Canadian Premier could have received same operation in Canada

If you've been following the story that is being touted by repubs about how a Canadian Premier recently was forced to go to the US for the latest in heart surgery, below is a useful update.

Bottom line: this surgery is widely available in Canada with little waiting time, but it is usually done just for cosmetic reasons, not because it is a better treatment.


The premier of Newfoundland and Labrador opted to leave Canada for his heart operation despite the fact the world leader in the surgery he needed is much closer to home.

Dr. Thierry Mesana, the University of Ottawa Heart Institute's chief of cardiac surgery, is the recognized expert in mitral valve reconstruction. Dr. Mesana's work was featured in the December 2009 issue of the New England Journal of Medicine.

Danny Williams, 60, who suffered mitral valve regurgitation (a leaky valve), was treated at Mount Sinai Hospital in Miami. In an interview with Newfoundland Television from his condominium in Sarasota, he defended his decision, saying, "It's my health and it's my choice."...

While the heart institute will not comment on the choices of individual patients, Dr. Mesana explained "minimally invasive mitral valve repair consists of doing an MV repair surgically through a five-centimetre small side chest incision instead of a 10-centimetre incision in the middle of the chest."

He added that while "there are a few advantages in terms of length of hospital stay, transfusion or post-operative arrythmias, the only real benefit is cosmetic. Many world-renowned experts do not advocate it. It is done in Canada, but again, with caution. I propose it only for cosmetic reasons in a young woman who dislikes the idea of having a scar."

http://www.ottawacitizen.com/health/Premier+bypassed+world+leader+surgery/2604879/story.html

He has a home in Florida however, maybe he wanted to recuperate there ..... who knows his reasoning. The good thing is, he had the choice, the bad - it implies we have no Cardiologists doing this surgery, which is 100% wrong.

by those who want Canadian healthcare opened to to private healthcare providers. The fact that it is a premier that is casting doubt on the quality of Canadian healthcare by goint to the US indicates that the campaign is moving into a higher gear.

From the article I read on google (http://www.google.com/hostednews/canadianpress/article/ALeqM5h0QC7bditrEb3wYz_6_b-gsGGDxA):

His doctors in Canada presented him with two options - a full or partial sternotomy, both of which would've required breaking bones, he said.

He said he spoke with and provided his medical information to a leading cardiac surgeon in New Jersey who is also from Newfoundland and Labrador. He advised him to seek treatment at the Mount Sinai Medical Center in Miami.

That's where he was treated by Dr. Joseph Lamelas, a cardiac surgeon who has performed more than 8,000 open-heart surgeries.

Williams said Lamelas made an incision under his arm that didn't require any bone breakage.

"I wanted to get in, get out fast, get back to work in a short period of time," the premier said.

Williams said his decision to go to the U.S. did not reflect any lack of faith in his own province's health care system.

"I have the utmost confidence in our own health care system in Newfoundland and Labrador, but we are just over half a million people," he said.

He is a rich man, and basically paid money to go to the U.S. to avoid a short wait time here, whereas with his money he could buy the same treatment immediately in Florida.

He said his doctors offered him surgery that required breaking ribs. He chose a superior technique that required a trip to the sunny south.

cardiologist offering the same exact surgery.

and more are able to perform the same non-invasive cardiac surgery.

Williams chose to go to Miami and pay out-of-pocket, because we don't allow queue jumping in Canada.

The fact that a rich foreigner can get immediate treatment in the US, ahead of a poorer American, is an indictment of the US for-profit health care system, not the Canadian one.

Sid

Edit: should have read the entire thread before posting. Spazito said almost the exact same thing before I did :hi:

How ridiculous your comments are.

The degree of urgency depends on the specific nature of the heart condition.

That's a heaping pile and you know it!

:nuke:

the procedure is done here, so it wasn't a case of wanting the 'best' possible care, as identical care is being practiced right here. He has a condo in Florida, I wonder if that played a part in it.

