Transcript: Show #20 | Feb 22, 2000

Maureen stands in a studio with windows and sofa chairs in the background. She is in her forties, has short, side-parted, curly blond-highlighted brown hair, and wears a red.

Maureen says HI, I'M MAUREEN TAYLOR.
WELCOME TO "YOUR HEALTH."

(music plays)
The opening sequence begins.

Clips of people of different ages flash on screen one by one against an animated blue sky background. First a baby boy, then a 10-year-old boy with short brown hair, a teenage girl with curly brown hair, a man in his thirties with middle-parted brown hair and glasses, and finally a woman in her sixties with long gray hair.

Maureen narrates
THIS WEEK BREAST CANCER, A
HIGHER RISK BASED ON GENETICS.

A clip shows doctors examining lab results followed by a woman sitting at a table.

The woman says YOU HAVE MUTATED GENES
BUT THEY ARE CI2.
I STARTED TO SHAKE.

The clip changes to Maureen and a man sitting at a table.

Maureen says MEDICAL MALPRACTICE.
HOW HARD IS IT TO SUE YOUR
DOCTOR.

The man says AND IT'S DIFFICULT TO
PROVE THAT THERE WAS A
FAILURE TO MEET THE STANDARD
OF CARE.

The clip changes to three elderly women sitting at a table.

Maureen says AND VISIT ALZHEIMER'S, OR
ARE YOU JUST FORGETFUL.

Back in the studio, Maureen says IF YOU KNEW YOU HAD AN
ALMOST 80 PERCENT CHANCE OF
DEVELOPING BREAST CANCER,
WOULD YOU LET DOCTORS REMOVE
YOUR BREAST THROUGH
DRASTICALLY REDUCE THAT RISK
EVEN BEFORE ANY CANCER WAS
DETECTED.
THAT'S THE DIFFICULT
DECISION FACING WOMEN WHO
TEST POSITIVE FOR THE GENE
MUTATION CALLED BRCA 1 AND
BRCA 2.
THAT MUTATION TENDS TO RUN
IN FAMILIES.
YOU'RE ABOUT TO MEET ONE
REMARKABLE FAMILY THAT IS
DEALING WITH THE LEGACY AND
THE IMPERFECT OPTION HAS THE
SCIENCE CAN OFFER THEM TODAY.

Black-and-white photographs flash of naked women in grief.

Maureen narrates WHAT DEFINES A WOMAN'S
FAMILY IT INTY?
WE KNOW IT'S NOT JUST OUR
BREASTS BUT WHEN FACED WITH
WITH THEIR SURGICAL REMOVAL,
WE EXPERIENCE GRIEF, FEAR,
AND LOSS.
THIS FAMILY HAS A LONG
HISTORY OF BREAST CANCER.
MOTHER, MARIA DIED OF LUNG
CANCER BELIEVED TO HAVE
STARTED IN HER BREAST.
HER OLDEST DAUGHTER INEZ DIED OF
BREAST CANCER TWO YEARS
LATER AT AGE 45.
OF THE FOUR SURVIVING
SISTERS, THREE HAD BREAST
CANCER.

Photographs of the women through the years flash across the screen.

Maureen narrates
NORMA HAD A MASTECTOMY AND
CARRIES THE MUTATED BREAST CANCER
GENE.
ANOTHER TESTED POSITIVE AND LOST A
BREAST.
MARIE DOESN'T CARRY THE GENE
BUT DEVELOPED BREAST CANCER
ANYWAY.
ALTHOUGH PAULINE CARRIES THE
GENE, OF ALL THE SISTERS
SHE'S THE ONLY ONE WHO HAS
NEVER HAD BREAST CANCER.
BUT SHE CHOSE A DOUBLE
MASTECTOMY RATHER THAN LIVE
IN FEAR.

A clip shows scientists conducting experiments in a lab.

Maureen continues
BECAUSE OF THEIR FAMILY
HISTORY, THESE WOMEN WERE
PRIME CANDIDATES FOR
RESEARCH INTO THE MUTATED
BREAST CANCER GENE.
NOW THEIR CHILDREN FACE
KNOWING TOO MUCH.
LAVINA’S DAUGHTER JANICE KNEW SHE
WAS AT HIGH RISK FOR BREAST
CANCER BASED ON HER FAMILY
HISTORY BUT HOPED AGAINST
ALL ODDS SHE WOULD TEST
NEGATIVE FOR THE MUTATED
GENE.

The scene changes to Janice, Maureen, and Lavina sitting a dining room table. Janice is in her thirties with curly blond hair. She wears a white and green patterned sweater. Lavina is in her late sixties with short, curly blond hair. She wears an orange sweater.

Maureen says DID YOU EVER CONSIDER NOT
HAVING THE TEST DONE AT ALL.

Janice says NO, I WANTED TO BE
TESTED.
I WANTED TO KNOW FOR MY SAKE
AND FOR MY DAUGHTER'S SAKE.

Maureen says YOU GO DOWN TO MOUNT
SINAI.
THE TEST RESULTS ARE IN,
WHAT DO THEY SAY TO YOU.
BRING ME BACK THERE, HOW
DOES THAT ALL GO?

Janice says THERE'S THREE PEOPLE IN
THE OFFICE BESIDES MY
HUSBAND AND MYSELF.
THAT'S GORD, A SOCIAL WORKER
AND DR. GOODWIN.
FIVE OF US IN THE OFFICE.
AND IT WAS LIKE OPENING AN
ENVELOPE OR SOMETHING, I
CAN'T REMEMBER, OH, YOUR
RESULTS ARE IN, AND YOU'RE
POSITIVE.
YES, TOUGH MUTATED GENE.
THE BRCA 2.
AND MY HUSBAND SAID MY FACE
IMMEDIATELY WENT RED.
I STARTED TO SHAKE.
MY HANDS WERE SHAKING, AND I
WAS TAKEN ABACK.
AND I DIDN'T KNOW WHAT TO
SAY.

