Canadians are dying preventable deaths in this country's choked ERs, doctors warn
Dr. Alecs Chochinov recently received a private message from an emergency medicine colleague who has been practising for more than a decade. “I’ve never been so despondent,” it said.
“That single doctor is speaking for many,” Chochinov said. “People are despondent. They’re scared that there are going to be bad outcomes and they’re going to feel responsible. But they don’t see any respite.”
In a new commentary, Chochinov and his co-authors warn needless, avoidable deaths are recurring “with unsettling regularity, not randomly, not rarely,” in Canada’s hospitals, a function of choked and overwhelmed emergency departments.
While media reports of individual people dying after languishing hours waiting for care in an emergency room are undeniably tragic, individual stories obscure a darker reality, they said — a “hidden pandemic” of excess deaths and a mortality rate “that exceeds that of a properly functioning system that citizens of a highly developed country have a right to expect.”
“A patient waits for hours in a Canadian emergency department, deteriorates quietly, sometimes visibly, then dies before being assessed,” Chochinov and his co-authors wrote in the Canadian Journal of Emergency Medicine.
“The cause is most often cardiovascular disease or sepsis; the details vary, the pattern does not,” they said.
“A review is launched. A statement is issued. Regret is expressed, perhaps a policy adjusted. Then the system resumes its normal operation.”
An estimated 8,000 to 15,000 Canadians are dying unnecessarily each year due to emergency department crowding, according to one analysis extrapolated from U.K. data.
Deaths can occur in the ED, on the wards or after someone has been been sent home from hospital prematurely.
In January, 55-year-old Stacy Ross died of cardiac arrest after spending 11 hours in a Winnipeg emergency department waiting to be admitted to a hospital room. Ross was suffering from pneumonia and sepsis before she died.
One month earlier, Prashant Sreekumar , a 44-year-old father of three, died after spending eight hours in an Edmonton emergency room with chest pains. He collapsed and died minutes after being admitted to a room.
In the wake of his death, Alberta doctors have called on the province to declare a state of emergency over wait times. Dr. Paul Parks told CTV News it’s not uncommon to have people in “ 10-out-of-10 abdominal pain with no pain medication, no comfort and nowhere to sit for 12 hours in our emergency department because we can’t get them in.”
He and colleagues across Alberta have compiled a list of at least six potentially preventable deaths that occurred over a recent two-week period, including a 50-year-old man who died from multi-organ failure from a bacterial blood infection, CBC reported .
Across Canada, emergency rooms are routinely operating beyond 100 per cent capacity, with 30 to 40 stretchers and cubicles in the back occupied by people who have been assessed and “admitted” to hospital, with no empty bed on a ward to move them to, because many of those beds are filled with people who no longer need care but can’t leave the hospital because there’s nowhere for them to go — no space in long-term care or home care or rehab. Meanwhile, 50 or more people are in the emergency waiting room.
“When patients stop moving, they accumulate. And the place where they accumulate is the only part of the system that cannot refuse entry,” Chochinov, a University of Manitoba professor of medicine, and his co-authors wrote.
Emergency departments are now in a “chronic disaster state,” with the capacity required to care for patients “patently inadequate,” Chochinov said in an interview.
“It’s gotten completely out of control and meets the formal definition of disaster — a serious disruption of functioning, that exceeds the ability of available resources and results in excess harm — on a daily basis.”
The crowding leads to delayed diagnoses, staff burnout, errors and excess deaths, he and his co-authors wrote, and crowded emergency departments are a proxy for crowded and dysfunctional hospitals. “When there is crowding all over the hospital, it leads to chaos in the ED, and bad things predictably happen in that setting,” Chochinov said.
“Eventually our system will just be seen by the public as unsustainable. I’ve got many friends who once believed that our health system was a defining feature of being Canadian, who are losing faith in the system.”
A special task force of the Canadian Association of Emergency Physicians has proposed a major redesign of the system . “Until we are able to translate the real lives lost in this hidden pandemic into terms that will resonate emotionally with the public — that will make them say this is untenable — we won’t get anywhere,” Chochinov said.
The federal argument that health is a provincial matter is a convenient cop out, he and his co-authors added. Timely access to care is enshrined in the Canada Health Act, and should be a national priority, they said. The federal government could demand that targets are met “and that persistent failure carries consequences,” such as holding back a portion of federal health transfers.
“The feds have to do something,” Chochinov said. “We are failing to deliver on a defining national priority.”
At 2.5 hospital beds for every thousand people, Canada has one of the lowest hospital bed capacities among OECD countries.
The crisis in primary care and long waits to see a specialist for chronic conditions — arthritis, inflammatory bowel disease, congestive heart failure — are also clogging up emergency rooms.
Chochinov fears Canadians have become resigned to emergency waits that are far worse than before.
“Ten years ago, a patient would wait for six hours, and you’d walk into the room, and the patient would tell you, animatedly, exactly what he thought about you and the health-care system,” he said. “Now we see patients who are exhausted, demoralized, sick and too tired to complain.
“Paradoxically, we took more flack 10 years ago, but when people stop complaining — in a hospital bed, or looking at the system as a whole — that’s a bad sign.”
National Post
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