EX-ST. PAUL’S SURGEON FIRES AWAY IN NEW BOOK
Dr. Stephen Pinney’s roots are in Canada, but he’s frustrated by the inefficiency of our health-care system — so he wrote his book How Hockey Can Save Healthcare. Pamela Fayerman checked in with him by phone.
Q You came back to Canada from 2010 to 2012 to work at St. Paul’s Hospital. How did the job offer come about?
A I wanted a clinical role with administrative oversight. I’ve always had strong feelings for Canada, so the job as head of orthopedic surgery at St. Paul’s sounded like a good fit. St. Paul’s has one of most respected footand-ankle programs in North America. Now I am chief of the orthopedic foot-and-ankle service at St. Mary’s Medical Center (in San Francisco).
Q It sounds like you had mostly negative experiences while here. In your book, you say the Canadian health system is often mediocre or even atrocious.
A People were quite nice and well-intentioned. Many patients get excellent treatment, but there were times the i’s weren’t dotted and the t’s not crossed. There were a lot of frustrating experiences.
Q One of the most disturbing parts of your book is your description of the “laissezfaire” sterilization processes in operating rooms. You write that health-care professionals leave ORs, walk outside for breaks and don’t bother changing their gowns before returning to the OR or they let their mask fall down during operations. You say your patients’ wound infection rate was only one per cent in San Francisco, but it went up once you were here.
A One of the problems in the system is the lack of dedicated, familiar teams. And the health providers you work with never see the outcomes of each case (to know if an infection occurred). The more you open the door to an OR, the more you stir up bacteria.
Q Your book opens with an anecdote about how it took five weeks to get a printer for your office because of the “stifling” bureaucracy. And it took about 50 hours just to get surgical instruments ordered, a process that takes 10 minutes in San Francisco.
A This is a stunning example of frustrating inefficiencies. When I showed up, I said, “Here are my instruments that I want to use.” They said, “We order everything for each case.” There were numerous meetings, phone calls, emails, and a year later surgeons got instrument sets, each costing $4,500. There were many operations where, in the middle of surgery, the circulating nurse would have to leave the OR to grab an instrument that was needed. This is very inefficient.
Q You mention a patient who stayed in hospital for nine months, even though he could have been discharged to a rehab or nursing facility several months earlier.
A This patient had surgery for an ankle fracture, but he was just the tip of the iceberg. I would say 20 per cent of patients were bed-blockers — using acute care beds (estimated to cost $750 to $1,000 a day) inappropriately. Sometimes they’re indigent with nowhere else to go, sometimes they’re elderly and too frail to go home, but they don’t need to be taking up expensive beds in the hospital.
Q A year before you moved to Vancouver, a future colleague performed wrong-sided surgery on a patient. And six months after you got here, another doctor nearly operated on the wrong foot of a patient. But there was no incident report, no immediate debriefing to figure out how this could have happened or been prevented.
A Wrong-sided surgery takes more than one mistake by one person to happen. There should be checks and balances between all health providers like nurses, anesthesiologists and surgeons. There has to be a critical incident report system in which every case is explored automatically and immediately. I found out there was a backlog of 1,200 incident reports at St. Paul’s.