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Showing posts from February, 2011

30% of patients with HAIs re-hospitalized within 30 days

Three out of every 10 Pennsylvania patients who got a hospital acquired infection (HAI) in 2009 were re-admitted to the hospital within 30 days for an infection or complication, according to a new report released today by the Pennsylvania Health Care Cost Containment Council (PHC4). That's about five times the rate for patients that did not get an HAI during their stay.   “The data suggest that if you contract an infection in the hospital, you are more likely to be re-hospitalized,” said  Joe Martin , PHC4’s executive director. “We don’t know why that is or how much the initial infection contributes to the readmission, but it may present opportunities for quality improvement and cost containment.” For more on this study click here.   dallan@cupe.ca

Campbellford man spends $26,300 to travel to regional hospital. Build rural hospital services instead!

Here's one account of what happens when patients have to travel for hospitals services.    Count Earle Nelson has spent, by his own calculations, more than $26,300 on transportation, parking and passes since 2007 travelling to hospitals an hour or more away three times a week to be hooked up to a machine that keeps him alive. "Not only is it costly to travel but also very stressful and anxiety often happens when weather conditions or other factors cause difficult situations that are detrimental to the well-being of a patient," he said last week. Mr. Nelson was speaking at a special meeting organized by six of his fellow tenants at Campbellford Memorial Multicare Lodge to generate support for people who suffer from renal failure. "The time has come. A dialysis unit must be considered a priority for Campbellford Memorial Hospital," said Mr. Nelson, who told one audience member he receives "a little, but nothing much" in the way of help for his out

For-profit health care: real costs or super-profits?

OCHU has repeatedly flagged the role of for-profit providers in driving up the costs of health care, and more often than not, the main offender is transnational pharmaceutical drug companies. Supporters of these corporations have often justified the expense of their drugs by citing  research and development costs.   $1.32 billion per drug is often bandied about So it is interesting to see Andre Picard's review in the Globe and Mail  of a  study that examined these, alleged, costs.  Picard reports that the study suggests a more realistic cost (after accounting for things like the true cost of financing, government tax subsidies, and public support via basic research from government and university labs) might be closer to $59.4-million.   That's quite a difference.   The actual costs are 4.5% of the amount claimed by the supporters of this for-profit industry. So, where does all that money we spend on drugs go?

Hospital centralization driving up ambulance EMS costs

A Hamilton City Councillor  is demanding the Local Health Integration Network (or the local hospital) pick up the tab for extra Emergency Medical Service (EMS) costs associated with hospital restructuring in that city. Councillor Tom Jackson says a consultants report predicts it could cost an extra $1.5 million in EMS (ambulance) costs. This sort of cost download is likely happening with a lot of the centralization of hospital services going on around the province.  Emergency Medical Services are increasingly required to move patients from one hospital to another, so that patients can get access to the variety of services they need at the specialized sites providing those services. From the province's point of view, this is a winning proposition: while they fund almost all hospital expenses, they only have to pay 50% of   approved EMS costs.  But for municipalities charged with providing Emergency Medical Services, hospital centralization creates new costs (and demands) for

LHIN CEO raises idea of hospitals as a hub for rural health care

Alex Munter, the new chief executive officer of the Champlain Local Health Integration Network, has suggested hospitals   in rural communities can become health hubs that bring together services from other providers, thus offering a broad range of health and social services at one convenient location. Following  the announcement by the Eastern Ontario Health Unit that it would move its home to the campus of the rural Winchester District Memorial Hospital, Munter stated :  "In rural communities, hospitals can become health hubs that bring together services from other providers and offer a broad range of health and social services at one convenient location. This is an exciting initiative that further speaks to the Winchester Hospital's innovative leadership in health care."     Coincidentally, OCHU has just submitted its comments on the Rural and Northern Health Care Framework/Plan, Stage 1 Report ,  and has  renewed its call  for hospitals to become hubs for health c

Victory! Health Minister orders hospitals to strictly limit bed charges

Following furors  in Windsor and Toronto , Health Minister, Deb Matthews has told hospitals not to charge patients waiting for a long term care bed more than $53.23 a day.  That's a lot less than the $1,800 a day that some wanted to charge, to help reduce hospital bed occupancy.  “It is completely inappropriate and unacceptable for any individual in this province in a hospital waiting for long-term care to be charged more than $53.23 per day,” Matthews  told the legislature Tuesday. These special charges have been around (and complained about) for some time, as jammed-up hospitals have felt increasing pressure to boot out patients.  So it's good to see the Ministers has finally felt compelled to do some thing about it.  Bed occupancy does need to be reduced -- but not by undermining medicare.   This is a good day for public health care.  dallan@cupe.ca

Superbug reporting: How many have died?

