Report to health ministry warns province already overwhelmed
Wednesday 31 January
The Ottawa Citizen
Demand far outstrips planned expansion
The waiting list for an MRI in Ontario is growing by almost 12,000 patients a year, according to a confidential draft report to the government that paints a bleak picture of the "inadequate" response to the demand and need for magnetic resonance imaging in the province.
Waiting lists are so long that some patients are being admitted to hospital just so they can get access to the high-tech head and body scans; cancer patients who need followup tests to see whether their tumours have responded to treatment are considered "elective" and aren't being bumped up the queue; and some surgeons are being forced to operate without the "anatomic road map" that an MRI provides, adding "time and unnecessary risk to the surgical procedure," says the report, obtained by the Citizen.
In addition, waiting times to get a scan can depend more on whether a patient's doctor has privileges at the hospital doing the scan -- or whether their private insurance company will pay for it -- than on the urgency of their medical need, the report says.
And while MRI examination has become the standard of practice in North America in diagnosing a range of heart, vascular and other conditions, it takes so long to get a test doctors are falling back on "suboptimal" tests using older, less-specific tools.
"The important potential uses of MRI for face and neck, cardiac, vascular, abdominal, pelvic and breast exams are, for the most part, unrealized," says the report, prepared for the Ontario Ministry of Health and Long-Term Care by the HayGroup, a Toronto consulting company.
The group warns that the ministry's planned expansion of MRI machines will meet only the "minimal level" of demand for MRI services, and that it won't be enough to meet future demand for new and emerging uses. "Demand will likely exceed supply within a short time after opening of all the planned MRI scanners."
There are 31 MRI machines in Ontario today. By the end of next year there will be 42.
A spokesman for the ministry refused to discuss the report. "I'm certainly not going to comment on a draft copy of a study. The ministry has the final copy. It's under review by ministry staff," Jeff Bell said.
The review was based on 10 hospitals that together provide half of the province's MRI services -- including the Ottawa Hospital, which has two scanners, and the Children's Hospital of Eastern Ontario, which operates one machine for pediatric patients.
The Ottawa Hospital is appealing to the province to fund a third machine, and the Montfort Hospital has been waiting months for the ministry to respond to a request for an "open architecture" MRI that can accommodate obese and claustrophobic patients.
"I think this whole region is shortchanged when it comes to MRI," said Gerald Savoie, chief executive officer of the Montfort.
Ottawa, in fact, appears to have the lion's share of the growing waiting list. More than 7,000 patients are on an Ottawa Hospital waiting list for an MRI. Patients are waiting an average seven months for a non-urgent, non-emergency scan.
The draft report said that in May 2000, there were 22,000 people on waiting lists in Ontario.
The HayGroup found that, during a three-week period, 3,272 patients received MRI examinations at the sample sites, but during the same period, 3,612 patients were added to the waiting lists as these hospitals. In other words, "there were 340 more patients added to the waiting lists for MRI than were examined." Assuming the 10 sites provide about half the volume of MRI scanning in Ontario, "then the number of patients waiting for MRI in Ontario is increasing at approximately 225 patients per week, or 11,700 patients per year."
The numbers mean that, without more machines on line, in five years almost 60,000 people could be waiting for publicly funded scans. But that's given present demand -- and demand, the report warns, is expected to grow.
But the report warns that waiting lists underestimate the problem, because waiting times have become so long that doctors are simply not referring patients for a scan. "There are a large number of patients who would benefit from MRI" who aren't being referred, and these people aren't reflected in the waiting lists.
The report also says there are no consistent guidelines for determining who should get priority access to scans. Though some hospitals give cancer patients priority access for initial diagnosis and to "stage" their disease, most treat follow-up exams as elective. "As a result, monitoring treatment and the resulting tumour load is relegated to other imaging technologies. This is a problem for the effective treatment of cancer patients."
Doctors generally agree that the same imaging test be used when dealing with a tumour to ensure any changes that are detected are due to a change in the tumour itself, and not because a different test is being used.
"Thus, for the most part, oncology patients in Ontario have not had access to the most effective and thus the most appropriate type of imaging technology," the document says.
Patients with suspected multiple sclerosis are waiting months for an MRI, even though the technology is better at detecting plaques than any other tool, and new drugs can reduce the severity of the disease if they're started as early as possible.
"More than ever, there is a need for patients with suspected MS to be investigated quickly to either confirm or refute the diagnosis," the report says.
The province has used the figure one machine for every 350,000 people to plan for MRI services. But the reports says it should instead be based on the number of scans needed per 1,000 population.
One study found that patients in the United States are receiving 48 scans per 1,000 population. A Calgary study recommends 45 scans per 1,000 population for this year, and up to 76 scans per 1,000 in 2005.
Right now, Ontario hospitals are providing about 12 exams per 1,000 population. And once new machines come online, capacity will reach only 18.7 exams per 1,000 population.
The report suggests every scanner in the province run for a minimum of 16 hours, five days a week, but hospitals like the Ottawa Hospital are already operating their machines 16 hours a day, seven days a week. Two hospitals are doing scans 24 hours a day.
The situation frustrates officials such as Mr. Savoie of the Montfort -- who, because the hospital doesn't have a machine, can't train medical residents to use one.
"We're sorting out
who's going to get access to this, where it is seen to be the gold standard
for a whole bunch of things."
Copyright 2001 Ottawa Citizen Group Inc.