CLINICAL EFFICIENCY v. RESEARCH.

from the BLOGGER.

Clinical research is valuable for the future.It provides glory, grant cash, personal perks and free trips to International conferences.

For the patient it is important to know whether one is an experimental Homo sapiens in a Trial

The patient wants BESPOKE medicine. Perfectly fitted to personal measurements.

This causes a conflict of interest especially in hospitals were docs are on salary and also where tenure depends on publication.

The best for a patient is a PRIVATE hospital whose function is not research but investigation and treatment.,
e.g King Edward VII--Sister Agnes in London, the UK Royal family's favorite, Or the PRIVATE section of a Teaching hospital.,e.g. Lindo wing of St Mary's ,Paddington.

The ideal is a SWISS hospital;clean, efficient, precise, and safe.

The USA Rochester Mayo is well-meaning but lacks investigational clinical precision
The laboratory postal service is excellent.

Toronto Princess Margaret hospital which houses the Ontario Cancer Research Institute attracts lots of Donor money for  furniture and fittings. Clinic organisation is pre-computer age. Important appointments overlap. Waiting time is in hours as appointments are block booked. There is no private wing. For the self-employed, visits are expensive as a full half-day must be allotted for a  15 min. visit.

More time efficient & comfortable is to travel by train or plane ( Toronto island airport ) to a PRIVATE hospital in Montreal e.g. ROCKLAND MD.

.

's.

OTTAWA: Francophone MONTFORT HOSPITAL

Founding of the Hospital
In 1953, the Francophone community of Eastview (Vanier), the Monfortain Fathers, the religious order of the Daughters of Wisdom and leaders of the Association canadienne-française d’éducation de l’Ontario joined forces to create Hôpital Montfort.

In adopting a community-based approach with an emphasis on family medicine, Montfort quickly became the hospital of choice for Francophones throughout the region. Though Montfort has always been an active participant in various teaching endeavours, the official agreement with the University of Ottawa relating to clinical teaching in French was actually signed in 1992.

This agreement transformed Montfort into a true teaching hospital and led to the creation of the Deneault-Beaulieu Training Unit in Family Medicine in 1994. This Unit was named in honour of Dr. Jocelyn Deneault, Montfort’s Chief of Staff, and Dr. Maurice Beaulieu, Assistant Dean of the Faculty of Medicine at the University of Ottawa at the time, both of whom played a crucial role in establishing a partnership between these two institutions.

The Montfort Crisis
On February 24, 1997, like a bolt out of the blue, Montfort was hit by the worst possible news. With no justification whatsoever, the Ontario Health Services Restructuring Commission, established by Mike Harris, premier of Ontario and his Conservative government, recommended closing Montfort, the only Francophone teaching hospital in Ontario and the only one in the entire country west of Quebec.

The reaction of the Francophone community was instant. The historic battle was on, spearheaded by Gérald Savoie, President and CEO of the hospital, Michelle de Courville Nicol, then Chair of its Board of Trustees and Gisèle Lalonde, former mayor of the City of Vanier who became President of the newly-minted SOS Montfort movement. Its battle cry: "Close Montfort? Never!" stunned Ontarians and rallied the Francophone population like never before.

After a series of massive demonstrations and extensive news coverage, the case was first heard in the Ontario Divisional Court where Montfort won on the basis of the fundamental unwritten principle guaranteed in the Constitution, the protection of linguistic minorities. Montfort’s victory is due, in large measure, to the argument presented by the sociologist Roger Bernard, who maintained that closing the hospital would promote the assimilation of Franco-Ontarians.

The legal implications of this ruling were monumental. Though the government appealed the decision, the Court of Appeal of Ontario not only ruled in Montfort’s favour but reinforced this historic ruling. ((10.1.2)). On December 7, 2001, Montfort’s stunning victory was complete.

A New Era
In July 2005, the Liberal government of Ontario, led by Dalton McGuinty, announced that Montfort would receive more than $171.5 million for a major expansion project New Montfort. Thanks to this investment, Montfort would become a world-class facility offering the best practices and the most advanced technology in the field of healthcare.

