Twelve out of 14 emergency physicians
and many senior nurses quit Cambridge Memorial Hospital
over the period of a few months late last year. The
exodus was swift and went mostly unnoticed. The question
is why.
TROUBLE
BREWING
Problems began back in 2004, according to Dr Harry Zeit,
one of the Cambridge twelve. He's one of the few who
has spoken publicly about what happened. He went to
the local media with his story, telling them why he
believed the emergency department deteriorated to the
point where staffers were fired or left.
"The big problems really began
when the administration pressured [doctors] to see more
patients," recalls Dr Zeit. Funding cuts by the Ontario
Ministry of Health meant fewer doctors were on staff,
resulting in longer wait times and more fed-up patients
languishing in the waiting room. "The nurses were suffering
horribly. I saw doctors detaching and caring less about
patients. In the end we weren't giving adequate care."
Frustrations mounted and tension
grew between the hospital administration and ED staff.
"There's a crisis in the emergency room," Dr Paul Quinlan
— the former chief of emergency who was forced
to resigned 'under duress' in August last year —
told Waterloo newspaper The Record. He added
that the dispute had grown ugly.
BACK
ROOM SHENANIGANS
Dr Zeit can attest to that and pinpoints the moment
when things took a turn for the worst. On April 5, 2005,
the administration held a meeting with the ED nurses
just before the nightshift. "I wasn't at the meeting,
but I got distressing emails from the nurses the next
day," he says. "I was informed that the CEO and the
head critical care nurse told them that I was calling
them the worst ER nurses in Ontario. They were in tears."
This, Dr Zeit says, was untrue
and the staff knew it. "I was saying [the nurses] were
the best. I was advocating for them. I was respected
for taking their side," he says. The fateful meeting
tore Cam-bridge's ED apart, dividing what was once a
tight-knit staff.
"This was an excellent department
making the best of not-excellent resources and working
at it like a family," another Cambridge emerg doc, Dr
Lori Elliott, told The Record. Her contract was
never renewed.
Many of the hospital's problems
were played out in the pages of The Record. Dr
Quinlan came forward with another issue. The ER doctors
weren't getting paid competitive rates. He told The
Record that they were earning, on average, $150 an hour
— the hospital administration claimed that figure
was closer to $165. He explained that other regional
hospitals, like the nearby Henderson Hospital, had found
ways to pay their ED doctors an average of $200 an hour.
Still, Dr Elliott insisted the departures weren't about
money.
A
DOWNWARD SPIRAL
In Dr Zeit's eyes, many of the problems started with
the health ministry. "[The McGuinty government] has
raped the whole emergency system," he told The Record
last April. Deep funding cuts by the ministry in
January 2004 forced Cambridge to reduce the number of
physician-hours over a 24-hour period in the ED from
39 to 35, which inevitably resulted in the department's
delays.
"The ministry wanted numbers,"
says Dr Zeit. "There had been reviews and they wanted
volume even though Cambridge had this excellent emerg."
The hospital's administration didn't deal with the problem
properly, he adds. "This created the idea of a fast-track."
The atmosphere changed. "I watched all the things that
made the system human disintegrate." Dr Quinlan expressed
a similar sentiment in The Record. "We were in
a death spiral," he said.
The hospital admin did attempt
to rectify the situation. In April 2005, they successfully
lobbied the ministry for an increase in the number of
ED physician-hours from 35 to 37. But it wasn't enough
to help a department that was already too far gone.
Dr Quinlan told The Record that increasing the
number of physician hours a day to 40 would have helped
attract and retain doctors. He was also very critical
of the administration. "[They] turned their backs on
the department and therefore on the people of Cambridge,"
he told the paper.
Needless to say, the bad press
wasn't welcomed by the hospital administration. There
were attempts to keep last year's problems under wraps.
"I was told not to talk about what happened," says Dr
Zeit. "A cardiologist came up to me and told me to watch
my mouth." Dr Zeit left Cambridge on May 31, 2005, not
of his own volition. He had announced that he would
resign, but only effective December 31, 2005. He explains
that his privileges were simply taken away.
Several of the physicians who left
were contacted for this article, but most declined to
be interviewed. Some said they weren't allowed to talk
about what had happened. "Everyone is terrified to speak
out," says Dr Zeit. "This was all accomplished by the
hospital offering very viable threats and by bodies
like the OMA and the College of Physicians and Surgeons
of Ontario standing by and pretending to look the other
way." The hospital CEO Julia Dumanian also declined
to participate in this article.
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