Health Committee on June 18th, 2009

[Dr. Jean-Luc Urbain]

First of all, I sent the document yesterday to the clerk for translation into English. Second, the NRCan document I believe would be available to you.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I think what you're saying, then, is that there might be some alternatives down the road, but that we're putting a lot of money into this dubious pursuit when in fact we have a crisis right now.

That was made apparent by the news. Your organization, Dr. Urbain, has been clear about the catastrophe that is looming or is with us. Dr. Driedger mentioned the question about thyroid cancer. We just had news out of Quebec showing that they've run out of iodine-131.

Today we got the report on the wait times, and it says that in fact the median time for radical cancer care is “46 days or nearly 7 weeks”, and the majority of these treatments exceeded “the benchmark for curative cancer treatment of 4 weeks”.

So now we have that statistic coupled with the shortage of isotopes. How bad is it going to get? Can you predict? Can you project? Can you tell us how serious it really is?

[Dr. Jean-Luc Urbain]

Madam Chair, I have the privilege and the burden at the same time to also be the co-chair of the Wait Time Alliance. That was one of the questions asked by the press. Today there is no doubt that the shortage of isotopes will disrupt the care of the patients and will prolong their access to care and also their access to treatment. This is particularly vivid in patients with cancer. We don't have that same problem with cardiac patients, as Drs. Ruddy and Beanlands said, but it's definitely a major problem for patients with cancer and for children.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Urbain.

We'll go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank all of the witnesses for being here today. I know that all of you have been very busy. I must say that I think everybody here appreciates all your advice and wisdom in dealing with this issue, because I think everyone around this table understands that it is a very serious issue.

I wanted to talk a little bit about solutions. I think we all realize that this is very much a global problem and will take a global solution.

Dr. McEwan, you mentioned that you're also working with the provinces and the territories. We had some discussions around the table about PET scans and coordination of these things. How advanced are these discussions with the provinces and territories? How is the government working with the provinces and territories and internationally at the present time?

[Dr. Sandy McEwan]

Madam Chair, I've been in the job three days, so if my span of knowledge is imperfect, forgive me.

I do know that the minister has had a number of teleconferences--I believe the figure is three--with her provincial and territorial counterparts on this issue. I do know that at the time of my appointment she spoke to all of her provincial and territorial counterparts as well, so I am assuming there are ongoing conversations.

I do know that in terms of international conversations the real activity is on how we access, as early as we can, alternative sources of supply. Certainly, I had been told by the suppliers of our radioactive iodine products that there was no problem with supply, so, like Dr. Driedger, I was surprised to learn that there is a problem with supply.

At the Society of Nuclear Medicine meeting, I talked to representatives of both OPAL, in Australia, and NTP in South Africa. They elegantly put it that they have buckets of radioactive iodine that they can actually make available to the supplier in Canada. The key there is to ensure that the regulatory framework is in place to facilitate that access. That is being done. I do know that there are documents from both countries that are being reviewed now. I think in the last week there have been 120 SAPs for radioactive iodine from those two suppliers.

The protocols that we've put in place really do appear to be working, i.e., we can rapidly get the regulatory approvals through to do that. I'm hoping that both the NTP and the Australian radioactive iodine will be made available to Canadian suppliers soon. I don't know what the timeline is. I don't know where it is in the regulatory process, but I do know that it's started, and I do know that until that is through, SAPs will be made routinely available.

[Colin Carrie, Conservative, Oshawa, ON]

You also mention that you've been in a working group for the past 18 months and you do have a draft guidance document. How successful have you been in getting that document disseminated to your colleagues?

[Dr. Sandy McEwan]

I do know that certainly in Alberta, for example, that document has been widely disseminated through the province through an Alberta Health Services working group that is looking at ways of ameliorating the crisis. I believe it's been available to all the other provinces. I do know the Province of Ontario really started the work on some of the protocols in that. So this is a real example of collaboration between the different arms of the community.

[Colin Carrie, Conservative, Oshawa, ON]

Okay. Thank you very much.

I have a couple of questions about some of the opening comments. Sorry, I don't have my glasses on. I think it was Dr. Beanlands and Dr. Ruddy. You said there's been no noticeable increased wait for your patients, and I think all of us as parliamentarians have concerned constituents, concerned citizens of Canada. You mentioned that, and I was wondering if you could elaborate a bit. I do know that there are alternatives to technetium. With these alternatives, is it safe to say that people will not be diagnosed, because we do have the ability to diagnose them? Is that a good comment?

[Dr. Rob Beanlands]

I'll speak specifically about the cardiovascular imaging. First of all, with the previous shutdowns we became aware that there could potentially be future problems, so we planned for this and we prepared ourselves and our staff for this type of eventuality. With careful planning, this situation has been partly dealt with.