The CANADIAN FORCES USE FOUR FLOORS.

POLITICAL MYTH: OHIP pays for MEDICAL NECESSITY

EYE EXAMINATIONS from age 20-64 (usually $80) NOT PAID by OHIP unless patient has eye disease.or diabetes.

ZOSTER VACCINE ($200) NOT COVERED BY PROVINCIAL INSURANCE (OHIP)

BUPRENORPHINE patch ($75 month) not paid by OHIP.

PSA SCREENING not paid by OHIP.

DENTAL TREATMENT not paid by OHIP.

PHYSIOTHERAPY not paid by OHIP

PHARMACEUTICS paid in Hospital. Social welfare patients and theOver-65s have some drug coverage.
Majority do not have Govt. drug coverage. UNIONS & GOVERNMENT DEPARTMENTS provide extensive drug benefits.

PRIVATE HOSPITAL ROOMS hard to find.

Canadian Law does not allow world-wide IHI(Denmark)-Bupa (UK) insurance company.to offer Canadians
coverage.

Secret of Medical coverage in Canada is to work for GOVERNMENT: Federal,Provincial,Municipal, being a UNION member or work for a major CORPORATION.  Individual private inzsurance gives limited protection. Doctors have been repremanded by the "College" of Physicians and Surgeons for telling a` patient about a NON-OHIP paid investigation. Many lab tests  are not covered by OHIP.

FRANCOPHONE OTTAWA MONTFORT Hospital has four floors reserved for the CANADIAN FORCES and Federal MPs.

Ontario:Medicine a la carte.

Ontario Government reduces`fee for General assessment to $50.This allows for about 25 minutes.

Patients who subscribe to private MEDISYS Health Group & CLEVELAND CLINIC CANADA at about $3,000 a a year will get a FIVE HOUR yearly General assessment.

The fiction of equal medicine for all  in Ontario is now obvious..

Officially Private medicine is not allowed in Ontario. The private clinics use a legal loop-hole by naming them
WELLNESS CLINICS.

"APOTEX" Dr.B.S.SHERMAN BSc(Eng. U.Tor) PhD (MIT) loses case

From McCARTHY TETRAULT LLP

Published by the IP Litigation Group 2013 January 22

Ontario Court Grants Summary Judgment Dismissing Apotex’s Claim for Unjust Enrichment by: Fiona Legere, Steven Mason and Brooke MacKenzie On January 15, 2013, the Honourable Justice Quigley of the Ontario Superior Court granted summary judgment to Abbott and Takeda, denying Apotex’s claim for disgorgement of profits on the basis of unjust enrichment. The case involved a claim for damages arising from Abbott’s invocation of the Patented Medicines (Notice of Compliance) Regulations. The PM (NOC) proceedings were ultimately discontinued by Abbott and Apotex thereafter brought an action, in the Ontario Court, for (a) damages under section 8 of the PM (NOC) Regulations; and (b) disgorgement of Abbott’s profits on the basis of unjust enrichment. In the Federal Court, generic drug manufacturers have been limited to their own lost profits as a remedy for any alleged delay arising from the invocation of the PM (NOC) Regulations.  Most recently, the Federal Court of Appeal in Apotex Inc. v. Eli Lilly Canada Inc., 2011 FCA 358, struck out a claim by Apotex for a disgorgement remedy. The Ontario Court initially took a more circumscribed view and refused to strike out claims brought by generic’s for disgorgement. In lengthy reasons for decision, Justice Quigley granted Abbott’s motion for summary judgment, providing three independent bases to support his decision: Apotex could not rely on equitable rights for additional remedies not provided for in the PM (NOC) Regulations. The PM (NOC) Regulations provide a "complete code" for compensation, which ousts common law rights that might have operated but for the statutory scheme. Parliament expressed its intention to eliminate any claim to unjust enrichment with "irresistible clearness". Apotex could not meet the tripartite test for unjust enrichment because the operation of the PM (NOC) Regulations constitutes a juristic reason for any alleged enrichment. Apotex could not meet the tripartite test for unjust enrichment because the September 2008 settlement agreement between the parties constitutes a juristic reason for any alleged enrichment. The Court held that the key issue in dispute was a question of law, and a comprehensive documentary record permitted the Court to make any necessary findings. The Court agreed with Abbott that this was precisely the kind of case that can and ought to be resolved by summary judgment, on the basis of the "full appreciation test" articulated in the Ontario Court of Appeal’s decision in Combined Air Mechanical Services Inc. v. Flesch. The decision is an important win for innovator pharmaceutical companies in Canada because it forecloses claims for disgorgement of an innovator’s profits merely because an innovator unsuccessfully invoked the PM (NOC) Regulations. Justice Quigley’s reasons make clear that no such claim lies in unjust enrichment where innovators avail themselves of the procedures provided for under the PM (NOC) Regulations.  Importantly, the law in Ontario is also now consistent with Federal Court jurisprudence.  Although Apotex argued that the Ontario Court was not bound by and should not follow the Federal Court jurisprudence, the Court held that there were strong reasons to do so. Indeed, the Court admonished Apotex for "seek[ing] to circumvent determinations that have already been made by the Federal Court" which could "leave itself open to an allegation that it is engaging in forum shopping". A copy of the decision can be viewed here.

