Manitoba has been subjected to yet another review of its cardiac care services, but this time the results are different.
Previous reviews, including one headed by Dr. Wilbert Keon, also called for amalgamation of Manitoba's cardiac care services at a single hospital. This time, however, the government accepted the recommendation. “Within an hour [of arriving], I found everyone knew the solution,” said Dr. Arvind Koshal of Edmonton, who chaired the review committee. An hour later he was meeting with Health Minister Dave Chomiak to ensure that the political will was in place to implement the recommendations. “He assured me they would be [implemented].”
Satisfied, Koshal's team spent 6 months putting together the most extensive review yet, which produced 42 recommendations. The upshot is that cardiac surgery will be consolidated at the St. Boniface General Hospital in Winnipeg instead of being shared with the Health Sciences Centre (HSC). “Having 2 sites was very divisive and inefficient,” said Koshal, director of cardiac surgery at the University of Alberta.
The report, released Aug. 18, also called on the province to find strong physician leadership for the program and to create a new position of medical director for the regional cardiac sciences program. The plan is to increase the annual cardiac caseload from the current 1200 patients (with a waiting list of 110) to 1500 patients within 3 years.
The change in political will is somewhat surprising. During the 1999 election campaign, the New Democrats promised to keep cardiac surgery programs operating in both hospitals. However, attitudes changed when people on the waiting list started dying — there have been 11 deaths since 1999 — and both the Liberals and Conservatives demanded Chomiak's resignation. The last straw appears to have been the death of Diane Gorsuch, 58, who died in February after spending more than 2 years awaiting surgery. Thirteen days after she died, the review was announced.
But Koshal says more than politics is involved in Manitoba's problems. According to the report, the delivery of cardiac services has a “history of internal conflicts and challenges. … Tensions have historically existed between surgeons at the 2 sites.”
“I told everyone in charge that we can't let 2 or 3 people win,” says Koshal. “We have to rise above the rivalry.”
In the end, a choice had to be made between the 2 sites, neither of which had the “critical mass/volumes required to optimize effectiveness or resources.” Choosing St. Boniface over the HSC was a “nonissue,” says Koshal, because St. Boniface had the necessary infrastructure in place. The HSC will retain a cardiology program.
New staff, particularly cardiac surgeons, will have to be found. With 1500 cardiac operations to be performed a year, the program will require 7 surgeons, including a new chief. There are now 5.
This is the second time in a decade that Manitoba has sought an outside opinion on its cardiac care services. It turned to experts from Toronto and Ottawa when questions arose concerning the death of a dozen children undergoing heart surgery in 1994.
The big difference between the pediatric and adult reviews is that the pediatric surgery program was shut down, whereas “this [review] will strengthen the program,” says Koshal.
Dr. Jon Gerrard, leader of the Manitoba Liberals, was “stunned” at how similar Koshal's recommendations were to those in the pediatric review. He said the new ones are “a big step in the right direction.” — Barbara Sibbald, CMAJ