Maureen says TAKE ME BACK EVEN THOUGH
MOM, NORMA, NANCY HAD
ALREADY TESTED POSITIVE.

Janice says YEAH.
I THOUGHT I WAS GOING TO BE
THE NEGATIVE ONE.

Maureen says TELL ME ABOUT THAT, WHY?

Janice says WHAT I WAS THE SIXTH
PERSON TO BE TESTED.
THE SIXTH PERSON.
THE FIVE BEFORE ME HAD ALL
BEEN POSITIVE.
I THOUGHT IT WAS A 50-50
CHANCE, I'M PROBABLY GOING
TO BE THE NEGATIVE ONE.
THERE'S GOT TO BE SOME
NEGATIVES IN THERE, RIGHT?
I HAD IT IN THE BACK OF MY
MIND.
SEE YOU LATER, I DON'T HAVE
TO COME DOWN HERE ANYMORE.
BUT I WAS POSITIVE.

Maureen narrates JANICE'S COUSIN, NANCY, ALSO
TESTED POSITIVE FOR THE
MUTATED GENE, BUT HER
REACTION ISN'T TYPICAL.

A clip shows Nancy and her mom trying on silly hats in front of a store. Nancy is in her early thirties with short brown hair. She wears a black v-neck sweater and hoop earrings. The scene changes to Nancy in a wood-paneled room with red walls.

Nancy says IT'S DEFINITELY MORE
POSITIVE TO TEST POSITIVE.
ACTUALLY YEAH, I'M UP WITH
THE BEST PROFESSIONALS.
I'M BEING, LOOKED AT, IF
THERE'S ANY DOUBT THERE
WOULD BE ANYTHING, I'M
IMMEDIATELY LOOKED AFTER.

Maureen narrates DR. PAMELA GOODWIN IS A
MEDICAL ONCOLOGIST AT MT. SINAI IN TORONTO.

A clip shows people walking into a tall glass door with a green frame. A sign above reads "Samuel Lunenfeld Research Institute."

Maureen continues
DR. GOODWIN RUNS A GENETIC
TESTING CLINIC THAT
EVALUATES A WOMAN'S RISK.
SHE EXPLAIN HAS IT MEANS TO
CARRY THE GENE MUTATION FOR
BREAST CANCER.

Inside a doctor’s office stands Dr. Goodwin with a patient’s chart open. She is in her sixties with greying blond hair down to her shoulders. She wears glasses, a black blazer with a patterned shirt.

The scene changes to Dr. Goodwin sitting in a room. A caption reads "Dr. Pamela Goodwin. Medical Oncologist."

Dr. Goodwin says CARRYING A MUTATION IN
BRCA 1 OR BRCA 2 MEANS THAT
YOU HAVE A HIGHER RISK OF
CERTAIN TYPES OF CANCERS.
IT DOESN'T MEAN YOU WILL
DEVELOP CANCER, IT'S A
MARKER OF RISK.
THE TWO TYPES OF CANCER THAT
ARE MOST STRONGLY
ASSOCIATED WITH THE GENES
ARE BREAST CANCER AND
OVARIAN CANCER.
IF YOU CARRY A MUTATION IN
BRCA 1, YOUR RISK OF BREAST
CANCER DEVELOPING OVER YOUR
LIFETIME IS QUITE ELEVATED.
THE DIFFERENT STUDIES SHOW
DIFFERENT NUMBERS.
SOME SHOW A RISK AS LOW AS
40 PERCENT.
OTHERS SHOW RISK AS HIGH AS
80 PERCENT.

Maureen narrates FACED WITH A POSITIVE
RESULT FOR THE MUTATED
BREAST CANCER GENE, WHAT
OPTIONS DOES A WOMAN HAVE?

The scene changes to Nancy sitting in the wood-paneled room. She sits across Maureen.

Maureen asks WHAT HAVE THEY TOLD YOU
YOUR OPTIONS ARE?

Nancy says AT THIS POINT I HAVE
BASICALLY THREE OPTIONS.
ONE IS TO BE FOLLOWED AND
HAVE CHEQUEUPS EVERY SIX
MONTHS.
ONE MONTH WOULD BE JUST A
BREAST EXAM, AND SIX MONTHS
LATER WOULD BE A MAMMOGRAM.
THE SECOND IS TO HAVE A DRUG
TREATMENT WITH WITH
TAMOXIFEN.
AND THIRD OPTION IS TO HAVE
THEM BOTH REMOVED.

Maureen says RIGHT NOW, EVEN THOUGH
THERE'S NO SIGN.

Nancy says IT IS AN OPTION TO HAVE
THEM BOTH REMOVED AT THIS
POINT.

Back to Dr. Goodwin, she says GIVEN THE CURRENT
SITUATION, WHAT WE ARE
RECOMMENDING TO WOMEN IS
THAT FIRST THEY CONSIDER ALL
OF THEIR OPTIONS FOR RISK
MANAGEMENT.
SECOND, THAT THEY CONSIDER
SCREENING TO BE THE MAIN OF
RISK MANAGEMENT.
THIRD THAT PROPHYLACTIC
MASTECTOMY SHOULD BE
THOROUGHLY DISCUSSED WITH
EACH WOMAN AND SHOULD BE
FACILITATE FORD AN
INDIVIDUAL WOMAN IF SHE
WANTS TO HAVE IT DONE.

A clip shows doctors administering a mammogram to a patient.

Maureen narrates IN JANUARY, 1999, THE
"NEW ENGLAND JOURNAL" OF
MEDICINE PUBLISHED A STUDY
THAT FOUND REDUCED THEIR
RISK BY AS MUCH AS 90 PERCENT BY
HAVING A PROPHYLACTIC
MASTECTOMY.