"ALL IN THE FAMIGLIA"

from TORONTO STAR

ORNGE paid $436,000 to top doctor to advise Chris Mazza

Published on Monday January 21, 2013

Share on twitter Share on facebook

University of Toronto Tom Stewart MD OTTAWA 1988 FRCPC (Int.Med) received $436,000 from ORNGE, and the company would like to know what he did to earn it.

Kevin Donovan
Staff Reporter

70 Comments

Mt. Sinai Hospital’s top doctor received $436,000 over seven years from ORNGE to advise founder Chris Mazza on medical issues — work that the air ambulance firm’s new managers cannot confirm was performed.
The additional payments to Dr. Tom Stewart — who earns about $607,000 in annual salary and benefits as Mt. Sinai’s physician-in-chief — were not disclosed on the provincial sunshine list that tracks how public dollars are spent.
Stewart’s $75,000-per-year consulting contract at ORNGE is similar to a contract of up to $400,000 annually that Mazza himself had. In both cases, the new managers of ORNGE are now struggling to determine what work was done to justify the payments. The monies paid to both men were public funds.
“Most interactions Dr. Stewart had with ORNGE were directly with Dr. Mazza. As a result, we are unable to confirm the work performed,” ORNGE spokesman James MacDonald said.
In a response to questions from the Star, Stewart said he delivered value for the money as Mazza frequently contacted him with questions. “I saw evidence of my counsel play out in several areas, for example, research development, clinician recruitment and improved critical-care system integration,” Stewart said.
The Mt. Sinai doctor, when asked, told the Star he also provided advice to Mazza on how to potentially sell the ORNGE air ambulance model to United Arab Emirates clients, a Mazza plan that went nowhere.
The consulting contract between ORNGE and Stewart ended in January 2012 after the former chairman of ORNGE alerted the provincial health ministry to his concern that Stewart and Mazza were both being paid for work they did not do. Chairman Rainer Beltzner’s Dec. 23, 2011 letter to the province raising these concerns was made a public exhibit at the Queen’s Park committee investigating ORNGE.
Stewart would not grant the Star an interview but, using Mt. Sinai public relations official Sally Szuster as an intermediary, he provided responses to questions over the past four days. At Mt. Sinai, Stewart is physician-in-chief and chief clinical officer.
Mazza and Stewart first met each other, Stewart says, during the SARS outbreak in 2003. Stewart said he, Mazza and others “led the effort against the SARS outbreak.”
They became social friends, Stewart said. When Mazza created ORNGE in 2005, he asked Stewart to provide ongoing advice. Stewart said he was “clinical care adviser for ORNGE.” He has a contract with ORNGE, but said he could not disclose it at the present time. ORNGE says it will release the contract but requires Stewart’s permission.
Stewart said his annual “stipend” from ORNGE was $75,000. ORNGE’s MacDonald said they have found payments totalling $436,000 to Stewart.
Friday, provincial health minister Deb Matthews released Mazza’s expense records, revealing that the ORNGE boss had a lavish lifestyle, jetting around the world, staying at fine hotels from Rio de Janeiro to Paris to Milan. Conservative critic, MPP Frank Klees, dubbed him “First Class Chris.”
Included in those records are several meals (modest compared to others in the box of documents) with Stewart and also several parking receipts filed when Mazza visited Stewart at Mt. Sinai. In February 2006 he filed for a $62 dinner with Stewart at Café Nervosa in Yorkville, and in July 2007 a $272 dinner at Blowfish restaurant on King St. West.
