From: "Sunshine _BC" <sunshine_bc@...>
To: Hlth.health@...
CC: sunshine_bc@..., aod_56@...
Subject: Resend: Wanda Hildebrand May 15, 1937 - September 27, 2006
Date: Tue, 10 Oct 2006 05:47:12 -0700

Honorable George Abbott
Minister of Health
P.O. Box 9050
STN PROV GOVT
Victoria, BC  V8W 9E2

Dear Mr. Abbott,

It’s Thanksgiving Day as I start to write my letter to you.  What should have been a day consisting of my mother cooking a wonderfully delicious turkey dinner with friends and family gathered around to enjoy it is only a day of sorrow for me and my family because my 69 year old mother, Wanda Hildebrand, passed away on September 27th, 2006.  Rather than continuing her life battling with both MRSA (Methicillin-resistant Staphylococcus aureus) and VRE (Vancomycin-Resistant Enterococci) she chose to discontinue the service of dialysis treatments.

On January 26, 2006 I wrote you a letter about my mother’s situation back then to which I received a reply on February 10th.  I responded back the same day but I never did receive a second reply.  Copies of all three letters are attached at the bottom of this email for your review.

I’d like to fill you in on what my mother went through up until her death.  But as you continue to read this letter I’d like you to remember how you celebrated your Thanksgiving Day in 2006 and think about how I am spending mine.  And after you have done reading, please don’t have someone from your staff reply back to me with a bunch of empty words of sympathy.  Although I miss my mother deeply I have accepted her death.  Besides I am writing to you and would appreciate a response from you directly.  A response perhaps with some positive news about what you, the Minister of Health is going to do to (or perhaps already in the process of doing) to ensure that other citizens of British Columbia do not find themselves in a situation of choosing death over life because they acquired MRSA and/or VRE during their hospital stay.

From November 30th to March 20th mom traveled by ambulance from Squamish to Vancouver to have dialysis at St. Paul’s Hospital.  She was not allowed to dialyze at the Community Dialysis Unit in Squamish because she was MRSA positive.  By the time she resumed her dialysis treatments in Squamish on March 22nd her health had deteriorated considerably due most certainly to those 48 long and stressful commutes to St. Paul’s.  One thing for sure, she was so happy she didn’t have to travel to Vancouver for dialysis any more!

I could speculate correctly as to why my mother had 4 angina attacks on June 24th and then a heart attack plus several more angina attacks on June 25th which ultimately got her transported and admitted to St. Paul’s hospital on June 26th.  I do not feel it necessary to go into detail at this time, however it would be suffice for me to say that I will be contacting the College of Registered Nurses of British Columbia to report the behavior and actions of a nurse that dialyzed my mother at the Community Dialysis Unit in Squamish and that I am glad she is no longer employed there.

On July 4th mom underwent triple by-pass open heart surgery.  The procedure went well however during her lengthy stay in ICU she acquired VRE in addition to the MRSA she already had which complicated and delayed her recovery because of the difficulty treating all the infections that resulted from the surgery.  Finally on August 1st mom was well enough to be moved to St. Paul's Hospital Heart Care Centre on 5B.  On August 9th she had a second surgery; this time to reposition and rewire her sternum.  Although the surgery was necessary it proved to be a major set back for her.  Still recuperating from the first surgery and now having the second one she was not able to actively participate in physiotherapy and so consequently she lost a great deal of muscle tone in her legs and arms.  For the most part she had become bedridden.  She could no longer wash and groom herself nor could she go to the bathroom without assistance.  Many times she would defecate in her bed and have to lay in it until her nurse was available to clean it up. 

In a meeting held at mom’s bedside on August 24th we were informed by Kate Sullivan (Operations Leader, Renal Program 6A at St. Paul's Hospital) mom would not be allowed to dialyze at the Community Dialysis Unit in Squamish because she was now VRE positive, had an unstable heart condition and was no longer ambulatory.  The only alternative she was given was to relocate to an extended care facility in Vancouver and continue to dialyze three times a week at St. Paul’s.  She would no longer be living in Squamish where the majority of her friends and two of her three grandchildren reside.  As it was, over the course of mom’s three month hospital stay only a handful of her friends from Squamish were able to come visit her at St. Paul’s and that was only because they where coming into Vancouver for scheduled appointments already.  Relocating to an extended care facility in Vancouver would mean mom would continue to be isolated from her friends.  At one point in the meeting my mother spoke words which pretty much summed up the situation from her perspective. She said, "You have taken everything away from me; my home and my dignity."