We made a decision to switch all our cardiac scans over to thallium, as well as to utilize the PET scanner for profusion imaging, or blood flow imaging. We made those two changes when we knew we had lost the technetium, or reduced the supply—Dr. Ruddy is right that it's not gone; it's just reduced. That would allow us to enable our sister hospital, the Ottawa Hospital, where most of the cancer imaging is done, to do more bone scans. We have a formulated plan. As well, our technologists come in on Saturday mornings to do some other scans to help with the load, because the timing for the thallium scans is a little bit different from that of the technetium.

These are things we were able to. It was mentioned that the technologists and the staff are being burdened and they are working very hard. This is true, but our primary goal is to make sure the patients get the care they deserve in a timely manner. At least in the cardiac section we've been able to achieve that. We have seen no noticeable change in the wait time for our cardiac patients.

[Colin Carrie, Conservative, Oshawa, ON]

Dr. Ruddy, you brought forward that it's not as if we don't have any isotopes. We are getting some, and I'm glad you clarified that because some people I've talked to thought we were totally cut off.

I was going to ask how you find cooperation with the technicians. My understanding is that the technetium we have has a half-life; it deteriorates. Are we able to run the machines 24/7 and as far as capacity? Is that making a difference right now?

[Dr. Terrence Ruddy]

We run longer hours, not 24/7. We work on weekends. A generator comes, and it's hot, and it decays. Typically, it comes on a Thursday or Friday, of all days, so that means on Saturday or Sunday the technicians work, and they don't usually do that. As Dr. Beanlands was saying, there are issues. People are not burning out, but they're getting very tired. So the solution is working in terms of patient care, but there is an expense in terms of the technologists.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Ruddy.

We're now going to go into the second round. The second round is five minutes for the questions and answers. We'll begin with Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you, Madam Chair. It's great to have such an array of expertise helping us understand this problem or potential crisis.

There are no wait times for cardiac procedures in the Ottawa facilities, but are there longer than normal wait times in other places? Are there patients not getting their treatments, and is there a way to quantify that across the country?

[Dr. Jean-Luc Urbain]

Well, it's very difficult to quantify across the country. What I can tell you is we are very proud that we have the Ottawa Heart Institute as a flagship. As a flagship program, typically you have pretty much everything at your disposal to take care of your specific area.

Most nuclear medicine centres across the country, basically, are providing not only cardiac services but also oncology services. The way you handle thallium, for example, is different from the way you handle technetium, so management is not as easy as with the technetium.

Yes, we have seen some delays in the procedures because we cannot accommodate as many thallium patients as we can accommodate technetium patients, particularly also because most centres do not have access to PET scans to do cardiac studies. I don't know what the experience in Quebec is.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

I heard from one of the witnesses--Dr. McEwan--that coordination across the country and making sure there's equal access in different facilities is not a problem. Do other witnesses believe more work should be done to ensure equal access and equitable sharing of the possibilities of the goods?

[Dr. Jean-Luc Urbain]

One of the problems is that the provinces are in charge of dispensing health care. So that's definitely a lot of work.

On the second aspect of it, Dr. McEwan mentioned that neuroendocrine tumours need isotopes for both diagnosis and treatment, and the situation in Ontario is pretty serious. The patients are now accusing us of providing health care based on postal codes.

[The Chair, Conservative, Joy Smith]

Excuse me, Dr. Urbain, but Dr. Beanlands would like to say something.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I have three other questions.

[The Chair, Conservative, Joy Smith]

You have time. You don't want to hear from Dr. Beanlands?

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I want to keep going.

We've heard advice about having a special committee to look at MAPLEs. Would it be helpful to have some other mechanism to help coordinate access in the short term?

[Dr. François Lamoureux]

I'd like to add something, madame la présidente.

I believe that a meeting of Canadian health ministers should be held, and that the federal government should provide each province with a sum of money—on a pro-rata basis—to ensure that PET technology can be implemented immediately.

The people from Alberta and Ottawa came here to tell you about excellent centres, models. But that is not what we see in the 245 centres in the rest of Canada. They do not have PET technology or options of that kind. Patients cannot be trucked from place to place. Furthermore, nuclear medical tests often cannot be scheduled: in 50% of the cases, they are urgent tests for which people cannot wait. That is where the danger lies. When you do not deal with national organizations, you do not get a global view of the problem.

Luckily, health is in provincial jurisdiction. In Quebec, we reached an agreement with our government to get an opinion from an association that brought together a number of partners rather than one individual adviser. Everyone gave their opinion on the issue and a consensus was reached. Now, our patients are better protected than elsewhere in Canada and have better access. Currently, in Canada, the best thing to do would be to hold a meeting of health ministers.

[The Chair, Conservative, Joy Smith]

Excuse me, Dr. Lamoureux.

Dr. McEwan, do you want to make a comment as well?

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I have another question on the name of the document.