MONTREAL — Some Montreal doctors added a dose of realism Saturday to the fiery debate south of the border that asked if Canada’s “socialized medicine” killed actress Natasha Richardson after she hit her head skiing on Mont Tremblant March 16.

“Canadacare may have killed Natasha,” screamed a headline in the New York Post. “Was Canada’s healthcare the problem?”asked another in the Chicago Tribune. The implication “is totally unjustified,” said Paul Saba, an emergency room doctor at Lachine Hospital and co-president of the Coalition of Physicians for Social Justice. He flatly rejected the notion that a lack of funding for overall public health care contributes to fatal head injuries like the one that claimed the life of Richardson.

Saba stressed he was not commenting specifically about Richardson, but “any patient’s refusal of treatment is crucial” to the outcome. So is not wearing a ski helmet, he added. Richardson, 45, wasn’t wearing a ski helmet when she fell around noon and was walking and talking afterward. She also refused an ambulance that came for her about 45 minutes later. Another ambulance was called about 3 p.m. and she arrived at the Centre Hospitalier Laurentien in Ste. Agathe, 42 kilometres away, nearly four hours after her fall. Two hours afterward she was transferred by ambulance to the trauma centre at Montreal’s Hepital du Sacre-Coeur, 83 kilometres southeast of Ste. Agathe. An article in U.S. newspapers by Cory Franklin, a physician who lives in Wilmette, Ill., took sharp aim at the lack of CT brain scanners in some Quebec hospitals and the lack of helicopter ambulances.

“With prompt diagnosis by CT scan, and surgery to drain the blood, most patients survive,” Franklin wrote. “Could Richardson have received this care? Where it happened in Canada, no. In many American resorts, yes.” But a simple phone call Saturday to the radiology department at the Centre Hospitalier Laurentien revealed that the hospital is in fact equipped with a CT scanner. It was not known, however, whether the device, which can cost $1 million, was used on Richardson. As for the need for a medical helicopter, Saba said that while it would be helpful in longer-range cases, it might not have saved the actress.

“You have to do a cost-benefit analysis,” Saba said. “It takes time to get the helicopter’s medical team assembled, get the helicopter to the location of the patient, pack in the patient and fly the helicopter to Montreal.” But Michel Garner, head of the emergency department at Sacre-Coeur, said Mont-Tremblant is a two or two-and-a-half hour drive from Montreal. Ste. Agathe can be an hour’s drive away, he noted. “I’m certain some patients would benefit” from a helicopter system, he said. Paul Brunet, president of the Council for the protection of patients, said the question of whether a medical ambulance would have made a difference was moot. “If she had worn a helmet and accepted to see a doctor would there be any talk of this need for a helicopter?

Disclosure: I was injured in a skiing accident in Breckenridge Co. about 7 weeks ago. I thought I had only tweaked my knee but I hit my head (“had my bell rung”) and came to quickly (around 30 seconds). I have many years of abusing my body through sports and I am no stranger to pain, so I shook it off, collected my gear and finished the run. The next morning I was admitted to a local trauma center where I learned that I had completely severed the ligament (ACL) that runs under the kneecap. How I was able to to finish the run or walk that evening remains a mystery to me. But the staff was more concerned about my head injury… I wasn’t. The health care I received couldn’t have been better or more expensive. I guess the point I am trying to convey is that we all have choices and decisions to make at the time of an injury. I probably (definitely) made the wrong decision, yet I was lucky. Miss Richardson was not so fortunate. And in case you’re wondering, no, I never even considered wearing a helmet.