CANADA

TURNING PATIENTS AWAY

Can new cash from Ottawa end the hospital crisis?

MARK NICHOLS March 1 1999
CANADA

TURNING PATIENTS AWAY

Can new cash from Ottawa end the hospital crisis?

MARK NICHOLS March 1 1999

TURNING PATIENTS AWAY

CANADA

BUDGET '99

Can new cash from Ottawa end the hospital crisis?

MARK NICHOLS

As Finance Minister Paul Martin rose in the House of Commons last week to deliver a budget earmarking an extra $11.5 billion for health care over the next five yea rs,

Maclean’s reporters were recording the distressing scenes unfolding in Canadian emergency rooms.

It was as if the crisis in Canada’s hospitals came to a head just in time to illustrate the need for an immediate cash infusion. In Victoria, hospitals faced with a shortage of beds and nurses were parking patients wherever they could find space—in treatment rooms, in hallways and, in one case, in a linen cupboard. “This is the worst time I have ever seen,” said Donna Saltman, a nurse at Victoria’s combined General and Royal Jubilee hospitals. “At Jubilee, we can be holding up to 25 people in emergency, some of them on stretchers, for up to three days.” According to Ron Youngash, an emergency physician in the same hospitals, pressures are so severe that emergency patients sometimes wait hours before being examined by a physician. In the past month, he said, two emergency room patients have died—probably needlessly. “Our very limited ability to respond,” said Youngash, “is dangerous to the public.”

In Montreal, antique dealer Errol Trachy is furious that his 93-year-old aunt Carmelita spent 48 hours on an emergency ward stretcher at the Royal Victoria Hospital before a bed could be found for her in January. She died a week later of complications following surgery for a blood dot on her thigh. Trachy does not blame the hospital staff, but “people shouldn’t be stuck in the corridor when they’re sick,” he said.

Across Montreal—where seven of the city’s 33 hospitals have been closed since 1995 as part of the Parti Québécois government’s health-care reform plan—patients have been lined up on stretchers because of a growing shortage of bed space. The congestion, said Dr. Marc Beique, head of the Royal Victoria’s emergency department, is as bad as he has ever seen. “The health-care system is operating with absolutely no leeway,” he said. “!f anything goes wrong, the whole system breaks down."

In Toronto, overcrowding was forcing seven of the 23 acute-care hospitals in the region to turn away ambulances on one grey morning last week. To the relief of paramedics Joe Gallagher and Paul Robinson, whose ambulance was carrying an 81-year-old nursing home resident suffering from shortness of breath and pains in her abdomen, Scarborough General was open—in theory. But the scene they encountered was not reassuring: about 20 stretchers holding patients waiting to be examined or to be admit-

ted crowded corridors. At the desk, a nurse snapped at the paramedics: “Who let you in here?” They wrapped their patient in blankets and parked her in a corridor.

To the south, in Ontario’s Niagara region, the situation was similarly bleak: on one day last week all four of the area’s critical-care hospitals refused to let ambulances unload patients.

At St. Catharines’ Hôtel Dieu Hospital—which may be closed in April, 2000, as part of Ontario’s radical health-care restructuring—patients were parked in hallways. An 83-year-old man with congestive heart failure had been in the emergency ward for five days. “We have a woman on oxygen out in the hall,” complained nurse Penny Kyle. “And every bed is full—what can we do?”

