Rose Lundy was three months' pregnant
when she started bleeding. She rushed with her husband
Rick to Calgary's Peter Lougheed Hospital, only to be
told there were no beds available. For three hours,
Rick Lundy pleaded with staff to attend to his wife,
as the blood pooled around her feet in the waiting room.
Then, in front of 40 other waiting patients, she lost
her baby.
It may be the heart of Canada's
richest province, but all is not well, it seems, with
Calgary's health services. In the aftermath of Ms Lundy's
waiting room miscarriage, the region announced it would
undertake a major review of emergency care provision.
The incident didn't leave them
much choice. Calmly but persistently, the Lundys have
made their case that Calgary simply lacks the resources
to care for its citizens. They did exactly as they were
told and waited. But the system, and the staff, failed
them.
As the city has blossomed to a
population of one million, emergency health services
have not kept pace, the Lundys argue. Many Calgarians
agree — Canada's boomtown has a busted health system.
"The medical system in the city
of Calgary is overstressed and in crisis," Rick Lundy
told a press conference after meeting with Calgary Health
Region officials. "We strongly suggest that Premier
Klein and Health Minister Iris Evans appoint an independent
committee to study the level of healthcare in the city
of Calgary."
That hasn't quite happened yet,
but the Lundys managed to get the next best thing. The
Calgary Health Region has asked the Health Quality Council
of Alberta to review all emergency and urgent care services.
NO
BIG SURPRISE
The chief executive officer of the Health Quality Council
of Alberta, Dr John Cowell, already knew that emergency
care was a sore point with the public. His organisation
has surveyed Albertans' satisfaction with health services
annually and emergency care has consistently scored
the lowest. And Calgary is the worst region, with just
40% of polled citizens satisfied with ER services in
2004. Given that 73% of Albertans rated their overall
health system as good or better, these are poor numbers.
And Calgary is one of only two regions in which satisfaction
with ER services is actually declining. The Lundys'
experience was obviously not an anomaly.
Dr Cowell said the review will
last seven months and will take a holistic approach.
"We will apply the six principles we always apply in
our reviews: acceptability, accessibility, appropriateness
of care, effectiveness, efficiency and safety."
Clearly, Rose Lundy's care failed
on all six counts. "I don't wish to pre-empt the review,"
said Dr Cowell, "but my impression is that the problems
in emergency rooms are most likely to occur in patients
whose problem is medium in severity. Those who turn
up with life-threatening trauma are going to get seen
very quickly."
STAFF
EXONERATED
Nobody is suggesting that Rose Lundy didn't deserve
better treatment. The executive vice-president of Calgary
Health Region, Dr Chris Eagle, conceded to the Calgary
Herald that his organization "dropped the ball"
and "lost the human touch" in this case. But he didn't
admit that Ms Lundy should have gotten a bed, or even
have been seen by a doctor. He said that if no bed was
available, she should at least have been offered a private
space in which to miscarry.
And Dr Eagle refused to blame staff
at the hospital. "I'm not criticising the staff. They
have a very difficult job." In fact, soon after the
scandal erupted, Calgary Health officials visited the
Peter Lougheed Hospital to reassure staff that they
are highly valued and that their services are vitally
needed.
The move may seem odd, but it reveals
a great deal about the real nature of the problem facing
Calgary. "Nurses like to try a stint in the ER for experience,
but many don't stay," says Michelle Senkow, president
of the Calgary chapter of the Alberta nurses' union.
"They are working 16 hour shifts, sometimes 10 or 12
days in a row, and they have to deal with every kind
of trauma and horrifying situation. With so many nursing
vacancies throughout the health system, they always
have the option to do something easier."
UNHEEDED
WARNINGS
Much has been made of the seemingly low number of emergency
beds in Calgary currently 171. A further 142 beds will
be added by 2010, if all of the Health Region's requests
get provincial funding.
But while many citizens can't believe
that 171 beds, or even the planned total of 313, are
sufficient to cater to one million people, the experts
don't see it that way. "If there's an agreed ideal ratio
of beds to people, a universal standard, I've not heard
of it," says Dr Cowell. "Is 171 enough? Ask me in six
months, after the review."
In fact, doing the sums suggests
bed numbers aren't the problem. "The problem is staff,"
says Ms Senkow. "Not just nurses, but radiology techs,
lab techs, all kinds of staff. Where will they find
the nurses to go with these new beds? They just aren't
being trained."
Ms Senkow blames the government
for not paying attention. "We've been warning them for
many years that this was coming. It's not that people
don't want to be nurses. People with good grade averages
are being turned away from the nursing course at the
university here, for lack of places."
Ultimately, Alberta will likely
use its wealth to solve the problem, luring nurses from
poorer provinces and abroad. But in the meantime, the
Health Quality Council of Alberta review has been graciously
welcomed. "We're going to look not just at provision
of service, but at the big picture of emergency care,"
said Dr Cowell. "Why do people choose to visit hospital
emergency departments? Are there categories whose needs
might be met better, and faster, in some other setting?"
In other words, if you can't fix supply, try adjusting
demand.
|