An image of the study in the magazine is shown. It reads "Efficacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer."

Maureen continues
THAT MEANS HAVING BOTH
BREASTS REMOVED BEFORE
THERE'S ANY SIGN OF CANCER.

Back to Dr. Goodwin, IN FACT, IF A COMPLETE
MASTECTOMY IS DONE WITH
REMOVAL OF THE SKIN AND
NIPPLE THAT RISK REDUCTION
IS PROBABLY EVEN GREATER AND
THERE ARE VERY, VERY RARE
CASES OF BREAST CANCER AFTER
THAT COMPLETE SURGERY.

Maureen narrates WHEN NANCY LEARNED SHE
CARRIED THE MUTATION, SHE
WAS WILLING TO ACCEPT
PROPHYLACTIC SURGERY.

Nancy says I WOULD HAVE WENT WITH
THAT.
BUT THEN AFTER TALKING WITH
THE DOCTOR, SHE'S A
SPECIALIST IN THE AREA.
I ASKED HER BASED ON MY AGE,
BASED ON WHAT SHE THOUGHT,
BASED ON AVERAGE AGE AS WHAT
SHOULD I DO, WHAT WOULD HER
SUGGESTION BE, BECAUSE I HAD
SUGGESTED WITH REMOVING
THEM.
I DON'T HAVE A PROBLEM WITH
THAT.
HER OPTION BASICALLY WAS TO
WAIT, WAIT AND SEE I'M ONLY
31.

Maureen narrates HER COUSIN JANICE FELT
QUITE DIFFERENTLY.

Back to Janice, she says I WOULDN'T SACRIFICE MY
BREASTS AT ALL.
PART OF MY SEXUALITY, AND
I'M NOT TAKING THEM AWAY
FROM ME IF YOU DON'T NEED
TO, THANK YOU VERY MUCH.
RISKS ARE HIGHER OF COURSE,
50 TO 80 PERCENT OF GETTING BREAST
CANCER.
IT'S NOT 100.
I MIGHT NOT EVER GET BREAST
CANCER.
SO I DON'T SEE NEED TO DO
SURGERY WHEN IT'S NOT
NECESSARY.

The scene changes to Dr. Goodwin’s office.

A caption reads "Dr. Pamela Goodwin. Medical Oncologist.

Dr. Goodwin says A DECISION TO UNDERGO
PROPHYLACTIC MASTECTOMY VERY
PERSONAL ONE, AND I DON'T
BELIEVE THAT A WOMAN SHOULD
BE TOLD SHE SHOULD HAVE IT
OR SHE SHOULDN'T HAVE IT BY
A PHYSICIAN PROVIDED WE KNOW
HE'S IN A HIGH-RISK
CATEGORY.
THE DECISION THAT SHE HAS TO
MAKE IS THAT RISK HIGH
ENOUGH?
AND IS THE RISK REDUCTION
GREAT ENOUGH THAT SHE'S
WILLING TO ACCEPT THE ANATOMICAL
CHANGES IN HER BODY AND
WILLING TO GO THROUGH MAJOR
SURGERY?

An image of a woman who had undergone a mastectomy flashes on the screen.

Dr. Goodwin says THE GROUP THAT HAS THE
GREATEST DIFFICULTY IS THE
GROUP OF YOUNG WOMEN WHO
HAVE NEVER HAD BREAST CANCER,
WHO ARE PERHAPS CONSIDERING
HAVING A FAMILY.
AND IN THAT CIRCUMSTANCE,
IT'S VERY DIFFICULT TO
CONTEMPLATE PROPHYLACTIC
MASTECTOMY, AND WHAT WE
OFTEN DO WITH THOSE WOMEN IS
SUGGEST THAT THEY MAKE THEIR
DECISION YEAR BY YEAR.
WE'LL DO A MAMMOGRAM NOW, A
BREAST EXAM NOW, IF IT'S
CLEAR NOW, THE RISK OF
BREAST CANCER IN THE NEXT
YEAR IS PROBABLY RELATIVELY
LOW.
SO LET'S JUST TAKE ATE YEAR
BY YEAR AND OVER TIME, THEY
COME TO DECISION THAT
THEY'RE COMFORTABLE WITH.

Maureen narrates AND THE DECISION CAN'T
INCLUDE LESS RADICAL
SURGERIES LIKE LUMP EKTMIES
BECAUSE WOMEN WHO CARRY THE
MUTATED GENES CAN'T AFFORD
TO LEAVE BEHIND ANY BREAST
TISSUE.

A clip of two doctors analyzing a mammogram plays.

Dr. Goodwin narrates THE REASON FOR THAT IN A
TYPICAL BREAST CANCER
PATIENT SHE HAS A CANCER
THAT'S LOCALIZED TO ONE AREA
OF THE BREAST THAT WE CAN
REMOVE LOCALLY AND THE RISK
OF CANCER DEVELOPING
ELSEWHERE IN THAT BREAST OR
IN THE OTHER INTEREST
RELATIVELY LOW.
IN A WOMAN WHO IS AT HIGH
RISK BECAUSE OF A GENETIC
MUTATION EVERY CELL IS AT
POTENTIAL RISK.
IF WE WANT TO DO SOMETHING
TO REDUCE THAT RISK WE WANT
TO REMOVE AS MUCH OF THE
BREAST TISSUE AS POSSIBLE IF
A SURGICAL APPROACH IS TO BE
USED.

Maureen narrates FOR EVERY WOMAN IT'S A
DEEPLY PERSONAL DECISION.
THESE WOMEN HAVE DECIDED TO
TAKE IT ONE YEAR AT A TIME,
AND THEIR CLOSENESS AND
POSITIVE OUTLOOK KEEP THEM
STRONG.