Shaken by half a decade of budget cuts and administrative changes, Canadian hospitals were hit even harder than in the past by the annual winter onslaught of influenza and chest infections. Their underlying difficulties include a growing shortage of nurses and a scarcity of long-term care facilities. Across the country, hospitals’ badly needed acute-care beds are filled with chronically ill patients who could be treated elsewhere—if only there were an elsewhere. After Martin’s budget speech, Health Minister Alan Rock proclaimed a “new era” in health care. But Ottawa’s largesse will, in fact, only restore federal contribution to levels in 1995, when Martin’s deficit-cutting drive slashed payments to the provinces. And experts warned that the federal infusion would not quickly cure deep-seated ills. “Throwing money at the hospital system may not help very much,” says Kim McGrail, a University of British Columbia health policy researcher. “The problems in health care extend far beyond hospital overcrowding.” For Canadians in need of urgent medical care, the nation’s hospitals all too often appear to be in a state of crisis. Horror stories abound—of patients turned away from hospitals, of cancelled surgeries, and cancer patients flown across the country or to the United States for treatment that cannot be delivered closer to home. In Toronto, a 45-year-old cystic fibrosis victim missed out on an urgently needed double lung transplant on Feb. 3; the operation had to be cancelled—and the donated lungs discarded — because no bed or nursing crew could be found.

There is no single reason for the problems plaguing Canadian health care, experts say. The system is staggering under the impact of converging problems, including tighter budgets and a growing population of elderly Canadians. The fiscal crunch imposed by Ottawa over the past four years forced provinces to close

down acute-care hospital beds before the necessary alternatives were in place—long-term-care beds for the chronically ill and community-based services for patients who can be treated at home. “If the long-term-care patients don’t have a place to go,” says Dr. Nicolas Steinmetz, associate executive director at the McGill University Health Centre, which administers five unified Montreal hospitals, “they wind up staying in acute-care hospitals.” That is precisely what is happening—typically, about one-fifth of the 119 beds at St. Catharines’ Hôtel Dieu were occupied last week by patients requiring long-term care.

As for the nursing shortage, spending cutbacks have played a role there, too. In Quebec, 4,000 nurses left their jobs after the province offered attractive early-retirement packages in 1997. In Ontario, a task force recommended last month that the province, which currently has 40,000 nurses, spend $375 million to train and hire 10,000 more. But the job lacks the status it once enjoyed. Because of generally poor pay and tough working conditions, fewer Canadians are training for the profession—and many trained nurses are being lured by better-paid positions south of the border. Victoria’s Saltman said that after finishing a 12-hour night shift recently, she received three calls the next day from hospital officials asking her to return to work. Saltman refused—but says she plans to keep on working in the hope that conditions will get better. “When I give up hope,” she says, “I’ll resign from nursing.”

How much difference will new federal funding make? In British Columbia, Penny Priddy, health minister in Glen Clark’s New Democratic Party government, told Maclean’s the priority targets for the federal money include more cash for hospitals to keep operating rooms running and to reduce waiting times, especially for children. As well, more will be spent on long-term-care beds. As for the province’s doctors, who have been staging days of curtailed service to back pay demands, Priddy asked: “Will more

money for physicians shorten wait times? I’m not sure that it will.”

In Ontario, officials in Premier Mike Harris’s Conservative government say the money will be used to tackle an array of problems—more nurses will be hired, steps will be taken to reduce waiting lists for cancer treatment and neonatal services, and an existing program to boost the number of long-term-care beds in the province from 57,000 to 77,000 by early in the next century will get a cash infusion. The need for those beds is urgent, says Cam Jackson, the minister in charge of long-term care, so “we can free up acute-care beds instead of just waiting for someone to die.” But even under a priority program, few of the beds will become available until next year at the earliest.

Despite the human suffering that emergency room chaos is causing, some health-care experts hold out hope that the current troubled period may ultimately prove to be a transition to an improved and smoother-working system. Plans for a more decentralized system that would shift services away from hospitals and into the community were just getting started when Ottawa’s cutbacks hit. Ironically, says UBC’s McGrail, “it may have taken the federal budget crunch to make things happen” by speeding the rate of change. Steinmetz agrees. “The federal cutbacks,” he says, “provided the kick in the pants needed to make us look at a better way of running the health-care system. Hospitals are no longer the central places—they’re important, but the majority of care is going to take place in the community and in long-term-care facilities.” Steinmetz thinks that “we now have the potential to create a better form of health care”—good news for Canadians who survive the current erratic state of a deeply troubled system.

RUTH ABRAMSON

SUSAN McCLELLAND

JOHN NICOL

BRENDA BRANSWELL