Although it hasn’t become an election issue, the changes Health Sciences North plans for the Breast Screening and Assessment Service has become a call to arms for many breast cancer survivors, their families and the public in general.
A letter-writing campaign was started. Nickel Belt MPP and NDP health critic France Gélinas started a petition. Hundreds of comments from cancer survivors and others impacted by the dreaded disease were left on Sudbury.com and on our Facebook page. Those comments dripped with fear, anger and despair.
Thanks in large part to the fantastic reporting from Carol Mulligan, whose work on the story helped galvanize the public campaign to fight the service cut, a compromise may have been reached. I’ll get to that in a second. It’s also thanks to surgeon Dr. Rachelle Paradis, who spoke out originally about the change.
It’s also thanks to people like Anne Matte, one of the screening and assessment service’s original nurses, who spoke out, and Dr. Nadia Alam, the president of the Ontario Medical Association, who said the move was bad for patients.
Some people misunderstand exactly what the hospital is planning though. Just to be clear, the hospital is not cutting mammograms or closing any programs. If you were worried or angry the hospital was doing just that, don’t be. That’s not what’s happening here.
But, what’s happening isn’t good and even with the possible compromise, the situation isn’t ideal.
Just so we all know what we’re talking about here, HSN is restructuring the Breast Screening and Assessment Service (BSAS) to eliminate surgical consultation (or reduce it significantly, if a compromise can be reached). Breast screening with mammograms, ultrasounds and other diagnostic tools will still be available.
What won’t be — and what has patients, survivors, local breast surgeons and other health professionals crying foul — is that surgical consultation portion of the service. This consultation occurs within days of a person receiving a diagnosis of a breast abnormality and involves the patient sitting down with a surgeon to discuss what was found.
In 80 per cent of cases, the abnormality is not cancer. But 20 per cent of the time, it is. Just that word, “cancer,” is fraught; it’s fraught with fear, anxiety, anger, depression. It’s just about the last word anyone wants to hear.
Almost as bad are the words “abnormal” and “possible cancer.” Prior to the advent of the BSAS, anyone who received an abnormal mammogram would wait weeks or even months to sit down with a doctor for an explanation of what was abnormal.
That waiting period is unbelievably frightening and stressful for the patient, and their loved ones. It can feel interminable. It meant weeks wondering if they were dying, if even as they waited the cancer was growing inside them. It is psychological torture.
The surgical consultation offered through the BSAS put an end to that torture. It meant within days of an abnormal scan, you were sitting with a doctor. It meant peace of mind for more than a thousand people every year. Modern medicine can be cold and sterile. The consultation offered through the BSAS shone like a warm light of humanity.
And how much does it cost the hospital to offer this consultation? A grand total of $270,000 or so a year — another reason people are so upset. It seems like such pittance, and compared to HSN’s $500-million budget, it is a pittance.
But the hospital has to climb out of an $11-million shortfall. That is huge challenge. It’s an enormous hole to fill and the only way to fill it is with money. After years of frozen health-care spending, all Ontario hospitals have to wrestle with rising costs and stagnant funding.
It is an untenable situation. Something had to give, and so we’re faced with situations like hallway medicine, of hospital’s sticking patients in any spare corner that can be found because there is no other choice. And we’re faced with situations where hospital officials entertain taking a scalpel to programs like the BSAS.
Some have accused the hospital of targeting women with this decision. I don't think that's fair. Health Sciences North is not a malevolent entity. It's not out to do harm. I think HSN is targeting dollar signs, and it targeted a portion of the BSAS that likely seemed expendable. Patients would still receive a consultation; they would just have to wait for it.
But, what anyone who has had to wait on a cancer diagnosis knows — but which apparently was forgotten by those involved in the BSAS decision — is that wait is torture, absolute torture.
What they forgot is the human element. The hospital was forced into this position by a provincial government that forgot the human element when it decided health-care spending increases were expendable, which forced the hospital to make a spending decision that was — by the account of the physicians and nurses involved — bad for patients and bad for care.
Now, the breast surgeons and the hospital may have arrived at a compromise. It hasn’t been finalized, but a meeting last week raised the possibility the surgical consultations would continue in a reduced capacity, and at a cost of $70- to $80,000 a year. Not ideal, but certainly better than no consultations at all.
Dr. Paradis hopes the community will continue to pressure the hospital over the restructuring, and she hopes that pressure will see HSN leave the BSAS as it is.
This is what I see, compared to the HSN’s budget shortfall of $11 million, that $270,000 is a drop in the bucket. It barely makes a dent. But for people with an abnormal scan, for those frightened people worried they have cancer, that $270,000 bought some peace of mind. It bought comfort. It bought an end to anxiety for those who could be facing the fight of their lives.
It seems a small price to pay, doesn’t it?
Mark Gentili is the editor of Sudbury.com and Northern Life.