Karl, I take your point, but still find it interesting that this debate has been going on for 10 years. Since Quebec is singled out as one area in Canada where it was not even an option, and since doctors have been trying to convince those in power that even one medivac helicopter in Quebec might be a good idea, the media's use of NR's accident to revisit the topic can't be brushed aside as mere ratings chasing or morbid fascination.
I know about the situation in Quebec because a close relative of mine was involved in a serious accident there (Quebec is next door to Maine) which evolved into a lawsuit, and because we have a similar situation regarding medivacs in Maine (also several other states have similar issues), that is we have a law that prevents corporations owned by physicians to operate ambulances, including air ambulances. There is a similar law banning physicians from operating HMO's. The reason given for this, at least here, was that in the past such companies tended to transport patients to hospitals where the financial interests of the ambulance operators would be best served, which was sometimes detrimental to said patients. Example: Hospital X is located 10 miles from accident site but ambulance company operators have vested interest in Hospital Y which is located 100 miles away, so they take the patient to Hospital Y instead, and bill the insurance company accordingly, invoking ambiguous reasons for not delivering the patient to the nearest ER.
There was an obvious conflict of interest and the state was pressured by insurance companies to dealt with it through legislation. Nowadays when medivac is really required in Maine the state police, Coast Guard or National Guard dispatches one of their helos, of which they have a fair number.
Even though Quebec has public Medicare (as do all Canadian provinces), it is the only province where private hospitals and clinics (usually owned by corporations consisting of physicians) are allowed following a Quebec Court of Appeals ruling (that's the highest court in the province), and unlike many other provinces the ambulance system in that province is privately operated so residents of the province (and visitors) must purchase private insurance to cover this service, or be billed for it. However there is a law that stipulates that no one can be denied the service and that if someone fails to pay, the provincial government will cover the cost and attempt to collect the patient later. Since the government is not allowed to seize assets of individuals who are under a given level of income, or are non-residents, a lot of them simply never bother to pay, incurring high costs at taxpayers expense.
Unlike Maine there is no law in Quebec that prevents doctors from operating ambulance companies but there are regulations as to where a patient can be transported: the nearest ER equipped to deal with the patient's condition and medics are not allowed to invoke ambiguous, weird conditions to avoid following the rules. Ambulance operators dislike this regulation and some have hired PR firms to spin media stories that make it appear as they are being forced to deliver patients to inadequate facilities but fail to mention that by "inadequate" they often mean less profitable for the operator because the distance is too short, since a large portion of an ambulance bill is based on mileage.
Enter the medivac. In Quebec only hospitals equipped with trauma units have helipads (and as far as I can tell, it's the same here) which makes sense since most patients transported by helicopter have life-threatening conditions of an unpredictable nature. Most ER's can stabilize patients with heart attacks and other life-threatening conditions due to illness but serious accident victims require accute trauma care, at least until their condition can be accurately assessed. Oddly enough most doctored media stories (no punt intended) omit to mention the helipads as this would amount to admit that there are medivacs in Quebec.
Indeed there are, but doctors can't own them and that's what bothers some of them (a small but vocal minority of businessmen-physicians, I must stress that as far as I know the huge majority of physicians in Quebec are more concerned about the wellbeing of patients than making profits off taxpayers) since it deprives them of what they perceive as a no-risk investment that is guranteed to generate profits because even if they transport some patients that turn out to be deadbeats they still collect the fee from the government. The risk for abuse is obvious.
Over a decade ago my father-in-law was involved in a serious -and ultimately fatal- traffic accident in Quebec where he travelled often (Quebec is next door to upstate New York where he lived). The accident happened near the city of Sherbrooke, and ambulance crews were at the scene within a few minutes. What happened next is still unclear and still in litigation, but apparently the ambulance driver contacted the ER of a hospital in Sherbrooke (a fairly large city with well-equipped hospitals including a university teaching hospital) and described the condition of his patient (my FIL) as serious but not immediately life-threatening, and gave an ETA to the ER of less than 10 minutes. He was cleared for the transport but about a mile down the road was contacted by a 911 dispatcher and told to
stop and wait for a medivac helo, which he did but the medivac took 30 minutes to get to the scene during which time the medics on the ambulance contacted dispatch at least 3 times begging (I have heard the recording) to let them drive my FIL to the ER as his condition was deteriorating but were told to stay put for the medivac. When the helo arrived it loaded my FIL but then flew him to Quebec City
120 miles away claiming that a hospital there was better equipped to deal with the patient. Indeed they took him to a hospital which is reputed to have one of the best trauma centers in Quebec but it took so long to get him there that we believe (along with the doctors who treated him there) that the delay may have prevented him from recovering from his internal injuries. He was operated on 6 times over 17 days but refused a seventh surgery and passed away 20 days after being admitted. The death certificate issued by Quebec and filed with NY state stated that "persistent internal hemorrhage subsequent to trauma suffered in a vehicular collision" was the direct cause of death but "patient transport delays" was also listed as a factor.