On August 28th after being left to sit in a wheelchair for way too many hours my mother fell to the floor hitting her head which caused a nose bleed, a large goose egg in the middle of her forehead and two black eyes.  The nurse said that when he asked mom if she had tried to get up she said yes.  I find that hard to believe because mom would never attempt to stand up without help and besides when asked about her fall she claimed it happened on the sidewalk which of course not the case.  I think in all likelihood what happened was she either tried to reposition herself or while sleeping in the wheelchair slumped over too far causing it to tip over.  In any case this accident should never have happened!

Friday September 15th proved to be the day of mom’s last dialysis treatment.  My daughter (Christina) and I stayed by her side pretty much for the entire last twelve days of her life and slept on recliners beside her bed at night.  We also had the honor of both being present when she drew her final breaths on September 27th.  She had courageously fought a battle she could not win due to poor health, government bureaucracy and a heath system that would not allow her to live in the city of her choice (Squamish) with her friends and family; that is why she chose to discontinue having dialysis.  She ultimately lost her will to live Mr. Abbott, but died on her own terms and with her dignity in tact and I will always admire and respect her for that.

During the countless hours Christina and I spent at St. Paul’s we quickly became aware many patients were acquiring MRSA and/or VRE during their current hospital stay.  However what was shocking to us was that a high number of these patients had not been told they had contracted those bacteria much less informed it would be something they would have for life and for which there was no cure!  Their antibiotics had been changed because the ones they had been on weren’t working and they were swab tested for MRSA.  Upon hearing this we suggested they talk to their nurse about the test results and sure enough they were MRSA positive.  A majority of these individuals didn’t have a clue as to what MRSA was before they met Christina and me. If a patient is diagnosed with cancer they are told they have cancer.  Why then are patients being diagnosed with MRSA or VRE not being informed they have acquired it?  How can the spread of MRSA and other antibiotic resistant bacteria be prevented if the patient is not told they tested positive?

Days prior to her passing mom asked me why God was letting this happen to her. I could not answer her question but I did tell her that I would do everything I could to make sure that more people knew about MRSA and VRE so that her death would not be in vain.

Well that’s about all I have to say to you at this point Mr. Abbott.  I will be no doubt contacting you again with my thoughts on how the provincial government can help improve the lives of it’s citizens by dealing with the issues of MRSA (VRE) in a more realistic and proactive manner.

I thank you for taking the time to read this letter and look forward to your reply in the near future.

Sincerely,

Debby Forsyth

P.S. I am attaching a picture of my daughter Christina and my mother.  Christina loved her grandma and was totally devoted to her.

Phone:  604-xxx-xxxx
email:  sunshine_bc@...

Cc:  Christina Forsyth, (Wanda Hildebrand's grand daughter) aod_56@...

From: "Sunshine _BC" <sunshine_bc@...>
To: Hlth.health@...
CC: lclark@..., phamm@..., ksullivan@..., aod_56@..., sunshine_bc@...
Subject: Wanda Hildebrand - MRSA Dialysis Patient
Date: Thu, 26 Jan 2006 12:57:58 -0800

January 26, 2006

Honorable George Abbott
Minister of Health
P.O. Box 9050
STN PROV GOVT
Victoria, BC  V8W 9E2

Dear Sir,

I am writing to bring to your attention a situation I feel, that for the mental and physical well being of my mother, must be rectified immediately.

Since Wednesday November 30th, 2005 my 68 year old mother, Wanda Hildebrand has been forced to travel three times a week by ambulance from Squamish (where she resides) to St. Paul's Hospital in Vancouver for dialysis treatments .  Prior to that she was having dialysis three times a week at Squamish General Hospital which is run by St. Paul's Hospital Renal Program.  However during her 10 day stay at St. Paul's Hospital in Vancouver (Monday November 14th to Thursday November 24th, 2005) she acquired MRSA (methicillin-resistant staphylococcus aureus).  Having contracted MRSA she was told she would need to be isolated and because the two dialysis nurses at Squamish General Hospital would have to be trained to deal with a MRSA dialysis patient she must travel to St. Paul's Hospital for her dialysis treatments until such time that is done.

The fact that she must travel to Vancouver every Monday, Wednesday and Friday in itself would be acceptable to some degree if indeed she was being isolated at St. Paul's Hospital.  Afterall that is why she is being transported there.  However this is not the case. She is placed in rooms where there are many other patients having dialysis.  In many instances the attending nurses do not wear gowns and in some instances they don't even wear gloves when handling my mother or the dialysis equipment.  So where is the isolation?

