Roadblocks faced by doctor raise concerns about system

Manitobans should be deeply concerned by reports that one of the province’s most specialized cancer physicians may be leaving after spending years trying to introduce a treatment already available elsewhere in Canada.

They should also be demanding answers.

The possible departure of interventional radiologist Dr. Alessandra Cassano-Bailey is troubling on several levels. First and foremost, it raises concerns about access to care for patients battling liver cancer.

Just as important, it raises broader questions about whether Manitoba’s health-care system is capable of retaining highly skilled specialists and supporting innovation when clinicians identify ways to improve patient outcomes.

According to a letter signed by 14 doctors and medical staff at CancerCare Manitoba, Cassano-Bailey has spent more than two years attempting to introduce transarterial radioembolization, or TARE, a minimally invasive treatment used for patients with certain liver cancers — in particular, those who are not candidates for curative therapies or chemoembolization.

The treatment is available in other Canadian jurisdictions such as Alberta, B.C., Ontario and Quebec, and has been associated with improved outcomes for some patients. However, not all provinces have this treatment available — Manitoba and Saskatchewan among them — and patients must be referred to out-of-province centres for this procedure.

In spite of holding years of meetings, repeated requests and discussions, the physicians say there is still no indication the procedure will be implemented in Manitoba. That should concern everyone.

When a nationally recognized specialist, backed by a multidisciplinary team of cancer physicians, spends years advocating for a treatment and receives little apparent progress, serious questions need to be asked.

Why has the process taken so long? Who made the decision not to proceed? What concerns, if any, were identified? Were those concerns clinical, financial, staffing-related or bureaucratic?

And if the procedure is appropriate and beneficial, why are Manitobans still being denied access to it in their own province?

Those questions deserve clear answers from Shared Health, CancerCare Manitoba and the provincial government.

Health Minister Uzoma Asagwara appears to recognize the seriousness of the situation. The minister has publicly stated concerns about the physician’s possible departure and indicated there are questions that require answers from health officials.

But Manitobans need more than expressions of concern. They need transparency and accountability.

The possibility of losing Cassano-Bailey also highlights a larger challenge facing Manitoba’s health-care system. Recruiting doctors is difficult. Retaining them is often even harder.

According to Doctors Manitoba, the province would be left with only five interventional radiologists if Cassano-Bailey departs. For a province serving not only Manitobans but also patients from northwestern Ontario and Nunavut, that is a troubling number.

The organization has also pointed to long-standing concerns about staffing shortages, limited equipment and resource constraints that affect the specialty. These are not new complaints. They have surfaced repeatedly across various areas of the health-care system.

When specialists consistently identify barriers that prevent them from delivering advanced care, policymakers and administrators must take those concerns seriously.

The warning contained in the physicians’ letter may be the most alarming aspect of this entire situation. The authors suggest that continued frustration could contribute to additional departures among highly skilled medical professionals. The province already struggles to retain physicians. Doctors Manitoba reports Manitoba continues to lose more doctors to other provinces than it gains through interprovincial migration.

Manitobans deserve a full explanation of what happened here. They deserve to know why a treatment supported by specialists remains unavailable. They deserve to know whether opportunities were missed. And they deserve to know what steps are being taken to retain a physician described by colleagues as an exceptional clinician and leader.

Most importantly, liver cancer patients deserve confidence that decisions affecting their care are being made efficiently, transparently and in their best interests.

The questions raised by this case are too important to remain unanswered. The public has a right to know what went wrong and what will be done to ensure it does not happen again.

» Winnipeg Free Press and The Brandon Sun