St. Joseph’s hospital  in Hamilton has begun to report the number of its patients who have died with hospital acquired infections, according to the Hamilton Spectator . In this, St. Joe’s is leading the way.  OCHU called years ago for the province to require hospitals to release information about hospital acquired infections (HAIs).  Eventually, the province did require hospitals to report the incidence of some of the most widespread HAIs. But the province still does not require hospitals to report patients who died with HAIs.  So here, St. Joe's deserve some recognition.  St. Joe’s is now one of the few hospitals with a broader public disclosure policy for HAIs.  Sixteen infected patients died at St. Joe's in a 3½-month surge of C. difficle.   The outbreak ended Feb. 11. The province should require all hospitals to report patients who have died infected with HAIs, and not leave it to  those willing to put their neck out.   With public transparency will com

Letter of the Day: $600 a day for a hospital bed illegal under Health Insurance Act

Long-term care act can't be overridden Windsor Star Tue Feb 22 2011  Page: A7  Byline: Jane E. Meadus  Column: Letters to the editor  Re: Crisis designation 'too little, too late,' by Sonja Puzic, Feb. 17. Gary Switzer, CEO of the Erie-St. Clair  Local Health Integration  Network, announced recently that the LHIN has designated area hospitals as being in " crisis " mode, allowing hospital patients increased access to long-term care home beds. While the LHIN does have such authority, the statement that this measure means that " patients who don't accept the first available long-term care bed in the community will face a $600 per day fee to remain at the hospital " is not in accordance with the law. Under the regulations to the Long-Term Care Homes Act, when hospital patients are designated as " crisis, " they move to the top of the list for their home choices. There is no requirement for them to accept beds in homes they have no

Toronto hospital stops trying to charge patients $1800 a day

Sunnybrook Hospital vice-president Craig DuHamel conceded in the Toronto Star today (" Pay $1,800 a day or get out: Hospital ")  that  it was a  mistake  to have told a patient she might have to pay $1,800 a day to stay in her hospital bed.  The " bed-refusal " practice was an ill-conceived idea introduced sometime last year " as a last resort " to move large numbers of patients through the  hospital , he explains. " It's one of those things that, I think, you look at all kinds of strategies to help  free  up beds and not all of them are the best idea, " he says. Sunnybrook halted the practice late last year after the Advocacy Centre for the Elderly warned it contravened the Health Insurance Act. DuHamel says some staffers obviously didn't get the message. " It's definitely coercive, " says Jane Meadus, counsel for the advocacy centre, adding that the organization received about 160 similar complaints last year.

Ontario hospital admissions fall sharply: Lowest hospitalization rate in Canada

Ontario acute care hospital admissions have declined rapidly since 1995-96.  Between 1995-6 and 2008-9 those admissions declined from 1,149,929 to 982,624.  That's a 14.5% decline (a little bit more than the Canadian average of 14.1%). Ontario also has the lowest (age and sex standardized) acute inpatient hospitalization rate of any province or territory in 2008-9.  And Ontario has the lead by quite a ways.   For the data on this, see the Canadian Institute for Health Information report here . Despite this (and problems with high bed occupancy), Ontario hospitals continue to be the biggest focus for government health care cutbacks. dallan@cupe.ca

