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					                              Winnipeg Custom Seating & Health Care Products
                                               186 Marion St. Winnipeg, MB. R2H 0T6
                                            phone 233-0333 fax 235-0117 cell 981-9833
                                e-mail: brucewcs@mts.net     web site: www.winnipegcustomseating.ca




October 1, 2007

Milton Sussman
Winnipeg Regional Health Authority
1800 – 155 Carlton Street
Winnipeg, MB. R3C 4Y1

Dear Sir :

We have received a request from a client in Roland, Manitoba to solve a problem with the wheels on
her SMD manual wheelchair.

We first met this client when she received her new SMD wheelchair about 7 years ago. She is a large
lady, approximately 350 lbs. The chair provided by SMD is a heavy duty chair with double cross
braces. The chair was rated to the correct weight for this lady but the design of the chair made it not
possible for her to move the chair. Her center of mass was positioned too far forward in relation to the
position of the rear wheels so the loading on the castors was too great. We provided some adapters to
move the wheels forward as well as added an extension to the back support as it was too low. We also
changed the wheel size from 20” to 22” so that she would be able to reach the wheels. After these
modifications were completed, the chair was satisfactory to the client and prescriber.

In January of this year, the client informed SMD that the tires had worn out on her chair. SMD mailed
out a new set of wheels. The client was expected to look after the wheel installation. She had a local
mechanic install the wheels. A couple of weeks later her wheels collapsed. She worked for months
with SMD trying to get this problem solved. Finally in June, she called us to look at the problem. The
problem was that the bearings were distorting the plastic bearing seats on the new wheels. The wheels
sent out by SMD were standard wheels with plastic bearing seats. The wheels she needs for her
system are the heavier wheels with metal bearing seats. We adjusted the wheels and informed the
client of exactly what type of wheel she needed. Now in September she is calling again. She has
continued working with SMD since June to resolve this issue. The last time SMD had sent out tires, not
the wheels she needed. She is now asking if we could go to SMD and get the right wheels and bring
them out. She realizes that she is supposed to be covered by the Manitoba Wheelchair Program but
she would have to pay for our time if she needs us to solve this problem. Despite being on a very
limited income, she has decided that she now needs help with getting this problem solved.

The big problem issue with the wheelchair program is supposed to be complex seating. However, this
job should have been simply changing tires on a manual wheelchair. The time to drive to Roland is
actually about the same as the time to drive across Winnipeg in rush hour. Unfortunately, since the
client lives outside the perimeter of Winnipeg, and even though Roland is still part of Manitoba, she is
not actually eligible to see a technician from the Manitoba Wheelchair Program. It appears that fixing a
chair by phone is not an exact science and that if you need wheels changed on a manual wheelchair,
there may still be a need for contact with the client by a technician.

Your office is still working on the process of reviewing the Manitoba Wheelchair Program. The steering
committee is really struggling to determine which concepts are important and would improve how we
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deliver services. I know you haven’t asked but I will offer a couple of more comments. First, it may be
difficult for the committee to come up with good recommendations on how to provide wheelchair
services if there are no full service wheelchair providers on the committee. Therapists are prescribers
and do not have any experience in delivering wheelchair services. SMD usually has a good reputation
in maintaining basic equipment. However, this case reveals a major flaw in the current program. The
rules for the program state that they are not allowed to travel outside the perimeter. Yet they are quite
prepared to allow a wheel replacement job to involve shipping wheels and tires for 9 months. Common
sense for any service business would indicate that if you mess up the first time, make an extra effort,
send out a competent tech with extra parts and make sure the job is done right the second trip. The
second suggestion is that what ever concepts the committees or administrators come up with for the
program, it would be a really good idea to run those concepts up against some real test cases. It would
be hard to imagine all the different situations we come up against on a weekly basis that demonstrate
problems with the current program. My suggestion is to take as many of these cases as possible,
identify the concepts that are not working and then determine how the new program concepts will
resolve these fundamental problems.

Sincerely,

Bruce Isaak
Winnipeg Custom Seating

				
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