Moola cited other data in the Fraser Institute report released last week that was less encouraging.
An indicator called “failure to rescue,” which measures a hospital’s ability to respond to complications ranked Kootenay Lake Hospital as seventh best in BC in 2001-02, prior to major changes. It has fluctuated wildly since, but is now near the bottom.
“The numbers and rankings aren’t so important, but before the changes in our health care system, Nelson did well in terms of our ability to deal with complications,” Moola said.
Based on measurements that track patients by municipality, Nelson area residents fare much worse than those in Trail in dying in hospital of congestive heart failure and gastrointestinal hemorrhage.
“It’s not clear to me why hospitals an hour away should have profound differences,” Moola said. “Someone suggested this is about transport. It may be about the lack of an intensive care unit. This might be about the lack of a general surgeon. I can’t tell you.
“It’s difficult to draw conclusions from the data, but I think it’s important that we ask questions of health care providers and administrators to say what has happened over the last ten years that is placing communities at risk?”
Moola also suggested having a “robust surgical service” including a general surgeon was important not only for the region’s health, but its economy, with many spin-off effects. “I suggest for businesses, tax base, and a variety of other reasons, it’s good to have a well-functioning hospital,” he said.
Moola noted he and colleague Dr. Carrie Fitzsimons, a pediatrician, are among the rare number of specialists outside major urban areas, disproportionate to the population they serve.
“There’s a huge disconnect. When we talk about two-tier health care in Canada, it’s not about public and private medicine. It’s urban and rural medicine. Where you live has a huge impact on the quality, access, and timeliness of care you may receive.”
Fitzsimons, who is also the medical staff president, told the forum she senses a “slow, steady, painstaking movement to more regional thinking and working together,” and hoped they would “continue going in that direction without being inflammatory and destructive to bridges built over the years.”
She said following “an administrative change of guard” locally and regionally, “I feel they’re very much on our side. They do hear us [although] sometimes they don’t do what we would like.”
The Health Task Force and Nelson and Area Society for Health organized the forum, which drew over 50 people.