Windsor hospital bed fees illegal says seniors advocacy group

Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly,  says  it's illegal for hospitals to charge patients $600 per day, even if they refuse to leave for a bed in a nursing home.   Meadus said that under the Health Insurance Act, the maximum a hospital can charge a patient awaiting placement is $53.23 per day.  "That doesn't change in a crisis," she said. ( The $600 fee planned by Windsor hospitals comes with a designation of a hospital bed crisis in the area.)   She said the demands for extra payment come when patients and their families are particularly stressed and vulnerable. Windsor Regional Hospital president and CEO David Musyj said he's aware of the group's position on the hiked fees, but the new policy won't change.  "I disagree with her interpretation of the regulations," said Musyj. He said the $600 fee is not meant to be a revenue generator or meant as a threat to patients to free up beds, but is designed t

Health care shortage hits home -- Ontario Liberals are being hit from every direction

The health care funding crisis is coming at the Liberal government from every direction lately, even from friendly newspapers.   The Toronto Star  has started a series on home care, showing how patients are falling through the cracks at a time when hospitals are discharging patients “sicker and quicker”. The  Star  found numerous stories of seniors denied access to home care or just given a few paltry hours.  A 90-year-old Scarborough woman with dementia is told she does not qualify for home care. A daughter in Stouffville begs to keep a few home care hours for her 86-year-old father who is paralyzed by a stroke. In Aurora, a woman who cares for her chronically ill husband, was refused home care after she broke her back. The series started Saturday ,  and continued Sunday  with more to come later this week.  Take a peek.  It seems it never rains, it simply pours:  The  Peterborough Examiner also ran a front page story yesterday detailing the trials of getting home care

Windsor Essex has lost over 120 hospital beds. That might just explain the bed crisis

There is a pretty simple explanation of the Windsor Essex hospital bed crisis: the provincial government has forced the closure of a lot of hospital beds in the area. In 1995-96 there was 1,183 hospital beds at the three hospitals in the area. Now, Windsor Regional Hospital claims 669 (for the year ended March 2010); Hotel Dieu, 305 ; and Leamington District something less than 88 .  So now there is somewhere less than 1,062 beds in Windsor Essex. That is a 10.2% reduction in the number of beds. And this probably underestimates the cuts.  Leamington District, as far as I can find, does not report the current number of beds, but rather reports that they had 88 beds several years ago and then cut staff and beds.  Moreover, the start year noted above, 1995-96, was already six years into the massive beds cuts during the Harris and Rae governments.  Indeed, by 1996, about a quarter of the province's beds that existed in 1990 were gone. It's possible that Windsor Essex e

Very ill patient stuck in US hospital - no hospital beds in Toronto

Oh brother -- it's worse than I thought.   The Toronto Star reports that for more than two months, a Woodbridge woman has been keeping vigil by her husband’s bedside in a U.S. hospital while trying to get him moved back home.But Kokila Joshi is being told by hospital after hospital in the GTA that there are no beds here.  The hospitals accept that there’s a problem, saying the flu season has overwhelmed their already strained capacity. But so far nobody has been able to do anything about Joshi’s plight. Bipinderoy Joshi, 67, suffered a cardiac arrest while on vacation in St. Louis, Missouri on Dec. 8. He has been in the SSM St. Joseph Health Center ever since. “If we had a bed available to safely accommodate this patient, we would do so,” said York Central hospital spokesperson Elizabeth Barnett.  "This flu season has overwhelmed hospitals and we have to take our patients who are in the emerg first,” said Scarborough Hospital spokesperson Tracy Huffman. “The challenge is our

Barrie hospital contracts out support services

The Royal Victoria Hospital (RVH) in Barrie is planning to close it's cafeteria and replace it with commercial food kiosks at the end of February.  Most of the  85 cafeteria staff are being reassigned. Four part-time casual cashier positions will be eliminated according to the RVH. The parking service has already been contracted-out and the  hospital  has been looking at  contracting out  the management of other services, including laundry and housekeeping.  " We are out in the market to see if there's interest, " said a hospital spokesperson. " It's allowing hospitals to really focus on the core business. " The hospital is planning appreciation activities for those involved in the cafeteria. The activities  include  a special tea, a pictorial history through a slideshow and the distribution of recipe cards from the  hospital  kitchen. " It's our opportunity to say thanks for nourishing our soul " says a hospital flak. Whoopee. A b

Steep increase in hospital bed occupancy

The Canadian Institute for Health Information (CIHI) reports that in 1995-96, hospital bed occupancy in Canada was 84.7%.  As reported  here  earlier this week,  it was 97.9% in 2010 in Ontario. Is it really any wonder we have problems with wait times, backlogs, cancelled surgeries, ambulance offload delay, and hospital acquired infections in Ontari, ari, ario? dallan@cupe.ca

Forcing hospital patients down the highway and into a retirement home. This is the solution?

