There have been two outrageous Maritime health care stories break this week. Both are about systemic abuse. One of a Moncton man in pain, the other of such outrageous disregard of privacy to rate the charge of interfering with human remains.
To the living: a Moncton woman pulled her car up in front of the ER doors, with her husband screaming in pain. She tried to get hospital staff to help her with her husband. They told her to call 911!
She was the width of a sidewalk from the door and hospital staff refused to come to their aid!
In a classic Catch-22 situation, the staff told this woman to call 911 because no staff at the hospital are designated to transfer patients from outside the hospital to the inside. The 911 dispatcher was equally incredulous to receive an emergency call literally from outside the ER doors.
Dr. Serge Melanson, The Moncton Hospital’s chief of staff told the CBC there are no staff members designated to the specific task of helping patients unable to walk into the hospital. “We do not have portering staff to attend patients in our parking lot,” he said. He also said, “There’s no policy indicating to patients that they need to call 911 to be brought into the emergency department. That would be a decision made at the time by a staff person, they would use their clinical judgment, and decide that that was the best solution to get them in.”
This is a prime example of the systemic lies of omission health care executives continue to perpetuate on the Canadian public. This is not the first time this type of thing has happened, and yet hospitals continually fail to address the problem.
In December 2009, Soldiers Memorial ER staff made national headlines for telling an 83-year-old woman whose 80-year-old husband was having a heart attack within sight of the ER entrance to either bring him into the ER herself or call 911. The hospital staff wouldn’t even make the 911 call for her. This is life-threatening because many older people don’t necessarily carry mobile phones.
AVDH, then presided over my Janet Knox and chief of medicine Dr. Lynne Harrigan, promised to develop a policy regarding health emergencies on their doorstep. In December 2014 I asked hospital workers about this and no one knew of any such policy regarding what to do in a similar situation. Nor did they know how they would handle a patient in need who was outside the physical envelope of the building.
As I wrote in June 2015, a man in Halifax collapsed on a hospital walkway. As he lay there there was debate about who would come to his aid: staff or paramedics.
On the one hand we are told that for heart attacks, strokes and other problems seconds count. On the other hand, health care has shown itself too lazy to come up with a viable solution to a problem that isn’t as occasional as “they” would have us believe. It stands to reason that people being rushed to hospital are sick and in need of urgent care so whether they come by ambulance – which the VG can take up to two hours to off-load – or driven by a family member or friend they could collapse before admission or anything else has taken place. Medical emergencies aren’t by appointment. Yet, our medical system, as these experiences show, has opted not to plan for them.
The public are partially to blame. We have been too complacent, too docile, too referential to health care. We should demand accountability. We should have activist health boards who are capable of saying “no” to health executives and are prepared to dismiss those who continue to fail to improve performance. Former Capital Health CEO, Chris Powers told the CBC that she felt executive compensation was warranted because it mirrored pay in the private sector. What Powers and her ilk overlook is that in the private sector if you fail to perform, you’re out the door. The recent removal of the president of Sobeys is a prime example.
As for the couple in Moncton, her husband wasn’t given any diagnostic tests beyond an ER doctor’s observation. He was loaded up with pain-killers and, disoriented from the medication, discharged.
“Discharged” is a nice word for it. He was practically given the bum’s rush and shown the door. A nurse said the room was needed for other patients. It would be interesting to meet these other patients and see just how sick they are. In 2012 a 106-year-old woman was brought to the Valley Regional Health’s ER in an ambulance. She was vomiting and had abdominal pains. She was left on a gurney for over five hours. When her daughter asked when her mother would be seen by a doctor, the nurses told her, “There are more important cases coming in than your mother.”
It would be interesting to have “more important” defined. Did they mean younger and therefore more worth their attention? The patient died in the next hour. Was it an illness, age or ageism that killed her?
In the case of the Moncton man, he wasn’t discharged to his wife or anyone else, but sent outside, in a johnny shirt, where his wife found him wrapped around a light pole.
In typical PR-speak the hospital chief of staff said there are procedures in place to deal with a situation where someone is ready to be discharged but there is no one on hand to safely bring them home. He said discharged patients can wait in the emergency room waiting rooms. “We do not discharge patients out of the hospital until they have a loved one or a family member who can come to their aid.”
Utter bullshit. Obviously, no one on staff knew the procedures or cared to follow them. Again, as much as executives can pretend to be horrified by this, it’s not a unique situation.