Clips play of Nancy and Janice with their moms.

Nancy narrates HAVING A BREAST REMOVED
ISN'T NECESSARILY LOSING A
PART OF YOUR WOMANHOOD, IT'S
A CHOICE OF LIFE.
AND LIFE GOES ON.

Back in the studio, Maureen says THE PHOTOS IN OUR STORY
WERE TAKEN BY NANCY
BROCKENSHIRE.
WE'D LIKE TO THANK HER AND
MODEL SUSAN HESS FOR
ALLOWING IS TO BROADCAST
THEM.

A blue slate appears on screen.

Maureen says READY FOR THIS WEEK'S QUIZ?

On screen a title reads "Your Health Quiz."

The question reads "If some is senile, are they: 1. old, 2. demented, 3. forgetful."

Maureen says WE'LL HAVE THE ANSWER AND
MORE ON AGING AND MEMORY
LATER ON "YOUR HEALTH."

Now, Maureen is sitting behind a table
She says A WOMAN GOES IN FOR A
KNEE REPLACEMENT AND THE
SURGEON FIXS THE WRONG
JOINT.
ANOTHER DOCTOR CLOSES UP
AFTER SURGERY BUT LEAVES AN
INSTRUMENT INSIDE THE
PATIENT.
HORROR STORIES LIKE THESE
ARE NOT COMMON BUT DOCTORS
ARE HUMAN AND THEY MAKE MISTAKES.
WHAT CAN YOU DO IF YOU THINK
YOUR DOCTOR HAS MADE A
MEDICAL ERROR?
ANDRE MICHAEL IS A MEDICAL
MALPRACTICE LAWYER IN
ONTARIO.
WELCOME ANDRE.
WHAT IS THE DIFFERENCE
BETWEEN MY DOCTOR MAKING A
MISTAKE AND MY DOCTOR
COMMITTING MALPRACTICE.

Andre Michael is in his late thirties with thinning black hair. He is clean-shaven and is wearing a brown suit, white shirt, and black tie.

Andre says A QUESTION WHETHER YOUR
DOCTOR HAS FAILED TO NEAT
STANDARD OF CARE.
ANY DOCTOR CAN MAKE A
MISTAKE, IT'S ONLY WHEN
THERE'S BEEN A FAILURE TO
MEET THE STANDARD OF CARE THAT
THE PATIENT CAN RECOVER
DAMAGES.

Maureen says LET'S ILLUSTRATE THIS
WITH CASES THAT YOU'VE
WORKED ON, A CASE WHERE STANDARD
OF CARE WAS NOT MET.
DESCRIBE ONE.

Andrew says I CAN GIVE YOU A
RELATIVELY RECENT EXAMPLE
WHERE A PATIENT HAVING
DEVELOPED AN INFECTION WAS
PLACED ON ANTIBIOTICS.
ONE OF THE KNOWN
COMPLICATIONS OF THIS
PARTICULAR ANTIBIOTICS IS
VESTIBULER DYSFUNCTION, IT CAN
CAUSE DAMAGE TO THE INNER
EAR.
IT'S INCUMBENT ON A
PHYSICIAN ADMINISTERING THIS
ANTIBIOTIC TO CAREFULLY
MONITOR CERTAIN LEVELS.
AND IN THIS CASE,
UNFORTUNATELY, THE PATIENT
DEVELOPED THAT DAMAGE, THE
COURT FOUND THAT THE
PHYSICIAN FAILED TO MEET THE
STANDARDS OF CARE BY FAILING
TO ADEQUATELY MONITOR THE
LEVELS OF THE DRUG AND
FAILING TO RESPOND TO A
CHANGE IN THE LEVELS.
IT WAS HELD THAT THE HARM
COULD HAVE BEEN AVOIDEDED
THAT PHYSICIAN COMPLIED
WITH WHAT WAS EXPECTED OF
HIM.

Maureen says CAN I ASK YOU HOW MUCH
MONEY YOUR CLIENT WON IN
THAT CASE?

Andre says MORE THAN HALF A MILLION
DOLLARS.

Maureen says HOW PHYSICALLY YOU KNOW
HARMED WAS HE BY THIS?

Andre says QUITE SEVERELY.
THE INNER EAR CONTROLS THE
BALANCE AND HE LOST HIS
SENSE OF BALANCE SO
HE CAN ONLY WALK NOW WITH
THE ASSISTANCE OF A WALKER.
HE IS NO LONGER ABLE TO
WORK.

A caption reads "Andrew Michael. Malpractice Lawyer."

Maureen says WHAT ABOUT A CASE THAT
YOU TRIED TO WIN, BUT
WEREN'T SUCCESSFUL AT.

