Re: Excerpt: The Truth About the Drug Companies by Marcia Angell

From: Robert (Robert_at_hotmail.com)
Date: 08/15/04 

Date: Sat, 14 Aug 2004 21:57:44 -0700

"Robert" <Robert@hotmail.com> wrote in message

You say Ontario only. Your politics are bull*** when you try and blame it
on one political party. These are real life issues and you try to bring the
political angle.

>From a hospital in BC

St. Paul's funding needs: What does it mean to patient care?
For a century we have been committed to two principles - service and fiscal
responsibility.

Our patients - from around the corner and across the province - have relied
on us to be there when they needed us most.

Our commitment to them hasn't wavered. But our ability to meet their needs
is in serious jeopardy.

This document describes the factors contributing to the current situation at
Providence Health Care/St. Paul's Hospital. It also provides an overview of
four key areas that require immediate attention.

All Hospitals are in the Same Boat, Right?
Not really. Although no one can deny times are tight for all health care
providers, several factors unique to St. Paul's have contributed to our
current situation.

The Cost of Fiscal Responsibility:
Rather than cut patient services, Providence/St. Paul's has sacrificed and
deferred spending on support areas, capital equipment, building maintenance
and information systems, to name a few. We knew that, continued indefinitely
and without relief, these band-aid measures would eventually impact patient
care. That day has come.

A History of Inequitable Funding:
By all measures, including the internationally accepted measurement of
Resource Intensity Weight (RIW), Providence/St. Paul's receives less per
patient funding than most hospital of a similar size and complexity. These
dollars are further stretched as we're relied on to provide care to patients
from across the province whose needs are growing increasingly complex. For
these patients, we are truly the "hospital of last resort."

Compounding the situation, our costs for support and other non-nursing
professional staff are lower than many hospitals with similar missions
inside and outside BC.

Inadequate Funding to Meet Needs of Disadvantaged Populations:
In addition to being a major provincial referral, teaching and research
facility, St. Paul's serves an inner city population similar to major US
cities. Our funding doesn't take into account the needs of medically and
socially complex patients, particularly those who live in the Downtown
Eastside:

54% of patients from the Downtown Eastside have a secondary diagnosis of
substance use
no fixed address admissions have skyrocketed by 400% in less than five years
the number of psychiatric admissions to the ER has tripled since Riverview
downsized
28% of patients who use injection drugs test positive for HIV/AIDS; 87% have
Hepatitis C; 30% test positive for tuberculosis
72% of BC's HIV/AIDS population resides in the Lower Mainland and 80% of
hospital services to this population are provided by St. Paul's

Funding Needs to Avert a Crisis.

1. Low Staffing Levels:
Providence/St. Paul's is significantly understaffed when compared to similar
facilities in BC and Canada.

Nurse-to-patient staffing levels are below average in several critical areas
(cardiac, orthopedic, thoracic/vascular/respiratory units).
St. Paul's is well below national and provincial averages in housekeeping,
ward aids, clerical staff and other non-nursing support. As a result,
nursing staff spend time doing a variety of duties not directly related to
patient care.
If, for example, funding were provided on the same basis as Vancouver
General hospital for patient care and drug costs alone, our base funding
would increase by $6 million:
The Funding Need:
$7 million is required this year to continue providing safe patient care and
to bring St. Paul's into line with other facilities.

The No-funding Scenario

a crisis-level shortfall of nurses
challenges in recruiting and retaining staff
longer wait lists
restrictions to provincial referral (tertiary care) services
inability to provide services to the Downtown Eastside
patients at risk either due to decreased access or increased demand on staff
and resources

2. Outdated Capital Equipment:
Life saving equipment needs are not being met due to a lack of funding. Part
of the problem is that BC spending on capital equipment is well below the
national average.

Based on hospital industry standards, Providence/St. Paul's should be
investing $15.6 million per year on capital equipment. This year we received
$1 million; last year it was $1.5 million.
Providence/St. Paul's has $34 million in equipment that's worn out: $12
million is mission critical; $7 million is urgent.
At the current rate of funding, it would take up to 109 years to replace
existing equipment. And this doesn't even take into consideration advances
in new technology.
The Funding Need:
$12 million for mission critical capital equipment, including:

cardiac and ICU monitors
defibrillators
cardiac sonograph
heart/lung machine
medical/surgical gastro intestinal scopes
renal dialysis (kidney) machines
surgical monitors
The No-funding Scenario

equipment failure and risk to patient safety
inability to deliver care at current Canadian standards
inability to attract and retain highly qualified staff
negative impact on our teaching programs

3. Substandard Buildings & Facilities:
The Burrard Building at St. Paul's - the home of the only Emergency
Department in the downtown core - will not likely survive a major
earthquake. Yet funding for a new building has not been approved.

The Funding Need:
Immediate approval to proceed with construction of a new building to safely
house the Emergency Department and inpatient psychiatry (one-time funding of
$49 million).

The No-funding Scenario

a major earthquake could leave the downtown core without a functioning ER
ongoing risk to patient, staff and physician safety

4. Outdated Information Systems (IS):
Because we've had to redirect funding to patient care, we're investing
significantly less in our Information Systems than needed. The end result is
compromised patient care and missed opportunities to improve services.

