Canada's killer health care & Natasha Richardson

Cory Franklin:

COULD actress Natasha Richardson's tragic death have been prevented if her skiing accident had occurred in America rather than Canada?

Canadian health care de-emphasizes widespread dissemination of technology like CT scanners and quick access to specialists like neurosurgeons. While all the facts of Richardson's medical care haven't been released, enough is known to pose questions with profound implications.

Richardson died of an epidural hematoma -- a bleeding artery between the skull and brain that compresses and ultimately causes fatal brain damage via pressure buildup. With prompt diagnosis by CT scan, and surgery to drain the blood, most patients survive.

Could Richardson have received this care? Where it happened in Canada, no. In many US resorts, yes.

Between noon and 1 p.m., Richardson sustained what appeared to be a trivial head injury while skiing at Mt. Tremblant in Quebec. Within minutes, she was offered medical assistance but declined to be seen by paramedics.

But this delay is common in the early stages of epidural hematoma when patients have few symptoms -- and there is reason to believe her case wasn't beyond hope at that point.

About three hours after the accident, the actress was taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the resort. Hospital spokesman Alain Paquette said she was conscious upon reaching the hospital about 4 p.m.

The initial paramedic assessment, travel time to the hospital and time she spent there was nearly two hours -- the crucial interval in this case. Survival rates for patients with epidural hematomas, conscious on arrival to a hospital, are good.

Richardson's evaluation required an immediate CT scan for diagnosis -- followed by either a complete removal of accumulated blood by a neurosurgeon or a procedure by a trauma surgeon or emergency physician to relieve the pressure and allow her to be transported.

But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn't have specialized neurology or trauma services. It hasn't been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada.

Compounding the problem, Quebec has no helicopter services to trauma centers in Montreal. Richardson was transferred by ambulance to Hospital du Sacre-Coeur, a trauma center 50 miles away in Montreal -- a further delay of over an hour.

Because she didn't arrive at a facility capable of treatment (with the diagnosis perhaps still unknown) until six hours after the injury, in all likelihood by that time the pressure buildup was fatal. The Montreal hospital could not have saved her life.

...

If her accident had occurred in the US, it is very likely she would have received the proper diagnosis, testing and care to save her life. It is important to remember that when Democrats are pushing for the Canadian health care system. Canadians often have to come to the US for CT scans because they are rationed up there. Rationed health care means waiting and that can be critical to many patients.

Comments

  1. I live only 20 minutes away from Mount Tremblant. I have known for years that if I or anyone else are in a serious medical condition .... our chances for assistance is limited because of the time that it will take to transport us to a medical facility.

    A few years ago my girlfriend broke her ankle while skiing. It took an hour for an ambulance to arrive, and another hour to get her to a hospital. This was frustrating for all involved, especially when we learned that no helicopter service was available. But this is a result of where we are.

    Everyone must understand one thing. We are not call the Great White North for nothing .... we are in the wilderness .... this is one of the attractions of northern Quebec and why I love to live here .... but unfortunately it will take time for medical assistance to arrive and to transport anyone who is in need.

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  2. I am a Canadian physician who has worked in various settings in Canada and around the world. I've practiced both at the Hopital Sacre-Coeur, which transiently cared for Mrs. Richardson, and one of Montreal's premier trauma centres, and in a few rural hospitals in Quebec, some as far as 7 hours drive from the nearest major metropolitan area. The tragedy that occurred to Mrs. Richardson and her family is truly regrettable, but it would be wrong to fault the medical system.

    Her medical care was delayed, to a degree, by her own volition. With an intracranial hemorrhage, time matters. The first ambulance en route to transport Mrs. Richardson was cancelled as a result of her initial refusal to accept care. By the time she was in crisis, even if the helicopter was stationed at the nearest airport and ready to go instantaneously, the time it would have taken to transfer to the helipad at Sacre-Coeur hospital would have approximated the time taken to transfer via ambulance, and would not have made a significant difference in her care.

    Contrary to your assertions, the Quebec medical system employs state-of-the-art medical technology, and uses an emergency airplane equipped with on-board critical care facilities on a daily basis to transport patients from our northern regions to Montreal and other major hospital centres. And it does this free of charge to all Quebec citizens, and with a more efficient, less-bureaucratic system than any found in for-profit centres in the United States.

    This tragedy would truly be compounded if we fail to prevent the next head injury by not insisting that skiers wear appropriate headgear.

    Sincerely,

    Adam Hofmann, MD

    ReplyDelete
  3. Dr. Hofmann,

    Did Sainte-Agathe-des-Monts have a properly functioning CT scanner at the time?

    In the U.S, just about every hospital has a CT scanner these days. Even the cities that have populations of 9000 have them.

    ReplyDelete
  4. If you have no insurance in the US you're SOL on getting any treatment after the initial evaluation. The US health care system is not all you say Merv. It all relative to how much money you have and if you speak English and not Spanish. If you have no money and no insurance, you might as well stay home and die in your own bed. We've had people die lying on the waiting room floor, waiting to see a doctor, being told to shut up by staff. We've had people with heart attacks refused because of no insurance by a hospital owned by one insurance company.

    As far as this case, epidural or subdural hematomas are blood CLOTS, caused by accumulation of blood. Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. In 85-95% of patients, this type of trauma results in an overlying fracture of the skull. Blood vessels in close proximity to the fracture are the sources of the hemorrhage in the formation of an EDH.

    EDHs are usually stable, attaining maximum size within minutes of injury; however, Borovich demonstrated progression of EDH in 9% of patients during the first 24 hours1 . Rebleeding or continuous oozing presumably causes this progression. An EDH can occasionally run a more chronic course and is detected only days after injury.

    I doubt rushing her to a US hospital would have helped. She presented no symptoms at first and she would have had to be there at the onset.

    It's strange that she hit her head on a beginner's slope and had the type of trauma caused baseball bat or hammer, ie:focused point on the head. I'm sure there is more to this story than we heard. Not blaming her spouse, but this is the usual. It's hard to hurt yourself that much. If she fell that hard, she was on ice and not snow and was maybe pushed down with force, maybe playfully. I've fallen many times on ski slopes and have never hit my head, because it's human instinct to protect your head by lifting it up as you fall. It's also hard to get hurt on a beginner's slope, for goodness sake. I really doubt the validity of this whole story. Sorry.

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