Winnipeg is a prime example of cavalier-to-the-point-of-lethal discharges and disregard for patients. In 2008, Brian Sinclair, an aboriginal wheelchair-bound double-amputee died of a treatable bladder infection in the Winnipeg Health Sciences Centre’s emergency room after spending 34 hours awaiting care and largely ignored by staff.
That wasn’t enough to bring about change. The hospital was found to send extremely ill patients home via taxi without any assurances anyone was there to care for them or who knew the patients were being discharged. In 2014 at 1:30 am on December 30, Winnipeg’s Grace Hospital sent a 78-year-old man, dressed in pyjamas and slippers home in a cab. He froze to death on the front porch of his home.
A day later the same hospital sent a 62-year-old man, awaiting admission to palliative care after suffering from a major aneurysm, home in a taxi by himself. He was found unconscious on the sidewalk less than an hour later and died before paramedics arrived.
That same year, the Seven Oaks Hospital sent a 68-year-old woman home in a taxi. She collapsed on her doorstep and died from a blood clot that had travelled to her lungs.
As a result of this the Winnipeg Regional Health Authority developed a policy for discharges, but only implemented it at one of their hospitals, not the others! What kind of bizarre choice is that?
There are many more cases across Canada. Back at Valley Regional Hospital, I witnessed the staff laughing at a patient who discharged himself and stormed off wearing a johnny shirt tucked into the back of his underwear to hitchhike home. They knew he had no money for a cab. I maintain that someone so dressed isn’t in full control of himself and someone should have intervened to at least contact his family or see him safely home.
Another discharge failure occurred on December 20, 2013 when an ambulance service took 89-year-old Tadeusz Czubak from the Trillium Health Centre in Mississauga, Ont., to his empty home. He was supposed to be returned to the retirement home where he’d come from and where his family had placed him for temporary care while recovering from knee surgery.
The ambulance service asked a person they saw shovelling a driveway to check on Czubak since no one was home. The stranger found the heavily-medicated Czubak collapsed on his stairs and called the family.
“This kind of event will happen over and over again,” predicted Sholom Glouberman, president of Patients Canada. “The hospitals don’t take responsibility for anything that happens outside the hospital. And that’s the way the system has been structured.”
“What kind of hospital system requires you to have a monitor, a chaperone to help you get through it safely?” she asks. “Nobody took any responsibility to make sure this man was safe at home.”
Saskatchewan patient advocate Donna Davis agrees that the Czubak situation “isn’t just a one-off.”
Davis, who is a nurse and co-chair of Patients for Patient Safety Canada suggests hospitals need to establish a family point-person, someone who must always be alerted by the hospital when an elderly or otherwise vulnerable person is in the system, and especially when they are discharged.
“This is certainly one case where we in health care obviously need to learn from and put something in place so it doesn’t happen again,” said Davis.
Some critics suggest the larger issue is the shortage of beds and a rush by hospitals to discharge so-called “bed blockers,” meaning elderly patients who no longer need acute care.
Glouberman doesn’t buy that and says the situation is more indicative of a larger problem with a health-care system that spends money primarily on hospitals rather than community care, where patients should be recovering and rehabilitating.
The second outrage this week is about long-term care and end-of-life. Unbelievably, a worker in a PEI care facility posted photos of a recently deceased patient on social media site, Snapchat!
An investigation found that for months an employee had shared multiple “inappropriate and degrading photos and videos of vulnerable residents while they were eating, sleeping, using the commode and when co-workers were providing personal care to certain residents after a bowel movement.”
How do staff not know this is wrong? It is wrong on so many levels that it is incomprehensible. It is so vile you almost want to have public stocks brought back. In typical fashion, the culprit’s name has so far been protected. Perhaps if naming and shaming were brought back, care – at all levels – would be better.
One person on Facebook asked why the families don’t sue. The answer is simple: because the system is weighted against the patient and patient family. Privacy regulations protect the wrong-doer and their employer more than the patient. Even those who have the authority to make medical decisions about care have difficulty getting information. Facilities, fearing inclusion in a lawsuit, will use their deeper tax-payer-funded pockets to fight a lawsuit and shelter employee, executive and information. And in jurisdictions like Nova Scotia, you are limited to a two-year window when you can sue. Health care knows this and works at an obstructionist pace to run out the clock.
The CBC report carries this classic line: “According to a spokesperson for Health PEI, the agency had policies in place before these incidents occurred which should have prevented them in the first place, including a policy stipulating employees not have personal communication devices like cellphones with them during work hours.”
Policies are meaningless if unenforced. Or purposely vague.
The bottom line is who are policies and privacy regulations protecting, the patient or the system?