Tuesday, July 8, 2008

Local brain specialist shortage finds relief

[Source: HEIDI ROWLEY, Tucson Citizen] - Tucson-area residents suffering from excruciating back pain or migraines, Alzheimer’s or Parkinson’s, multiple sclerosis or seizures may wait months to see a local brain or spinal cord specialist.

For those who need immediate care for a brain or spinal injury after a car accident or other life-threatening emergency, often the only option is helicopter transport to Phoenix, San Diego or Las Vegas, because either no on-call neurological specialist or space is available at a Tucson hospital.

Hundreds of patients are sent out of the Tucson area every year for treatment of nervous system illnesses and injuries, said Greg Angle, chief executive at St. Joseph Hospital. Some rural southern Arizona hospitals are bypassing the Old Pueblo, by sending patients to Phoenix because of Tucson's shortage of neurologists and neurosurgeons.

"We've not done a good job in Tucson in providing this service," Angle said.

That is changing.

• The Center for Neurosciences opened in March at 2450 E. River Road.

The center touts six neurosurgeons, four neurologists and high-tech diagnostic tools to provide more coordinated and convenient outpatient care. Its team, who had practiced in five offices citywide, includes Tucson's only pediatric neurosurgeons and neuro-oncologist.

The effort has attracted two more neurological specialists to Tucson, neurosurgeon Abhay Sanan said.

"We've had to struggle for years for someone to join us," Sanan said.

• The Carondelet Neurological Institute, a collaboration between Carondelet and a medical practice group, Western Neurosurgery, opened 42 beds in May exclusively for neurological patients. The institute is on the fifth floor of St. Joseph Hospital's new Women's Pavilion at 350 N. Wilmot Road.

Intensive-care rooms and three state-of-the-art operating suites will be completed by fall.

The institute will offer the most comprehensive inpatient neurological services, Angle said, and will have neurosurgeons and neurologists on call all day, every day.

"The gem is not the new technology," neurosurgeon Matthew Wilson said. "It's the 24-hour coverage."

• Tucson Medical Center has been designated a Neuroscience Center of Excellence by the health care consulting and assessment company NeuStrategy Inc., which is based in Chicago.

TMC has two neurosciences operating rooms, an eight-bed neurointensive observation unit, a 37-bed neuronursing unit, epilepsy monitoring units for adults and children and a sleep diagnostics lab. The center offers nurses six months of training to understand neurology patients.

Specialist, bed shortages

Nationwide, the pool of neurosurgeons has been shrinking. A study by the American Association of Neurological Surgeons counted 3,050 in 2004, down from 3,100 in 1991 and 3,400 neurosurgeons in 1997. The association does not have more-recent numbers.

An Arizona physician work force study found only 20 neurosurgeons working in Tucson in 2005, the most-recent year for which numbers are available.

Wilson, who started working in Tucson that year, was surprised there were not enough neurosurgeons to cover emergencies at Tucson's hospitals while responding to daily patient needs.

Even now, Wilson said, only one surgeon is available on call many nights to cover Tucson's seven hospitals.

Tucson's neurology specialists, no matter which hospital or practice group they belong to, take turns being on call at Tucson's emergency rooms and most will continue to do so after the Carondelet institute's opening. Both Sanan and fellow neurosurgeon Eric Sipos, director of the institute, said they would eventually like to focus on one or two hospitals, but neither has established a timeline for doing so.

When a blood clot formed in Manuel Moreno's brain in November 2006, the Tucson bishop was sent to Phoenix, not because of a lack of neurosurgeons to treat him but because there were no beds available at the local hospitals where the specialists were working, Sipos said.

It was Moreno's health crisis and subsequent death that galvanized local doctors and specialists to focus on the need for more neurosurgeons and beds for their patients.

Efforts drawing praise
Patients are praising the results.

Leona "Lee" Schnebly, 75, had back surgery June 10 at St. Joseph's Hospital to repair damaged disks causing immense pain and then stayed in one of the new beds at the Carondelet Neurological Institute.

"I've had surgery before, but it's never been this pleasant," she said the day after Wilson removed bone and inserted titanium screws. "I'm amazed and so glad."

Schnebly was impressed by the attentive and caring staff, and she loved her spacious, private recovery room.

Sierra Vista couple Robert Jamison, 49, and wife Lucy, 47, appreciate the convenience that the Center for Neurosciences' centralized care provides.

Three days after Robert Jamison's terminal brain cancer was diagnosed in May 2007, Sanan removed a large tumor at St. Mary's Hospital.

Lucy Jamison said scheduling appointments and medical services her husband needed after his surgery was challenging because the doctors and services were in different offices.

Now, Jamison sees both Sanan and Dr. Michael Badruddoja, Tucson's only neuro-oncologist, and gets the tests he needs at the same place.

Center for Neurosciences' coordination reduces the stress on those facing terminal cancer.

Sipos, director of the Carondelet Neurological Institute, said a new Western Neurosurgery building under construction near the institute will also provide outpatient services.

Tucson lures more doctors
The developments here are making Tucson more attractive to neurological specialists.

Dr. Dave Teeple, an epilepsy specialist from the Barrows Institute in Phoenix, is one of the specialists joining the Center for Neurosciences. The other is a neurosurgeon from the Mayo Clinic in Phoenix.

Teeple, a neurologist who grew up in Tucson, said he will be on call at St. Mary's Hospital and TMC and will be in charge of running an adult epileptic monitoring center at the latter.

"There is a need for epilepsy specialists down there," he said last week from Phoenix. "There is a monthslong waiting list to see an epileptologist."

Teeple will start in mid-July.

Carondelet Neurological Institute is also recruiting.

"We're seeing improvement as the word about what we are doing has gotten out there," Sipos said. "We're seeing some very strong applicants. As we have neared completion, the interest is escalating."

Sipos hopes to hire stroke and spinal care specialists.

"I'm feeling more optimistic about neurologists and neurosurgeons in this town than I ever have. It is still a concern, but a big part of what we're doing is making that problem go away."

No comments: