An unapologetic Danny Williams says he was aware his trip to the United States for heart surgery earlier this month would spark outcry, but he concluded his personal health trumped any public fallout over the controversial decision.
In an interview with The Canadian Press, Williams said he went to Miami to have a "minimally invasive" surgery for an ailment first detected nearly a year ago, based on the advice of his doctors.
"This was my heart, my choice and my health," Williams said late Monday from his condominium in Sarasota, Fla.
"I did not sign away my right to get the best possible health care for myself when I entered politics."
The 60-year-old Williams said doctors detected a heart murmur last spring and told him that one of his heart valves wasn't closing properly, creating a leakage.
He said he was told at the time that the problem was "moderate" and that he should come back for a checkup in six months.
Eight months later, in December, his doctors told him the problem had become severe and urged him to get his valve repaired immediately or risk heart failure, he said.
His doctors in Canada presented him with two options - a full or partial sternotomy, both of which would've required breaking bones, he said.
He said he spoke with and provided his medical information to a leading cardiac surgeon in New Jersey who is also from Newfoundland and Labrador. He advised him to seek treatment at the Mount Sinai Medical Center in Miami.
That's where he was treated by Dr. Joseph Lamelas, a cardiac surgeon who has performed more than 8,000 open-heart surgeries.
Williams said Lamelas made an incision under his arm that didn't require any bone breakage.
"I wanted to get in, get out fast, get back to work in a short period of time," the premier said.
Williams said he didn't announce his departure south of the border because he didn't want to create "a media gong show," but added that criticism would've followed him had he chose to have surgery in Canada.
"I would've been criticized if I had stayed in Canada and had been perceived as jumping a line or a wait list. ... I accept that. That's public life," he said.
"(But) this is not a unique phenomenon to me. This is something that happens with lots of families throughout this country, so I make no apologies for that."
Williams said his decision to go to the U.S. did not reflect any lack of faith in his own province's health care system.
"I have the utmost confidence in our own health care system in Newfoundland and Labrador, but we are just over half a million people," he said.
"We do whatever we can to provide the best possible health care that we can in Newfoundland and Labrador. The Canadian health care system has a great reputation, but this is a very specialized piece of surgery that had to be done and I went to somebody who's doing this three or four times a day, five, six days a week."
He quipped that he had "a heart of a 40-year-old, so that gives me 20 years new life," and said he intends to run in the next provincial election in 2011.
"I'm probably going to be around for a long time, hopefully, if God willing," he said.
"God forbid for the Canadian public I won't be around longer than ever."
Williams also said he paid for the treatment, but added he would seek any refunds he would be eligible for in Canada.
"If I'm entitled to any reimbursement from any Canadian health care system or any provincial health care system, then obviously I will apply for that as anybody else would," he said.
"But I wrote out the cheque myself and paid for it myself and to this point, I haven't even looked into the possibility of any reimbursement. I don't know what I'm entitled to, if anything, and if it's nothing, then so be it."
He is expected back at work in early March.
C
I haven’t heard anybody say that Danny Williams shouldn’t have been allowed to travel to the U.S. for heart surgery. As the Newfoundland premier has declared in interviews published yesterday and today, it’s his heart, his health.
But accepting the personal nature of the choice hardly ends the conversation. Williams’ decision to check into Mount Sinai Medical Center in Miami to be operated on by a veteran surgeon has been seized upon by critics of public health insurance as proof of the Canadian system’s inherent weakness.
Since I support the single-payer model, I admit I was worried about how details of Williams’ condition and treatment, when he finally talked about them, might reflect on Canadian cardiac care. If it turned out he had needed some esoteric procedure not available in Canada, I figured the critics would have a field day.
But the reality appears to be the opposite of what I feared. Williams needed an operation on his mitral valve. His office admits the procedure was, in fact, available in Canada. It’s more than that, though: Canadian cardiac surgeons happen to be renowned for their expertise in valve repair.
It was two Canadian physicians who wrote the how-to paper on valve surgery published only late last year in the New England Journal of Medicine. There are famous surgeons like Toronto’s Dr. Tirone David, who’s been called a “virtuoso” valve man. Minimally invasive procedures, the style of surgery Williams chose, are offered in Canada in places like the University of Ottawa Heart Institute.
None of this is to suggest that Williams might not have had good reason to go to Miami. He might have heard impressive things about the surgeon who worked on him there. He might have preferred to be close to his Florida condo for recuperation. He might have liked the sound of the amenities and privacy offered by a pricey U.S. hospital.
But those sorts of factors don’t tell us anything about the capacity of the Canadian health care system to provide high-quality care. I’ve heard no credible claim that Williams would have faced a long wait, if any wait at all, for surgery in Canada. And now we know that his category of heart problem, far from being one Canadian surgeons can’t handle, is one of their fortes.
I’m reminded of another politician’s medical history and how it briefly made news decades ago.
When Paul Tsongas, the former Massachusetts senator, was running for president in 1992, he lashed out at the Canadian health model. Tsongas had suffered from lymphoma, and he said, rather dramatically, that the bone marrow transplant that saved his life was an example of how the American system spurred innovation that would never happen under creativity-stifling Canadian-style health care.
It was a gripping personalized take on the issue. The only problem was that the key research breakthroughs that led to bone marrow transplants were made in Toronto, and Canadians, at the time Tsongas was speaking, were receiving the procedure more often than Americans.
Case studies that initially cloud the broader issues can ultimately be quite illuminating.
UPDATES:
Getting into the details of why Danny Williams made the choice to go to Miami is delicate. Health is a personal matter, and anyway, the real issues here are about policy, not the particulars.
Still, Williams told Canadian Press that doctors in Canada suggested conventional surgery, while his U.S. surgeon did the operation through a incision under his arm that didn’t require opening up the bones in his chest.
This might create the impression that minimally invasive surgery wasn’t offered in Canada because of some limitation in the techniques available here. I put the question to the University of Ottawa Heart Institute. Quite properly, the institute stresses that its doctors can’t comment on Williams’ case.
But Dr. Thierry Mesana, chief of the institute’s cardiac surgery division, and a leading international authority on mitral valves, responded by email on the general question of how minimally invasive surgery is viewed by the experts.
“Minimally invasive mitral valve repair consists of doing an MV repair surgically through a 5 cm small side chest incision instead of a 10 cm incision in the middle of the chest. A recent survey published at the Society of Thoracic Surgeons meeting (Jan 2010) expressed some word of caution and showed it is not recommended for complex mitral valve repair and also that the rate of complication (strokes in particular) is higher.
“There are a few advantages in terms of length of hospital stay or transfusion or post-operative arrythmias. The only real benefit is cosmetic. Many world renowned experts do not advocate it, in fact. It is done in Canada, but again, with caution. I propose it only for cosmetic reasons in a young woman who dislikes the idea of having a scar visible in summer. This procedure is well publicized in the U.S. in some centres.”
ANOTHER UPATE:
I mention above the well-known Toronto heart surgeon Dr. Tirone David. From India, where David is teaching just now, he responded by email to questions I asked through his office. Here’s what he said:
“I don’t know the reasons Mr. Williams opted to have his operation in Florida. It is certainly not because minimally invasive mitral valve repair is not available in Canada. Canadian heart surgeons routinely do minimally invasive mitral valve repair including techniques involvng endoscopic and robotic approaches.
“There is absolutely no evidence that robotic mitral valve repair is superior to other minimally invasive approaches, such as a limited sternotomy or lateral thoracomy, with or without the aid of endoscopes. Moreover, when it comes to heart valve surgery, there are very few places in the world that can match the outomes we have provided at Toronto General Hospital.
“Having said all that, Mr. Williams certainly had the right to go anywhere he wanted for surgery.”
By Bob Unruh
© 2009 WorldNetDaily
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The chief of Hawaii's Department of Health twice has issued statements trying to convince doubters that President Obama was born in the state, and now those words may backfire if a new legal challenge comes to fruition.
Leo Donofrio, who brought one of the first legal challenges to Obama's eligibility to be president and unsuccessfully tried to get the U.S. Supreme Court to get involved at the time of the election, is reporting on his website that Hawaiian state law requires "information collected and maintained for the purpose of making information available to the general public" be released.
In July, the state's director of health, Chiyome Fukino, issued a statement on the subject of Obama's birth:
"I, Dr. Chiyome Fukino, Director of the Hawaii State Department of Health, have seen the original vital records maintained on file by the Hawaii State Department of Health verifying Barack Hussein Obama was born in Hawai‘i and is a natural-born American citizen. I have nothing further to add to this statement or my original statement issued in October 2008 over eight months ago."
Last year, at the time of the election, she stated:
"There have been numerous requests for Sen. Barack Hussein Obama’s official birth certificate. State law (Hawaii Revised Statutes §338-18) prohibits the release of a certified birth certificate to persons who do not have a tangible interest in the vital record.
"Therefore, I as Director of Health for the State of Hawai‘i, along with the Registrar of Vital Statistics who has statutory authority to oversee and maintain these type of vital records, have personally seen and verified that the Hawaii State Department of Health has Sen. Obama’s original birth certificate on record in accordance with state policies and procedures.
"No state official, including Governor Linda Lingle, has ever instructed that this vital record be handled in a manner different from any other vital record in the possession of the State of Hawaii."
While her statements have been picked to pieces and, in fact, leave out a number of key issues, they now are being used as a reason for a demand that "information collected and maintained" be made public.
On his blog, Donofrio explained that one of his contacts, identified as "TerriK," had asked for all of the state information "collected and maintained" for the purposes of preparing Fukino's public statements.
Under state law, he said, "such information must be released."
"TerriK was interested in knowing how Director Fukino came to the conclusion that the president was a natural born citizen. She was familiar with Section 92F-12(15) which demands that all information collected and maintained for the purposes of making such a public statement be made public. She was denied that information despite the clear wording in the statute. Furthermore, the case law from Hawaii clearly demands production of the records TerriK requested," he said.
