The Métropolitain

The Mark Blandford tragedy... M. Barrette, we need medicine not manslaughter!

Par Beryl Wajsman le 17 janvier 2016

The Oxford dictionary defines manslaughter as "the crime of killing a human being without malice aforethought." The tragic death of Mark Blandford, due to government restrictions on St.Mary's Hospital's allowable medical procedures, brings our current crisis into even starker relief. Bureaucratic miasma has morphed into bureaucratic manslaughter. How many other deaths have been, and will be, caused by it?

The government claims that the written directives disallowing surgery for emergency aortic aneurysms at St.Mary's  - the condition Blandford died from - had not been sent out in written form. But it admits that the verbal discussions had been made clear since July. More bureaucratic doubletalk. And more bureaucratic confusion. The reality is that the hospital was squeezed by the ministry, a leading surgeon who was on the spot could not perform the procedure and Blandford died after being transported to the MUHC. The window for repairing aortic aneurysms is generally no more than twenty minutes depending on the bleed. Blandford walked in on his own steam. It took more than hour to get him to the MUHC.

To add fuel to the fire, the bureaucratic response was even more galling. As part of her response to media inquiries, Claire Roy, public affairs assistant to CIUSSS West Island director-general Benoît Morin, stated “The medical literature indicates that the mortality rate varies between 80 per cent to 90 per cent during a ruptured abdominal aortic aneurysm.” That is true, but only if the event occurs outside hospitals. The mortality rate falls by a third when a rupture occurs in a hospital. But what was the point of her statement? Are we now to understand that Quebec is doling out medical procedures on the basis of probability of success? If that is the case it is criminal. And we are not being pejorative. That kind of policy is a violation of the Canada Health Act and when it leads to death, can be reasonably considered manslaughter.

Our written requests for an explanation, and indeed for an English copy of Roy's release, have gone unanswered as of presstime. Over 125 clinicians at St.Mary's signed a letter to the Health Ministry criticizing its cuts to St.Mary's. The most drastic cuts in its 90 year history. But the most eloquent statement on the Blandford tragedy, indeed on the current government's general directives, were made by a St.Mary's professional on condition of anonymity. “It is unacceptable, in fact, unethical that a patient died because some bureaucrats made a bad decision to prevent a qualified surgeon from potentially saving this patient." 

It's time for pushback on the Couillard government's healthcare "reforms."Health Minister Barrette knows the score. Before entering politics he actually advocated for all the right things. Not anymore. Everything that can be wrong, can be found in Bills 10 and 20. The bills violate the two central organizing principles of any civilizied, compassionate and progressive healthcare system. First, do no harm. Second, medicine must follow the patient, not the other way around.

We must be honest as a society and realize that our current direction has been an abject failure.  The government claims all these cuts, and all the centralizations, are necessary because of budgetary reasons. But that is only a half-truth. What saps the strength out of  our budgets is the groaning leviathan of bureaucracy. That is the crippling factor. 

Quebec is the only political jurisdiction in the western world where over 50% of the people paid in the healthcare system are bureaucrats who have nothing to do with the delivery of medical care or the operation of hospitals. They make the lives of medical professionals miserable with their tables and restrictions and grey-card protocols. 

No Quebec government, regardless of party, has ever had the courage to make the needed cuts for one simple reason. Fear of taking on the unions who represent the bureaucrats. Because that means  losing votes. The government instead has made cuts in areas directly affecting the health of its citizens. From closing seniors centers to limiting medical procedures hospitals are allowed to do to overworking nursing staff.

Well, as we face the reality of hundreds – if not thousands – of needless deaths and unquantifiable suffering, the state will have to make a vital moral decision: stay silent for votes, or cut the bureaucrats and free up the money needed for the personal and equipment to bolster a healthcare system quickly descending to failed-state status. Much of the next decade of all our lives, and the legacy of this government, will rest on this decision.

We wouldn’t send children to be educated as far away as we send the sick to be healed. Some 80 percent of our medical institutions are concentrated in a very small area in the centre of Montreal. It is vital to keep local hospitals robust. Aside from St.Mary's, Lachine, LaSalle and Lakeshore not only serve important community needs but are excellent medical settings. As much as people do better as out-patients, they also do better in smaller institutions with  more personal attention. Patients feel less alienated. Psychological health has an important impact on physical recovery. The closing of hospitals like the Reddy Memorial and the Queen Elizabeth have been demonstrable, disastrous mistakes. Instead of super-hospitals, we should have used existing, empty infrastructure to build at least a half-dozen local medical facilities across Montreal island. Institutions of human scale that treat patients as whole individuals and not just cogs in an overburdened machine. 

We need to give our doctors and nurses incentives and make maximum use of them through an understaffed system. Ontario has a central referral registry that allows hospitals to share specialists when they are short. Quebec needs to implement that system. It may have prevented the Blandford tragedy. We also need to ease the procedures for admission for healthcare professionals from other countries. 

This past year alone, some 25 percent of Montreal’s medical school grads – Quebec grads - announced they would be leaving the province. And the stats don’t change much whether they are English or French. Canada as a whole needs 2,500 new medical graduates just to keep up with existing demands. We’re only graduating 2,200. Yet one stark figure stands out in relief. In Quebec there are more non-frontline personnel in our healthcare system than doctors or nurses. It is a bureaucracy gone mad that merely perpetuates political power and does nothing to relieve suffering. And we’re paying for it. When you look into the problems, the solutions jump out at you. It merely takes the political will to do it. And the courage to admit past mistakes and talk straight to the people. If this is not done, the our healthcare system will truly become, as I wrote in a September op-ed, "A system to die for."