Good morning. Thank you for inviting me. It's a pleasure being here.
My name is Dr. Christopher O'Brien. I'm immediate past president of the Canadian Society of Nuclear Medicine and president of the Ontario Association of Nuclear Medicine. And I'm medical director of three community hospitals in Ontario, so I bring a perspective on what happened in the community hospital setting across Ontario.
Nuclear medicine specialists do a five-year residency training program. A significant part of this training program deals with radiation safety. It deals with the concepts of how we protect our patients, how we protect our workers within the nuclear medicine environment, and how we protect the public from the inadvertent release of radiation from our labs. So we have a significant background. Many of our physicians are radiation safety officers within the hospital environment.
We are very familiar with the concept of ALARA, which means “as low as reasonably achievable”. This is the radiation safety policy we follow to ensure that patients' care is not compromised as a result of the inadvertent use of radiation, and the concept of being reasonable is the underlying philosophy we follow.
What we would see within the community hospitals is somewhat different from what we would see in downtown Vancouver, Toronto, Hamilton, etc. We don't have the resources that many of these larger centres have, and nuclear medicine plays a very significant role in the management of patients in the rural community setting.
As medical director of three hospitals, I was acutely affected by the isotope shortage that occurred. We first got reference for this on November 27, and we started to gather information on how this was affecting our patients. By December 5, our nuclear medicine community put out our first letter of concern, as a press release dealing with the fact that many of our hospitals in the community setting were forced to start rationing access to health care.
On a day-to-day basis we weren't sure what patients we would be able to treat or how we were going to help them. We were able initially to maintain our emergency services, but as the crisis progressed—and this was a crisis in the rural settings....
I will grant that the impact was variable across Canada, with some centres less affected, but in the rural communities in which I work—Pembroke Regional Hospital, Stratford General Hospital, and Brantford General Hospital—we were significantly impacted by this. Two of my hospitals were actually closed for a few days because they had no isotopes available.
In my own hospital, towards the end of the crisis we were having difficulty maintaining emergency services, and actually, towards the end of the situation two of my patients came in on whom we were unable to do emergency procedures. This was dealing with blood clotting in the lung, which has a significant and high mortality rate if it is not diagnosed appropriately.
These individuals could not undergo a CT scan, because they had allergies to the x-ray dye, and they were in renal failure. So to the issue of whether these patients were placed at increased risk, the answer is, absolutely. Could these patients have died if they had not been appropriately taken care of? Absolutely.
This was a crisis. This was a situation in which, when you're in the trenches, as we were with the technologists, clerical staff, nurses, and physicians trying to deal with it, we had a tremendously difficult time trying to decide who would get what treatment when and how we would do it.
We have patients who were dependent on us for assessment for their heart. If they're undergoing chemotherapy, one of the requisitions will come down frequently to us stating, please do this urgently; we have to know how the heart function is so that we can determine whether the patient can undergo chemotherapy.
We had similar situations from orthopedic surgeons, saying to us, I have to bring this patient for surgery; we have to know what the heart status is. There were patients with lung cancer, breast cancer, prostate cancer. When trying to determine the most appropriate treatment available to them, we were not able to address those issues in a timely fashion. So we found ourselves in a crisis situation.
We found ourselves actually teetering on the brink of disaster just before the reactor was brought back online. It was at that point that in my own hospital, Brantford General, we had those two patients come forward and were not able to treat them appropriately. This was very frustrating for the patients and very frustrating for the emergency room staff.
These are people who come to the emergency room; this is not an elective procedure. They come in with acute chest pain. The possibility of it being a heart attack or a pulmonary embolism is a major discussion. So these are critical situations that have to be addressed in a timely fashion.
So what happened? Our doctors had to decide how to treat these individuals without knowing sufficiently what the actual underlying problem was. As physicians, part of our oath, as you know, is to do no harm. And to do no harm we have to actually know what is actually happening with the patient in a timely fashion so we can get the proper treatment done. We found ourselves in the very uncomfortable situation of perhaps doing more harm to our patients by treating them, because the treatments we use are not without risk. When you really want to start treating those individuals, you want to have a definite understanding of what you're doing.
Luckily, the patients did not die, but they were definitely placed at increased risk. And these patients, if they were inappropriately treated, could have died from complications from the treatment itself.
So from the community hospital setting.... I will grant that it's variable across Canada. Out west, in Vancouver and Alberta, the impact was less. The main provinces that were significantly impacted were Ontario, Quebec, and the Maritimes. From speaking to colleagues in Sudbury, I know they were down to 25% capability at one point. At my own hospital, Brantford General, we were reduced by 25%. Stratford General was down about 35%, and Pembroke had about 40% reduced capability. For my colleagues out in Sydney, Nova Scotia, again there was a significant impact. So the examples I'm using are rural, community-based hospital practices.
We were very comfortable with the reactor coming back online in a safe process. We understand that it was a safe reactivation of that reactor, and since the isotopes have come back, we are now at full capability, and patients are being treated appropriately.
Thank you.