Andre says ANOTHER RELATIVELY RECENT
EXAMPLE IS A CASE INVOLVING
AN EMERGENCY PHYSICIAN.
IN THIS CASE THE PATIENT
WENT TO THE EMERGENCY
DEPARTMENT BECAUSE OF A
SUDDEN ONSET OF HEAD PAIN,
AND THE EMERGENCY PHYSICIAN
SUSPECTED THAT HE MAY BE
SUFFERING FROM A CEREBRAL
HEMORRHAGE, BLEEDING INTO
THE BRAIN SO
HE INVESTIGATED FOR THAT.
HE GOT A CT SCAN, VERY
QUICKLY, AND RULED OUT THAT
AS A CAUSE.
THE PATIENT ALSO APPARENTLY
RESPONDED REASONABLY WELL TO
THE ADMINISTRATION OF
DEMEROL AND THE PAIN WAS
RELIEVED.
THE PHYSICIAN MISTAKENLY ASSUMED THAT
THERE WASN'T ANY MORE
OMINOUS CAUSE OF THE HEAD
PAIN AND DISCHARGED HIM
HOME.
BY THE NEXT MORNING HE WAS
DEAD.
AND WE OF COURSE SUED AND
WHAT HAD ACTUALLY HAPPENED
WAS THAT THE PATIENT HAD
SUFFERED AN AORTIC
DISSECTION, HE HAD CHILDHOOD
HEART SURGERY, AND THIS
NIGHT JUST OUT OF THE BLUE,
THAT PROBLEM AROSE, AND HE
WAS BLEEDING JUST ABOVE THE
HEART.
AND IT WAS CAUSING THE
DEVELOPMENT OF AN ANEURYSM.
WE HAD EXPERT EVIDENCE THAT
A MORE COMPLETE HISTORY
WOULD HAVE REVEALED THE
CHILDHOOD SURGERY.
FURTHER INVESTIGATION WOULD HAVE
REVEALED THIS PROBLEM. HOWEVER,
ON BEHALF OF THE DOCTOR,
EVIDENCE IS ALSO CALLED THAT
THIS IS A VERY UNUSUAL
COMPLICATION AND THE DOCTOR
HAD DONE ALL THAT COULD
REASONABLY BE EXPECTED OF
HIM.
THE COURT RULED IN THE
DOCTOR'S FAVOUR AND FOUND
THERE WAS NO NEGLIGENCE.

Maureen says I SEE.
NOW WHEN YOU HAVE CLIENTS
COME TO YOU SAYING MY DOCTOR
MADE A HUGE MISTAKE OR
WHATEVER, WHAT DO YOU
NORMALLY TELL THEM FIRST?

Andre says I TELL THEM THESE CASES
ARE ALWAYS VIGOROUSLY
DEFENDED.
THEY'RE VERY EXPENSIVE.
ON THE CLIENTS.
YOU KNOW, THE CLIENTS HAVE
THE BURDEN OF PROOF, THE
FAILURE TO MEET THE STANDARD
OF CARE.
IS THE CAUSE OF THE HARM
THAT IS SUFFERED, AND THE
ONLY WAY WE CAN PROVE THAT
IS BY RETAINING EXPERTS,
OTHER PHYSICIANS WHO ARE
PREPARED TO COME TO COURT TO
TESTIFY AS TO THE STANDARD
OF CARE, AND WHY IN A
PARTICULAR CIRCUMSTANCE OF
THIS CASE IT'S THEIR OPINION
THAT THERE WAS A FAILURE TO
MEET STANDARD OF CARE.

Maureen says WHAT ARE THE COSTS
INVOLVED?
GIVE US A BALLPARK.

Andre says TENS OF THOUSANDS OF
DOLLARS.
WITHOUT EXCEPTION, YES.

Maureen says JUST TO GET THE BALL
ROLLING.
AND WILL YOU SOME LAWYERS IN
SOME PROVINCES CAN WORK ON
CONTINGENCY FEES.

Andre says IN ONTARIO, WE ARE ONLY
ALLOWED TO WORK ON
CONTINGENCY FEES IN CLASS
ACTION LITIGATION.
IN REGULAR MEDICAL
MALPRACTICE LITIGATION IS
NOT ON A CONTINGENT FEE
BASIS.
WE ASK OUR CLIENTS TO PROVIDE US WITH A
RETAINER OF 3 TO 5,000
DOLLARS AND THAT'S ONLY TO
COVER THE DISPERSEMENTS
OBTAINED IN THE MEDICAL
RECORDS AND OUR INITIAL
CONSULTATIONS WITH OTHER
PHYSICIANS, WHO ARE EXPERTS IN THEIR FIELD
TO GIVE US THE
PRELIMINARY OPINION ON
WHETHER THERE MAY BE MORE
RESULT TO THE POTENTIAL
CLAIM.

Maureen says AND EVEN WHEN CLIENTS ARE
WILLING TO BEAR THE COST, I
READ MOST OF THE TIME THE
DOCTOR WINS THESE CASES.

Andre says THAT'S VERY TRUE.
NATIONALLY LESS THAN 30
CASES ARE WON ON AN YEARLY
BASIS BY PATIENT.

Maureen says WHY IS THAT IN YOUR OPINION.

Andre says IT'S IMPORTANT TO
RECOGNIZE WHAT MUST BE
PROVED.
IT'S NOT SUFFICIENT FOR THE
PATIENT TO ESTABLISH THAT
SOMETHING WENT WRONG.
YOU KNOW.
MEDICINE BY ITS VERY NATURE
IMPLIES THAT WAS A HEALTH
ISSUE.
YOU KNOW, AND BY DEFINITION
ALMOST AN UNCERTAIN OUTCOME.

Maureen says THINGS CAN GO WRONG.

Andre says THINGS CAN GO WRONG AND
IT'S DIFFICULT TO PROVE THAT
THERE WAS A FAILURE TO MEET
THE STANDARD OF CARE.
THE HURDLE IS HIGH.

Maureen says WHAT ABOUT GETTING OTHER
DOCTORS TO TESTIFY AGAINST A
COLLEAGUE.
HOW DIFFICULT IS THAT.

Andre says THAT CAN BE DIFFICULT.
CERTAINLY CAN BE DIFFICULT.
THERE ARE A NUMBER OF
DOCTORS WHO ARE PREPARED TO
TESTIFY BECAUSE THEY
CONSIDER IT THEIR DUTY TO
THE PUBLIC AND TO THE
PROFESSION TO MAINTAIN
QUALITY CONTROL.
AND THAT THIS IS A SERVICE
THAT THEY ARE PROVIDING.
OF COURSE IT'S ONE FOR WHICH
WE COMPENSATE THEM.
IF THEY DID NOT HAVE THAT
ATTITUDE, IF THEY SIMPLY
CHOSE AS A PROFESSION, WE
WOULD HAVE GREAT DIFFICULTY.

