Alberta South Zone Physicians Speak Out

Below is the text of 2 letters put out by Alberta physicians in the south zone in response to upcoming health funding changes implemented by the Alberta government:

 

An open letter from Alberta South Zone emergency physicians

March 3, 2020

Premier Jason Kenney
Health Minister Tyler Shandro
Mr. Nathan Neudorf
Ms. Michaela Glasgo
Mr. Drew Barnes

c.c. Ms. Shannon Phillips

We write to you today as a united voice of southern Alberta Emergency physicians in the cities of Lethbridge and Medicine Hat to add our voices to those of physicians across Alberta in response to the imminent changes coming to our healthcare system. We are deeply concerned that as early as April 2020 our emergency departments will begin to be overwhelmed due to reductions in local primary and specialist care. We also warn that any decision that degrades access to community based primary care medicine will inevitably result in increasing, unsustainable health care expenditures that will rapidly reverse any budget savings anticipated by these measures.

The emergency department has often been called the “canary in the coal mine” for problems in any healthcare system. When patients are unable to obtain or visit a family doctor, they come to the ER for routine care. When referral visits to specialists or for elective surgeries are delayed, patients come to the ER in crisis. When community long term care beds and accessible home care is unavailable, patients who no longer need hospital care have nowhere to go and languish in expensive hospital beds. When hospital beds are full, new patients requiring admission cannot be accommodated and remain in the emergency department. Elective surgeries are cancelled because there is no postoperative recovery space available.

All these factors combine to grind the efficiency of the emergency department to a halt, impairing its ability to accept and treat new patients. Wait times soar, ambulances pile up and become unavailable to respond to new emergencies. These causes of emergency department crowding are well documented and understood by health care professionals. There is abundant evidence that emergency department crowding increases costs to the health care system and has a cost in patient lives. There is also abundant evidence and consensus from health care experts here and around the world that investing in primary care, long term care and home care is the most effective and affordable way to reduce the burden of expensive hospital-based care.

We recognize and applaud this government’s stated intention to increase the availability of community long-term care and await details as to how this will be implemented. Nonetheless, we are concerned that the current government either does not fully understand the above relationship, or does not understand how the unilaterally imposed changes that were vehemently resisted by the Alberta Medical Association will rapidly decrease access to quality community health care, resulting in poorer health for Albertans, and a rapid increase in the utilization of expensive emergency and hospital based care.

Southern Alberta currently enjoys some of the best emergency department wait time indicators in the country. The average wait to see a physician in a south zone regional hospital is about 55 minutes. Our zone has been identified in the past as one of the most cost efficient in the province. This is in large part due to an excellent primary care system that is accessible to patients, and a network of specialists available to provide timely consultation, admission and follow-up for emergency department patients.

Currently, a simple visit to the family doctor costs Alberta Health $38-$56, from which clinics pay their operating expenses and employ their support staff. An equivalent simple visit to the emergency department costs $359 in hospital overhead + $29 in doctor fees. If additional time, complexity, consultation or testing is required, that expense rises significantly. There is a similar disparity in cost to the system between community and hospital care in other areas of medicine. The ER is generally busiest on weekends, holidays and Mondays – all related to times when community care is less readily available. As community care decreases and more people become reliant on the ER for their care, it is easy to see how health costs rapidly rise.

 

The following are specific ways in which we anticipate our emergency departments will be immediately affected by these changes beginning April 1:

  • The reduction and loss of complex care modifiers will make it difficult for family medicine and specialist clinics to remain financially viable unless visit lengths are significantly reduced. Less time translates into poorer care, making it more likely complex patients will experience a health crisis requiring a trip to the ER and/or hospital admission.

 

  • Daily visit caps on community physicians will shorten or eliminate evening walk-in clinics. These patients will come to the ER instead.

 

  • Daily visit caps will disproportionately affect high volume orthopedic, surgery and cast follow-up clinics, meaning more patients will come to the ER as they cannot see their surgeon.

