Last week, CBC TV aired the story of a Comox resident suffering from an eating disorder who had unwillingly been discharged from St. Paul's Hospital about two months ago.
It was a disturbing story that vilified St. Paul's Hospital as a callous and "unethical" facility for discharging a woman who was so clearly ill. The story struck me as unfair.
Whether the CBC couldn't devote more time to the piece or St. Paul's wasn't willing to share more details due to patient confidentiality, the story of 30-year-old Amber Foster and others like her requires more context than what appeared on TV. It was too simplistic for such a complex illness.
St. Paul's, where Foster had been getting treatment for eight years, is the provincial resource for adults with anorexia nervosa and bulimia nervosa. Foster suffers from anorexia and was 80 pounds when she was discharged.
When I first heard the piece, many things went through my mind. My gut reaction was not sympathetic. "Then eat, already-if not for yourself than for your young son."
Of course it's not as simple as that. I also wondered if Foster was doing all she needed to get well. I compare the situation to an addict at a rehab centre. If an addict uses drugs, he or she is typically kicked out. Zero-tolerance policies exist for a reason. Part of me also wondered if eating disorders only affect people in wealthy countries. My heart goes out to Foster. But I'm not convinced St. Paul's is the bad party and simply shoved Foster out into the cold as the CBC story suggested.
St. Paul's Hospital discharged Foster after she failed to meet "stringent and evidence-based criteria," the hospital told the CBC. No hospital is perfect, but an issue like eating disorders can put a hospital between a rock and a hard place. If a patient is unwilling to meet program criteria (and is not motivated to help themselves) and there is a waiting list for other patients, what is a hospital to do?
Dr. Julia Raudzus, interim medical director with the provincial adult eating disorder program, isn't as blunt as that. The soft-spoken psychiatrist worries the story might leave people with the impression help isn't available for people with eating disorders outside Vancouver. Resources exist in all health regions, she said.
Contrary to comments made by Foster, Raudzus said the program supports chronic cases, but it refers some to other centres locally or outside B.C. (six went out of province this year) when the illness is combined with addictions and other underlying psychiatric conditions that are a barrier to dealing with their eating disorder. The St. Paul's program receives about six referrals a week, treats another 55 to 60 patients in a residential program per year, manages a large volume of out-patients, brings together 40 out-patients a week, runs group sessions and has seven in-patient clients in hospital beds.
In-patients typically stay a week to a month, though one patient was on the unit for two years, which Raudzus described as an "outlier" situation. The program has waiting lists, but Raudzus says they try to manage these patients through a menu of treatment programs until a bed becomes available, though the goal is to keep them out of a hospital bed. Better to connect them with community resources to build resiliency outside the hospital and get them home where they family and friends can offer support, she said.
Raudzus estimates it takes seven years of treatment before a patient gets better. Some, however, will have chronic conditions. It's not uncommon for Raudzus to see women in their 40s, 50s and 60s who've had the illness half their life. "It's an incredibly complex illness. They can't face weight gain, but they look at how to keep themselves stable and out of hospital."
Extended in-hospital stays also don't benefit the patient. "It leads to treatment refusal and disengagement," said Raudzus. It's also costly.
But what cannot be overstated is personal motivation. "Their readiness and motivation for change-that can't be left aside as a factor that isn't important," Raudzus said.
St. Paul's, however, should have more detailed information about the program on its website. Information and transparency are vital, especially regarding "evidence-based criteria."