It was two Canadian physicians who wrote the how-to paper on valve surgery published only late last year in the New England Journal of Medicine. There are famous surgeons like Toronto’s Dr. Tirone David, who’s been called a “virtuoso” valve man. Minimally invasive procedures, the style of surgery Williams chose, are offered in Canada in places like the University of Ottawa Heart Institute.

http://www2.macleans.ca/2010/02/23/canadian-health-care-survives-danny-williams-surgery/

“I don’t know the reasons Mr. Williams opted to have his operation in Florida. It is certainly not because minimally invasive mitral valve repair is not available in Canada. Canadian heart surgeons routinely do minimally invasive mitral valve repair including techniques involvng endoscopic and robotic approaches.
“There is absolutely no evidence that robotic mitral valve repair is superior to other minimally invasive approaches, such as a limited sternotomy or lateral thoracomy, with or without the aid of endoscopes. Moreover, when it comes to heart valve surgery, there are very few places in the world that can match the outomes we have provided at Toronto General Hospital.
“Having said all that, Mr. Williams certainly had the right to go anywhere he wanted for surgery.”

"Maybe you’re guessing now that the premier decided to travel to the famous hospital where one of the physicians who authored the article fixes hearts. That would make sense. But here’s the funny thing: the authors are Dr. Thierry Mesana of the University of Ottawa Heart Institute and Dr. Subodh Verma of St. Michael’s Hospital at University of Toronto.

Apparently Ottawa and Toronto have somehow managed to emerge as leading centres for both the theory and practice of heart surgery—in particular, it seems, the operation Williams needed—despite the horrors of socialized medicine.

In case this leaves you fearing that the the premier might have received substandard care in the U.S., please don’t worry. I understand they have excellent physicians there. And that New England Journal of Medicine article is specifically meant to spread the word of the latest surgical techniques everywhere."



http://www2.macleans.ca/2010/02/22/heres-hoping-danny-williams-got-canadian-style-heart-surgery/

but he could, and did, in the U.S. He is also going to submit his 'expenses' in hopes of being reimbursed (not going to happen). It's pretty sad when a foreigner (Williams) can bump an American citizen from the top of the 'list' because he can pay the outrageous cost where others cannot.

His actions are not going over well in most of Canada.

Under your system, rich people have to wait in the same line as poor people. This upsets their sense of entitlement and of being a better class of human being than ordinary mortals.

The rich prefer our system, where they can go to the head of the line just for flashing some cash.

and they do NOT speak well of him, imo. His leadership abilities seem to be in the vanity and self-importance category, unfortunately.

Under your system, rich people have to wait in the same line as poor people. This upsets their sense of entitlement and of being a better class of human being than ordinary mortals.

The rich prefer our system, where they can go to the head of the line just for flashing some cash.

The dude's a snowbird. Many Canadians winter in the US and have an additional plan that covers medical treatment in the US. Why should the guy have traveled all the way back to Canada when he was covered to have the operation in Florida, where he was living?

It's not at all as if this guy had to travel all the way from Canada (oh my) to have an operation in the US, he was already living here!

have to "travel all the way from Canada" he was NOT "already living there". He is not a retired snowbird and, btw, most snowbirds do come back to Canada for any major surgery because of the cost, over and above any insurance coverage.

and wish to recuperate at your nice warm condo in Florida. He was quoted as saying he would apply for the coverage, we'll have to see if he gets it or not.

and will he pay for them to 'jump the queue' too? I don't think so. As you well know, Newfoundland is one of the poorest, if not the poorest, Province in Canada which means the vast majority of Newfoundlanders would have to 'put up' with being on a waiting list if their health issue was not an emergency. What a wonderful role model he is....NOT.

I wonder how Newfoundlanders will feel having their tax dollars pay for the vanity of their Premier, thousands of their tax dollars which they can ill afford, if any of his costs are covered.

but they are all entitled to a second opinion with any cardiologist in Canada who agreed the surgery necessary and probably still been covered for it, if things work there like they do here in my area.
I agree with you though ...... he certainly could have done it to jump the queue, but there really is none for emergency heart surgery. My friend's husband was dx'd with two blockages a few weeks ago, had the surgery and is recuperating now at home. If his condition had been worse, he'd have been in surgery immediately. I guess I can say, they're certainly not wealthy ....... but then he didn't care if his scar was a bit larger. If so, he'd have been free to go elsewhere in Canada and had the minimal invasive surgery and (probably?) had it covered if his cardiologist agreed. I'm not 100% sure about that. I think the good Premier could pay for his own, if not.

an emergency. I have NO doubt that had it been deemed a medical emergency Williams would have highlighted that. From what I have read, the condition had become serious enough that his doctors recommended he have corrective surgery but serious does not equate necessarily to that of an emergency. If not an emergency then a waiting period may well have ensued but, hey, if you have the bucks you can bump an American citizen out of line, assuming they even had the dollars to be put in line, whereas in Canada you are placed according to need NOT according to the thickness of one's wallet.

