First, I would like to say that the hospitals I knew in England, prior to the NHS, were spotlessly clean. In the hospital where I did my medical training infections were virtually unknown. The Matron (Miss Marriott) went round the wards every single day speaking to each patient. “Good morning, Mr. Jones. Is everything all right? Are you comfortable? Are your family coming to see you?” One step behind her was the Hospital Secretary-Superintendent (Brigadier Hardy-Roberts, retired Army Officer, Eton and Sandhurst). His job was to see to it that anything the Matron noticed which was out of line was put right the same day.

The Secretary-Superintendent was invited to give a talk to the medical students one day. He said, “You may sometimes wonder why a lay person, ex-Army at that, could become a hospital Secretary-Superintendent. My reply is that as a lay person, I have a unique, non-medical perspective. The Matron is in charge but my job is to see that the whole hospital is run properly so that the doctors and nurses can do their work in the best possible environment.”

I worked as a House Surgeon in the hospital where I trained. We did a long Surgical List of operations occupying two whole days every week. My Chief was a Consultant Surgeon and his specialty was major general surgery. There were no long waiting lists.

In 2003 I visited my old hospital (Middlesex Hospital, London. Est. 1745). I was shocked and dismayed by what I saw. The hospital was like a third rate hotel and a dirty one at that. I wrote a letter to complain. The first reply came after one month and further replies over a period of two more months. Each reply was from a different level of lay administration. One woman’s title was so long I could hardly fit it on the envelope when I wrote back to her. In my reply I said, “The letters I have received indicate to me what could be wrong with the National Health Service. I would have liked to have received replies from a doctor or a nurse, someone with medical training. The replies I have received came from no less than three different levels of lay administration. When doctors and nurses were in charge….hospitals were much, much better. It is my impression that the NHS is top heavy with bureaucratic lay administrators who create work for each other and all of whom have to be paid and eventually pensioned off.” I have received no reply to that letter.

I worked in Saskatchewan in the 1950’s, prior to the introduction of Medicare. I worked in a small Prairie town with its own hospital. The hospital had a Matron and the hospital was efficiently run and very clean.

I go back to visit periodically and the hospital has been closed by the government. Patients are supposed to go to bigger Regional Hospitals for “better care”. In our Prairie hospital, we delivered 70 babies a year. We looked after the mothers through their confinement and post-natally. Where the hospital was formerly there is now a small clinic and visiting doctors come from different towns for a half day or whole day so that patients can never tell which doctor they are going to see. Expectant mothers have to travel to different towns to have their babies. After their confinement they return home and a visiting nurse goes around in a car to assist them with breast feeding. One may well ask if this is better care.

Many problems exists in today’s Canadian Health Care system, often referred to as socialized medicine. The two most common complaints by far are ... hospital infections and waiting lists.

Hospital infections

"Fraser Health Institute Struggles with Infection Control - Fraser Health is aware that it does not currently demonstrate infection control prevention, surveillance and control best practices and it is taking steps to address the issue.” (Acting Auditor General Arn van Iersel)

“Patients are very safe in Fraser Health.” (Dr. Tony Taylor. Fraser Health Authority Vice-President of Quality and Patient Safety. News item dated April 4, 2007)

“We do audits.” (Dr. Tony Taylor. CBC Early Edition, 27 of March, 2007)

(Newspaper item dated 13 January, 2006) Shantel Bennett gave a statement that her newborn baby endured “filthy” and “unsafe” conditions in the Pediatric Ward at Surrey Memorial Hospital. The mother and grandmother of the infant said they found a used syringe with a protruding broken needle in the dust under the baby’s bed. The mother said the baby’s bathtub was “filthy” and the garbage can was so full its lid would not close. “If this ward is for sick children, don’t you think it should be clean?” she asked. The grandmother was told not to worry about the floor because a two week old baby would not be walking and the needle was dismissed as “only a syringe”.

She also said that a cleaner working across the hall twice refused her request to clean the baby’s room. The mother said she later received a phone call from a Fraser Health Authority official “who apologized up and down and said they will make it better. But I said it didn’t matter because we are never going back there.” Simrita Johal-Virk of the Fraser Health Authority said managers liaise regularly with the private cleaner contracted to ensure sanitation standards are met including a minimum daily cleaning of a patient’s room. “I assure you we strive to provide a safe, clean environment for our patients” said Johal-Virk.

A while back on CBC Radio, Morning Edition, a woman described her experience at the Royal Columbian Hospital in New Westminster, BC.

She went to the hospital to receive some medication prior to an eye investigation. She suffered a reaction and was placed in a bed in the Emergency Department. After a short time she felt uncomfortable, the sheet she was lying on was wet and on inspection was stained brown and smelled. Her husband helped her onto a chair and it was pointed out to the nurse who said, “We do not change the linen between patients – it’s too expensive.”