Donofrio said work is under way to press the demand.
"I will provide legal research and relevant examples of official correspondence in my follow up report and press release at this blog. TerriK has previously provided details of her investigation and correspondence with the state of Hawaii in comments to this and other blogs. She has also authorized me to speak publicly about her case and to provide the public with all relevant correspondence," he said.
Under the state's law addressing records. exceptions are made for government records that would "constitute a clearly unwarranted invasion of personal privacy." Also exempted are various records regarding prosecutions and certain court papers.
But it explains that disclosure "shall not constitute a clearly unwarranted invasion of personal private if the public interest in disclosure outweighs the privacy interests of the individual."
Department spokesman Janice Okubo told WND the laws have been interpreted to leave birth documentation exempted from public disclosure.
But she admitted the law allows a challenge to such decisions in the courts.
In fact, the law states, "A person aggrieved by a denial of access to a government record may bring an action against the agency at any time within two years after the agency denial to compel disclosure. … The circuit court may examine the government record at issue, in camera, to assist in determining whether it, or any part of it, may be withheld."
WND also has reported on plans by Hawaii state Sen. Will Espero, a Democrat, to pursue legislation through which the state's lawmakers would force the public disclosure of all Obama's birth documents held by the Hawaii Department of Health, including Obama’s long-form original birth certificate.
Espero told WND at the time his bill is aimed at "giving citizens access to birth records" under a standard of government transparency which would permit journalists to request in writing the public disclosure of vital birth records, including long-form birth certificates of all persons born in Hawaii.
"My decision to file the legislation was primarily a result of the fuss over President Obama's birth records and the lingering questions," Espero said.
Espero told WND that he believes President Obama was born in Hawaii.
"My motivation is strictly to promote transparency," he said. "When I found out that Hawaii birth records were not available to the public my first thought was, 'Why wouldn't they be available to the public?' "As far as I am concerned, records regarding whether a person was born here or not should be in the public domain."
Donofrio said he would issue a full statement and make available the complete history of correspondence with the Hawaii agency on his blog.
"Any legal assistance provided by me to TerriK will be pro bono. I will seek to be admitted pro hac vice in Hawaii for purposes of filing the case and conducting the trial. If such admission is not forthcoming, other counsel may be retained or TerriK may represent herself pro se. In any case, I will be drafting the pleadings. The only issue will be related to who files them and conducts the trial de novo," he said.
He said correspondence already has confirmed "President Obama's vital records have been amended."
But he said this case already has circumvented the issue that has been the downfall of many of the court cases challenging Obama's eligibility: "standing."
"The [state] manual states: 'Any person' may make a request for government records under part II, the Freedom of Information section of the UIPA. 'Person' is defined broadly to include an individual, government agencies, partnerships and any other legal entities," he wrote.
WND has reported on dozens of legal challenges to Obama's status as a "natural born citizen." The Constitution, Article 2, Section 1, states, "No Person except a natural born Citizen, or a Citizen of the United States, at the time of the Adoption of this Constitution, shall be eligible to the Office of President."
Some of the lawsuits question whether he was actually born in Hawaii, as he insists. If he was born out of the country, Obama's American mother, the suits contend, was too young at the time of his birth to confer American citizenship to her son under the law at the time.
Other challenges have focused on Obama's citizenship through his father, a Kenyan subject to the jurisdiction of the United Kingdom at the time of his birth, thus making him a dual citizen. The cases contend the framers of the Constitution excluded dual citizens from qualifying as natural born.
Complicating the situation is Obama's decision to spend sums estimated over $1 million to avoid releasing an original long-form state birth certificate that would put to rest the questions.
WND also has reported that among the documentation not yet available for Obama includes his kindergarten records, Punahou school records, Occidental College records, Columbia University records, Columbia thesis, Harvard Law School records, Harvard Law Review articles, scholarly articles from the University of Chicago, passport, medical records, files from his years as an Illinois state senator, his Illinois State Bar Association records, any baptism records and his adoption records.
The campaign followed a petition that has collected about 475,000 signatures demanding proof of his eligibility, the availability of yard signs raising the question and the production of permanent, detachable magnetic bumper stickers asking the question.
The "certification of live birth" posted online and widely touted as "Obama's birth certificate" does not in any way prove he was born in Hawaii, since the same "short-form" document is easily obtainable for children not born in Hawaii. The true "long-form" birth certificate – which includes information such as the name of the birth hospital and attending physician – is the only document that can prove Obama was born in Hawaii, but to date he has not permitted its release for public or press scrutiny.
Oddly, though congressional hearings were held to determine whether Sen. John McCain was constitutionally eligible to be president as a "natural born citizen," no controlling legal authority ever sought to verify Obama's claim to a Hawaiian birth.
"Where's The Birth Certificate?" billboard at the Mandalay Bay resort on the Las Vegas Strip