Many of our key information systems are 15 - 20 years old and not capable of
supporting modern health care delivery.
Patient charts average 150 pages. Physicians and staff currently have to
wade through them by hand.
Electronic clinical decision support has been proven to reduce medical
errors and duplication of costly diagnostic procedures resulting in safer
patient care.
The Funding Need:
$5 million a year to begin developing a common clinical information system.

The no-funding Scenario:

compromised patient care
missed opportunities for cost savings to be used to improve access
inability to meet increased needs for health care services
increased frustration of medical staff and staff in general at roadblocks
that hinder quality care

ACTION:

We have prepared a case for additional funding and are discussing the
solution with the Vancouver/Richmond Health Board and the Ministry of
Health.
We are consulting with our key stakeholder and community groups.
We are meeting with our staff, physicians and unions to discuss the funding
emergency and its potential impact on patient care.
Questions? Comments?

We'd like to hear from you. Call our hotline at 806-8339 or use the "Contact
Us" feature on our Web Site to send us your comments.

---------------------------------------------------------------------------- 

----
Trends
more people needing care and service
shorter lengths of stay in acute care hospitals
The Future at Providence:
New technology and changes in medical practices have created new
opportunities for service delivery. Expanded ambulatory care services will
be an innovative step forward: high quality care; easier access; a
"one-stop" shopping" philosophy; and efficient use of valuable health care
resources. Ambulatory care includes diagnostic tests and treatments that are
more specialized than those you'd receive in a doctor's office, delivered in
a way that doesn't require an overnight stay in hospital. Most procedures
take only a few hours, so you are able to return to your home the same day,
with home care provided. Health care dollars are used wisely, more people
are served and beds in acute care hospitals remain available for those who
need them most. We will also provide state-of-the-art diagnostics and very
specialized care and services as one of the major referral centres for
British Columbia.
Trends
aging population
health-conscious population
better management of chronic diseases
The Future at Providence:
Not all older people have the same needs. One person may need information on
health eating and exercise; another may need help managing a chronic disease
like Alzheimer's or diabetes; and another may require live-in residential
care. Providence Health Care's geriatric centre will be designed to meet the
unique and individualized needs of an aging population. It will include
inpatient services, ambulatory care and community outreach; be sensitive to
the client's preference for lifestyle and care; ensure ease of access by the
elderly and their loved ones; and concentrate on maximizing abilities,
function, quality of life and independent living. A Centre for Excellence in
Health and Aging will help clients, caregivers and care providers learn more
about how to manage chronic diseases and maintain health and wellness as we
age. And for those who can't live independently, Providence Health Care will
continue to provide residential care in a compassionate, home environment.
Trend
Diverse Population
The Future at Providence:
In a community like Vancouver, health care is not only about diagnosis and
treatment. It's also about our ability to provide care that is sensitive to
language, cultural, social and spiritual needs. For guidance on how to
provide care that respects diversity, we only need to look at our past - to
one hospital that provided needed care to new immigrants; another hospital
that came to the aid of the poor and unemployed; and another that developed
the first services in the province for individuals with HIV/AIDS. In the
future, we'll continue to build on our rich history of translation services,
pastoral care, multi-language promotion and prevention services, and health
care services that meet the special needs of our diverse communities.
Trend
Increasing numbers of disadvantaged persons in the downtown core and
Eastside.
The Future at Providence:
St. Paul's and Mount Saint Joseph Hospitals serve individuals with perhaps
the most complex health needs in the province. The challenges are similar to
those faced by inner cities in the United States - poverty, illiteracy and
English as a second language; homelessness, HIV/AIDS, mental illness and
addictions. By creating partnerships with the community and expanding our
range of services, we will continue to provide appropriate care for pregnant
women who are substance mis-users, isolated seniors living in poverty,
injection drug users, street youth, refugees, new immigrants and others in
our city who are disadvantaged. Providence Health Care has also entered into
a partnership with Vancouver Hospital and Health Sciences Center to
coordinate acute care mental health services in Vancouver, with a view to
improving the care and treatment to those who struggle with mental illness.
Trend
national shortage of skilled health care staff, particularly nurses
The Future at Providence:
According to recent estimates, 29 per cent of registered nurses now working
will be at retirement age by the year 2004. With fewer young adults
graduating than the total number of older adults retiring, a critical
shortage of skilled staff is being felt by health care facilities across the
country. Providence Health Care is putting into action a strategy that will
result in our facilities becoming "referred" places to work. We are
listening to the needs and concerns expressed by our staff, asking for their
help to make improvements, focussing on the quality of work life at all of
our facilities, addressing health and safety issues, and making sure that we
have the staff available to provide the care needed by those we serve.
Trends
continuous quality improvement
utilization management
The Future at Providence
In four years, Providence Health Care expects to be caring for 11 percent
more patients than it cares for today. To do that successfully and
economically, we must make sure that we are doing the right thing, in the
right place, at the right time, to get the right result for each patient - a
result that meets each person's unique needs. We will continue to focus on
establishing relationships where the patient is more in control and the
service providers work more effectively with the patient - and with one
another - to get the best possible health outcome. Many people who might be
hospitalized today will be seen in ambulatory care or community settings in
the future. Links with other hospitals and community agencies will be
strengthened so people move through the system with fewer frustrations and
delays. Community and home services will make it possible for people to
return home sooner, confident that the support they need will be available.
Basic and clinical research will continue to focus on the evaluation of
outcomes and the impact of new technology on diagnostic procedures and
treatments to ensure that the care we provide is excellent.
Quantcast