 

  • Yet to be clarified changes to specialist in-hospital visits and the loss of on-call stipends have our consulting specialist colleagues already notifying us of decreased future availability to rapidly see and admit patients in the ER, as they will need to book additional time in clinics to continue covering their overhead expenses. This will dramatically increase the amount of time patients will be held in the ER before moving into the hospital or receiving an urgent procedure.

 

  • Of particular concern is the potential loss of the stipend supporting the Acute Trauma on-call service, which provides general surgeon coverage in hospital to respond to trauma team activations. This 7-year program has decreased adult and pediatric trauma death in Lethbridge by 65%. In 2018 there were 107 major trauma patients treated in Lethbridge, and 63 in Medicine Hat. Time is critical in these instances, and an increase in preventable traumatic deaths is highly likely should it be lost. The status of this program is unclear due to governments’ lack of response to requests for clarification and is expected to be lost on April 1.

 

  • Palliative care is losing the stipend needed to cover the travel cost of home visits to vulnerable and dying patients. Home visits may no longer be possible requiring more palliative patients to be admitted to hospital and preventing us from discharging them back home into palliative care.

 

  • We provide emergency referral care to all community hospitals in southern Alberta. Rural physicians across the province have been speaking up loudly about their impending inability to provide the same level of care under the new framework. We anticipate unplanned intermittent rural ER closures due to a shortage of physician coverage, similar to those experienced elsewhere in Canada. This will mean more visits from rural communities by patients seeking emergency care.

 

  • The elimination of “good faith billing” means that disadvantaged patients with addictions, mental illness or homelessness are likely to face significant barriers to obtaining care in the community, as many of them are unable to produce proof of provincial health insurance.

 

  • Already we are hearing established community physicians and soon to be graduating medical residents making plans to work outside Alberta due to the instability and acrimony of the relationship between physicians and government. The government’s plan to dictate where future doctors will be allowed to practice will drive many graduates from Albertan medical schools to other provinces. There is abundant work elsewhere. This will mean fewer community providers, and higher reliance on the ER.

 

 

Alberta has developed its current model of “the medical home” in primary care over two decades of thoughtfully structured changes to all levels of health care funding. World leaders in health economics and comprehensive patient care have helped build a primary care system that is the best in Canada. It is currently used as an example by other provinces to improve their health services and recruit physicians into similar models providing the best value per dollar in health care. To be frank, the currently planned changes on April 1 risk rapidly destroying 20 years of health delivery progress in this province.

We recognize that the fiscal reality of Alberta means savings must be found in all areas of the budget. Physicians have been willing partners, voting to accept decreases in fees in our last round of negotiations, and had again proposed global cuts to their own fees in the recent negotiations terminated by your government. The Alberta Medical Association has repeatedly expressed its willingness to return to the negotiating table to find sustainable decreases in health spending that will not have draconian and devastating effects on the foundation of Albertan’s medical care. If the AMA was “not willing to consider” your proposals this is why; they will immediately harm patients, and they will not save money.

It is not too late to put a hold on these changes and return to the negotiating table to repair this government’s relationship with physicians and find actual savings in health care. We urge a similar cooperative rather than adversarial approach to ongoing negotiations with other public sectors. The experts in each field are the best positioned to identify potential cost savings and avoid the unintended consequences of indiscriminate cuts. Use their knowledge and experience. A financially secure Alberta is in everyone’s best interest.

The elephant in the room right now is the inevitability that health care workers in Alberta may soon be overwhelmed by the response to a coming pandemic. As always, we will rise to the occasion and provide the best care we are able. Please Premier Kenney, Minister Shandro – can we deal with one freight train crashing into our health care system at a time?