Initially we had been concerned about the quality of care he was receiving and inquired about transfering him to Albany or NYC but were told by NY doctors that the hospital where he was was top-notch and that in any case he shouldn't be transported. When we visited him there we saw that the hospital -which was very large- and staff were indeed of the finest quality. My FIL was kept in ICU where I noticed that, to my untrained eye at least, were a lot of complex-looking computerized machines and monitors that looked brand new and certainly more sophisticated than what we have in our little local hospital here. My FIL was heavily sedated with narcotic painkillers we were told, but seemed relatively comfortable when awake. He said he felt very little pain, which was great comfort to my MIL.
Over a year after my FIL's death my mother-in-law, armed with the death certificate, hired a Quebec attorney to investigate the reasons why it took so long to get her husband to an ER when no less than 4 were located within a 10-mile radius of the accident site. She (the lawyer) made a few troubling discoveries. First the medivac was fully licensed but belonged to an air transport firm which is unusual as private medivacs are usually operated by ambulance corporations. Turns out the transport firm was owned by a man whose brother, a physician, is a known proponent of doctor-owned air ambulances. That's a bit suspicious but not illegal, however someone somewhere appears to have been able to convince 911 dispatchers to risk patients' lives in order for someone to make more profit off their medivac helo, and that's very likely not legal. However it took 9 years to get local law enforcement to look into the matter, with various agencies claiming it wasn't their jusrisdiction. Currently a provincial government investigator has been assigned part-time to assess if any wrongdoing took place in this case and several others. Obviously the case is still in litigation.
It is while reading court documents pertaining to the case and various other sources that I became aware of the issues at stake regarding medivac vs ambulance not only in Quebec but in various US states as well. Reading between the lines it appears that it's not so much the cost per se that's the core of the matter, but that this cost may be incurred through abusive practices.
Privately operated medivacs in Quebec obtain most of their revenue from government (Medicare) contracts regarding the transport of patients in remote areas. The goverment itself operates several state-of-the-art jet air ambulances which are modified Challenger bizjets (in the world of bizjets the intercontinental Challenger sits dang near the top). These aircraft are staffed with pilots (obviously) but also surgeons, anesthetists and OR nurses in case a patient requires surgery on-the-fly (literally), and also serve as mobile operating rooms serving remote areas, mainly in the north. In the much more densely populated south medivacs are mostly operated by police, Cost Guard and the military. Many of the police helos used for SAR are also equipped as medivacs. So when the media says there are no medivacs in Quebec they are distorting the truth.
ETA: This isn't just about NR. It's about the safety of the citizens of and visitors to Quebec. When was the last time you went on vacation and asked about medical facilities? I'll bet it crosses a lot more people's minds now.
Hopefully these people will get their info from sources other than mainstream media articles about celebrities. If CNN had bothered to fact-check their story instead of parroting local interest groups we probably wouldn't be having this discussion.
Unfortunately most of us can only tell a media story is way off the mark when they talk about something we happen to be familiar with. I remember reading in the English version of a French travel guide similar to Lonely Planet that shark attacks were frequent in Maine (they are not), that Jaws had been filmed here (Matha's Vineyard is not in Maine) and the picture they had published of a "typical beach in Maine") which featured palms and a blue lagoon was obviously not taken anywhere near Maine. Having little else to do on that particular day I emailed the magazine and suggested they correct these factual errors, but when the reply came (I'm surpised they bothered) I was told in true Parisian fashion that I was, basically, a butt who should mind his own business
