Democracy Gone Astray

Democracy, being a human construct, needs to be thought of as directionality rather than an object. As such, to understand it requires not so much a description of existing structures and/or other related phenomena but a declaration of intentionality.
This blog aims at creating labeled lists of published infringements of such intentionality, of points in time where democracy strays from its intended directionality. In addition to outright infringements, this blog also collects important contemporary information and/or discussions that impact our socio-political landscape.

All the posts here were published in the electronic media – main-stream as well as fringe, and maintain links to the original texts.

[NOTE: Due to changes I haven't caught on time in the blogging software, all of the 'Original Article' links were nullified between September 11, 2012 and December 11, 2012. My apologies.]

Monday, July 02, 2012

Woman says she was denied sedation for cataract surgery because of OHIP fee cuts

When Sharon Phillips was wheeled into the operating room at Oakville Trafalgar Hospital on Monday, she was prepped and ready to undergo cataract surgery.

When her ophthalmologist was about to start the procedure, 65-year-old Phillips nervously stopped him with a question: “Wait a minute, where’s the sedation?”

She was shocked to find out there wouldn’t be any, and then angered when reportedly told that it was because of recent OHIP fee cuts to “conscious sedation,” a procedure that involves an anesthetist giving intravenous medication for pain, anxiety or comfort. Patients stay awake but are dozy.

“My doctor was very upset he had to put patients through the procedure without sedation,” said the retiree. “My doctor did say later that this is why doctors in future will be refusing to do any cataract surgery because it’s dangerous.”

Dr. Lorne Martin, the hospital’s chief of staff, said he looked into Phillips’ allegation and was assured that sedation was not withheld because of OHIP fee cuts. Explaining that privacy laws prevented him from saying too much, Martin suggested sedation may have been denied for medical reasons.

He acknowledged a doctor may have inappropriately grumbled about the fee cuts in front of a patient.

“What I have been told in my investigation is that if the patients are appropriate for sedation they would receive it and if, in an anesthetist’s view, they were not appropriate for sedation, they would not receive it,” Martin said.

But Phillips says she is a healthy woman and was told by her ophthalmologist that she and 14 other patients undergoing cataract surgery that day would not be getting sedation because of the fee cuts.

She was so angry she wrote a letter to all MPPs, saying: “I have a wonderful ophthalmologist who was very disturbed about putting his patients in this position . . . . I am appalled at what our government and this (Health Minister) Deb Matthews is doing to our health-care system.”

Phillips’ letter, which did not disclose the name of the ophthalmologist, went on to describe the surgery as “very frightening and painful at times.”

Ophthalmologists are among the angriest of doctors over 37 changes to the OHIP fee schedule that were unilaterally imposed by the province in May after negotiations with the Ontario Medical Association fell apart. Some of those cuts are due to come into effect Sunday, including a combined fee for conscious sedation which drops to $60 from $120.

Some ophthalmologists have warned they may have to stop doing cataract surgery because the cuts could result in patients not getting sedation, something that could be risky. Nervous patients could end up moving during the very delicate surgery and that could result in blindness, they warn.

Conscious sedation fees are paid to anesthetists, not ophthalmologists. But some anesthetists have said that because of the cuts, it may no longer be financial feasible to participate in cataract surgeries.

It would be financially worth their while only if they worked on up to three patients at the same time. But only larger hospitals or clinics like the non-profit Kensington Eye Institute have the resources for that. They can devote more than one operating room at a time to cataract surgeries.

The Liberal government wants to move more cataract surgeries out of hospitals and into clinics like Kensington.

Ophthalmologists are also angry that the fees they get paid for performing cataract surgery have been chopped, something the province argues is justified because advances in technology now allow the procedure to be done much faster. As well, they face cuts in fees for self-referrals and diagnostic testing.

Observers say the province is targeting the highest-paid physicians with the fee cuts, those earning more than $600,000 a year. The average annual compensation for ophthalmologists last year was $666,000, up 61 per cent or $253,000 since 2003-04, according to the health ministry.

Matthews said she has been assured by the hospital that no sedation protocols have changed as a result of fee cuts, but she indicated Phillips may have been misinformed by the ophthalmologist about why she was not getting sedation.

“I understand the patient was left with the impression that the care she received was different than it would have been had there not been changes to the fee schedule and I can tell you that if any doctor left that impression I would be terribly disappointed,” the health minister said.

“I know there are some doctors who are not happy with me right now but that is a disagreement between them and me and patients should never, ever be put in the middle of that and no patient should ever be given the impression that the care they are receiving has been affected by these changes because it has not,” she added.

Any patient who feels they were given poor care should contact the College of Physicians and Surgeons of Ontario and the hospital’s patient relations department, Matthews said.

“Patients should never, ever be made to feel that they are receiving substandard care. Every patient should be able to expect with confidence that they will receive the highest possible quality of care,” she said.

Dr. Nav Nijhawan, chair of the OMA’s section on ophthalmology, said the standard of care in Ontario for cataract surgery involves applying topical anesthetic drops in a patient’s eye, followed by and anesthetic injection and then IV conscious sedation.

Martin indicated Phillips had received only the topical anesthesia.

“It’s extremely rare for someone not to have IV sedation,” Nijhawan said.

Meantime, following calls made by the Star to the hospital and health minister, Phillips said she didn’t want to talk about her surgery anymore. But she did send this email:

“The hospital has been in touch with me, and the issue is being dealt with. I have (been) assured this will not happen again to anyone. I consider the matter resolved.”

Original Article
Source: the star
Author: Theresa Boyle 

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