Doctors, readers respond, regarding choice of CT scanner at Kincardine hospital

To the Editor:

The South Bruce Grey Health Centre board of directors press release, published Feb. 6, indicated its intention to proceed with the purchase of the Edge Plus CT scanner for Kincardine hospital.

Over 100 years of combined experience in serving the medical needs of Kincardine say that the hospital board is making a wrong decision, and should purchase the Drive CT.

The Kincardine Physicians Group represents a group dedicated to the advancement of quality health care for our community. As a physicians group, we, who have served in the community for more than five decades - and those physicians who will come after us - are committed to being able to provide quality health care to our patients, now and in the future. This means, making the correct choice for our CT scanner.

We are very concerned as to the quality of the information and representations of the hospital board in the media release of Feb. 6.

Specifically:

Drive versus Edge Plus
 

• To say the two CT machines are identical is a misrepresentation. Simply put, the Drive CT has two separate tubes placed at a 90-degree angle to allow capacity for fantastic definition and lower radiation exposure. The Edge Plus has one tube.

Expert Opinion
 

• Dr. Nikolaos Tzemos is a professor of medicine at the London Health Sciences Centre and trained in internal medicine with clinical training using advanced imaging techniques as a means of connecting basic science to clinical outcomes. He supports Kincardine’s Cardiac Program and gives unequivocal
• support for the Drive CT as our best choice if we can afford it.
• Dr. Raymond Yee, chief of city-wide cardiology at the London Health Sciences Centre and Western University, recommends the Drive CT for Kincardine’ s future.

Consultation
 

• The effort to secure a CT for Kincardine was started publicly, at the board’s request, with a joint presentation of the physicians group, Kincardine and Community Health Care Foundation, and the hospital board. It was at this public municipal council meeting that acquisition of the Drive CT was supported as the preferred option and the premise under which we have been operating and working toward.
• Co-operation and progress were excellent until a delay in October, 2020, when the hospital board unilaterally decided to develop a case for the cheaper Edge Plus model. The physicians group, hospital foundation, and the Municipality of Kincardine remained in support of the intended Drive CT. Bruce Power agreed that its $1-million donation could be applied to the Drive CT.
• Consultations have heatedly been information sessions to inform us us of board decisions with no meaningful revision.

Resources
 

• The Drive CT will be at an additional cost of $1.26-million in capital and maintenance as calculated over a 10-year span. This is $126,000 per year and has been a cost the foundation has indicated it is prepared to consider supporting. The community has openly recognized the value and the challenge
• and is prepared to respond.
• No one has calculated the cost of retrofitting to the Drive CT if we will be considering the purchase of another CT in five-years.
• No one has estimated, or can estimate, the potential for lives saved and the relevance to cost.

The goal of the Kincardine Physicians is to ensure that decisions that impact our ability to provide excellence in patient care, are made with consideration for the opinion of those who will provide that care, and the community that will be asked to pay for that care.

The Drive CT has exciting potential for the evolving care of strokes and cancer. We will not be buying another CT in the next 10 years. This is our opportunity to get what we need to move forward and to provide the best care for our growing community.

Respectfully,
Dr. Gary Gurbin
Dr. Mike Ballantine
Dr. Angela Cavanagh
Dr. Catherine Ciszkowski
Dr. Lisa Denobriga
Dr. Damian Gunaratne
Dr. Jason Murray
Dr. Lisa Scott
Dr. Leanne Thomson
Kincardine Physicians Group
 

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To the Editor:

I have some questions and concerns about the Edge Plus CT scanner proposed for the Kincardine hospital.

The Edge Plus unit has not been installed in Canada, to date. So this brings to question the availability of critical spares for this machine and maintenance. If the service specialists are used to working on the Drive CT scanner, then how readily available are parts and service specialists to maintain and repair this device?

The Drive CT does the scans in less than half the time, which in reality, would be like having two Edge Plus CT scanners.  This means that you would have to run the Edge Plus 24 hours per day, just to accomplish the quantity of scans that the Drive would do in 12 hours. This leads to increased costs for technicians and staff to perform the scans. 

The operating and troubleshooting documents and manuals will be different in the Kincardine hospital than the other hospitals. So, this will lead to extra costs even for these documents and the upkeep of them.

The suggestion was made that, if required, the patients can be transported to other hospitals that have the capability to do the required scans. This creates a few issues, one being that most winters, the highways are closed for 50-75 per cent of the time and are dangerous to travel on. 

In some cases, nursing staff is required to travel in the ambulance with the patient, which strains the already-overworked staff at the hospital. The transportation, in most cases, will be done by ambulance and stresses the ambulance staff which creates this ripple in the system that requires ambulances from other areas to reposition to cover the area that is left open for emergencies due to the ambulance being tied up.   

So, by doing this, the board is saying that its opinion to go with the Edge Plus unit is more important than anyone’s in the area, locally, and the help that they may require at any given moment. I don’t believe that this purchase should put people at a greater risk and longer wait to get the urgent help they need in an emergency. 

To add to this, after the patients are transported to the other location where the Drive model is available, their ride back to the Kincardine hospital is not as important, so they will have to wait for an ambulance to be available. This causes waiting in hallways of hospitals for a ride to become available for both the patient and the nursing staff. Have the ambulance directors been asked or notified that this is required? What is their feeling on this?