The p roposed medium term remedy for the Windsor Essex hospital bed crisis is to open 62 interim long term care beds at a Leamington retirement home next month. The Leamington Court home is reportedly part of Allegro Residences, which, in turn, is part of the Maestro Group, which is based in Montreal and operates residences across the country with a staff of 2,500.   This, of course, raises the issue of shipping public hospital patients off to retirement homes -- homes which are overwhelmingly run on a for-profit basis.  Serious questions have been raised about the quality of care for hospital patients at retirement homes. And in Windsor, doubt is also being raised about the wisdom of shipping hospital patients miles away.  Any forced movement of hospital patients can have a serious health impact. But there is also concern that shipping Windsor seniors miles down the road to Leamington will leave them isolated from their loved ones and put more strain on families. "I think th

The plot thickens: British government opens negotiations with P3 corporations to cut costs

The British government, which claims to be clamping down on public spending, has opened negotiations with the corporations involved in government funded "public private partnerships" (P3s, or PFIs as the British call them).   The Independent reports :  ' One hospital was reported to have been charged £333 by a PFI firm to change a light bulb, while a school was charged £300 for an electricity socket.. . The industry could become the next target for public anger after the banks. Uncertainty around the future of the contracts could also impact on the companies' share price. Ministers think this is behind the willingness to do a deal…. (A) Treasury source said: "PFI is not immune from other savings in the public sector during the current economic downturn and we are looking to make savings.”' But it's hard to believe the British "Con-Dem" government will achieve anything much here (other than a media release announcing savings).  And indeed,

For-profit healthcare: the main cost driver?

"The biggest cost increases in the system are spending on new drugs, medical technology, medical imaging, costly interventions and community services." This from the Canadian Institute for Health Information (CIHI) report Health Care in Canada 2010 . Notably this list is comprised mainly by for-profit providers of health care. dallan@cupe.ca

Like trying to fit 19 ER patients into 1 hospital bed

After declaring a hospital bed crisis in Windsor Essex, Gary Switzer, CEO of the Erie-St. Clair Local Health Integration Network told the Canadian Press `` Currently we have, in one of the hospitals, 19 patients waiting in the  emergency room  for a bed. '' There's `` more to be done '' to help hospitals in the Windsor area Premier Dalton McGuinty said Wednesday. He should know.  Ken Deane, until very recently an Assistant Deputy Minister of Health and LTC, was appointed supervisor by the government of the  Hôtel-Dieu Grace Hospital  in Windsor on January 5.  Deane reports directly to the Minister of Health and LTC. But there still is no sign that the hospital bed cuts will stop any time soon. dallan@cupe.ca

Niagara speaks with one voice: Review the "hospital improvement plan"

The  Niagara Falls Review , the  Welland Tribune  and Liberal MPP Kim Craitor have joined the call by Niagara Regional Council for an independent review of the Niagara Health System's 'hospital improvement plan'.  The plan cuts hospital services in several smaller communities in Niagara and has caused a major uproar in local communities.   Health Minister  Deb Matthews  has repeatedly said she's impressed by the work done by the Niagara Health System and that it can continue implementing its blueprint for the future. She said she has no plans to appoint an investigator.  For more see  here .    dallan@cupe.ca

Surge in Emergency Room Visits: More patients waiting for a hospital bed

The Ontario Hospital Association (OHA) reports a surge in patients visiting hospital emergency departments (EDs) in January, in part, because of the flu season. Over January, the OHA noted a 22% increase (150 patients) in the number of patients in EDs waiting for admission to an inpatient bed, and a 10% increase (253 patients) of Alternate Level of Care (ALC) patients in acute care beds. The OHA adds: "Because occupancy levels in hospitals are already at maximum capacity, this influx of patients has pushed some hospitals to take great measures to ensure patients have access to the care they need."   The OHA is collecting data for a February report.     dallan@cupe.ca