While the patient was sitting in the chair, a female patient went into the adjoining toilet; she was wearing a colostomy bag which broke and she came out leaving the liquid contents of her colostomy bag on the floor of the toilet. Patients were beginning to go in there and the patient sitting on the chair nearby said, “Don’t go in there. The floor is dirty.” The patient witnessing all this called a nurse and said to her “Could you please have that room cleaned – patients are trying to go in there and the floor is soiled.” The nurse replied, “We do not have the authority to tell the cleaners what to do.”

All this was on the CBC Morning Edition. I subsequently phoned this patient as her name was given on the air. She corroborated everything that was said.

“Hospital Kitchen Fails Health Inspection” - The kitchen at Delta Hospital got poor marks this Summer when it came to being free of pests and protecting food from contamination. The hospital kitchen is staffed by Fraser Health employees. An inspection found that the premises were not kept in a sanitary condition and was not free of pests, which was listed as a critical problem.

Other violations listed in previous inspections included potentially hazardous foods stored at inappropriate temperatures, equipment and utensils not properly washed or working and at least one employee lacking good personal hygiene, clean clothing or hair control.

On June 4, 2004 the Canadian Medical Association Journal published a report about an outbreak of clostridium difficile involving several hospitals in Montreal. This disease results in debilitating diarrhea which can be fatal in elderly patients.

A nurse of my acquaintance contracted clostridium difficile working in hospital as a result of which she developed a Toxic Megacolon. This resulted in her having to have a complete colectomy (removal of the entire colon following which she has to wear a permanent ileostomy bag).

An outbreak of clostridium difficile infection has contributed to the deaths of nineteen people at a Quebec City hospital.(CBC News report, September 28, 2007)

No one should ever go into hospital and contract infection resulting in death.

In National Health Hospitals in England the situation is no better. An outbreak of clostridium difficile in an NHS hospital has killed seventeen people since December.(news report dated April, 2007)

"Coroner shocked by C.Difficile deaths" - A Nottinghamshire, U.K. Coroner said he has been shocked by the dramatic increase in deaths of hospital patients linked to clostridium difficile. Dr. Nigel Chapman said he had dealt with 110 cases in the last ten months. In November, 2006 there were seven reported deaths which rose to 13 in June, 2007. Dr. Chapman said, “C. difficile is almost in epidemic proportions – we have still not got it under control.”

At least 49 people have died from a super-bug at three hospitals in Leicester, U.K. in the past eight months. (BBC News dated 1^st of October, 2006)

Clostridium difficile has outstripped MRSA (Methicillin-Resistant Staphylococcus aureus) as a cause of death in hospital. Even so, MRSA death totals are still mounting year after year. The bug was specified on 1,629 death certificates in 2005, an increase of 39% on the previous year.

"Super bug problem driving patients to the private sector" - Independent (private) hospitals have fared very much better. The mounting problem of hospital “super-bugs” is causing patients to seek private treatment. NHS hospital managers admitted that a survey of patients in State (NHS) hospitals showed that fear of hospital-acquired infection overshadowed fears of the risk of surgery. Infection rates have continued to worsen fuelled by the emergence of clostridium difficile, a super-bug highly resistant to anti-bacterials. Deaths involving the organism have increased every year since 2001. Mortality increased by 69 percent from 2004 to 2005 – from around 2,200 to 3,807. (Office of National Statistics)

“Private hospitals don’t get MRSA” (Telegraph report dated 25 July 2004)

Last year, the three biggest private hospital chains said they experienced no confirmed MRSA cases. (Weekly Telegraph, March 28-April 3, 2007)

One may well ask why unclean conditions which would not be tolerated in a hotel are tolerated in hospitals. The obvious answer is “Because we have no choice.” In Canada’s state hospitals there is no one in charge in each hospital with the necessary authority to make sure that:

1. The hospital is kept clean at all times.

2. Nurses and doctors are never allowed to leave the hospital to walk outside in the street in their runners and hospital scrubs with their stethoscopes slung around their necks - an all too common sight.

There is no hospital discipline any more.

In the U.K. where Socialized Medicine began in the form of the NHS there are now no less than 200 Private Hospitals in response to patient demand. In 2006, I visited a Private Hospital in England and I was impressed, first of all by the cleanliness and secondly by the atmosphere of quiet efficiency.

In short, Canada should offer it’s citizen’s freedom to choose private care if they so wish. Prior to Medicare there were Medical Insurance Plans which worked perfectly well – MSA and C.U. and C. - as well as Medical Insurance provided by larger corporations.

Keep Medicare by all means – but let there be freedom to choose.

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