Maureen says IF A DOCTOR IS FOUND
GUILTY OF MALPRACTICE, WHAT
HAPPENS TO HIM?
DO THE PHYSICIANS AND
SURGEONS GET INVOLVED.
TAKE AWAY THE LICENSE.

Andre says NOT AT ALL.
IN OUR SETTING IN THE CIVIL
SETTING ALL THAT WILL BE
FOUND IS THAT IN THAT
PARTICULAR INSTANT, IN THESE
CIRCUMSTANCES THE DOCTOR
FAILED TO MEET THE STANDARD
OF CARE.
IT DOES NOT MEAN HE IS NOT A
GOOD DOCTOR.
NOTHING OF THE SORT.
IT DOES NOT MEAN THAT HE'S
NOT CONSCIENTIOUS.
ONLY MEANS IN THESE
CIRCUMSTANCE, HE FAILED TO
DO WHAT WAS REASONABLY
EXPECTED OF HIM.

Maureen says IS THERE A MORAL
OBLIGATION THOUGH ON THE
PART OF THE MEDICAL
COMMUNITY TO MAKE THIS
INFORMATION AVAILABLE TO
FUTURE PATIENTS?

Andre says I DON'T THINK SO.
RATHER, IT IS IMPORTANT TO
RECOGNIZE IT JUST BECAUSE IT
HAPPENED ONCE.
IT DOES NOT MEAN IT WILL
NECESSARILY HAPPEN AGAIN.
CERTAINLY WE EXPECT IF THERE
HAS BEEN REPEATED
OCCURRENCES AND THERE HAVE
BEEN A NUMBER OF COMPLAINTS
THAT THE COLLEGE OF
PHYSICIANS WILL INVESTIGATE.
AND IT'S WITHIN THEIR DOMAIN
TO DECIDE WHETHER A
PHYSICIAN SHOULD BE
SANCTIONED.

Maureen says GOING TO ASK YOU FINALLY
ANDRE ABOUT THE POSSIBILITY
OF LAWSUITS AROUND SOME OF
THE RECENT THINGS HAPPENING
IN HEALTH CARE ACROSS
CANADA.
THE WAIT IN EMERGENCY ROOMS.
THE WAIT FOR CANCER DREAM.
DO YOU FORESEE LAWSUITS
LAUNCHED OUT OF THOSE
SITUATIONS.

Andre says ABSOLUTELY.
I THINK THERE IS A POTENTIAL
FOR THAT.
THE INTERESTING ISSUE IS WHO
BEARS THE RESPONSIBILITY FOR
THESE DELAYS?
IN OUR CASES IT'S IF A
PATIENT HAS BEEN SEEN BY A
PHYSICIAN, AND IF THE
PHYSICIAN HAS FAILED TO MEET
THE STANDARD, THE ISSUE MAY
ARISE.
THE PATIENT MAY NOT BE ABLE
TO SEE A PHYSICIAN.
IF THE IS IT THE HOSPITAL'S
RESPONSIBILITY.

Maureen says IS IT THE GOVERNMENTS?

Andre says THAT REMAINS TO BE SEEN.

Maureen says THANKS FOR DOING THIS.

Andre says YOU'RE WELCOME.
IT'S MY PLEASURE.

The screen changes to three elderly women sitting around a table.

Maureen narrates COMING UP, DOCTOR I THINK
I HAVE ALZHEIMER'S.
THE DIFFERENCE BETWEEN THE
DISEASE AND ORDINARY
FORGETFULNESS.

Back in the studio, Maureen says BUT FIRST, BEHIND THE CRISIS
IN EMERGENCY ROOMS, BEHIND
THE WAITING LISTS FOR
NURSING HOMES AND HOME CARE
SERVICES, IS A NATIONWIDE
NURSING SHORTAGE.
BARB WAHL IS THE PRESIDENT
OF THE ONTARIO NURSES
ASSOCIATION.
IN HER SECOND OPINION MONEY
ALONE WON'T BRING THEM BACK.

Barb Wahl appears on screen with a blue screen in the background that reads "Second Opinion." Barb is in her sixties with short black hair. She is wearing a black coat with a pink turtleneck.

Barb says ACROSS THE COUNTRY OVER
THE LAST FEW YEARS NURSES
HAVE BEEN UNDERVALUED FOR THE
CONTRIBUTION THAT THEY BRING
TO THE HEALTH CARE SYSTEM.
GOVERNMENTS HAVE LOOKED AT
THIS HUGE WORKFORCE AND SAID
WE CAN CUT BACK HERE.
LET'S CUT THE FUNDING TO
HOSPITALS.
NURSES WERE PUSHED OUT OF
THE PROFESSION AND THE
PATIENTS HAVE SUFFERED
DRASTICICALLY.
WHAT WE'RE SEEING IS THE CUTS
HAVE MEANT THERE ARE FEWER
NURSES ON THE FRONTLINES.
FEWER NURSES IN EDUCATION
AND THE MANAGEMENT LEVEL.
THE IMPACT IS PATIENTS ARE
NOT GETTING THE SAME LEVEL
OF CARE WE BELIEVE THEY
REQUIRE, AND THEY'RE NOT
EVEN GETTING ENOUGH CARE
SOMETIMES TO MEET THEIR
BASIC NEEDS.
IF YOU CAN IMAGINE A NURSING
HOME, SOMETIMES ONE
REGISTERED NURSE LOOKING
AFTER HUNDREDS OF PATIENTS
ON NIGHTS, IN ICU AND CCU A
NURSE HAS DOUBLE THE PATIENT
LOAD WHEN IN FACT SHE SHOULD
BE GIVING PATIENT CARE ON A
ONE-TO-ONE BASIS.
THIS MEANS
NURSES CAN'T MEET THEIR OWN
STANDARD OF PRACTICE.
THOSE ARE THE RULES AND
REGULATIONS FOR NURSES AND
THEY'RE CONCERNED THEIR
PATIENTS AREN'T GETTING THE
CARE THAT THEY NEED.
REPUBLIC HAS BEEN ABSOLUTELY
FANTASTIC TO NURSES
THROUGHOUT THIS WHOLE
ORDEAL.

