It seems Muskoka Algonquin Health Care’s much lauded and newly implemented plastic surgery program has hit a bit of a snag.
That is because Dr. Oleh Antonyshyn, the plastic surgeon brought on board on a locum basis for the program, prefers to use a method referred to as frozen section for certain surgical procedures, particularly as they involve facial areas.
Frozen section involves rapid tissue analysis by a pathologist while the patient is still in the operating room. It requires the support of a pathologist, specialized laboratory services and a cryostat—all of which are located, and operate out of, the Bracebridge hospital site.
While the pathologist works out of the Bracebridge site, he is there to support both sites, said MAHC CEO Natalie Bubela. But the lab work required for the procedure is done in Bracebridge and the machinery, a cryostat, is also located in Bracebridge.
Huntsville hasn’t had a cryostat since 2016, when the equipment broke down and could not be repaired, according to Bubela.
“It was very old and was unable to be repaired,” she explained. “As a result, there was a review done by the surgical committee that has representation largely from physicians at both sites…and they actually did an audit for just over six months to look at the amount of times it would be required if it was replaced and they found that there were two cases in that period of time when they did the audit where a cryostat machine would’ve been required.”
Consequently the committee decided not to replace the roughly $40,000 equipment at the Huntsville site, according to Bubela. “So the entire surgical committee voted in favour of not replacing the machine and single siting that service, like we’ve single sited other services, to the Bracebridge site,” she said, emphasizing the fact that the decision was not an administrative one, but one made by the “clinical people actually utilizing that piece of machinery.”
In terms of laboratory services, again MAHC’s pathologist who manages laboratory services works out of the Bracebridge site and certain services have been single sited to one hospital or the other. “At Huntsville we do cytology and microbiology, it’s not done at Bracebridge. At Bracebridge we do histology, which is not done at Huntsville, and then there are core lab services done at both sites,” explained Bubela.
She said the plan is to continue offering plastic surgery at the Huntsville site, but procedures requiring frozen section will be done in Bracebridge.
What we were not able to forecast with Dr. Antonyshyn was the type of referrals he was going to get. When they heard a maxillofacial plastic surgeon was available, he received referrals for facial cancers that we had not anticipated. MAHC CEO Natalie Bubela
“So because of that, given the area in which an excision is required, it’s his preference and his practise to do a frozen section. So it was only available in Bracebridge, so those times when he needs to do that, we are bringing those cases down to Bracebridge,” she added.
Esther Millar, Chief Nursing Executive & Clinical Services for MAHC, said the hospital is fortunate to have brought plastic surgery services to Muskoka. “Through the flexibility of both sites we are supporting the unique needs of these surgical patients for the best possible patient care. Some of Dr. Antonyshyn’s cases at MAHC have been plastic surgery treatment of facial skin cancers, and those procedures can require frozen sections. A frozen section is a laboratory procedure that allows for the rapid analysis of cancerous tissue by the pathologist to aid in detecting if the margins (boundaries) of the removed tissue is clear of cancer. This happens while the surgical patient is still in the Operating Room and helps the surgeon to decide if further resection (removal) of tissue is required to remove all the cancer,” said Millar.
“For years now, the histology department of the laboratory with frozen section capability and the pathologist who reviews frozen sections, have been based at SMMH (South Muskoka Memorial Hospital),” she added. “The use of the frozen section technique helps to minimize the tissue being removed. Without the frozen section, the surgeon may have opted to take more tissue, which does not put the patient’s best interests first. By having flexibility in surgical services operations across our sites, we can take a patient-centered approach to best support the patient’s needs.”
Dr. Biagio Iannantuono, a general surgeon at MAHC and the interim Chief of Staff, tried to put it into perspective. In an email to Doppler, he stated: “It is rare for a surgeon to need and/or use a cryostat for cancer-related surgery because frozen sections do not work on all body parts. That is because of the different types of tissue in the body that do not lend themselves to this technique. For example, a frozen section does not work for breast cancer-related surgery where a tumour would be removed, nor for breast reconstruction surgery. And to further clarify, not all skin cancers, mainly facial but still very few facial skin cancers, require a frozen section.”
