Did Quebec's health system kill Richardson?

[Dr Mordrid]

The issues to me are;

1. why in HELL doesn't Quebec have med-evac choppers? Is this just a skewed version of Canada's 'let 'em die before we have to pay for treatment' govt. health care plan?

2. could the Ski Patrol have done more to encourage treatment? Here our squad guys will actively encourage (sometimes to a fault) a 'just to be safe' trip to the ER in cases where someone suffers a head trauma.

3. does Quebec's Ski Patrol have EMS training or are they just window dressing? See #1.

ABC NEWS link....

After Wake, Some Wonder If Helicopter Could Have Saved Richardson

British Actress' Family and Friends 'Devastated by the Tragic Death of Their Beloved Natasha'

By SHEILA MARIKAR

March 21, 2009

A day before Natasha Richardson's scheduled funeral, some are wondering if a medical helicopter might have been able to save the actress, who passed away Wednesday at age 45 after falling on a Quebec ski slope.

The province of Quebec lacks a medical helicopter system, often used in the US and other parts of Canada, to airlift stricken patients to major trauma centers. Montreal's top head trauma doctor told The Associated Press that may have played a role in Richardson's death.

"It's impossible for me to comment specifically about her case, but what I could say is ... driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal's hospitals, told the AP.

Razek's comments came on the heels of a celebrity studded wake for Richardson, held Friday afternoon at the American Irish Historical Society in New York City.

A hearse carrying Richardson's body arrived at the society, at 991 Fifth Ave. and E. 80th Street, early Friday. Liam Neeson, her actor-husband, arrived shortly after with their two sons. Her mother, Vanessa Redgrave, sister, Joley Richardson also attended.
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Celebrities including Lauren Bacall, Uma Thurman, Ethan Hawke, Sarah Jessica Parker, Ralph Fiennes, Laura Linney, Stanley Tucci and ABC News' Diane Sawyer showed up to mourn the death of the industry-beloved star.

According to the AP, Neeson left society at 8:40 p.m. Friday night, more than six hours after the wake began.

Richardson's body was moved to the society Friday morning from the Greenwich Village Funeral Home in downtown Manhattan. She will be buried Sunday during a private funeral service in Millbrook, N.Y., where she belonged to St. Joseph's Roman Catholic Church.

The New York City Medical Examiner's Office conducted an autopsy on the Tony Award-winning actress Thursday. The office ruled her death accidental, citing the cause as an epidural hematoma due to blunt force trauma to the head.

Neeson and family members were by her side when she died. Her death was announced in a statement released Wednesday evening by Neeson's publicist.

"Liam Neeson, his sons and the entire family are shocked and devastated by the tragic death of their beloved Natasha," the statement said. "They are profoundly grateful for the support, love and prayers of everyone, and ask for privacy during this very difficult time."

[Brian Ellis]

Don't forget that she carried on skiing after the accident and it was much later that symptoms started to appear, by which time it would probably have been too late anyway. Under the circumstances, as the haematoma was obviously slow but widespread to develop, it is probable that the only way to save her would have been a rapid MRI diagnosis and operation (if possible) to find and stop the bleeders.

Apart from the helicopter lack, which would probably have made no difference under these conditions, as the symptoms did not appear immediately, why was she not wearing a ski helmet? This is becoming quasi-mandatory on many European slopes and insurance companies will not pay for cranial injuries if the skier/snowboarder was not wearing one, even on the nursery slopes.

[Dr Mordrid]

She refused a helmet, which I also find a problem with: the resort should have mandated them. Their slopes, their rules. Don't like it: go somewhere else.

Still - the syndrome she displayed has a magic hour before they show symptoms and a similar time during which treatment could be successful.

I think the absence of a chopper and decent medical facilities where there is a large potential for serious injuries to occur is a big question that has to be answered by the Provincial authorities since Quebec is so very socialist - if they want all the authority that goes with that then it's incumbent on them to act responsibly and be punished when they're shown to be negligent.

As such, if they're going to have/encourage sports resorts in remote locales within their jurisdiction then the infrastructure must be in place to handle such eventualities.

If it isn't and people get seriously injured and/or die then maybe someone in the government, including the leadership that allowed this situation to persist, needs to do some hard time so their successors think twice when it comes to such matters.

