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Canadian Researchers Have Discovered How to Convert Any Blood into the Universal “Type O”

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Researchers at the University of British Columbia in Vancouver have discovered a technique that could make all blood donated compatible with all patients. In August, Stephen Withers, a biochemist with the University, announced at a meeting of the American Chemical Society that he and his team had found a way to convert different blood types to the universally compatible Type O.

 

There are four main types of human blood: A, B, AB, and O, each distinguished by the presence of sugars which make up antigens on the surface of the red blood cells. Type A has A antigens, Type B has B antigens, and Type AB has both. Type A blood cannot be given to a person with Type B blood, and vice versa, as the recipient’s immune system will produce antibodies to attack red blood cells with antigens that do not match its own. People with Type AB blood are able to receive any type of blood because their blood cells have both A and B antigens. Type O, however, lacks any antigens and is essentially invisible to the recipient’s immune system, which makes it highly valuable in medical settings.

Converting Blood to Type O

The newly discovered process to convert blood into Type O treats blood with bacterial enzymes from the human gut, which strip away sugars that make up the antigens, effectively turning Type A and B blood into Type O. This process does not change the Rh antigen – the “positive” or “negative” part of a given blood type, so it does not create Type O-negative – the true universal donor blood that can be given to anyone. However, it is still a major step forward.

The researchers began searching for an enzyme – a protein that targets specific molecules and cuts them. They suspected there may be a natural source for the necessary enzyme in the form of a bacterium that might produce it, but the task was to identify the bacteria. It turns out that microbes in the human gut are good at breaking down sugars found on proteins in the intestine. The team extracted 20,000 different DNA sample from gut bacteria and found that a number of them could produce the enzymes to break down sugars. From there, the researchers noticed one new class of enzymes that was particularly good at cutting the sugars from the blood cells.

Although Type O-positive is the most common blood type, there is often a shortage since group O blood can be transfused to any recipient and is used in emergency settings when there is no time to determine the patient’s actual blood type. Scientists had previously found ways to remove antigens from blood, but these methods were too expensive to use on a large scale. This new method is approximately 30 times faster. Less enzyme is needed in the conversion process, leading to lower production cost and, more importantly, less of the enzyme needing to be filtered out after the conversion process. If successful, this method could help alleviate the almost constant blood shortage experienced throughout the world.

The researchers warned, however, that they are still about two years away from testing the treated blood in people. Extensive safety tests are still necessary to ensure that the enzyme does not inadvertently cause any other problems before the converted blood can be approved for use in transfusions.

The question of medical negligence in British Columbia’s Cambridge affair

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As described in part one of this series, Drs. Sean and Rosemarie Cambridge, two foreign-trained physicians, provided medical care to hundreds of patients in Chilliwack, B.C., from 2011 to 2017, under a provisional medical licence issued by the College of Physicians and Surgeons of British Columbia.

In the fall of 2017, the Cambridge physicians’ medical licences were cancelled on the basis that they had failed to meet the requirements for continued registration and licensure. Specifically, they had failed to pass the first of two required examinations designed to evaluate the physicians’ skills and medical knowledge, notwithstanding several failed attempts and several deadline extensions required for personal reasons.

Cancellation of Licenses

The cancellation of the Cambridge physicians’ medical licences naturally leads many patients to question the care they received from these doctors, and whether any medical problems they suffered were caused by substandard care, or could have been avoided with appropriate treatment.

In considering a potential medical negligence claim, it is important to recognize that the Cambridge physicians do not get the benefit of being held to a lower standard of care on the basis that they were still in the process of qualifying. The standard of care expected of them is the same as the standard of care expected of any physician, which is that he or she use that reasonable degree of learning and skill ordinarily possessed by practitioners in similar communities in similar cases (Wilson v. Swanson [1956] S.C.R. 804; Robinson v. Sydenham District Hospital Corp. [2000] O.J.

Susanne Raab

No. 703).

If a physician holds him or herself out as a family physician, he or she is held to the same standard of care as all other family physicians, regardless of whether the licensure is provisional or full. This aspect of the law makes sense as it accords with the reasonable expectations of patients who expect any physician licensed to provide medical services in British Columbia to be competent to provide a safe level of care.

Potential Liability of the Physicians

It is, however, important to appreciate that the fact that these physicians did not satisfy the examination requirements is not evidence that they fell below the required standard of care in their treatment of any individual patient. In considering potential liability on the part of these physicians, it is, in fact, not even sufficient to prove that they fell below the standard of care. In order to succeed in a medical malpractice case, in addition to establishing a duty of care and breach of the standard of care, a plaintiff must prove, usually through expert evidence, that a specific breach of the standard of care was the legal and factual cause of the plaintiff’s injury or loss (Ter Neuzen v. Korn [1995] 3 S.C.R. 674).