There is an irony in that Williams' actions showcase what is WRONG with the current US system of healthcare as opposed to anything else.

He absolutely has the right to choose who will operate on him, but expecting to be reimbursed for that choice is another matter.

...both for the convenience of his winter home and because he preferred the way the procedure was done at that clinic. He certainly seems to be recuperating from the surgery in Florida, no? Or do you think they're lying about where this interview took place?

There's nothing wrong or scandalous about that. Surgeries are done based on how the surgeons at that particular hospital like to do them, leading to great variation from hospital to hospital. There is nothing wrong with "shopping around" to get the surgery and surgeon you feel comfortable with. That's how health care should be.

the procedure is readily available at Canadian hospitals.

Williams chose Miami because he has the cash to jump to the front of the line.

Sid

There's no "one way" to do any surgery.

Take hysterectomies for example, which is what I assisted in during my last rotation. These days, when woman elects for a hysterectomy, she has the choice of an open abdominal surgery, a laparoscopic surgery, or a vaginal surgery. If she chooses laparoscopic, she has the additional choice to make of robot-assisted or not. And there are the additional decisions to make regarding what's to be done with her ovaries and cervix. Which surgery she and her doctors choose will often times decide not only which hospital would be best for her, but which specific surgeon at that hospital is the best fit (i.e. most experienced with best outcomes with that particular surgery).

With regards to this guy's heart surgery, it looks like Mt. Sinai Miami has a whole team set up to do these surgeries. There was a link to it on their front page. And the picture at this link shows that they at least have the ability to do it laparoscopically. That is a huge advantage over open heart surgery, for those who are eligible. If the Canadian surgeons haven't developed that technology yet, I don't fault this guy for a moment for looking elsewhere.

http://www.mountsinai.org/Patient%20Care/Service%20Areas/Heart/Procedures%20and%20Services/Mitral%20Valve%20Repair/Surgery

the minimally invasive, laproscopic surgical technique was invented by Canadian surgeons in Toronto and Ottawa.

Sid

While the heart institute will not comment on the choices of individual patients, Dr. Mesana explained "minimally invasive mitral valve repair consists of doing an MV repair surgically through a five-centimetre small side chest incision instead of a 10-centimetre incision in the middle of the chest."

He added that while "there are a few advantages in terms of length of hospital stay, transfusion or post-operative arrythmias, the only real benefit is cosmetic. Many world-renowned experts do not advocate it. It is done in Canada, but again, with caution. I propose it only for cosmetic reasons in a young woman who dislikes the idea of having a scar."

And why it was recommended to him. And tell me what volume of surgeries Dr. Mesana has and with what success rate compared to the team at Mt. Sinai. These sure as hell would be things I would want to know before signing on with any surgeon.

You do realized that Mesana is only speculating which surgery the Premier had, unless of course he illegally obtained his medical records.

Listen, I'm sorry that Dr. Mesana's ego is bruised that a high-ranking Canadian did not choose him for his surgery, but if you're waiting for me to concede that patients should not have the right to decided who operates on them or how they will be operated on, please do not hold your breath.

that's a hell of a commute to the Provincial legislature!

Sid

I don't get your point.

I'm going to take a guess that he stays at this condo either when he's on vacation or when parliament is not in session, which for the sake of the Canadian taxpayers, hopefully overlap.

Many Canadians have vacation properties in Florida, that they use for a couple of weeks a year. Have you seen how cheap Florida real estate is lately?

Premier of Newfoundland is a full-time job. Williams might vacation in Florida, but he certainly isn't a snowbird, who spends the entire winter in Florida, and he most definately doesn't "already live there".

Sid

...where he vacations.

He had the procedure at an area he was familiar with and possible even came recommended to him by acquaintances.

Listen, I'm not saying that he did or did not line jump. What I am saying is that one man's decision about how best to manage his own health says NOTHING about how good or bad US or Canadian health care is. If we start sacrificing patient's rights and patient choice in this debate, we've already lost.

he is a member of his Province's Legislature, just to be sure you recognize the difference. He is the equivalent of a State governor.