 

Thank-you,

Chinook Regional Hospital (Lethbridge) Emergency Physicians:

Dr Stephanie Brass

Dr Richard Buck

Dr Nathan Coxford

Dr Ryan Derman

Dr Chrisjan deWaal

Dr Sharon Fehr

Dr Kevin Foster

Dr Nic Hamilton

Dr Mervyn Hiebert

Dr Ehi Iyayi

Dr Matthew Kriese

Dr Peter Kwan

Dr Magdalena Lisztwan

Dr Duncan Mackey

Dr Kevin Martin

Dr Nicholas McPhail

Dr Adrian Millman

Dr Bilal Mir

Dr Wes Orr

Dr Braden Teitge

Dr Alan Wilde

Dr Sean Wilde

 

Medicine Hat Regional Hospital Emergency Physicians:

Dr Ryan Currah

Dr Hendri Faul

Dr Chris Ghazal

Dr Dan Girgis

Dr Geoffrey Harris

Dr Joe Hawkwood

Dr Ash Jaffer

Dr Jan Joubert

Dr Michael Lee

Dr Tyler van Mulligen

Dr Edwin Orellanna-Jordan

Dr Paul Parks

Dr David Sameshima

Dr Chris Stewart

 

******************************************

From Dr Tony Gomes, Chinook Regional Hospital Department of Surgery

Dear Residents of Southern Alberta: When you are brought to the Chinook ER after a serious accident or an with an urgent surgical problem, we Trauma and GI Surgeons would love to assure you that we will be there waiting to take care of you, but the Alberta Government does not value this (hopefully you do). Her is our letter to our local MLA’s-please take a moment to read it.

Dear Local MLA’s:
I am attaching a letter sent to Alberta Health Services administration last month. We still have not received a reply from AHS, and assume our Acute Surgery/Trauma service will terminate at Chinook regional Hospital as of March 31, as all such programs are being defunded by the current government.

In a nutshell, in 2013 our group of 6 General/Trauma Surgeons saw gaps in Hospital and Trauma care and proposed an in house surgeon to provide better onsite care, improve trauma mortality and move patients through the hospital system more efficiently, avoiding or shortening hospitalizations and completing as much care as possible during the daytime to (avoid nighttime overtime for our support services such as Nursing, and saving money).

This program has been very successful, decreasing the number of patients dying of trauma by over 65%. We have succeeded in saving money , shortening hospital stays and delivering more efficient care. In addition, our rural patients transferred in for surgical opinions and specialized procedures received them within a few hours and were often transferred back to their local rural hospital on the same day.

Unfortunately, all such stipend arrangements end March 31, and combined with other fee changes (the clawback of any physician fees related to hospital visits), will make it impossible for us to keep a surgeon in the hospital during the daytime for emergent issues or rapid trauma care.

We also want you to be aware of the consequences of not having this program after March 31- longer hospitalizations, longer waits in ER for the surgeon who will be working in their office and cannot attend til 5 PM, more night time emergency cases, which all lead to more overtime, more hospital overcrowding and higher costs. In addition, based on our statistics, there will also likely be a higher trauma death rate.

Please support programs like this by supporting your local physicians and contacting your MLA to ask why important and vital programs are being deleted by our present UCP government.

We want to be there waiting for you!