Even if multiple breaches in the standard of care are proven, the most challenging part of any medical negligence case is establishing that one or more of these breaches of the standard of care caused or contributed to the injury or loss. This is most often where cases fail.

Proving Medical Malpractice

Proving causation in medical malpractices cases can be challenging because typically the plaintiff has pre-existing injuries or illnesses (the impetus for seeking the impugned medical treatment in the first place) and the precise mechanism of the injury is often unknown or alternatively explained by multiple contributing factors.

Further, advances in science can serve to muddy the waters rather than connect the dots between the breach of the standard of care and the injury or loss by adding to the proliferation of “known unknowns” or potential non-negligent causes of the injury or loss.

Indeed the difficulties in proving causation in medical malpractice cases is borne out by their dismal success rate. The statistics reveal that since 1996, the success rate of plaintiffs in medical malpractice trials has never exceeded 30 per cent.

The most recent annual report of the Canadian Medical Protective Association reveals that a mere 16 per cent of medical malpractice trials in Canada in 2016 were decided in the plaintiff’s favour.

While the statistics for settlements are somewhat more favourable to plaintiffs, they still fall in the minority.

For this reason, a cautious approach, informed by a thorough and comprehensive assessment of the case with the benefit of expert opinion, is required before any medical negligence case is commenced against a physician, even a physician whom the college has deemed to be not qualified to practise medicine.

This piece was originally posted in The Lawyers Daily. You can also read the PDF from our Publications page. 

B.C. College of Physicians and Surgeons protects public by delisting uncertified doctors

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From 2011 to 2017, Drs. Sean and Rosemarie Cambridge, two foreign-trained physicians, provided medical care to hundreds of patients in Chilliwack, B.C., under a provisional medical licence issued by the College of Physicians and Surgeons of B.C. During this period of time, the government paid the Cambridge physicians millions of dollars in fees, according to B.C.’s Medical Service Plan (MSP) billing records. In the fall of 2017, the Cambridge physicians’ medical licences were cancelled on the basis that they had failed to meet the requirements for continued registration and licensure.

Specifically, they had failed to pass the first of two required examinations designed to evaluate the physicians’ skills and medical knowledge, notwithstanding several attempts and several deadline extensions required for personal reasons. As a consequence, the Cambridge physicians ceased to practise medicine, and hundreds of patients in an already underserviced area were left without a family physician.

The circumstances of this case have been widely publicized in the media which has generated both concern about the extent to which the College of Physicians and Surgeons of British Columbia (the college) is discharging its mandate to protect the public interest, as well as concern among the Cambridge physicians’ former patients about the safety of the medical care they received.

Physicians are not qualified

How could it be that a physician is permitted to provide medical care in B.C. to so many patients for such a long period of time, only for the college to subsequently find the physician to be not qualified to practise medicine?

By way of background, the college grants provisional licences to foreign trained physicians who wish to practise medicine in British Columbia, provided they meet basic eligibility requirements.

These physicians are required to have a sponsor — a health authority or university faculty of medicine, and a supervisor — an individual physician approved by the college who must provide regular reports attesting to the competency and professionalism of the physician holding the provisional licence.

The provisional licensee must then meet specific requirements including the successful completion of two examinations; the first of which must be completed within the first three years. General monitoring and oversight of this process is done by the registration committee of the college, while more direct supervision of the physician is done by the physician supervisor.

HPRB Concerns

The registration committee’s monitoring and oversight of this program has recently come under criticism by the Health Professions Review Board (HPRB) in light of the Cambridge affair as well as other similar matters.

The HPRB has raised concerns about how the registration committee is adequately serving the public interest. The HPRB specifically noted that there is a fundamental disconnect in allowing foreign trained physicians to be registered and practise medicine in British Columbia, sometimes for many years, with large patient loads, and without passing requisite exams, only to conclude at the 11th hour that the physician is not qualified to practise medicine based on the failure to pass the requisite examinations within the stipulated time frame.

The HPRB described this disconnect as deeply troubling, expressing concern for both the safety of the public and unfairness to the physician.

Patients in British Columbia have benefited greatly by the many foreign trained physicians who have initially been granted provisional licences, successfully met the requirements of full licensure and now call British Columbia home. To assess whether the college is fulfilling its mandate to protect the public safety by reference solely to the Cambridge doctors would be unfair and unduly myopic, although it is acknowledged that the HPRB’s comments were informed, at least in part, by broader experience with this program.

Further, the failure of the Cambridge physicians to satisfy the requirements of continued licensure is not, on its own, evidence of any particular failing on the part of either the Cambridge doctors, or the college.