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Jim Sinclair says
The hospital CEO seems to be a Bracebridge patriot, all of the handwringing and lengthy explanations notwithstanding, we’re going to see more of it.
If Bracebridge is the best location, why did Huntsville have a cryostat in the first place?
We in Huntsville are urged to be more vigilant over the next few years, but what can we do if these moves and the long, involved platitudes defend the choices to relocate various things to the south?
Len Macdonald says
Jim, perhaps you might read this article again. The doctors, all of the doctors, who were involved in this decision recommended that one piece of specialized equipment be located at South Muskoka. Is this what is going to happen with each clinical decision that gets made by the doctors from now on? Conspiracy theories still abound – what benefits one site must disadvantage the other.
How about the recent large and generous donation to Huntsville? Should half of that be shared with Bracebridge?
wendy brown says
No it shouldnt be shared with Bracebridge if the man who donated it wanted it shared he would have shared it but he wanted Huntsville to have it so Huntsville gets it all. There have been quite a few sizable donations to the Huntsville hospital and im sure they are thankful for them.
Len Macdonald says
That was a rhetorical question. The point that I was trying to make is that some things belong in Huntsville (that particular donation) and some things belong in Bracebridge (that particular piece of equipment.) It’s one hospital, on two sites. Not everything needs to be duplicated on both sites. I leave it to the experts (the doctors) to make these kinds of recommendations.
Tim Withey says
Len, what you missed is that the decision to direct limited capital funding to other purchases, such as the new board room furniture I noticed in the Huntsville meeting two weeks ago, was made prior to knowing Dr. Antonyshyn was going to be operating in Huntsville. I find it hard to believe that Ms. Bubela claims they had no forewarning of the types of procedures the Dr. Antonyshyn would be undertaking. He is a ‘high powered’ Toronto specialist. Was there an impact analysis completed? Due diligence? How could such a crucial step in his surgical process not be anticipated?
Ms. Bubela seems to be more focussed on blaming the doctors for not recommending that the broken Cryostat be fixed or replaced in the past, which was backed up by some dubious numbers from the administration at the time, than making sure there is functioning equipment in place for a new programme originally reported to be taking place in Huntsville.
I understand replacement of the Huntsville Cryostat was recommended to be added to the Foundation Capital list just last week in a letter signed by all of the Huntsville surgeons – including Dr. Antonyshyn! This now needs approval of the senior administration. Will this be happening soon?
Jim Sinclair is absolutely correct, we need to be extra vigilant in these matters. You may recall about five years ago when Ms. Bubela tried to move all obstetrics to Bracebridge. When the plan was exposed, the decision was reversed.
Remember, the interim Chief of Staff, into the third year of a six month appointment, is still in place. The very one who publicly stated that all surgery needs to go through one door – and that door is in Bracebridge.
Carolyn Maw says
I think it’s an issue that our chief of staff is pushing for one hospital in Bracebridge
I think it’s time we hire a new chief of staff that supports our hospital in Huntsville
Doug Charles says
Sad to see the potential for in-fighting by the public over which hospital will get which services after such a victory of two hospitals both with a full ER and OR’s. Having to travel for scheduled surgery is still likely in many cases, including travel outside of the region, may be inconvenient but necessary. Having services to stabilize a patient within reasonable proximity is the primary goal that I hope doesn’t get lost in further debate.
Here in Windsor-Essex we are fighting to keep two major hospitals instead of just one for a population of 400,000. Currently services are already divided between the two major hospitals. The third small hospital in Leamington, over 45 minutes away from the city and serving approx. 70,000 people is at risk of losing further services potentially including the ER. The Muskoka district covers more than twice the area of Essex county and needs two ER’s, but with a reported population of 60,000 people (100,000 in the summer) be thankful for any specialty services in the district.
Regardless of our outcome here, we will still have to travel to London or Toronto because with with only 650,000 people in the southern three counties there are still a limited number of cases to support certain specialties. By the way we only have 4 plastic surgeons in Windsor-Essex. I just think at this point Muskoka is lucky if things go as planned to have two ER’s rather than Urgent Care Centres, and most other services are still available within the region. I would hate to see a division between north and south disrupt the gains made to this point.