A caption reads "Barb Wahl. President, Ontario Nurses Assocation."

Barb continues
THEY HAVE BEEN SUPPORTIVE 100 PERCENT
OF THE TIME.
BUT WE KNOW THAT THERE ARE
TIMES WHEN NURSES JUST CAN'T
GET TO THAT PATIENT OFTEN
ENOUGH.
IF YOU TAKE THE TRIAGE
SITUATION, IF YOU'RE GOING
INTO EMERGENCY, SOME
PROVINCES ARE LEGISLATING
THAT YOU MUST BE SEEN BY A
REGISTERED NURSE IN 15
MINUTES.
SURE YOU'RE SEEN BUT HOURS
GO BY BEFORE THAT NURSE HAS
A CHANCE TO GET BACK TO YOU.
WE'RE CONCERNED ABOUT THAT
FOR OUR PATIENTS' SAFETY AND
ALSO WE KNOW IT INCREASES
THE LEVEL OF FRUSTRATION FOR
OUR PATIENTS AS THEY WAIT
WITH THEIR LOVED ONES OR
WAIT ALONE.
WE BELIEVE WE NEED TO HAVE
MORE STAFFING IN ALL AREAS
OF NURSING
SO THAT WE CAN MEET THOSE
BASIC NEEDS AND REDUCE THE
FRUSTRATION.
BECAUSE IF YOU'RE FRUSTRATED
IT'S GOING TO TAKE YOU THAT
MUCH LONG TORE GET WELL.
NURSES ARE LEAVING BECAUSE
THEIR DAILY LIVES ARE
IMPOSSIBLE.
MANY ARE FINDING THEY CAN'T
PROVIDE SAFE PATIENT CARE
AND MANY ARE FINDING THEIR
WORK LOADS ARE IMPOSSIBLE SO
NOT SAFE FOR THEM EITHER.
WE SEE THERE ARE MORE NURSES
RETIRING THAN ARE COMING IN
TO REPLACE THEM FROM THE
GRADUATING CLASSES.
WE SEE THOSE WHO COME, 50 PERCENT
OF THEM LEAVE IN THE FIRST
FIVE YEARS OF PRACTICING AS
A REGISTERED NURSE.
WE'RE CONCERNED ABOUT THAT
BECAUSE OVERALL YOU CAN SEE
THE NUMBERS ARE GOING TO
CONTINUE TO DROP, AND YET WE
KNOW THAT THE POPULATION
NEEDS MORE NURSING RATHER
THAN LESS IN THE NEXT FEW
YEARS.
THE REALITY IS WE KNOW THAT
ADEQUATE NURSING CARE WOULD
ACTUALLY COST LESS THAN THE
KIND OF PIECEMEAL APPROACH
WE HAVE NOW.
IF YOU WAIT UNTIL PEOPLE
HAVE A BIG PROBLEM IS GOING TO
EMERGE.
THAT'S A HIGH COST PROVISION OF CARE.
IF YOU CAN PROVIDE CARE WHEN
PEOPLE START TO GET A LITTLE
BIT SICK.
PROVIDE CARE BY PUBLIC
HEALTH NURSES IT'S ACTUALLY
MUCH MORE COST EFFECTIVE,
AND THEREFORE SHOULD BE
SUPPORTED BY GOVERNMENT.
THE CONCERN IS THAT THIS
PROBLEM IS GOING TO GET
WORSE.
WE NEED TO HAVE GOVERNMENT
STRATEGY PUT INTO PLACE TO
DEAL WITH THE NURSING
SHORTAGE THAT
MEANS FULL TUITION SUPPORT
FOR STUDENTS LOOKING TO GO
INTO THIS PROFESSION AND
MAKING SURE THAT THE WORK
LOAD ISSUES ARE ADDRESSED,
MAKING SURE NURSES CAN
TAKE PROGRAMS AND TIME OFF
WHEN THEY NEED IT SO THEY'LL
CONTINUE TO PROVIDE CARE TO
PATIENTS.
THE GOVERNMENTS HAVE THE
ABILITY TO CHANGE THESE
STRATEGIES, AND IF WE DON'T
DEAL WITH IT, WE'LL HAVE A
GROWING CRISIS, AND A HUGE
SHORTAGE AND THAT'S A GLOBAL
SITUATION, WE WON'T BE ABLE
TO AT THE LAST MINUTE GO TO
ANOTHER COUNTRY AND SAY
BRING THE NURSES IN FROM
OVERSEAS.
THE FACT IS IT'S RIGHT HERE
IN CANADA.

The health quiz appears back on screen.

Maureen says DID YOU REMEMBER THIS
WEEK'S QUIZ?
IF SOMEONE IS SENILE IT ONLY
MEANS THEY'RE OLD.
SENILITY HAS NOTHING TO DO WITH
BRAIN FUNCTION OR MEMORY.

Back in the studio, Maureen says AND NOW SOME RECENT HEALTH
NEWS.

She stands next to a t.v. screen. A woman clutching her head appears on the screen.

Maureen says CHINOOKS MAY TRIGGER
MIGRAINES, CHINOOKS ARE THE
WARM WESTERLY WIND HAS THE
BLOW ACROSS THE PRAIRIES.
THE UNIVERSITY OF CALGARY
ASKED 75 MIGRAINE SUFFERERS
TO KEEP TRACK HOW WEATHER
AFFECTED THEIR HEADACHES.
32 OF THEM REPORTED MIGRAINES
DURING CHINOOKS.
CHINOOKSS ARE IDEAL FOR
STUDYING A LINK BETWEEN
WEATHER AND MIGRAINES
BECAUSE THEY HAVE A DEFINITE
TIME OF ONSET AND SIGNIFY A
PROFOUND CHANGE IN THE
WEATHER.

