Image source.
It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to heaven, we were all going direct the other way–in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only. (Dickens, A Tale of Two Cities)
This opening captures how I feel after working for nearly two decades in MB’s health care system. Unfortunately, we have moved to the “worst of times” end of the spectrum.
I was struck with a strong sense of déjà vu after reading a series of Winnipeg Free Press stories about a Neurosurgeon and a Neurologist who left the province because the epilepsy program they were recruited to build was not supported. (Fed up with provincial government, brain surgeon to leave Manitoba , Neurologist feeling déjà vu, Cost-cutting agenda degrades health care).
This story resonated with me as I have recently resigned from my Nuclear Medicine HSC day job largely due to the erosion of funding and the agonizingly protracted health care transformation exercise we are all going through.
I am truly saddened that many of the innovative gains made in my department during the first decade at the job have largely evaporated into a dysfunctional bureaucratic quagmire in the subsequent ten years.
When it comes to putting patients first I have always been a positive change agent advocating internally and, when this is not effective, externally.
To that end, consider this my exit interview.
I was hired as an HSC staff Nuclear Medicine Physician in 2002 after finishing my Nuclear Medicine specialty training in Edmonton with a fellowship in PET (positron emission tomography) imaging (University of Washington, Seattle).
I had seen firsthand how PET scans benefited cancer patients and helped tailor their treatment. I piggy-backed on work that had already been done to start a PET program in MB and started networking and advocating to bring this technology to MB. I gave lectures to medical folks, gave talks to social service groups, and met with the HSC Foundation to seek support and funding.
I have fond memories of a live radio interview with Richard Cloutier (CJOB) discussing how PET scanning would benefit Manitobans.
Long story short, someone knocked on my office door and asked if I would be interested in taking the lead in planning a PET program for MB. With enthusiasm I said - yes!
The PET scanner was installed on the U of M Bannatyne campus (7th floor JBRC) in 2004. The first patient was imaged in 2005. We continued to grow the program by hiring technologists, physician specialists and research scientists. A medical cyclotron was installed in 2008 to produce PET radiotracers on site versus having to fly them in from Edmonton. The program has ramped up to more than 2000 PET patients a year.
It was exciting times!
Early on it was apparent that demand for PET scanning could not be met with only one unit. There was a lot of buzz about installing an additional specialized PET/MRI hybrid unit which had already been financed. At the time this would have been cutting edge and one of a handful in Canada.
A considerable amount of staff time was spent planning the PET/MRI install and, despite a very parsimonious install plan, we remained over budget. This signaled that the original install budget was not realistic. WRAH would not budge, and we never proceeded with purchasing a PET/MRI.
This was a harbinger of a period of cut-to- the-bone fiscal austerity.
To show the enthusiasm and support for the PET program one of our Nuclear Medicine Technologists, in addition to their day job, took additional training to be an MRI Technologist in anticipation of the PET/MRI install. This was no small feat and, and for the system, an opportunity lost.
We were also planning on expanding the PET program to add novel radiotracers to image prostate cancer and to image and treat patients with rare neuroendocrine tumors. We added a “research” room adjacent to the cyclotron to support the synthesis and chemistry needs to add novel radiotracers.
Unfortunately, no new clinical PET radiotracers have been added since the program began in 2005.
Things started to go downhill around 2015 when the PET scanner neared its expected end of life.
The U of M location for the original PET scanner was “temporary” as it had many disadvantages such as: no access to hospital “code blue” services, having to call an ambulance for emergency situations, the U of M elevators were too small for standard hospital beds, more expensive to operate as a satellite service, and there were barriers to sedating patients when needed.
As the PET scanner approached its end of life the Nuclear Medicine clinical program lobbied for the replacement PET scanner to be installed at HSC versus U of M. This led to a series of meetings and no decisions being made as to where to put the replacement PET unit. Despite being in a “temporary” location for 15 years HSC/Shared Health (SH) leadership did not have a plan on how best to consolidate PET scanning with other Nuclear Medicine services within HSC.
We were running out of time as we had received notice from the PET manufacturer that they could no longer guarantee parts and service for our existing unit as it was too old. If the PET unit went down we may not be able to fix it and patients would have to go out of province.
SH leadership put considerable pressure on the clinical program to swap out the old PET scanner with the new one in the same location at U of M. This was presented as the cheapest solution but came with all the patient limitations we had lived with for 15 years. It would also limit our ability to install two PET scanners close together to achieve maximum operational efficiency.
After considerable pressure from the clinical program the replacement PET unit was installed in early 2021 in yet another “temporary” space, but thankfully in HSC. The PET scanner in U of M remains the back up until a 2nd PET unit is installed (at the time of writing the wait time for PET scanning is ~ four weeks which is unacceptable for newly diagnosed cancer patients).
The inability to continue to build and grow the PET program started long before COVID put pressure on an already eroded health care system.
Despite SH being formed in 2017 the organizational structure for Diagnostic Imaging managers and directors is still not finalized.
The inability to make decisions and move forward has had profound negative impacts on staff morale. For example, the HSC Diagnostic Imaging Director position has been vacant for almost three years and the Cyclotron and Radiopharmacy Director positions have been vacant for over two years.
The current strategy is to have existing staff stretch themselves to cover off these vacancies while, at the same time, not being sure what positions will be left once the plan is finalized.
To be blunt they are essentially being told: “After busting your asses to cover off all these duties feel free to apply for your job when it is posted.”
Sadly, the combination of fiscal austerity, or as I call it “erosion management”, lethargic SH leadership, and COVID has resulted in a protracted state of uncertainty and “muddling” through. Putting “patients first” through innovation and rational program planning is not possible. (previous blog articles on such, Accountability, Transforming Health Care)
Hence, I am hanging up my hat at HSC and moving on to expand my health policy advocacy role through my U of M appointment.
The saga of the PET program is a microcosm of what is happening in MB’s health care system. Stories, such as those referenced at the beginning the article, prolonged ER wait times despite a lull in COVID admissions, escalating wait times for elective procedures, and severe shortages of health care workers speak to this.
One of the mantras going around during the formation of SH was that the MB health care system was “broken”, and that SH would “fix the broken health care system”.
Well, our health care system is certainly broken now, and SH leadership should be held accountable to fix it or step aside and let someone else do it.