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Cuts to Ophthalmology service at SMH spills over into council chamber

Posted January 21, 2014

In 2006, Dr. Baseer Khan's arrival at Stevenson Memorial Hospital (SMH) elevated the then two-year-old Ophthalmology program in Alliston to include advanced cataract and glaucoma surgeries not only to local patients, but referrals from across the province.

Two years later, Dr. Khan and his surgical assistants, put Stevenson's opthalmology program on the map when they became only the third team in the country to perform a Canaloplasty, "a minimally invasive procedure, which provides the hope of managing glaucoma without medication or major surgery.

In 2012-13, he performed about 190 glaucoma surgeries, at a cost of about $1,000 each to the hospital. It's the only hospital north of Toronto where these surgeries take place.

Last April, SMH informed Dr. Khan that the board implemented a funding hard cap of 45 glaucoma surgeries a limit reached in September. He hasn't performed one in Alliston since Sept. 21, and there are no guarantees the hospital board will even meet that level in 2014.

As reported here first last October, Dr. Khan has spent that past year drawing attention to the sudden funding squeeze which he warned was creating longer waiting lists, and putting patients in jeopardy of losing their sight because of it.

Last night, he brought his campaign to New Tecumseth councillors, but was caught by surprise after mayor Mike MacEachern invited SMH board chair John Swinden and new CEO Jody Levac to provide "a balanced" view of the situation.

Dr. Khan told councillors his deputation was "not necessarily for any intervention or action -  I'm not sure what the capacity of this council to do anything - but more than anything else after speaking to some of the members of this council, I was advised that it might be a good idea to at least come and share some of the thoughts, and considerations, and concerns that I have faced over the last year."

He recapped how after 13 years of post secondary training, and with two months prior to completing his training, he was attracted to SMH because of the "interest and the insight of the doctors, ophthalmologists were here at Stevenson at the time, and the support of the administration, we saw the opportunity to build a program that would be beyond what every other hospital pretty much in this province does, which is just cataracts."

"Over the last eight years we've been able to develop a program in Alliston that truly is world class," said Dr. Khan. "Only two or three other hospitals in the province that are able to provide the services. .... In April 2013 I was told by the hospital that we were going to have to reduce significantly reduce the cost of the Ophthalmology program in Alliston, principally because of the fact that 90 per cent of the patients I was operating on were outside the immediate catchment area of Alliston."

The hospital has justified the funding cuts to glaucoma because the majority of patients having surgery in Alliston are from outside the Central LHIN, but funded by the local budget.

"Look, at the end of the day, myself and Dr (Ray) Seto, who is the other ophthalmologist, we don't just provide surgical care for local people, we also provide medical care for local people. We're running clinics twice, each of us weekly, so you're getting two of us on a weekly basis providing medical care. We provide after hours care for emergencies, and finally, we've created a practice where there's nowhere else to really be able to send these patients," said Dr. Khan. "And I said listen, I have a problem where I've accepted burden of care for all these patients, I continue to get referrals because I'm the only guy doing this in the immediate LHIN and the surrounding LHINs, what do you want me to do with these patients? The Chief of Staff said to me, 'do what everyone else does and send them downtown (Toronto). Outside of opthalmology I understand the really advanced and difficult stuff is really done in the downtown core. Ophthalmology is a little different because we don't need complex anesthesia to support our patients. I get patients from there. And the response to me was, 'not our problem.' I was instructed to just do cataract surgery. On Sept. 17, 2013 I received a letter from the hospital, and that was by email, it wasn't by person, it wasn't by phone call, it was basically a cease and desist. 'You need to stop doing glaucoma surgeries immediately' even though I had three consecutive OR days after that booked where patients were already scheduled for surgery. I was able to at least get them to recant for the one four days away. But I have not been able to perform any surgery other than Cataract surgery. "I've got patients that are going blind, what do I do?"

It's a message he said he's tried to get across to Central LHIN, and attempts to reach the Ministry of Health to help restore funding, have not created any waves, and there's growing concern that Stevenson could lose cataract surgeries to Southlake, which would further jeopardize the Ophthalmology program in Alliston. LHIN, he said, suggested that Stevenson had an obligation to consult with the community before implementing the service reductions.

"The first year I came here, the hospital put my son and I on a float in the Potato Festival," said Dr. Khan. "Honestly, it's a pain to get up here (he lives in Markham), but when I get up here, I really enjoy it, because I've always felt at home and welcome in this city and the hospital. But I have to be honest with you, the last year, I don't feel that sense of welcome in the hospital, and that's a really bad feeling, because I think together, with the support that I've had with prior administrations, and with the other efforts of people around me, I think we've been able to truly build a world class program."

Mayor MacEachern said "I would think the doctor would be placing these issues before the hospital board, and the hospital governance that's over there."

"It's hard for the municipality to take any sort of action with regard to the hospital in the case of not knowing how it's basically run with regard to the funding that's available," said the mayor. "I know that all the hospitals struggle with the resources they have available to provide the best quality of service to as many different people as they can."

Ward 1 councillor Jamie Smith, and Ward 3 councillor Paul Whiteside were not as enamoured with the hospital's role in the situation.