The South Bruce Grey Health Centre board states the following:
 

• The only difference between these units is that the Drive has two tubes and the drive is faster in some cases with the same imaging. But that is not correct, the Drive also has two kilowatt generators, and all the equipment that is used to drive these tubes. So, if the device can drive with only one tube, does that mean that if a tube or a generator is down for some reason, is the scanner still available to run with the one? If so, this creates redundancy for the machine and less down time?
• There is no difference in the quality of the CT scanning capabilities, how is this confirmed? Has the board confirmed this or is this an opinion from Siemens? We have none of these scanners installed in Canada, to date, so I don’t understand how this can be proven factual in all cases.  For some reason the decision has been the same all across the country to go with the Drive unit; is our hospital board more knowledgeable then the rest across the country?
• The board says it will reduce the amount of trips to other sites with CT scanners, eight out of 10 times. This is like saying that the police or the fire department can protect us from 80 per cent of the risk, but we will have to call someone else for the other 20 per cent of the time!
• The Edge Plus is the newest to become approved in 2020. So, we are going to have this all to ourselves and be the test case here? It only stands to reason that over time, the Drive has been used throughout the county and the bugs have been ironed out.
• Lower cost of ownership? Can you actually advertise for one unit or system or goal and raise money for that device? Only to change your mind and go with a cheaper unit and use the money elsewhere – say, Walkerton?
• Respectfully, how can a chief radiologist honestly say with confidence and proof that the images produced are the same? There is no other CT scanner like this in the country, so if the staff that is hired and even the ones with experience, it will be all on the Drive and makes their training and experience on the Drive CT watered down at best. So, to have the same machine in all of the hospitals is great for training and experience and critical spares. This makes everyone very adaptable in any hospital. 

We need transparency with regard to this board, just like any other board. Accountability needs to be upheld - profit and losses made public, at least annually. Their meetings need to be available to the public and the staff with sufficient notice and agenda. Due to the fact that they are going in a different direction to the vast majority of local citizens and physicians' opinions, there needs to be an inquiry. 

In addition to this, we need to understand the policy of how the board members are selected for these positions. Their decisions are going to make it very tough to fund-raise for future projects because they have lost the trust of the citizens. The fact is, why would we fund-raise? Regardless of what we want, we are dictated to what we need and what we will get. 

Quite frankly, I do not believe this board is as forthcoming as it says it is. The members’ opinions, experience, factual representation are very much questionable to the point it feels plotted. Completely ignoring the advice and needs of our own physicians, their decisions result on the turn of a dime.

Speaking of dimes, we need to have an audit to account for all money raised for the Kincardine hospital - where it went and what it was spent on. It is common knowledge that in selling and marketing, there is always something to entice along the way that can swing decisions. Due to the fact that this is such a huge purchase, we would like to know what incentive was placed on the table for this purchase? We were also told that there is no need for another Drive CT in this area. However Southampton is well in the process of funding to  purchase the Drive. This just proves that the statement we were led to believe is not true.  

Speaking of transparency, the last Zoom meeting with the board and public, held Jan. 26, was far from transparent. The time allotted was not sufficient. Many citizens had questions which were ignored.  Hand-picked questions by the CEO worked for the board’s benefit. The rhetoric became very obvious and quite frankly, nauseous. 

For instance, chief radiologist Dr. Douglas Mowbray commits that the imaging will be identical. How does he know this because he has zero experience with the Edge Plus CT. There is no other one in Canada; we are the guinea pig.

There are many gray areas and now people are asking questions and want answers. For too, long the board has been able to fly under the radar and not be held accountable. People did not ask questions because the board is supposed to look out for our hospital’s best interest. This is a setback, not only is our hospital hurting and falling behind, we too easily accept minimal, we have lost so much already.

We were, at one time, a very viable hospital until we gave up our private control. It’s time we start asking questions and taking back control. Our community is growing quickly, Kincardine has much to be desired. Yet, we have nothing to offer new physicians, there are no optics or even a clear picture to give doctors who are considering moving here. Our own doctors don't even have a voice and feel unappreciated. 

So far, the future of our hospital under this board’s regime looks risky, nothing to be desired by anyone. Better provisions must be made. Time for change and make the Kincardine hospital a priority again. 

Lorelle Hedley  
Kincardine
 

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To the Editor:

With respect to the recent flurry of letters concerning the purchase of a CT scanner at the Kincardine hospital, I I have the following comments.

I watched the Kincardine council meeting Jan. 25, where Dr. Gary Gurbin presented his case, and I watched the Zoom meeting Jan. 26, hosted by the South Bruce Grey Health Centre board of directors.

I have read the justification for the purchase on the health centre web site and also read the FAQs page (click on sbghc.on.ca/q-a-kincardine-hospital-ct-project/).

The end result, is that I strongly support the decision of the hospital board and strongly disagree with those people who are insisting on the Drive CT scanner.

As pointed out in the FAQs, there have only been five to 10 people in the past four years who could have benefited from the additional heart scan capabilities of the Drive CT.

Contrast this number with about 3,000 people in the Kincardine catchment area (Kincardine, plus Ripley and the Huronville area in Huron-Kinloss) who do not have a primary care physician and have to drive hundreds of kilometres, not for a CT scan, but just to get basic primary health care.

So, as a suggestion, maybe some fraction of the $1.26-million in savings could be used to fund improvements at the Kincardine clinic or recruiting initiatives that would attract more doctors or primary-care nurse practitioners to this area. 

David Whiting
Kincardine Resident
 

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To the Editor:

Imagine for a second, the difficult task of recruiting new doctors to our Kincardine hospital, the second busiest in the area. 

With the hospital board’s recent decision flying in the face of our doctors’ diligently-researched request, and a board insensitive and unbending toward a public that has supported our hospital faithfully and generously over several decades, and with obstetrics and surgery gone, what prospective new doctor will choose to step on a welcome mat like the one that’s being rolled out in our community?

Respectfully,
Ralph Bruce
Kincardine