When she was having dialysis in Squamish from the time the Handy Dart picked her up at her residence at 7:30 AM to the time she was returned home was approximately 5 hours. Now the ambulance picks her up at 10:30 AM (if they are on time) at her residence and she returns home about 9:30 PM, some 11 hours later.  This is drastically taking it's toll on my mother and is totally unacceptable.

We have discussed our concerns in meetings with the Operations Leaders (for both the Squamish General Hospital and St. Paul's Hospital Renal facilities) and also with Lee Clark, Director of the Renal Program.  However no fixed solution is in sight and we maintain that we do not see any reason why my mother could not resume her dialysis at the unit in Squamish General Hospital.   We were told about 25% of the dialysis patients at St. Paul's have either MRSA or VRE (vancomycin-resistant enterococci).  I suspect the percentage is even more and considering what I personally witnessed at St. Paul's Hospital I would have a tendancy to believe that with the complacent attitude of some of the staff (from nurses to cleaning staff - from not wearing gowns or even gloves when touching equipment and my mother) it is a problem that needs to be addressed in itself.  Hospitals must wake up to the need for proper infection control including nurses who know how to recognize the signs of an infection and enough cleaning staff to keep commonly touched surfaces free of bacterial contamination.  There should be more done to track down the source of an infection when an outbreak occurs so that the hospital doesn't keep making people like my mother sick in the first place.

However my priority is my mother's current situation.  Being transported to St. Paul's Hospital three times a week for dialysis is just not a suitable solution for the long term.  Not only is it continuing to cause unnecessary stress to her personally it is incurring unnecessary costs to our health-care system.  I don't believe for a minute that the solution to the problem (having my mother's dialysis treatments at Squamish General Hospital) is as complex and complicated as what the staff at St. Paul's Hospital would like us to believe.  With that said I am requesting that you take every measure necessary to ensure the dialysis facility at Squamish General Hospital is updated immediately so that my mother can resume her dialysis treatments in Squamish.  She is truly a victim of the health-care system and it is the health-care system's responciblity to step up to the plate take action now that this has been brought to your attention.

As of the date of this letter my mother has travelled 25 times to St. Paul's Hospital for dialysis.  I think it would be fair to say two weeks would be more than an adequate amount of time for you to investigate and reply to my letter.  I look forward to hearing from you with a positive responce prior to February 15th, 2006.  If I do not hear from you I will present this information to the media.

Yours truly,
Debby Forsyth
Phone:  604-xxx-xxxx
email:  sunshine_bc@...

CC:
Lee Clark, Renal Program Director
Paula Hann, Operations Leader, Renal Program Room 6240
Kate Sullivan, Operations Leader, Renal Program 6A
Christina Forsyth, (Wanda Hildebrand's grand daughter)
Dr. Ronald Werb
Wanda Hildebrand

"Politeness and consideration for others is like investing pennies and getting dollars back." ~ Thomas Sowel

From: "Health, HLTH HLTH:EX" <HLTH.Health@...>
To: "Sunshine _BC" <sunshine_bc@...>
Subject: Ministry of Health Response - 644229
Date: Fri, 10 Feb 2006 13:22:35 -0800

644229

Ms. Debby Forsyth

sunshine_bc@...

Dear Ms. Forsyth:

Thank you for your email of January 26, 2006, regarding your mother, Ms. Wanda Hildebrand, and her dialysis treatments.  I was sorry to read about your distress in this situation.

Providence Health Care works hard to ensure equitable access to high quality renal care for their clients.  In conjunction with the British Columbia Provincial Renal Agency, Providence Health is responsible for decisions regarding the allocation of resources and ensuring patient needs are met within their service area.  Their offices are best equipped to address your specific concerns regarding your mother’s treatment program.

Ministry staff contacted Providence Health Care and I understand that your mother is currently receiving treatment at the main hemodialysis unit in St. Paul’s Hospital, which employs infection control practices to manage patients with antibiotic resistant organisms such as methicillin resistant staphylococcus aureus (MRSA).  Please be assured Providence Health Care is eager to reduce your mother’s travel time and ensure she receives treatment as close to her residence as possible.  The clinical decision to send your mother for treatment at St. Paul’s was made in the interest of patient safety and to ensure she received an appropriate level of care.  The Community Dialysis Unit in Squamish is undergoing operational improvements so they may handle patients with antibiotic resistant organisms such as MRSA.  As soon as these measures are in place, patients with these conditions may be treated at that facility.