Windsor Essex hospital bed crisis declared

The Windsor Star reports that t he Erie-St. Clair Local Health Integration Network has officially declared a  crisis  in Windsor and Essex County to deal with overcrowded hospitals, lengthy  emergency room  waits and cancelled surgeries. " It is desperately needed at this moment, " said Windsor Regional Hospital president and CEO David Musyj of the  crisis  designation. " We have to look at the whole system. For the whole system not to grind to a halt, we have no other option but to do this. " The  crisis  designation will help move patients from hospitals to LTC facilities, but few hospital beds will be emptied as a result; there are only six long-term care beds available throughout the city and county." Every bed is important, " Musyj said. " If there are six beds available in the community, that's six less surgeries that need to be cancelled. " Ron Sheppard, spokesperson for the Erie-St. Clair LHIN, said it's unclear how lon

P3s: "Little more than money-making mechanisms for builders and banks"

Banks and construction companies are ratcheting up vast profits from public private partnerships (P3s) according to a new British study that looked at equity sales for P3s. A study of p3 projects from 1998 through 2010 by Dexter Whitfield for the European Services Strategy Unit reveals that there are huge profits to be made from the sale of equity once a P3 project is operational.  The study found more than 240 P3 equity sales involving more than 1,000 P3 projects.  The sales generated £10 billion.   This amounted   to an average profit of around 50%.   That's not too shabby when compared to an average operating profit for construction companies of 1.5%. Whitfield said that, based on the findings, P3 projects were "little more than money-making ventures." "The level of profiteering from PPP equity transactions makes a nonsense of the original value for money assessments," he said. "If these profits had been taken into account at the evaluation stage then fe

Anyone for Regional Health Authorities?

The now former head of the Champlain LHIN, Dr. Robert Cushman, continues his outspoken ways, raising the idea of reducing the number of Local Health Integration Networks (LHINs) and turning them into regional health authorities with the Ottawa Citizen . "Are there too many LHINs? And should the LHINs become regional health authorities? I think they need to go through an iteration," he said. "Let's keep the regionalization, but let's improve the governance. Let's look for less bureaucracy throughout the entire system." In other provinces, "regional health authorities" go well beyond the funding responsibilities currently held by the LHINs and directly deliver health care services, replacing the existing hospital, nursing home, and home care employers within the region. Obviously, this could have a major impact on employment relationships and bargaining units.  And, consistent with the regionalization approach, Cushman raised concern about too

Another privatized P3 success story

Moncton's new privatized "public private partnership" (P3) courthouse is scheduled to open Monday, 2½ years late and costing almost twice the original estimate. The building was slated to open in May 2008 at a cost of $27 million, but wound up costing more than $50 million. The courthouse was built in a public-private partnership arrangement with the Province of New Brunswick. Citigroup Properties constructed the building and is responsible for operating and maintaining it. The city will lease the building for 30 years at $7.1 million a year. Advocates, naturally see this as a big success.  Michel Boudreau, the head sheriff in Moncton, said Thursday that the new courthouse will mark a vast improvement over the existing one in terms of security, starting with a metal detector at the front door.  "It's hard to put a dollar amount on people's security and safety." With this sort of outcome for Ontario P3 hospitals, however, there won't be

Ontario hospital bed occupancy is 97.9% (and there's no plan to reduce it)

As reported in the last blog entry, Ontario lost 614 hospital  beds in 2010, about 2% of the total number of beds.  As of 2010, there were  30,810 hospital beds. (See here for more.) Also in 2010, the average number of inpatients on any given day was 30,184  (See here for more.). Putting these figures together, hospital bed occupancy was 97.9% in 2010.  This very high level goes a long way to account for the cancelled surgeries, overflowing emergency rooms, and ambulance offload delays that are now choking-up our hospitals.   It also is way , way higher than the 85% bed occupancy target Britain has established for fighting hospital acquired infections.   When will Ontario establish a target for lower bed occupancy to reduce hospital superbug infections and backlogs?  There is precious little sign of it now.   dallan@cupe.ca  