In his email responses, Stewart said his knowledge of critical care issues at hospitals helped Mazza structure ORNGE. In explaining what he advised Mazza on for $75,000 a year, Stewart said he performed: “The review of clinical care policies and procedures, recruitment of physicians and researchers who specialize in specific areas of critical care and transport, advising on how patient transport services can optimize patient flow.”
Stewart acknowledged that his initial contacts were primarily with Mazza. “I was contacted most frequently by Dr. Mazza who would often refer me to other members of the ORNGE staff.”
At no time, Stewart said, did he hear any rumblings that “the terms of my engagement were not being met.”
At ORNGE Sunday, officials told a different story.
ORNGE spokesman MacDonald said that “objections were raised regarding this contract within ORNGE, but Dr. Mazza gave direction that it remain in effect.” The contract was renewed “automatically,” MacDonald said.
At the public hearings into ORNGE last August, former chair Rainer Beltzner said that in late December 2011 (three weeks after the Star broke the first part of the ORNGE story) he learned that Mazza had an annual contract as medical director and it was unclear what, if anything, Mazza did to earn up to $400,000 a year for the job. Just that portion of Mazza’s salary over the years totalled $2.2 million.
Beltzner wrote a letter Dec. 23, 2011 to a top provincial health official, raising the issue of both Mazza’s and Stewart’s payments.
“On another matter brought to my attention yesterday … it appears that the company, through Dr. Mazza’s authorization and insistence, was paying a Dr. Tom Stewart at Mount Sinai Hospital for services that do not appear to have been needed or delivered. This relationship has been going on for some time apparently, and there is a need to examine the underlying motive and authorization for these payments and the acceptance of these monies by Dr. Stewart.”
It is unclear who ended the contract, ORNGE or Stewart. ORNGE said the contract was “terminated.” Stewart said he resigned in January, 2012. By that point, Mazza had left ORNGE, first on sick leave then permanently. The for-profit ORNGE company he was employed by was put into bankruptcy.
As to his annual ORNGE payments not being part of the Sunshine List, Stewart said he was “not aware of how ORNGE reported its salaries.”
The Sunshine List records public officials paid more than $100,000 in public monies, but it is not clear how an individual is dealt with if they receive funds from more than one public source

DEATH CERTIFICATES

From American Medical Association

Manner vs. cause
In signing death certificates, physicians need to be aware of the difference between the “manner of death” and “cause of death” entries, Dr. McDonald said. He often sees certificates where physicians have mistakenly filled out the manner of death portion of a certificate.
In most states, the manner of death would be either natural, suicide, homicide, accident or undetermined. In many states, such as Pennsylvania, only a medical examiner or coroner can answer that question on the form. Errors can have serious consequences, Dr. McDonald said.
In one instance, a person died of a seizure, and the physician thought it was a natural death. It turned out that the seizure occurred as a result of injuries from an assault, making it a murder.
“In that case the homicide was almost missed, and a murderer almost went free,” Dr. McDonald said.
For the cause of death, it’s important that physicians list a disease and not a mechanism, said Yul Ejnes, MD, immediate past chair of the ACP’s Board of Regents. For example, one would list “pneumonia” and not “respiratory arrest,” he said.

