Dr. Cory Franklin had a provocative piece in the New York Post yesterday exploring whether Canada’s government-run health care system contributed to the tragic skiing death of Natasha Richardson. He writes:
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.
Actually, it has been reported that Richardson received a CT scan at Centre Hospitalier Laurentien. The hospital does have the equipment.
Defenders of universal health care think this ends the debate and accuse critics of Canada’s system of “exploiting” Richardson.
But health care blogger Dr. T points to the government-engineered lack of specialists in Canada:
Neurosurgeons are not so easy to find in Canada where subspecialization is not rewarded, and 50-60% of boarded neurosurgeons leave the country to practice somewhere else within 2 years of their certification.
The last good data I could find listed only 174 neurosurgeons in the entire country. In the U.S. we have 3,500. A study on the need of neurosurgeons listed the density of neurosurgeons in the U.S. to be about 1/55,000 people which means that an analogous number of neurosurgeons needed in Canada would be about 604.
It is true that neurosurgeons eschew emergency room coverage in the United States, but it is for completely different reasons than in Canada. Here, our ED’s don’t want to pay what it takes to hire a neurosurgeon for coverage; in Canada, no one wants to even be a neurosurgeon.
So, in a sense, the Canadian model for health care failed Natasha Richardson because of an artificially created shortage of subspecialists, which is a purposeful design meant to keep costs low in a taxpayer-funded-system. The U.S. would very much like to go in this direction and the plan is to broaden non subspecialized care options while reducing higher-tech procedures, diagnostics and physicians.
But as we go towards a single-payer system, we can all expect that when we need it most, the system will not be there for us, as it was not there for Natasha Richardson.
There’s no shame in asking what went wrong, how our health care system can minimize preventable deaths, and whether current proposals to radically alter our health care system would increase these tragedies.
It would be irresponsible to do otherwise.
Read this. Hat tip – Greg Pollowitz:
Connie and Donald McCracken were watching CNN one evening last week when they learned of the tragic death of actress Natasha Richardson from a head injury. Immediately, their minds turned to their 7-year-old daughter, Morgan, who was upstairs getting ready for bed.
An injured Morgan McCracken has benefited from awareness after Natasha Richardson’s death.
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Two days earlier, Morgan, her father, and brother had been playing baseball in the yard of their Mentor, Ohio, home when her father hit a line drive that landed just above Morgan’s left temple. A lump formed, but the McCrackens iced it down and the swelling subsided within an hour.
“For the next two days, she was perfectly fine,” Donald McCracken says. “She had no symptoms. She went to school both days and got an A on her spelling test as usual. There were no issues whatsoever.”
But after hearing about Richardson’s death, the McCrackens wondered if Morgan was really as OK as she seemed. After all, Richardson had been talking and lucid immediately after her fatal injury.
When they went upstairs to kiss Morgan good night, she complained of a headache. “Because of Natasha, we called the pediatrician immediately. And by the time I got off the phone with him, Morgan was sobbing, her head hurt so much,” McCracken says.
The McCrackens took Morgan to the emergency room at LakeWest Hospital in neighboring Willoughby, where doctors ordered a CT scan and immediately put Morgan on a helicopter to Rainbow Babies and Children’s Hospital in Cleveland, with her father by her side.
“I knew it was bad when she had to get there by helicopter in six minutes, instead of the 30 minutes it would have taken to get to Cleveland in an ambulance,” McCracken said.
When the helicopter arrived at Rainbow, the McCrackens were greeted by Dr. Alan Cohen, the hospital’s chief of pediatric neurosurgery. He whisked Morgan into the operating room, pausing for a moment to tell McCracken that his daughter had the same injury as Richardson: an epidural hematoma.
McCracken remembers standing in the emergency room, feeling like the life had just been sucked out of him. “My heart sank,” he says. “It just sank.”
Unlike Richardson’s, Morgan’s story has a happy ending.