The image on the t.v. screen changes to black rat.

Maureen continues
ALBERTA SCIENTISTS
SUCCESSFULLY USED GENE
THERAPY TO TREAT ASTHMA IN
RATS AND HOPE IT WILL
REPLACE STEROID TREATMENTS
IN HUMANS.
RATS WERE GIVEN A SPRAY OF
TINY FAT-LIKE DROPLETS
CONTAINING GENETIC MEDICINE.
INFLAMMATION IN THEIR LUNGS
WAS REDUCED BY 75 PERCENT.
STEROID BASED MEDICINES ARE
USUALLY EFFECTIVE IN
CONTROLLING ASTHMA BUT THEY CAN
HAVE SIDE EFFECTS.
SO SCIENTISTS ARE FOR
ALTERNATIVES.

The image on the t.v. screen changes to a bushel of carrots.

Maureen says AND A STEADY DIET OF OAT
BRAN AND VEGETABLES CAN
LOWER THE RISK OF PROSTATE
CANCER.
DOCTORS PUT A GROUP OF MEN ON HIGH
FIBER DIETS AND TRACKED THEM
AFTER FOUR MONTHS.
THEIR LEVELS OF PROSTATE
SPECIFIC ANTIGEN OR PSA HAD
DECLINED.

A blue slate appears. It reads "Last year more than 16,000 Canadian men were diagnosed with prostate cancer. Source: National Cancer Institute of Canada, 1999."

Back in the studio, Maureen says YOU CAN'T FIND YOUR CAR
KEYINGS.
YOU FORGOT YOU HAD A DOCTORS
APARTMENT TODAY.
ARE THESE THE FIRST SYMPTOMS
OF ALZHEIMER'S DISEASE.
HERE'S DR. PAUL CALDWELL
WITH ALZHEIMER'S AND
FORGETFULNESS.

The scene changes to Dr. Paul Caldwell’s office.

He is in his sixties with a grey receding hairline. He has a short trimmed, white beard. He is wearing a white shirt and a red and white patterned tie.

Dr. Paul Caldwell says WE ALL LOSE OUR ABILITY
TO REMEMBER AS WE GET OLDER.
BUT BECAUSE 250,000
CANADIANS HAVE ALZHEIMER'S
DISEASE, EACH OF US WORRIES
EVERY TIME WE FORGET
SOMETHING WHETHER IT'S THE
BEGINNING OF THIS DISEASE OR
NOT.
WELL IT'S FAIRLY EASY TO
TELL THE DIFFERENCE.

A caption reads "Dr. Paul Caldwell. Family Physician."

He continues
FIRST OF ALL THE BENIGN
FORGETFULNESS OF OLD AGE AS
WE GET OLDER USUALLY
INVOLVES THE SIMPLE INVOLVE THE
SIMPLE
MUNDANE EVERYDAY
EVENTS IN LIFE.
INSIGNIFICANT DETAILS WHETHER
YOU LEFT THE TOASTER ON. WHERE’D
YOU PUT YOUR KEYS.
BUT IN ALZHEIMER’S DISEASE MEMORY
LOSS IS MUCH MORE PROFOUND.
IT INVOLVES SUCH THINGS AS
THE NAMES OF YOUR
GRANDCHILDREN.
SO THERE'S A DIFFERENCE IN
QUALITY IN THE MEMORY LOSS.
NUMBER TWO, IN ALZHEIMER'S
DISEASE YOU LOSE THE ABILITY
TO LEARN SO
THAT YOU ACTUALLY CANNOT
FORM NEW MEMORIES.
IN BENIGN FORGETFULNESS WE
CAN ALWAYS LEARN SOMETHING
NEW AS LONG AS WE TAKE THE
TIME TO FOCUS ON IT.
AS LONG AS WE NOTE THAT IT
IS MEMORABLE.
NUMBER THREE, ALZHEIMER'S DISEASE IS A
DEMENTIA.
DEMENTIA IS BRAIN FAILURE
SO
ALWAYS YOU'LL SEE OTHER A
ABOUT NORMAL TIFS BRAIN
FUNCTION.
ALZHEIMER'S DISEASE PATIENTS
DO NOT HAVE INSIGHT.
THEY CANNOT CALCULATE
PROPERLY. THEY CAN’T THINK PROPERLY.
SO, IN GENERAL, IF YOU CAN
REMEMBER THE LAST THING THAT
YOU FORGOT, YOU PROBABLY
DON'T HAVE ALZHEIMER'S
DISEASE.

A blue slate appears with the title of the show.

Back in the studio, Maureen says AND THAT'S OUR PROGRAMME
FOR THIS WEEK.
WE'D LOVE TO HEAR YOUR
COMMENTS AND SUGGESTIONS.
I’M MAUREEN TAYLOR THANKS
FOR WATCHING AND WE’LL SEE YOU NEXT
TIME ON "YOUR HEALTH."

A slate reads "Your Health, Website, www.tvo.org/yourhealth; e-mail, yourhealth@tvo.org, fax 416-484-4519."

Another slate reads "The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances."

Another slate reads "Footage Provided By: The Ontario Breast Cancer Screening Program."

The end credits roll.

Music, Andy McNeil,

Editors, Douglas Beavan, Craig Gellner, Dean Henry, Elizabeth Payne.

Story Editory, Susan Sutherland.

Director, Michael Smith.

Producer, Cathy Perry.

A production of TVO Ontario, copyright 2000. The Ontario Educational Communications Authority.

Watch: Show #20