Please understand that the safety of patients is paramount to the Ministry of Health and all health authorities involved in health service delivery.  I note that you have copied your letter to representatives of Providence Health Care’s Renal Program.  Providence Health Care works closely with the communities within its service area to fairly evaluate the population’s needs and provide the necessary services effectively.  I encourage you to continue working with Providence Health Care to ensure the ongoing assessment of your mother’s needs. 

Thank you for bringing your concerns to the Ministry’s attention, I appreciate the opportunity to respond.

Yours truly,
Effie Henry
Executive Director

From: "Sunshine _BC" <sunshine_bc@...>
To: HLTH.Health@...
CC: sunshine_bc@..., aod_56@...
Subject: RE: Ministry of Health Response - 644229
Date: Fri, 10 Feb 2006 19:34:06 -0800

ATTENTION:  Effie Henry, Executive Director

Thank you for responding to my email.

On Wednesday February 8th, my daughter Christina Forsyth and I attended a meeting at St. Paul's Hospital to discuss my mother's situation.  Progress on having my mother resume her dialysis treatments in Squamish is at best, slow and an expected start date has still not been established.  When asked we were told "a few more weeks".  When asked to define "a few more weeks" we were told "6 weeks more or less".  We have requested another meeting to track the progress further which is scheduled for March 8th. 

In your reply you said, " I understand that your mother is currently receiving treatment at the main hemodialysis unit in St. Paul’s Hospital, which employs infection control practices to manage patients ... MRSA."  Let me assure you this is not the case!!!  They do not employ infection control practices.  Not only have I witnessed staff not wearing gloves let alone gowns while attending my mother during her dialysis, I personally have demanded on several occasions these staff to put them on!!  In one particular instance the staff member was "ushered" away by another staff member and I was later told that she was "new" and did not understand the precaution procedures when dealing with MRSA patients.  One would "assume" that as a "new" staff member she would have been properly trained prior to starting her duties in the renal unit.  Never the less that is no excuse as Providence Health Care Contact Precautions are clearly posted within the unit and one could "assume" the staff member can read.  In as much as Providence Health Care would like you to think they are doing their best I can assure you they are not.  Furthermore if that is their best, I would hate to see the results of their worst.  The lack of practicing their own Contact Precautions is the direct cause of my mother's present situation and how she acquired MRSA during her stay at St. Paul's Hospital (November 14-24, 2005) in the first place.

I would like you to be aware of the following.  While dialysis patients are waiting to get on a machine they sit in a waiting room located just outside the renal unit.  This waiting area is used by MRSA and VRE infected and non infected patients alike.  In addition the patient washroom is for the use of all dialysis patients and since the MRSA and VRE disease is transferred by contact (rather than airborne) non infected patients are at risk of being infected.  In your email you stated, "The clinical decision to send your mother for treatment at St. Paul’s was made in the interest of patient safety and to ensure she received an appropriate level of care."  While I can comprehend and accept the reason why she is not permitted to dialyisize in Squamish at this time, I find it totally unacceptable that St. Paul's Hospital as an alternative venue for her to have dialysis is nowhere near to having systems in place to stop spreading the disease.  As for "appropriate level of care", I can assure you, there is nothing being done at St. Paul's Hospital that wasn't already being done during her dialysis treatments in Squamish and that is why this situation is so infuriating.  Why put my mother through all of this, it makes absolutely no sense whatsoever.

In closing, while it can be argued and proven that MRSA can be acquired anywhere, a hospital should be the last place it should be acquired.  Like the majority of people I have talked to since finding out my mother has MRSA I was not aware of what MRSA was much less aware of the problem in our local hospitals.  Upon doing a considerable amount of research I now know MRSA represents a significant global problem within hospitals around the world.  To have my mother resume her dialysis treatments in Squamish started off as and remains my primary goal.  Her physical and mental well being is of utmost and urgent importance.  However it is also my personal goal to educate the public in whatever way I can and to expose our hospitals' lack of precautionary practices when it comes to attempting to stop the spread of MRSA.  I can only hope that the Ministry of Health will join me in the fight to reduce the risks in our hospitals to unsuspecting patients.

Yours truly,
Debby Forsyth

CC:
Christina Forsyth
Wanda Hildebrand

"Politeness and consideration for others is like investing pennies and getting dollars back." ~ Thomas Sowel