BERMUDA: Dr.Sidney LOWRY:"The End of Medicine & the Last Doctor"

From the  Bermuda ROYAL GAZETTE

Are machines replacing your doctor?

Cathy Stovell

Comments ( 0 )

 

• 
  Could robots like this one day replace humans as doctors? File picture.
  

It's looking like the end of an era for patient-doctor relationships in the hands-on way that we have grown up with, according to Sidney Lowry, a former Edward VII Memorial Hospital oncologist.

Patients are increasingly demanding test results and place much less weight on a doctor's physical examination findings, Dr Lowry believes.

He's put his views in a new book, ‘The End of Medicine and the Last Doctor'.

“Patients no longer want to be examined. They want an MRI,” he said. “The physician is being gradually replaced by a range of health professionals, and the machine.

Dr Lowry contends that technological advancements are well on the way to displacing the traditional physician.

Employer vs Employee

http://www.webmd.com/cancer/what-to-expect-from-radiation-therapy?page=4

From Toronto BLANEY McMURTRY LLP

January 2013

When Can an Employer Sue an Employee for Damages?

D. Barry Prentice

Property Damage
Emily Anne Maclean worked in a farmer’s market. On August 1, 2003, she placed eggs on a hot plate to boil in order to make them ready for the next day’s sandwiches. She got distracted in another part of the store. Upon smelling smoke, she returned to the hot plate only to find “full blown flames”. The farmer's market was destroyed and Ms. MacLean was sued in negligence by the market’s insurer. In dismissing this claim, the Court concluded:

• employees are not generally held liable for ordinary negligence or carelessness in the performance of their duties;
  
• the imposition of liability in such a case would be unjust and/or unfair;
  
• an employer accepts the risk of employee fallibility and takes that into account in the costs of doing business, supervising the employee and insuring the enterprise.

Accordingly, although it is clearly reasonable for an employer to expect its employees to exercise reasonable care in the performance of their duties, it will only be where the degree of fault by the employee goes beyond mere negligence, that a claim for damages will have any chance of success.

The inability to recover damages in negligence does not preclude the employer from alleging cause for dismissal in an appropriate case.

A Suit to Recover Damages Payable to a Third Party
It is settled law that employers are vicariously responsible for the harm caused by an employee in the performance of the employee’s duties. The question then becomes whether the employer can recover the damages it paid to the third party from the negligent employee. As one might expect from the analysis above, the likely answer is that recovery will be restricted to those situations where the employee’s conduct was grossly negligent. Again, inability to recover does not prevent discipline and, where justified, dismissal for cause.

Suing for Breach of Contract
It is quite common for employers to require senior employees to execute covenants which prevent or restrict certain activities. Examples include maintenance of confidentiality and prohibiting the soliciting of clients or co-workers for a reasonable period of time following resignation or termination. Provided these clauses are carefully drafted to meet current judicially mandated standards and are incorporated into a properly executed employment agreement, they can form the basis of a successful lawsuit against an employee who ignores contractual terms to which the employee agreed.

In this type of lawsuit, the employer must act quickly after learning of the breach, seeking a mandatory order prohibiting the continuation of the offensive action. While an order actually prohibiting continuance of the breach (an injunction) may not be granted, the employee will be required to pay the damages suffered by the employer resulting from the competitive activity. Furthermore, the very act of commencing the lawsuit may cause the offending employee to cease the prohibited activity.

Breach of Duty of Fidelity
Even without a valid restrictive covenant, senior employees are required to act in good faith towards their employer and not exploit the vulnerability which flows from the nature of the relationship. For example, although such an employee is entitled to compete following employment, in doing so, he/she must not do so unfairly. This means that for a reasonable period of time following resignation, he/she is not to utilize confidential information or affiliations developed during employment in a manner detrimental to the former employer. Doing so is considered unfair and a breach of this obligation of fidelity. Provided the status with the employer was senior enough, a court will enforce these obligations by way of requiring the departed employee to disgorge the profits earned from the improper activity.