She felt like she was suffocating while covered by a surgical drape sheet, with only an opening for her eye, she says. Trying to get more air under the sheet, she kept raising an arm. An anesthetist kept putting it back down.
“(Imagine) having to lay perfectly still while you watch the doctor bring a scalpel to your eyeball and then make an incision. All this while you are wide-awake and alert!,” she wrote in a letter of complaint to the hospital.
“To have to do this without sedation is quite frankly inhuman.”
Cooper is the second senior to come forward to complain about having cataract surgery without sedation at the hospital on June 25 because of recent OHIP fee cuts. Sharon Phillips, also 65, told the Star recently that her ophthalmologist was quite upset about having to do the operation without sedation and had complained that doctors would stop doing it because it was dangerous.
The two women say they were among 14 cataract patients denied sedation that day. They say they were given no advanced warning, but that they did get a topical numbing gel.
What Cooper says she finds particularly galling is that, not only was an anesthetist present, but the doctor told the ophthalmologist performing the surgery, Dr. Omar Hakim, that it was an “experimental day” to see how patients would respond without sedation.
In Cooper’s case, not too well.
“Had I known what I was to go through in the next 10 to 20 minutes, I never would have had the operation,” she says. “The operation was very painful and extremely stressful. I experienced an anxiety attack and could not lie still for the most part of the operation.”
Describing Hakim as kind and caring, she says he tried calming her by assuring her he would talk her through the procedure.
In the recovery room, Cooper’s blood pressure was extremely elevated.
Even though Oakville Trafalgar normally provides sedation to cataract patients, OHIP fee cuts had nothing to do with patients not getting it that day, the hospital says.
In a statement released Friday, the hospital apologized to patients who felt their needs were not addressed and expressed regret over possible inadequate communication.
While not specifically explaining why there was no sedation, the statement reads: “Sedation during ophthalmology procedures is usually administered and will continue to be offered by our anesthetists when it is both safe and clinically appropriate. There is a wide variation in clinical practice for cataract surgery and not all cataract surgery patients require or receive sedation.”
Cooper finds the explanation difficult to understand given that she had cataract surgery on her other eye back in January — at the same hospital, by the same doctor — but with sedation.
The commotion is happening at a time when Ontario doctors are squabbling with the province about cuts to OHIP fees. In early May, the province unilaterally made 37 changes to the OHIP fee schedule after negotiations with the Ontario Medical Association fell apart.
The provincial government wants to hold the line on physician compensation at $11 billion annually in an effort to slay a $15-billion deficit. The average annual compensation last year was $666,000 for ophthalmologists and $436,000 for anesthetists, according to the health ministry. That’s a jump of 61 per cent and 59 per cent for each specialty, respectively, since 2003.
The combined fee anesthetists get for conscious sedation has dropped to $60 from $120.
During cataract surgery, patients are typically given this type of intravenous sedation for pain, anxiety or comfort. They stay awake during the surgery but are dozy.
Some anesthetists have said it will no longer be financially feasible to provide one-on-one care to patients during cataract surgery. Some ophthalmologists have responded by warning they will then have to stop performing cataract surgery because it would be dangerous without sedation.
At the non-profit Kensington Eye Institute in downtown Toronto, one anesthetist works on three patients at a time with the help of assistants. The provincial government wants more cataract surgeries moved out of hospitals and into clinics like Kensington.
Dr. Jim Watson, chair of the OMA section on anaesthesiology, says that by changing the OHIP fees, the government is changing incentives to doctors and thus, changing the way they practice. In the case of anesthetists, there is less incentive to provide one-on-one care during cataract surgery.
“In the press, we have been painted as the bad guys. We really don’t want to be in that position. We would rather have a fulsome discussion with the province about changing patterns of care,” he says, adding that the Kensington model won’t work in smaller communities.
Watson notes that while Ontario has historically provided IV sedation to cataract patients, other jurisdictions do not do so.
Health Minister Deb Matthews said it’s unacceptable for patients to doubt they were given anything but the highest quality care and said Oakville Trafalgar is contacting patients in question.
“I am pleased that the hospital is taking these complaints very seriously and reaching out to all patients who had cataract surgery that day,” she said.
Original Article
Source: the star
Author: Theresa Boyle
No comments:
Post a Comment