Other Concerns

In a recent survey conducted on recruitment and retention of family physicians, physician burnout was a major concern, with lack of collegial team-based environments and billing and administration challenges identified as primary contributors.

Imposed on top of these challenges, a myriad of unforeseen circumstances, both personal and professional, can arise and conspire against successful completion of the required examinations by any individual candidate.

The length of time, however, that these physicians were permitted to provide medical services to patients without having demonstrated the minimum level of skill and medical knowledge is fair criticism and highlights the need for greater support and monitoring of foreign trained physicians working toward full licensure.

This is important both for the benefit of the physician, as well as the safety of the public. The public has a reasonable expectation that physicians who have been licensed to practice medicine in British Columbia have demonstrated the level of skill and competence required to protect public safety, and the college has the mandate to ensure this occurs.

This article is the first of a two-part series. You can read part two here.

This piece was originally posted in The Lawyers Daily. You can also read the PDF from our Publications page. 

Engaging Patients in Reducing Preventable Harm

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At Pacific Medical Law all of our clients have concerns about the health care they have received. Often they have tried to be active participants in their care by asking questions and reporting concerns about their care, but those concerns are not always heard. Engaging Patients in Patient Safety – a Canadian Guide recognizes that patients often see solutions to problems but are not always asked for their ideas. The Guide was developed by the Canadian Patient Safety Institute (CPSI) in partnership with Patients for Patient Safety Canada (PFPSC) with a goal of encouraging collaboration among patients, families, healthcare providers, managers and leaders to identify risks, support those involved in an incident and find ways to prevent similar incidents in the future.

The Guide describes ways that patients can be involved in preventing incidents in health care and what patients and families can do if a family member has experienced unanticipated harm. For example it suggests:

For your safety and the safety of others:

  • Get informed, educate yourself, and ask questions.
  • Actively participate in your own care and treatment.
  • Share information, concerns, and suggestions.
  • Work closely with your care providers, especially during care transitions.
  • Learn how to reduce infection risks while at home and in the community.

If you or your family member has experienced unanticipated harm:

  • Speak up and ask questions about what happened, why, and what will be done about it.
  • Seek out the proper way to report the incident.
  • Expect an apology and to be informed about next steps.
  • Ask for practical or emotional support to cope with the incident.
  • Find out where else you can find support if you feel you are not getting the answers you need (e.g., patient complaints or ombudsman office).
  • Share ideas, concerns, and suggestions to improve the incident management process.

The Guide emphasizes the importance of patients and caregivers working together collaboratively and proactively to shape safe, high-quality care delivery, co-design safer care systems, and continuously improve to keep patients safe.

You can read more about the initiative here:

http://www.newswire.ca/news-releases/bridging-the-gap-between-patients-and-providers-625494873.html

New Mind-Controlled Robotic Hand Restores Independence in Daily Activities after Quadriplegia or Stroke Deficits

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A new mind-controlled robotic hand may help increase independence for people living with quadriplegia or the effects of a stroke, according to a recent study published in Science Robotics.

The low-cost robotic device – a hybrid brain/neural hand exoskeleton – was tested on six people with quadriplegia affecting their ability to grasp or manipulate objects. Participants wore a cap that measured electric brain activity and eye movement, which allowed them to send signals to a tablet computer that controlled the glove-like device attached to their hand. The device used a system known as brain-machine interfaces (BMIs), in which the participants’ visualization of a closing hand results in the actual hand-closing of the robotic device. Within 10 minutes, participants were able to learn how to use the device, enabling them to perform everyday tasks such as using a fork, drinking from a cup, or signing their name.

While brain-controlled robotic aids for people with quadriplegia or stroke deficits are not new, many existing systems require implants which can cause health problems, or use wet gel to transmit signals from the scalp to electrodes. Because the gel needs to be washed out of the user’s hair afterwards, it is impractical for daily use.

Participants in the study were individuals with high spinal cord injuries – they were able to move their shoulders but not their fingers. A limitation to the system is that users must have sufficient shoulder and arm function to reach out with the robotic hand. As well, mounting the system requires help from another person.

The authors of the study stated that the device could be brought to market within two years and would cost 5,000 to 10,000 euros ($7,100 – $14,200 in Canadian dollars) depending on functionality. The device could also be used to help re-train the brains of stroke patient undergoing rehabilitation, the authors state.

In our practice, we have represented many people who live with quadriplegia or have suffered the effects of a stroke, so we closely follow new developments in the field of rehabilitation. We are hopeful that brain/neural-assisted technology will offer increased independence and autonomy for people who have suffered such injuries.

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