Thank you, Mr. Chair and committee members, for the opportunity to appear once again before you. I last spoke to this committee in February 2008 in the aftermath of the regulatory shutdown at the NRU at Chalk River. I'm also a member of the group of experts that was called together in December 2007 by the federal Minister of Health to provide advice on the medical isotope supply, and I continue to serve in that capacity.
When I appeared here some 16 months ago, I spent some time describing my practice and its dependence upon the secure supply of medical isotopes. That dependence on a secure supply hasn't changed, but I'm not going to return to that description, as I know that members of the government have been involved in a detailed exploration of those issues since that time. However, I would like to present to you today what we have done in the interim to prepare for this crisis, which I think Dr. Lamoureux had referred to. We knew it was going to happen; we just didn't know when it was going to happen. We in fact believed this was going to be inevitable.
As an advisor to the federal Minister of Health, the group as a whole has provided advice on alternative radiopharmaceuticals, advice regarding alternative diagnostics and treatments, and information to assist in the preparation of a document that outlines strategies to maximize the use of any existing radiopharmaceutical supplies. That document has been very useful to all the centres across this country in dealing with the current issue.
I've also provided advice to the Ontario Ministry of Health and Long-Term Care, where we drafted a plan to use in the case of this particular event. In fact as the ink was drying on the last version of that plan, the shutdown at Chalk River occurred this past May.
We've prepared plans, as well, to roll out sodium fluoride bone imaging, but that is only going to replace a small proportion of the bone scans that are performed across the province. That plan was worked on in concert with people at the Cross Cancer Institute in Alberta, and I believe another plan was worked on as well in Sherbrooke, Quebec. Finally, we have developed a plan to monitor the situation in each local health integration network across the province.
Internally at Hamilton Health Sciences and St. Joseph's, my staff has been working to be sure we're in a position to be able to take that plan out of the drawer and in fact implement it. In particular, we've developed communication strategies so that the medical staff and the public in our city of Hamilton—all of whom are very concerned about the current situation—are kept informed.
Where do we stand today? We're four weeks into the current situation, which was triggered by a safety shutdown at the NRU. In large part, the planning undertaken by the nuclear medicine community in conjunction with the federal and provincial health ministries has worked. The radiopharmaceutical suppliers have developed backup supplies, but these are in smaller quantities and at an increased price. Of course, my organization and other organizations across the country are struggling within their constrained budgets to deal with that price increase.
We've maintained our usual workloads for the first three weeks using these strategies, but last week we experienced a 20% reduction in the number of examinations we were able to perform, and this week we expect a reduction of about 30% of our usual volumes.
To a lot of observers from the outside, it might not appear there is a crisis. That's because of the very talented and dedicated staff who work in each of Canada's 245 nuclear medicine facilities and radiopharmacies. Patients are booked and rebooked to make the best use of radiopharmaceuticals. Doses and patients are transferred from one facility to another to ensure that the patient in the greatest need of the examination receives the dose of the radiopharmaceutical.
But the efforts to manage this situation come at a considerable cost. I think the increased costs of radiopharmaceuticals are perhaps the simplest example. More important are the opportunity costs—the time spent by a technologist to reorganize workflow, rather than providing that extra bit of care that's really so important to our patients with cancer and heart disease, and the time spent by physicians and scientists managing this effort rather than teaching tomorrow's physicians or exploring new frontiers. So this is a costly event that we are attempting to manage.
When I appeared here last February, I was asked a very difficult question on whether patients would have died had the reactor not resumed operations. The answer that I gave at that time was understood by the media to be no. I'd like to set that record straight today.
In large part, what we are dealing with here is a limitation in diagnostic testing, as opposed to therapy, which has been caused by a shortage of medical isotopes. A diagnostic test is one element of a process that begins with a patient complaint and leads to a history and physical examination by a physician and eventually to a diagnosis and a prescription of therapy.
Appropriate diagnostic tests, as prescribed by the physician, are used to increase the certainty about the diagnosis. If the test is not available then the level of certainty remains at a lower level, and in fact the diagnosis may be incorrect. There are many steps between the initial assessment and eventual patient outcome, and the drawing of a direct line between the lack of a specific test and the death of an individual patient is a difficult connection to make. However, the withdrawal of nuclear medicine testing from the Canadian health care system, which operates at the best of times within significant constraints, is resulting in difficulties in delivering care to patients.
I would like to think that we can manage this event, but if the level of medical isotope supply falls to the point that we are able to deliver fewer than 50% of our usual examinations, then I believe that deaths could occur due to the additional strain placed on the health care delivery system.
I want to stress again that although we are coping reasonably well in mitigating the impact on patients at this time, this is taking a toll on our health care system and each individual involved in the system, in particular the patients. It results in increased costs and the refocusing of already stretched resources.
I'd like to thank the committee today for the opportunity to appear before you, and along with the others, I would be pleased to answer any questions you might have.
Thank you.