BURST
Alberta doctors have compiled a series of cases involving “preventable deaths” and “near misses” that have occurred in emergency rooms across the province.
Postmedia obtained a document listing the cases from an anonymous source . It identifies six deaths as preventable and more than 30 “near misses,” all of which have occurred in the wake of Prashant Sreekumar’s passing.
The 44-year-old died on Dec. 22 at the Grey Nuns Community Hospital, more than eight hours after entering the emergency department (ED) complaining of chest pains.
Dr. Paul Parks, president-elect of emergency medicine with the Alberta Medical Association (AMA) and the physician behind the document, said it was shared internally amongst senior leadership, including with Premier Danielle Smith and Hospital and Surgical Health Services Minister Matt Jones in order to illustrate how dire conditions have become and to show Sreekumar’s death was not an isolated case.
Parks said doctors are seeing preventable deaths and near misses due to severe overcrowding almost daily.
“It was intended to try to really impress upon the government that point, but also to plead for some help (and) get them to share our urgency,” he said.
The document was produced less than two weeks after Sreekumar’s death, with Alberta doctors submitting anonymized cases that detailed the severity of the situation.
Parks said Jones has yet to respond to the distribution of the document.
Jones held a press conference last Thursday where he announced the province would implement a triage liaison physician at the six busiest emergency rooms in Alberta — a solution Parks likened to putting a “Band-Aid over a gaping wound.”
In a statement to Postmedia, Kyle Warner, a press secretary with the ministry of hospitals and surgical health services, said they are unable to comment on “unverified anonymized patient information” due to privacy and legal considerations, but that they take all information on patient outcomes seriously.
He said Jones has reached out to set up a meeting with the AMA and Acute Care Alberta to share plans and potential solutions to address acute care pressures.
“(Jones) wants to ensure a shared understanding that the system is under exceptional strain, is responding as it has in past years, and requires additional resources beyond flu season. The government is working on long-term solutions to significantly expand capacity,” Warner said.
“Acute Care Alberta is leading daily province‑wide co-ordination with AHS, Covenant Health, Primary Care Alberta, Recovery Alberta and Assisted Living Alberta to manage flow, staffing, and site‑level pressures.”
Six fatalities of preventable cases documented
In one of six preventable deaths cases, a physician reported a patient suffered cardiac arrest in the hallway of a tertiary care site. The patient never made it to a care space and showed clear signs of deterioration and died as a result.
“Our hallways and waiting rooms have become death zones and we wonder how many ‘ticking time bombs’ will drop dead when they should be receiving life-saving care in a functional emergency care space,” the physician wrote.
In another case, a patient who arrived at the emergency department with septic and renal failure was awaiting a general internal medicine assessment, but due to overcrowding and the service cap, the patient was in the emergency department for 24 hours. The patient’s condition deteriorated and they died.
A physician reported there were multiple emergency department handovers before the patient received a consult.
According to the document, delays and overcrowding directly contributed to the deaths of the patients in each of the six cases.
Parks said these cases are just the tip of the iceberg.
“The waiting room has metastasized into many different areas and we are routinely seeing very bad outcomes in these areas because of prolonged waits,” Parks said.
“Those words (from) our colleagues represent what a lot of us feel when we go into an emergency department that is so severely overcrowded and unsafe that we do really worry about all those patients that are spread across our waiting room and our hallways.”
More than 30 critical “near misses”
The second section of the six page document listed more than 30 cases of “critical near misses” where patients nearly died or were in a dire situation. Three patients were admitted to the intensive care unit and physicians said they are unsure whether or not those patients will survive.
Several cases described prolonged long-wait times before being seen, lack of privacy in some cases and illnesses that quickly deteriorated and could have resulted in death if physicians had not intervened in time.
In one case, a paraplegic patient arrived with catheter complications and autonomic dysreflexia — a potentially life-threatening condition which causes sudden high blood pressure for those with a spinal cord injury. She was on a stretcher in the hallway for upwards of 11 hours. Approximately 14 hours later, staff informed her the interventional radiology room wasn’t functioning due to staffing and she was sent home.
Another patient was resuscitated in the hallway — the physician wrote there was no other space available.
In a third case, a man in his 20s came in with shortness of breath and waited more than seven hours before being seen. He ended up in septic shock and was intubated in the ICU. It is uncertain whether or not he will survive.
Dr. Warren Thirsk, the head of emergency medicine for the AMA and an emergency room physician at the Royal Alexandra Hospital, said the health care system is already at a point where it’s unsafe for patients. He said the system crossed that threshold 20 years ago and the situation has only worsened.
“What happens is there is an attempt to pin the systemic problems throughout the entire health care system on transient events like a flu coming through town,” Thirsk said.
“The problem is not the flu. The problem is chronic fiscal constraint and failure to account for growth and infrastructure needs.”
Thirsk said the call to declare a state of emergency is a call to acknowledge the large issues burdening the health care system in order to find meaningful ways to address them.
He worries that in five years from now waiting rooms will see even longer wait times, which will be accepted since “we’ve normalized abnormal.”
Alberta NDP Leader Naheed Nenshi said the United Conservative Party (UCP) needs to do more and listen to issues health care professionals on the ground are raising when it comes to the situation in hospitals and emergency rooms.
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