St. Boniface surgeon threatens to stop hand surgeries if physio and occupational therapy programs cut

The head of plastic surgery at St. Boniface Hospital is protesting the Winnipeg Regional Health Authority's decision to cancel the on-site outpatient occupational therapy and physiotherapy services and says he is "strongly considering" not doing some hand surgeries as a result.

CBC News has obtained an email written by Dr. Avi Islur after the cuts were made back in July, criticizing the health authority's decision to axe outpatient physiotherapy and occupational therapy there and citing the value of the program to his patients' recovery. The surgeon gave the CBC permission to report the letter, which he sent to Health Minsiter Kelvin Goertzen and the St. Boniface Hospital board of directors, but declined an interview.

"I am extremely disappointed by the decisions that have been made and I am saddened that the quality of care our patients will receive will be second rate," he wrote, of the looming loss of outpatient therapy. 

Islur specializes in cosmetic and hand reconstruction surgery, including joint reconstruction, chronic hand trauma, nerve transfers, and treatment of brachial plexus injuries. 

"Ultimately I am at a point where I will strongly consider not performing complex reconstruction, arthroplasties and replantation in the future," he wrote. 

"Surgery is only 40-50% of of the patient's eventual outcome. The other 50-60% is achieved by the OT/PT therapists. If I know that patients will receive a poor outcome without appropriate therapy, it is likely in their best interest to forego surgery and live with their disability.

"This is the worst type of medicine to practice but is the reality of what the region is creating."

Islur states that the success of the hand and upper extremity surgical program at St. Boniface Hospital is dependent on the "cohesive team" of nurses, therapists and surgeons who work together, in the same space, directly with the patients. 

'They're not supposed to do any harm'

A senior occupational therapist within the program agrees that when the outpatient program ends at St. Boniface Hospital, so should some of the surgeons' operations.

"I think it's very prudent because according to their oath, they're not supposed to do any harm," said Melissa Abrams.

She works with seven physiotherapists and three other occupational therapists out of the basement at St. Boniface hospital to do outpatient rehabilitation with the hand patients. Their program, which is slated to end sometime this month, can not be replicated in the community, she said. The occupational therapists specialize in treating hands, wrists and elbows, and work with the patient in consecutive visits to remove surgical dressings, perform wound care, mobilization, splinting and other tasks to aid in their recovery. 

"I foresee a lot of issues in the next few years with the decrease in service," she said, calling the closure of the outpatient service "horrific" and "devastating."

In Islur's email, he explains that the physiotherapist and occupational therapist visit "each and every hand patient" once a week at clinic, allowing the provision of "individualized and immediate care to all patients regardless of their 'vulnerabilities.'"

"Ultimately I am disappointed by the region and their lack of insight," he states. 

"I fear considerably for my future patients."

In response to his concerns, a spokesperson for the Winnipeg Regional Health Authority wrote, "We have made it clear to specialists across the region that outpatient therapies related to hand reconstruction and arthroplasty will continue to be offered by outpatient clinics within HSC at no charge to patients."

"We continue to work with clinicians to establish clinical criteria that will be used to determine eligibility for outpatient physiotherapy services at HSC."

But Abrams said no new positions have been posted at the HSC, which she believes will result in "tremendous" workload increase to the existing physiotherapists and occupational therapists there. 

Last year, she said, the occupational therapists treating hand, wrists and elbows in the plastic surgery program at St. Boniface Hospital saw 970 patients. 

The occupational therapists at the Health Sciences Centre treated 1,200 such patients, she added.

"I know firsthand that the outcomes of patients seeing community or private therapy centres is poorer compared to those seen by our therapists," wrote Islur. 

He cites the relationship, and proximity, between doctors, therapists and the patient as the reason why in-house post-operative care is superior to what patients could access in the community.

And while he wrote that research at St. Boniface Hospital will also suffer with the loss of the program, it all comes down to one thing. 

"If we don't do anything or achieve any change, we have failed our patients," he said.