"It's quite clear there is a problem here, and there are people who are not getting the care that they need. And that fact seems to be about the least important thing to the LHIN, to the hospital, and to the province," said Mr. Smith. "Everyone's taking a bureaucratic approach to it. I know it's completely unfair to ask a small hospital like Stevenson Memorial to finance a regional program out of their budget. But it's also completely unfair for a small hospital like Stevenson Memorial having started a program like that to cut it out without taking some steps, any steps, and it's not apparent they've taken any, to preserve that program. It's irresponsible on the part of the LHIN to not inform themselves as to the care that's necessary. They clearly didn't understand this and we had a similar conversation with them about the hospice at the same time. And it's clearly irresponsible of the province to ignore this. So what I'm going to be asking is we do something to try and get all of those parties to get together and try and provide service for these people not for any political reason, not because we have any power, but purely for humanitarian reasons because that seems to be the lost thing, the patient seems to be the person that's lost in all this."

Before Mr. Swinden addressed council and Mr. Khan's concerns, mayor MacEachern referenced the previous situation "where the maternity ward was being closed at the hospital, and it pitted the community against the hospital, which I don't think was very helpful at all. Most of the people that I've dealt with at the hospital community - both the board of directors and the doctors - have the interest of the patients at heart, and are trying to do the best that they can with the resources available."

Mr. Swinden, who prior to answering Mr. Khan's concerns, introduced Mr. Levac to council. He noted Stevenson Memorial had attracted five applications for the CEO position - four from Southlake, and one from within - and that he expected the Alliston facility to continue being a training ground for Southlake executives.

When he turned back to the issue at hand, he said first that "we at Stevenson and myself personally have a great regard for Dr. Khan, he is a remarkable physician with a reputation that stretches a long way."

"Dr. Khan through this kind of presentation, and through other meetings and the comments he's made to people, has tried to bring this subject into the public arena. As board chair trying to run a hospital given all its responsibilities and financial constraints, this is uncomfortable and we don't like it. It's difficult to deal with these complex issues in a public arena."

He said the board of directors are responsible for a financial criteria that requires balanced budgets that have to balance the "competing needs at the hospital." He said the hospital budget is zero based, and for the third year, expects only a one per cent increase in funding from the ministry, "in an environment" where the province negotiated a three per cent increases for nurses, and more for doctors and fees, and 72 per cent of the budget "is for people." As a result, he said the board is faced with chopping about half a million dollars to balance budget.

"Dr. Khan's glaucoma patients, five per cent come from our LHIN, 95 per cent come from other LHINs. As hospital board chair I say why doesn't Dr Khan and others go to the other LHINs to help pay for this stuff? Why is that the Central LHIN's problem? Why is that Alliston's problem? Why is that Stevenson's problem?" he said.

"This year we have to find another half a million to cut out of our budget. And we have to look at the services we're doing, and if we can't find the money we have to reduce the services.... We have dilemmas we can't solve on Dr. Khan's appeal. ...  It's not helpful for Dr. Khan to politicize this matter, and get citizens heated up, and get patients calling and complaining about the hospital. It's a very complicated issue. And the citizens of our area have difficulty comprehending all the pressures. The hospital board's hands are tied. Must balance the budget, and try to manage the hospital for all the illnesses the community faces. Here we are and that's the way it is. You don't want to politicize one illness versus another versus another. .... I don't want to get into a slinging match with Dr. Khan, it's bad for the hospital, it's bad for the community. We're now doing our budget. I have no guarantee there will be 45 surgeries next year. Have to be fair."

Mr. Swinden then turned to address Mr. Smith's concerns, suggesting "we are concerned about all of the health needs of the citizens of the community. Every health need is important. There's no motive about the hospital board being insensitive to the citizens and the needs of the community.

We worked very hard to do what we can, even pirating other programs to keep what we're doing now."

There was agreement, and a recommendation for the Town to try and get all the parties together at a meeting to discuss dedicated funding from the ministry which would recognize that the glaucoma surgeries from outside the area should not have to come out of SMH's budget.

"I really have a feeling that there's nobody there other than Dr. Khan advocating for the patients right now," said Mr. Smith. "And the hospital ought to be looking for a strategy to put this question before the minister, and should be helping to do that. The Town can help do that as well. ... I don't think there's any point in really discussing money and budgets and so on because we're not going to solve that. But I really do think that there's not been enough advocacy for the patients in this mix. And it hasn't been coming from any of the institutions that are involved. There are patients now, according to Dr. Khan, not getting the help that they need on a timely basis and we should be moving towards helping that happen and not worry too much about the budget. I don't expect the hospital to pick that bill up, because I don't think they can afford to."

Mayor MacEachern told Dr. Khan that he didn't want a repeat of the "health care issue in this community a few years ago in regards to maternity and it seemed to turn into an us against them at the community level. I'm trying to move this discussion more to what do we do as a community to support our hospital. How do we as a municipal council provide some support to try and move this along so at least we're doing something to advocate for our community members that need the service."

Mr. Swinden agreed. "We don't want to have scraps between doctors and the hospital administration in the community, that's not good for anybody."

Dr. Khan told Free Press Online this morning that while he would have appreciated a "heads up" about the hospital board representation to hear his deputation, "it was the right thing to do."

"I had a good talk with Swinden and the new CEO and corrected Swinden on a variety of inaccuracies he had stated," wrote Dr. Khan via email. "I emphasized that I have tried not to politicize this and my biggest grievance has been, as Jamie Smith stated, I feel that I've been an island in dealing with this and haven't received the support of the hospital in finding a solution. I think I finally communicated that and there seems to be a greater willingness for cooperation which, if that's achieved from last night, is worth it."

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