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economist suntribune hhaii h thursday ji toi i 2600 er crunch scaring away potentially ill patients by jennifer brown staff writer doctors fear horror stories about long waits and no beds at hospital emergency rooms may be prevent ing patients from seeking the care they need what weve been seeing over the last few days is people are petrified to come to the emerg because of the press thats been out there about how busy things have been said dr david austin chief of emergency at markham stouffville hospital and what concerns austin and other physicians isthat patients could be putting their health in jeopardy weve had a lot of people phoning in and asking how lengthy the delay is and in a few cases people call in and say theyre worried about whether to come to emerg and then we find out theyre very ill which is a negative side to all this there are people who should be coming to the hospital who are staying home a similar fear is growing at york central hospital in richmond hill where doctors say that because the hospital has been on critical care bypass and redirect so frequently over the last few weeks people believe they wont be treated its a concern weve been talking about said dr david wortzman chief of emergency at york central because of the crisis weve been in in terms of being on ccb and redirect weve heard cases where people dont call an ambu lance but go in their family car and depend ing on their condition it may not be the safest thing to do last week wortzman said the number of patients who visited emergency was actually lower than expected but not because the crunch is over i assume its because people are reluctant to come and thats a little disconcerting if they are at home with chest pain and theyre afraid to come staff photorob alary dr eligio palermo says patients at the dixon medical clinic are willing to wait if they know it is the best alternative and if there are concerns people are mis using hospital emergency rooms it isnt hap pening at local hospitals almost everybody we saw yesterday arrived by ambulance there isnt much in the way of the walking wounded noted austin explaining that with the holidays over and walkin clinics returning to regular hours anyone with minor ailments has for the most part been seeking treatment away from the er the story is the same in northern york region where waiting time at walkin clinics increases from the norm of about half an hour to more than two hours they are quite understanding if they know it is the best alternative they have said dr eligio palermo a family physician at the dixon medical clinic on davis drive who is also an emergency doctor at york county hospital in newmarket the dixon clinic is open seven days a week from 9 am to 930 pm and was closed only on christmas day however if there were concerns that some walkin clinics were closed over the holidays putting further pressure on hospitals palermo says the system does little to encour age them to stay open there is a disincentive because there used to be a premium payment on weekends and holidays but three years ago they elimi nated that he said and despite suggestions to the contrary palermo says people are not jamming york countys emergency rooms for minor prob lems people are using facilities quite appropri ately he said like york central and markham stouffville palermo says for the most part york county doctors have been treating serious cases that require admission but because of the back log end up on stretchers in the hallway of the er department if we had a lot of minor cases they could be processed quite quickly we have room for that but that is not where the problem is explained palermo york central physicians agree generally the people were seeing are people who should be there there is always the exception of course where that may not be true but if youre asking me are there peo ple abusing emerg id say no generally they are very sick and need to be seen saidwortzman who cringes when it is suggested people should selfdiag nose instead of seeking care at a hospital when i see articles in the paper about when to go to emergency it makes me ner vous its asking patients to make decisions as to when it is appropriate or not even with the skill we have at the hospital we are faced daily with the challenge of mak ing triage decisions we cant ask patients to do that for themselves wortzman said all three hospitals promise that everyone who enters an er will be helped in a timely way certainly we are trying to see everybody who shows up and generally patients with minor injuries are accommodated we still have our fast track area and we can process people fairly quickly wortzman said and even as the crunch eases slightly wortzman says hospitals are still finding it a challenge to find beds for those who need admitting weve the er become a satellite medical ward which paralyzes our area on any given day we have 15 to 20 admissions occupying a stretcher in the emergency ward which is not our function and when we only have 24 to 28 and most are occupied youve shrunk your er depart ment i feel badly for patients who have to wait to be examined in hallways even though clinics report that the crush is starting to taper off palermo says this flu sea son is the worst he has seen in 25 years its a worldwide phenomenon its really quite remarkable i havent seen it to this degree this year has been worse than usual and there is just no slack in the system it seems theyve designed the system for an average load and not for increased numbers safety and legality of online prescriptions questioned by patrick casey staff writer a loophole in health canadas cur rent legislation has created uncertainty surrounding the legality of filling pre scription orders via the internet and e- mau programs however that has not stopped a markham company from forging ahead with a fourmonth trial in which physi cians and pharmacists offer the trans mittal of electronic prescriptions through a secure internetbased facility rodney dobson president and chief executive officer of rxritecom said he expects health canada will rule on whether or not internet prescriptions are legal by the time his company finish es beta testing by the end of march people say you either can or cannot transmit prescriptions over the internet but it is the absence of regulations that is causing the uncertainty there is no leg islation that one can point to that says you cannot transmit prescriptions elec tronically said dobson there are guidelines that you have to adhere to the irony is that contrast ed against todays paper world the opportunities that are available are so much more advanced with a system such as rxrite canada should be mov ing to embrace this opportunity last year 250 million canadian pre scriptions were filled each costing an average of 32 including hospital and drug plans canadians spend more than 10 billion each year on prescription medicine dobson maintains electronic trans mission and storage of prescription information offer a higher degree of accuracy and reliability for patients while also facilitating the sharing of information among health profession als handwritten prescriptions or a ver bal message from a doctor have been the two recognizable methods in canada for approving drug orders although health canada recently allowed faxed prescriptions to be filled however marty belitz vicepresi dent of pharmacy regulatory affairs for shoppers drug mart said the canadian market is not ready for internet phar macies since online drug forms are not standardized and only 2 per cent of doc tors offices are fully computerized im not going to start spending my resources to write software just to receive prescriptions said belitz past- president of both the ontario college of pharmacists and the national association of pharmacy regulatory authorities this has to be fully stan dardized to make some sense this is still in the infancy stage but we have this window of opportunity to start working with the pharmacy orga nizations to start standardizing this process before it goes out to the doctors the different players are operating behind closed doors because they want to be the first one to the market in the us president bill clinton has proposed new regulations to crack down on rapidly expanding internet pharmacies thanks to the growing popularity of viagra and weightloss pills there are more than 400 us internet sites offer ing online prescription drug business and concerns range from the sale of outdated medicines or unapproved drugs to prescriptions from doctors who have not met the patients but dobson said canadas health industry is quite different than its us counterpart while the privacy of the rx- rite utility makes it a compelling ser vice physicians require a user name and password to log on to a secure portion of the website before selecting from a menu of services including writing a new prescription or reviewing a patients medical history once the pharmacy receives notification of a new online prescription a pharmacy is able to confirm exactly where the prescrip tion came from because it is tied direct ly to the physician profile we are confident the system we have built addresses any security provi sions and makes it a compelling enough utility for health professionals said dobson we are taking a fairly conserv ative approach and going the extra nine yards people realize where this is going and not just rxrite but the need to have prescriptions and health informa tion available we are changing the way the world operates in the area of the health system there are going to be questions when that happens staff photomike barrett rodney dobson president and ceo of rxritecom pre dicts health canada will rule on the legality of online pre scriptions by the end of march