It's usually the case that monopolies beget poor service, whether the organization is governmental or private. In this case both government and the resort failed the customer (Richardson), but IMO government bears the larger responsibility since it assumes so much authority in Quebec's socialism.

The resort just did what everyone does up there (and increasingly down here): wait for the Province or central government to do it (provide emergency facilities & resources).

Not a good plan at all IMO.

For a long time in our area there were also just a few large hospitals spread over 100 miles. It too became unwieldy, slow and too often unavailable.

The matter was resolved not by building more public hospitals but by a private initiative put on the ballot by petition (Michigan gives this power to voters, along with amending the state constitution). The goal was to implement a state/2 county/private partnership called the "Peoples Community Hospital Authority" (PCHA).

The State provided one-time seed money for construction and enabling legislation.

The counties part was collecting a small property tax to fund the operations of the Authority.

The private part was to use these resources to build a network of hospitals, each with a trauma center, across the covered area and operate them.

Each had helipads and chopper service was provided by the U of M Medical Center and private ambulance companies.

As a result 5 million people had hospitals within 5-10 miles of their homes instead of having to drive a long distance to a major center like the U or M, Detroit Receiving or William Beaumont.

The PCHA is gone, dissolved and absorbed into larger private/universithy hospital networks owned by the large centers, but even farmers in remote areas can still get a chopper in their front yard in very short order because of its now evolved infrastructure.

[cjolley]

...The goal was to implement a state/2 county/private partnership called the "Peoples Community Hospital Authority" (PCHA)...

In other words, use taxes to subsidize a private corporation that couldn't make it on it's own.
You socialist you.


PS Actually it's worse than that. Use taxes to capitalize a corporation then transfer it to private hands.
And I doubt that the U of M is runs on private funds ether.
I'm not sure what to call that, but it sure ain't Capitalism.

PPS What do you want to bet that public funds are paying, or at least subsidizing, huge salaries for management in the "private" entity?

PPPS I guess Atlas Shrugged well before 1/20/09

[Dr Mordrid]

I spent a year at one of their facilities, so I know the finances. Set up the cath labs and nuclear medicine unit before returning whence I came.

All the state did do the usual oversight done for any hospital, public or private, and the counties collected the millage which was passed on to the system. Even then those funds were a fraction of the operating budget - that system was a money making operation with or without them - at least it was until government mandates made them unable to compete with the large hospital networks.

Note: some smaller hospitals were already in existence but outdated, so they were folded into the system with upgrades and some rebuilt entirely.

[cjolley]

...the counties collected the millage which was passed on to the system. Even then those funds were a fraction of the operating budget - that system was a money making operation with or without them...

Then why didn't capitol flow to that demand until the government got involved?

[Dr Mordrid]

Because of the ramp-up that always occurs. That money was critical in the beginning then became less so later on. Decades later when the unfunded mandates from DC caused expenses to outrun income they became important in keeping things going until the privates took over. Now most all run under the Henry Ford Hospital (private (Ford): Detroit). Oakwood (corporate: Dearborn) and St. Joseph's (Catholic: Ypsilanti) systems.

Henry Ford alone has almost 30 medical centers in the region, several capable of surgeries including robotic, and is based on the Mayo Clinic model. Erik was born at their Wyandotte center (a city south of Detroit).

[cjolley]

OK, you put it to a vote and see if the people of Quebec want to turn their publicly funded health care system over to the tender mercies of a "private" entity.

As to the med-evac choppers, I still don't get who funds them in your area.
U of M? A private corp? Publicly financed corp?
I know the system here is not self supporting, in fact they are fixing to tack some charge for it on water bills or something. I doubt there is a truly private ambulance system in the entire US.

The main point anyway Doc is that you are trying to use two really odd examples to show that the Canadian health care system is bad.
A private individual's decision to not wear a helmet, have an accident, and then refuse treatment.
And a publicly financed, or at least capitalized, med-evac system in the US.

[Dr Mordrid]

The U of M Survival Flight etc. fund their own choppers and the teams that run them through the state budget since they're a state university. They also have fixed wing capabilities through leased jets. They also run a chopper dedicated to organ procurement. Private outfits fund them out of their budgets like any other business.

They fly Bell 430's.

Payment is often gratis in the case of the U of M shipping to their own facility in Ann Arbor, billed to individuals , insurance companies or Medicare/Medicaid (whose contribution is almost nil).

One I forgot to mention is the Coast Guard who also do rescue operations, even inland if needed, who of course are DoD.

