Winnipeg Custom Seating

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					Marion Street, Winnipeg Custom Seating 186 233-0333 Fx Winnipeg, MB. R2H 0T6 Ph 235-0117 Cell 981-9833 e-mail; brucewcs@mts.net & Health Care Products web site; www.winnipegcustomseating.ca

November 1, 2006 Vice President of Community Care, Winnipeg Regional Health Authority 1800 – 155 Carlton Street Winnipeg, MB. R3C 4Y1
Re: Service for publicly funded wheelchairs in Manitoba Dear Sir: The current process for supplying publicly funded wheelchairs in Manitoba causes hardships for all parties involved. I would request that the process be reviewed by someone who is competent and objective. We need a system that operates effectively and efficiently. This month we have established a record in inefficiency. A publicly funded power wheelchair 1 project has taken 22 months to complete. In a normal distribution system, this job would take about 3 months. This case provides glaring examples of the problems with our delivery system. The same problems exist with many of the wheelchair projects we see. I will provide more details of this project later. Delays in supplying rehab equipment can delay hospital discharge. Poorly fitted equipment can cause pressure sores and readmission to hospital. This is one place where improvements in service can reduce both direct and indirect health care costs. In a normal market product is fabricated by the manufacturer. Rehab products are modular and designed to be adjusted and fitted to every client. The role of the equipment vendor is to provide all the client services associated with fitting the product to the consumer. The Manitoba market is much more complicated and inefficient. We use the same equipment manufacturers. Authorized dealers sell product to SMD. SMD delivers stock chair frames to the consumer without seating components, setup or dealer services. Authorized dealers sell cushions to MDA. MDA delivers stock cushions to the consumer without service. Rehab Engineering fabricates non-commercial products but does not want to provide full dealer services. The ‘Manitoba system’ expects that equipment will be set up and fitted by the occupational therapist. Therapists are prescribers and are not qualified by training or experience to set up complex rehab equipment. This is the role of the rehab technology supplier. Therefore, qualified rehab technology suppliers are often requested to set up and fit equipment supplied by other vendors that are distributed through the Manitoba system. The Manitoba system is complicated and inefficient. Costs to the public purse are significantly higher than on the open market. Delivery times through the Manitoba system can extend projects for months and years. One recent project through the Manitoba system took 17 months to complete. The cost billed to the public purse was $16,400. The same project could have been completed within 12 weeks and would have cost $10,700 on the open market. The difference in pricing is that SMD billed the public purse $5700 commission for dropping off equipment at HSC. Full dealer services would be included on the open market. The project referred to in the second paragraph was to replace a 10 year-old power wheelchair. This project initiated in December 2004 was supplied through the Manitoba system. This chair was finally scheduled for delivery to the client in October 2006, 22 months after it was initiated. [Unfortunately the client was not able to have the chair at this appointment as the electronic
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controls failed. Maybe it will work this next month.] This project is likely the record for the most inefficient wheelchair delivery in Manitoba. The power chair supplied by SMD for this project is an older discontinued model. The manufacturer for this chair has been out of business for more than five years. Many people have questioned why we are investing so much effort on fitting a chair that would have been retired in most markets. Another client recently received a complex power chair through the Manitoba system. This is a young man who wants to be active in the community and in his home environment. Very late in the fitting process we discover that the chair is not capable of performing some of the basic functions required by the client. The power base cannot negotiate normal outdoor obstacles. The electronics cannot support all of the required chair functions. The client requires the chair to control driving, power seat operations, environmental controls and computer operation. The electronics are not expandable and cannot support all of these functions. The client is frustrated because he is aware that other equipment is available on the market with full capability at no additional cost. The chair not on the Manitoba program has expandable electronics that could support the required functions and still has capacity for more functions. The other chair also has a base designed for optimum outdoor performance. Unless the system is replaced now, this client will be stuck with equipment that does not allow full operation until the chair will be scheduled for replacement in 5 to 10 years. Two clients were in HSC rehab at the same time and progressed through rehab at the same pace. One client received his completed power chair system in 8.5 weeks from initial assessment through a single vendor. The client who received his chair through the Manitoba system remained in HSC rehab for an additional 3 months while his wheelchair was completed. With a hospital day rate almost $1,000 per day, the extra cost would be sufficient to fund a new doctor's annual salary. I received a call this week from Kim Klassen, the coordinator for rehab equipment services at ACL Steinbach. ACL is the day program attended by many disabled people in that community. She explained that she had not been able to get SMD to provide repair services to their center in the past two years and wondered if our company would be able to service their chairs. I have had the same request recently in Altona, Morden, Winkler and Brandon. SMD indicates in their literature that they provide rural service from April to November. [What happens if your wheelchair breaks in December?] SMD stated to the committee that they have a service network in rural Manitoba. In fact, ‘Manitoba’ wheelchair service ends at Winnipeg’s perimeter. Rural clients are required to bring or ship their equipment to Winnipeg for service. These are just a few examples of the frustrations that we experience with the Manitoba program. Most therapists that fit complex wheelchairs are well aware of the difference in service levels and would like to see changes to allow them to work efficiently. SMD is very careful to conceal the costs of the Manitoba system to the public. On rare occasions we see that SMD charges close to full suggested retail pricing to government programs for delivery only and no fitting service. Pricing on the open market in Winnipeg often includes discounts of 25 to 30 percent with full dealer service. Marlene Stern was asked to chair a committee to review this issue in 2005. The mandate of the committee was to review the process for distributing complex rehab equipment. Her comments to me before the committee met were that she was satisfied with the current program and that I was not to contact committee members directly. The committee did not include a single experienced full-service equipment supplier. SMD had two members on the committee but is not a full-service supplier. SMD distributes wheelchairs but does not supply seating components and does not supply the service of setting up and fitting the equipment. SMD has a vested interest in maintaining the current program structure that allows them to supply partial wheelchair systems without service and without competitive pricing. I have requested a copy of the committee's final report. Neither I nor other committee members I have spoken to have seen a report.
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Sincerely,

Bruce Isaak Manager, Winnipeg Custom Seating

Distribution list: Honorable Theresa Oswald Minister of Health 310 Legislative Building Winnipeg, MB. minhliv@leg.gov.mb.ca Honorable Greg Selinger Minister of Finance 103 Legislative Building Winnipeg, MB. minfin@leg.gov.mb.ca Hugh McFadyen 172 Legislative Building hmcfadyen@leg.gov.mb.ca Honorable Jon Gerrard 169 Legislative Building jgerrard@leg.gov.mb.ca Dr. Sharon Macdonald, Vice President of Community Health Services, Winnipeg Regional Health Authority 1800 – 155 Carlton Street Winnipeg, MB. R3C 4Y1

Client initials: 1 PM 2 VT 3 RO 4 RO &JM


				
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