UBC Hospital prepped for cuts
Savings modest as patients face inconvenience

 Pamela Fayerman

Vancouver Sun

Thursday, December 19, 2002

The long and drawn-out saga over the fate of the
University of B.C. Hospital is expected to culminate
today with an announcement that it is to be downgraded
to a site offering only elective surgery and limited service
for urgent, not emergency, care.

A decade of speculation should come to an end when
the Vancouver Coastal Health Authority (VCHA), whose
representatives would not comment when asked to do so
Wednesday, is to deliver news of the impending changes
to health professionals today.

The authority scheduled an all-day private meeting
Wednesday to finalize the decision about the 20-year-old
hospital which has an $80 million a year budget.

The VCHA has a $1.9 billion annual budget and the cost
savings associated with the UBC changes are not expected
to reap more than a few million dollars in the first year.

The public won't find out specific plans for patient care
until later today or Friday but it is expected that many
routine surgical procedures will be shifted from Vancouver
General Hospital's West 12th Avenue site to UBC.

The two sites will swap cases, with VGH taking the most
serious cases. The changes are not expected to be
implemented until the first quarter of 2003.

The UBC emergency department, which had 20,000 visits
last year -- compared to 50,000 at the VGH site -- is
expected to be designated as an urgent care centre,
which will treat only patients who don't need surgery
and aren't in a state of trauma. Essentially, that means
it will be for the walking injured, and ambulances would
take seriously ill patients to VGH or St. Paul's Hospital.

Dr. John Cairns, dean of the UBC medical school,
who last week expressed alarm, said Wednesday he is
not as worried about the reconfiguration of the UBC
hospital because he has been assured that any changes
will not compromise the training of medical students,
residents and post doctoral fellows.

"Any change is always a cause for concern and we felt
our concerns from the perspective of education and
research, weren't being addressed initially, but now
they have been taken into account," he said, adding
that changes will present more of an inconvenience
to patients and students alike.

"Essentially, our residents will have to move around
the system, getting experience in various places,"
he added, referring to the fact that other hospitals
in the region, like the one in Richmond, will have to
play more of a role in teaching medical students.

"The thing that everybody needs to understand is that
there are financial constraints in the system and we
must face this reality that they are trying to achieve
operational efficiencies," Cairns said.

While UBC will see a shift from being a full-service
hospital to a sub-acute facility doing planned, elective
surgery, it will retain its brain research centre, student
health services, psychiatry services (55 beds) and
outpatient clinics, which include those for neurology,
Parkinson's disease, and multiple sclerosis.

The Purdy Pavilion, which has nearly 200 long term
care patients, will also be unaffected.

VCHA background documents estimate the cost savings
at $5 million a year with a one-time cost of upgrading
the emergency department at VGH at about $3 million.
Cairns said apart from the cost savings, there should be
improved efficiencies to patient care. He said if elective
surgery is consolidated at the UBC site, there won't be
as many cancellations due to emergency cases
bumping the elective cases out of the operating room.

That is a frequent occurrence at VGH.

The changes the VCHA makes to the hospital will cap
a long- standing and continual erosion of the UBC
hospital's mandate. In 1994, a year after the closure
of Shaughnessy Hospital, the rumour mill was rife with
speculation the UBC Hospital would be closed. At that
time, the hospital had 200 acute care beds open; today
it has just over 100.

The uncertainty over the fate of the hospital, especially
in the past six months, has meant that doctors have
been leaving en masse, jostling to secure privileges
at other hospitals so they wouldn't be caught without
a place to treat patients when the final decisions about
UBC were made.

The panic reached such a point that there have been
times in the past few months when there were no
anesthesiologists or internists available for surgeries
at UBC and the severe drop in patients meant that
there was less teaching going at the UBC site.

Discharge records show that last year, there were
5,687 patients who stayed in the hospital, compared
to 6,207 in the 2000/2001 period.

Dr. Lynn Doyle, the vascular surgeon who is president
of the B.C. Medical Association, said she doesn't know
what kinds of surgery the hospital will do but expects
it can be little more than "lumps, bumps, hemorroids
and hernias" without an emergency department and
without intensive care beds or a broad range of specialists.

She said even some of her straightforward vascular cases
have been impossible to do at the UBC site lately,
because of the shortage of anesthesiologists.

Even more uncertain is how the health authority proposes
to shift more burden on the already strained VGH site
where it is not uncommon for emergency department
delays of several hours, and where even urgent surgery
cases are delayed for days or weeks.

Judith McGrath, a UBC psychiatric nurse who is also
a chief steward of the B.C. Nurses Union, said there
are 616 registered nurses working at the UBC site
(compared to 2,500 at VGH) and "it would be nice if
the people making these decisions sought the advice
of the professionals working at the patient bedsides."

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SOURCE: The Vancouver Sun
http://www.canada.com/vancouver/news/story.asp?id=4466142E-2D95-4D21-
A83C-0BDC0E64294D

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