Doctor's departure spotlights therapy
MD 'alarmed' by rise in shock procedure

Wednesday, February 28, 2001
Globe and Mail

VANCOUVER -- The head of medical staff at B.C.'s largest mental-health facility resigned yesterday in frustration over his failure to get answers about why electric-shock treatment for geriatric patients has increased significantly since doctors started receiving extra pay for the procedure.

In announcing his resignation, Dr. Jaime Paredes, 57, said yesterday he has attempted to "seek the facts and to ensure accountability" for several months. "I am in particular alarmed that the number of electro-convulsive shock therapy (ECT) treatments in the geriatric psychiatry program at Riverview has more than doubled since fee-for-service was introduced," he said.

"My professional and personal concerns have come from the heart," Dr. Paredes added. "In response, my questions have been met with indifference and defensiveness from certain quarters."

His resignation comes days before the provincial government is expected to release the results of a clinical review sparked by his concerns. Dr. Paredes initially raised questions about the increase in the controversial procedure a few months ago.

Nadine Criddle, a Health Ministry spokeswoman, said the review has been completed and "shared" with Riverview Hospital, although she did not know who had seen the report. (A spokesman for Riverview said later the hospital had not received the report.) Ms. Criddle declined to release the report.

After reviewing the findings and recommendations, the government will make the report available to the public, possibly next week, she said. Statistics provided by Riverview Hospital show the number of treatments for geriatric patients jumped to 1,533 in 1999 from 689 in 1996 and 1,249 in 1997. The hospital has about 800 beds.

The province's health-care plan began paying $62 for each electric-shock treatment in 1997. In addition to the ministry's review, the province's Medical Service Plan is looking into whether any doctors on staff at the hospital also received payment for the electric-shock treatment, in effect, double billing the government. Also, the province's mental health advocate is looking into the issue of consent by geriatric patients.

Dr. Paredes came to Canada from Chile in 1974 and, after re-qualifying as a psychiatrist, has been practising psychiatry in Canada since 1977. He has been the head of Riverview's medical staff for three years. He would like to continue on staff at the hospital, he said in an interview, but he was not sure whether he would be forced out. He was told last week that his colleagues wanted a secret vote on his leadership.

"I'm stepping down as president, partly because I became aware [my colleagues] don't want me, and they'll vote me out anyway," Dr. Paredes said. Riverview spokesman Alastair Gordon said issues raised by Dr. Paredes sparked three reviews.

Although the results are not available, Mr. Gordon said the number of treatments may have doubled in 1997 because the ECT unit was closed for part of 1996. Dr. Paredes' resignation indicates he no longer has the confidence of the doctors at the hospital, possibly because he raised questions in public about his colleagues' professional credibility without consulting them, Mr. Gordon said.