Ontario's Health Ministry says hospitals should have one machine for every 350,000 adults. In Ottawa, 'we have one for about every 550,000,' and even a new, private clinic can't help dent the backlog
Monday 22 January
Sharon Kirkey and L. Robert Morris
The Ottawa Citizen
More than 7,000 people are on an Ottawa Hospital waiting list for a magnetic resonance imaging test, a massive backlog of "suffering" people who are waiting seven months and longer for a body scan to diagnose everything from painful back problems to multiple sclerosis.
Demand is so high that the area's first private MRI facility is unlikely to put a dent in the numbers, Ottawa Hospital officials say.
Two MRI machines at the hospital's Civic and General sites are working 16 hours a day, seven days a week, to deal with the waiting list, says Tom Holland, director of diagnostic imaging for the Ottawa Hospital. Except for downtime for cleaning and repairs, the machines are working "flat out," he says. More funding would be needed to increase the number of hours of service.
Emergency and urgent cases get top priority, with emergency cases seen within hours if needed. But "elective" patients are waiting seven months on average for the test, which uses a combination of radio waves and a huge magnetic field to pick up tumours and diseased tissue earlier and better than any other diagnostic tool available.
Some doctors have grown so frustrated with the delay for a non-emergency MRI that they're taking patients off the waiting list and sending them for more invasive, often more painful, but often less precise, tests.
The hospital is appealing to the province to fund a third MRI machine for adult patients. But the Ministry of Health insists the city has an "adequate" supply of machines.
Trish Besner doesn't buy it. She's been waiting since October for an MRI, when she first began experiencing strange fainting spells. She's been told she could be waiting until June. The 31-year-old registered practical nurse can't see properly, her balance is off and she constantly feels a strange "pins and needles" sensation in her head. She and her 21-month-old son, Logan, have moved in with her parents because she can no longer care for herself or her child alone. (Her husband is a long-distance truck driver and on the road often.)
Her mother, Joan Penney, has had to take an unpaid leave of absence from her job at a children's clothing store at Bayshore Shopping Centre to care for her daughter and grandson.
The doctors "keep mentioning MS to me," Mrs. Besner says. "And that's a very scary thing, and I know an MRI can rule that out."
Without a firm diagnosis, the doctors are "exploring all avenues," she says. They prescribed Paxil, in case her symptoms were due to anxiety or panic attacks, but it isn't working. She's taking an anti-seizure medication. She needs a sleeping pill to help her get through the night.
Her last spell was two days ago. She couldn't move, "and my mom just lost it. She fell to her knees and started crying. It's been a huge stress on my family."
"She's lost weight. She's thin and drawn. She can't be by herself. She can't drive. She can't work," Mrs. Penney says. "But we have no information as to what is wrong with Trish. She feels like all the life is leaving her body."
Mr. Holland, who has spoken with the family, says he can only "offer her our sympathies. Unfortunately, we hear stories like that all the time.
"There's a tremendous amount of anxiety for the patients. And a tremendous amount of anxiety for the people who are working here as well," he says as he stands outside the MRI chamber at the Civic site.
"Every request that comes in is looked at by a physician, and essentially he plays a guessing game: Is this a condition that will deteriorate, or won't deteriorate, based on the information he has? The patients call and explain in great detail what (the delay) means to them in their daily lives, how this is affecting them at work, how the mom can't essentially care for the three or four or five kids who are at home.
"Everybody associated with this operation deals with this on a daily basis."
Magnetic resonance imaging has become one of the most important advances in diagnostic imaging in the last century. In many cases, it's considered the definitive test. It's used to diagnose problems in the brain and spinal cord, in detecting early cancers and examining joints and soft tissues.
When patients are slid inside the tunnel-like interior of the massive machine, a magnet emits short bursts of powerful magnetic fields and radiowaves. The bursts stimulate atoms in the patient's tissues to emit radio signals that are detected by a computer, which it uses to create a three-dimensional image or "slice" of the area being scanned. The painless procedure is five to 10 times more accurate than anything else available, including the CT scan.
Each machine costs about $3.5 million, plus more than $2 million a year to operate, of which the province pays $800,000.
The Ottawa Hospital argues that even when the ministry's benchmark of one MRI for every 350,000 people is used, the city falls short.
The newly amalgamated City of Ottawa has an adult population of about 624,000, which would mean 312,000 patients per MRI scanner. But when the hospital's entire "referral population" is taken into account -- that is, the number of people who receive care in Ottawa hospitals regardless of where they live -- "we have one machine for about every 550,000 population," Mr. Holland says.
The hospital treats patients from Prescott-Russell, West Quebec and communities as far north as Sudbury. He says the hospital's referral population is expected to hit 1.46 million by 2003. Children 17 and under account for about 22 per cent of that number. Of the remaining 1.14 million adults, that would mean 570,000 patients per MRI machine.
The Children's Hospital of Eastern Ontario also has an MRI, and the ministry has said that machine could be used for adults. But Mr. Holland says the scanner is already operating full-out to deal with babies and children, who typically need to be sedated and anesthetized. "Their unit is not sitting idle for any amount of time during the day either."
Ottawa appears to compare poorly to other cities.
The City of Toronto has 10 MRI scanners for adult patients, or about 181,800 adults per machine, based on its population. Toronto is scheduled to get two more scanners by the end of this year. That would bring the ratio down to 151,500 adults per machine.
Metro Toronto is also surrounded by the Greater Toronto Area, which includes communities such as Oshawa and Mississauga, where five more MRIs are scattered. Each area draws on the other's resources, giving Toronto and the GTA a total of 17 MRIs, or one per 272,000 adults.
The district of Hamilton-Wentworth has one scanner now, and a second is expected to be operating by the end of February. A third machine should be operating by the end of the year, and a fourth machine has also been approved by the Health Ministry as part of a provincewide expansion of MRI services. A fifth MRI has been approved for research purposes.
Ministry of Health spokesman Jeff Bell says the Hamilton hospitals serve a larger area. The Hamilton region has a "minimum" patient referral population of about 1.15 million, according to Marion Emo, executive director of the Hamilton-Wentworth District Health Council, but it increases to 2.2 million when neighbouring areas are included.
Money can give Ottawa residents closer, and faster, access to a scan.
The Ottawa Valley MRI clinic in Hull began accepting patients in early December. For $725, patients can get an appointment within 48 hours, with the results back to their referring physician within 48 hours.
Robert Hecht, a partner in the new facility, says the clinic's machine is "on par with the work that any hospital MRI can do." (Another partner is Calgary Liberal Lorne Paperny, who runs some of the country's major private MRI clinics.)
Mr. Hecht says the Hull clinic is seeing patients "who are in some type of pain, be it a sports injury or back problem," people who "don't have an interest in waiting for a public scan."
But it also means people who can afford it are getting access to an MRI ahead of people who may be in even greater need -- and getting in the treatment queue ahead of them.
The closest publicly funded MRI machine to Ottawa is in Kingston, which has about a five-month waiting list, Mr. Holland says.
The Ottawa Hospital did get money from the province last year to replace a temporary MRI housed in a trailer at the Civic site with a permanent machine; it also agreed to replace a 12-year-old magnet at the General. But the hospital had also asked for a third scanner, "and the lack of a third machine is what's causing this massive backlog," Mr. Holland says.
Last year, the hospital scanned about 15,000 patients at both sites combined.
"With both of these two new units up and running, we'll hit the 22,000 mark" by the end of the year, Mr. Holland says.
He hopes the hospital will be able to reduce the current backlog to five months by the end of April, "but we'll never get to our benchmark of four weeks, which is where we ought to be with this for an elective patient."
And he and others worry that demand will only surge as the population ages, since older people are considerably more likely to require MRI scans than are younger people. Ottawa's over-75 population is expected to increase by 27 per cent by 2004.
Critics say the Ottawa situation reflects Canada's "dismal" place in the world when it comes to MRI and other high-tech equipment. One study released last year found that Canada ranked 11th out of 13 developed countries studied -- just barely ahead of the Czech Republic and Poland -- in terms of MRIs.
"We are providing a service that meets only about 65 per cent of present demand," Mr. Holland says. "That's a serious shortage on the supply side, and the effect on the more than 7,000 patients waiting is, indeed, drastic."
The province recently commissioned a group of consultants to look at MRI services and waiting times across Ontario. Their report has just been submitted to the Health Ministry and isn't yet available to the public.
In the meantime, Mr. Bell, of the Ministry of Health, says Ottawa "is considered to be adequately serviced for MRIs."
He says that when Kingston's MRI is included, the region in fact has access to four machines.
But Mrs. Besner's family has become so frustrated with the delay they're considering going to a hospital in Montreal, or to the new private clinic in Hull.
"We don't have $725 sitting around, but we'll find the money and we'll do it," Mrs. Penney says.
She sees bitter irony in the new Ontario government advertisement playing on television that shows a woman being helped up off an MRI machine with a tag line extolling the importance of early diagnosis.
"We've seen it 50 times. And I'm so annoyed, because you can't get early diagnosis," Mrs. Penney says.
"They know what's