Health Care and the premier of Newfoundland

One of the big back and forths in the health care debate is over the quality of US health care. Those who say it’s not first in the world took an apparent hit when the Premier of Newfoundland, Danny Williams, chose to have his heart surgery at Mount Sinai hospital in Miami, Florida.

Not so fast.

Mr Williams had Mitral Valve Regurgitation. In simple, one of the valves doesn’t close all the way and so some of the blood is pushed the wrong way during part of the process.

Now there are a lot of very good cardiac surgeons all over the world who treat this on a (fairly) regular basis. However, there are always a few that seem to get referenced regularly, who can be argued to be the cream of the cream. One of those happens to be in Canada; Ottawa Ontario instead of Newfoundland, but Canada nonetheless. His name, for those who wish to review, is Dr. Thierry Mesana, and he is chief of cardiac surgery at the University of Ottawa Heart Institute.

So if one of the best in the world is in Canada, why did Mr. Williams go to Miami, Florida?

Simple, really. You see, there are two ways to conduct this surgery: through the front, and through the side. The side approach is less invasive and leaves a smaller and less noticeable scar. Proponents argue that it is a lower risk procedure and that post-operation recovery is faster. Opponents point out that there’s a higher incidence of failure (resulting in strokes as well as heart and valve stoppages) from the low-invasive procedures. The trade-off, then, is convenience and immediate risk vs long-term risk.

Now you may have figured this out already, but Dr. Mesana comes down on the side of a front entry, reserving the side entry for uncommon and specific requirements. In fact, there are allegedly only four individuals in Canada who will go through the side either by preference of patient or by habit. All four are good, but they’re not, well not near the top of list for quality.

In fact, all of the ‘top of the list’ for that procedure are not only outside Canada but are in the US, and one of those is at, yep, Mount Sinai in Miami.

So Mr. Williams did not go to the US because it was “better than Canada”. He went because the US has a better team that does a particular type of surgery for a problem he has, even though one of the best for his problem (but not using that procedure) is in Canada.

In Canada he’d have had to settle for the procedure more likely to see him live a longer time instead of one that let him be prettier and on his feet a week or two earlier. Go figure.


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