Ontario hospital beds hit new low

Ontario lost 614 hospital  beds in 2010, about 2% of the total number of beds.  Most of the closed beds were acute care beds (418). Complex continuing care lost 129 beds and rehabilitation lost 70 beds.  Psychiatric beds increased by 3. Hospital beds have fallen from 49,391 in 1990 to 30,810 in 2010,  a loss of 18,581 beds or 37.6%.  Since 1999 hospital beds have remained pretty constant at about 31,500 (going up slightly mid-decade).  So 30,810 is a new low for decades. dallan@cupe.ca

Most smaller Ontario communities currently have access to hospital services. Will they in the future?

Key findings from a new ICES report on health care services for people in small town Ontario: • In 2009, communities with 30,000 or fewer residents comprised 2,588,144 people—approximately 22.7% of the Ontario population. • Emergency departments were accessible within 30 minutes by car for 97.8% of the population in communities of 30,000 or fewer  people and within 60 minutes for 99.0% of that population. All Ontario communities with a population of at least 5,000 people had access to an emergency department within 30 minutes.  185 communities were more than 30 minutes travel time from an emergency department (131 in northern Ontario and 54 in southern Ontario). Fifty-five communities did not have access to an emergency department within 60 minutes—all were in northern Ontario. (Institutions were defined as having emergency departments if were open 24/7 and were located at hospital sites with inpatient beds.) • Hospitals with obstetrical delivery beds were accessible to 93.8

For-profit home care corporation settles lawsuit for bad care

Comcare, one of Canada's largest for-profit  home care  providers, must pay more than $800,000 toward the lifetime care of a disabled Kitchener girl injured by its care. The child's parents sued Comcare after a former Comcare nurse was convicted of aggravated assault for  abusing  their baby girl, Leandra Knarr, over several months in the spring of 2002. The already handicapped baby was 20 months old when Comcare began to provide overnight care so the couple could sleep. A home videotape showed the nurse punching and slapping the baby in the head and chest, pulling her from her crib by her hair and pushing her hand down on her face as though suffocating her. She  violently  twisted her limbs, resulting in three fractured limbs. Along with Comcare, the parents also sued the  Community Care Access  Centre (CCAC) of Waterloo Region, which contracted with Comcare to provide nursing service.  (CCAC's are required by the provincial government to contract out home care s

More privatization of surgeries proposed

Saskatchewan is planning to expand its privatization of hospital surgeries.   In January, the Saskatoon Health Region issued a Request for Proposal (RFP) for a third party to do pediatric dental procedures, cataracts, and certain nose procedures for a three-year term with another two-year option. It also wants to continue contracting out knee arthroscopies, shoulder arthroscopies and anterior cruciate ligament repairs which it did with Saskatoon Surgicentre last fall. At the same time,  Regina Qu’Appelle Health Region also issued a RFP for the provision of ear, nose and throat, as well as gynecological, orthopedic and dental procedures from this fall to the end of 2013. It also plans to extend a contract it already has with Omni Surgery Centre in Regina to provide dental surgery and knee arthroscopy procedures. Last week, the region signed a 32-month contract for 42,500 CT scans to be done by a private clinic. Privatizers sometimes claim they will only contract out support servi

P3 time bomb coming to Ontario?

Local authorities in Scotland face a financial time-bomb for schools built through public private partnerships ("P3s") because of a series of flawed assumptions made when they entered into contracts, according to a new analysis by independent economists.  P3s bring for-profit corporations into our schools, hospitals and other public sector organizations by privatizing the financing and some of the operations of these organizations when new facilities are built. Gaps towards the end of some long contracts when central government funding runs out, over-optimism on associated land sales, and an “astounding” failure to allow for inflation being higher than predicted, are all contributing to the grim picture in Scotland. One local authority has already decided to raise taxes by 1% annually for 12 years just to honour a P3 contract. “The consequences, both in terms of an increasing squeeze on other local authority services, and in terms of pressure for steep council tax inc