The point being, of course, that Quebec has chosen to do NOTHING along any lines to provide even a modicum of air rescue services in their jurisdiction. I find this at the least governmental malpractice, and if you check the media from there you'll find the province is getting tons of heat over it. Apparently Quebecers feel like I do.

As for the helmet bit: the squad guys apparently had 2-3 opportunities over 4 hours, both at the scene and at her quarters, to do a visual assessment of her. Here, because of her headache etc., she would have immediately been taken to a trauma hospital like it or not. This is because EMS have the responsibility to override the patients wishes if they feel there is a head injury affecting their judgment.

If in Quebec their squads don't have that capability and training then that too is the fault of the province, if not the central government in Ottawa for not setting national guidelines.

[cjolley]

Doesn't the fact that other provinces do it differently show that this is not about the Canadian health care system at all?
It's about the fact that any organization can be run poorly.

And what kind of laze fare argument is it that the system should be privatized AND have more federal government control?


PS What do you think of motorcycle helmet laws?

[Dr Mordrid]

A proper national government should set guidelines for the provinces/states as regards EMS services. The US does. Most other 1st tier nations do. What's with Canada? Or is Quebec just being 'French' again and winging it?

I don't look at it as a contradictory mix at all. Government does have it's uses, setting standards for certain interstate activities is one, and EMS services are interstate in these parts. Think of it as the embodiment of the 'equal protection' clause.

I'm all for helmet laws and yes, I'm a rider. Remember: I spent almost 30 years cleaning up those messes and seeing how much good a helmet does: a LOT. Saved my noggin a couple of times.

[cjolley]

...Or is Quebec just being 'French' again and winging it?

Would they do that?

My life was definitely save by a motor cycle helmet.
As it was I spent 18 hours in a weird amnesia fugue state where my memory of the previous six months would slowly return and then suddenly disappear over and over while I lay in the hospital. It was 35 years ago still have some lingering effects.
This was before CT scans, MRI and such. My "treatment" consisted of an X-Ray and checking to see if I was still alive once an hour.

[Dr Mordrid]

Back in the early 70's we would have done a brain ultrasound to see if your brains midline had shifted. A significant shift would indicate a bleed.

Ultrasound was in its infancy then, so it consisted of a single probe, some logic boards, a tone generator & a 10 point light array to show the echo's relative distance from the probe. After each pulse you would plot the distance on a graph paper. After 20 pulses you'd do the same on the other side, marked in a different color. Identical readings were stacked vertically, so a peak formed. If both peaks aligned it was interpreted as where the falx cerebri was (membrane between the hemispheres) - the "midline".

Fortunately soon after our first EMI brain CT, one of the first in the nation, was delivered and we could do real imaging - but it took several minutes per 5 or 10 mm thick slice and they had to be stored on 8" cardboard floppies. They were then photo-printed onto a 14x17 sheet of film and developed.

Only 80x80 resolution though. Later scanners gave almost HD resolutions: 256x256

[DukeP]

There is really no reason to lay blame on anyone.

Shit happens.

I dont think I know of any country that uses more cash per capita on medical than the US. And still, people in the US die.

Death is a danger we are born to live with.

~~Dukep~~

[Dr Mordrid]

Tell that to Richardson's kids.

It's easy to be in medicine and feel that way, I've done it myself at times, but the fact is the system failed her and her family in so many ways and needs to be fixed. It won't prevent 100% of such incidents, but even if it stops just a few it'll be worth the effort.

Quebec is still saying that air ambulance is "not a priority" and they'll consider it "in a few months" which is patently ridiculous, but with all the hell being raised in Quebec and Canada as a whole I bet their tune will change - if not before then certainly after the next provincial election as I can see this being a major campaign issue.

Canada.com article.....

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Trauma specialists have been warning of this lack of service for years, saying it could lead to unnecessary deaths.

"This is like not having a fire department in a community," said Dr. Tarek Razek, head of the trauma team at the McGill University Health Centre.

Timeliness is crucial after major head traumas, he stressed.

"You need to get to a trauma centre fast, and the faster we can organize that, the more likely you are to live," he said.

He stressed that Quebec is one of the few jurisdictions in North American and Europe that don't have emergency medevac helicopters.

"I'm really worried. What's going on? Why do we have this gap in our services?" he asked, adding even the smaller province of Nova Scotia has this service.

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