10 thoughts on “Alberta South Zone Physicians Speak Out

  1. January 3, 2020 slipped and fell on ice, sustained a severe glenohumeral anterior shoulder dislocation that was reduced at approximately 2030 in Pincher Creek Hospital Emergency under propofol and 10 mg morphine (pain 10/10, begging them to “just reset it already, my hand is numb”. Opioid naive.
    Two X-rays there.
    Placed in a shoulder immobilizer sling. Woke up feeling like “uhhhh finally it’s back where it should be.”
    – Off work for 2 weeks, physiotherapy week three of injury, sent for an urgent shoulder ultrasound for a suspected labra or biceps ligament tear.
    – Found out I had a hill Sachs lesion at week 3 of injury that was present on Jan 3 in Pincher ER. Back in the sling for 6 weeks.
    – Feb 27, acute pain crisis (was no longer able to take regular Advil after 7 weeks as it was giving me severe stomach issues).
    – Feb 14, had second anterior dislocation that I was able to reduce myself at home. (Cue pain).
    – Feb 22 had my first ever pain induced panic attack (Scary shit) was able to calm myself down in the shower with 5-4-3-2-1 exercise and deep breathing like I’ve done with many of my kiddos before.
    – Feb 26 Given a prescription for Naproxen/esomeprazole to help by Dr. Brett Kelly.
    – Waiting for an urgent MRI under contrast for a suspected labral tear in my shoulder, hyperextended elbow, amongst other things. (Found out Feb 26).
    – Feb 27: woke up unable to move my left hand, it was cold and numb (CSMW compromised … went to physio when I should have went to emerg but I’m a stubborn nurse) lol.
    – Waited in ER from 1130-1430 before I went back, 1530-1745 until an orthopaedic tech saw me.
    – 1845 went for shoulder x-ray (4th one in 7 weeks). Bones are intact.
    – 1930 seen by the ER dr who gave me a prescription for a topical analgesic and Zofran, and advised to drink Ensure Nutrition Supplement after I was bawling that “I would never treat my patients the way I’ve been treated today.”
    – Lost 25 pounds since this accident, despite my efforts to eat at home but I’ve been so nauseated I had to take gravol and FORCE myself.
    – March 1 had first ever anaphylactic reaction to Naproxen/esomeprazole and took reactine and Benadryl.
    – No pain medications for me at this point except cold rubs and ice and heat on my shoulder.
    The thing that got me through this was knowing the nurses and doctors are doing THE BEST THEY CAN. Missing breaks, trying to get everything done in 8 or 12 hours in an already strained system.
    Watching people sit in agony, coming in one after another asking where their family was who “just got taken here by ambulance” in tears was ALOT for this empathic, compassionate nurse. UCP if you think this is okay …. then I beg you to sit in the waiting room of a busy hospital, doing the very best they can with ALREADY strained resources to help ALBERTANS.
    Enough is enough. From a patient nurse.

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  2. My self and my family are worried about health care as stated by the doctors in this letter. We are older and need the help. Mr. Kenny please be educated in your decisions to make cuts to health care and the damage they will do

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  3. As a former Registered Nurse in the UK now living in Lethbridge I have seen the devastating effects such cut-backs have had on the National Health Service.
    The domino effect that will occur following such a culling of staff and resources will have a devastating effect on patient care and outcomes and the strain on hospital staff trying to deliver even basic standards of care to meet the needs of an ever-growing population will result in the collapse of our health system here in Alberta. Please reconsider the wider long term picture. It’s madness to make financial decisions that will destroy a superior healthcare system that should be invested in and protected. Listen to the people who deliver the service who are the only ones who can see how this will end !

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  4. It seems that it is always the most vulnerable- the sick, injured , elderly, disabled and poor that end up paying the price for all these cutbacks. Please reconsider and listen to these frontline people who know the real issues before making drastic changes. We all know that there needs to be more fiscal restraint but please have some insight and compassion.

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  5. Thank you to the above doctors for not only attempting to educate our provincial government with regard to the effects of the proposed changes to take place on April 1st, but thank you as well for educating all citizens. This letter sheds a bright light on what we will possibly face in the near future. While all of the points are valid and likely equally important, I wanted to share my own experience, because attached to all of these “dollars” being saved, are the lives of people and their families.
    With regard to Palliative care losing the stipend needed to cover the travel cost of home visits to vulnerable and dying patients…
    My mother was diagnosed with stage 4 lung cancer in the fall of 2018, at only 61 years old. She passed away in September of 2019 in her home, surrounded by her family. Prior to that day, my mother fought cancer with ever ounce of energy and spirit she had. The Palliative Care team in the Medicine Hat region made it possible for her spend her final months in the comfort of her own home, where she was able to create countless memories that will forever be cherished by her 7 grandchildren, 3 daughters and husband. We were able to have a last Christmas dinner as a family, celebrate birthdays, learn to perfect treasured family recipes, laugh and cry together. Being together made an unbearably difficult time, so much more meaningful. This is what she wanted. These memories are what we hold on to. These are the days her we will remember. These are the moments her grandchildren will remember. Forever.
    Without the incredible support of the palliative home care team, none of this would have been possible. In addition, the money saved over the twelve months she would have required hospitalization for is tremendous. Our family was able to provide around the clock care for our mother, with the nurses coming to assist with only her medical needs.
    Sure there is a cost to palliative home care. But what is the cost to months of hospitalization? And financial considerations aside, I would ask how do you put a price on the time we were able to have as a family? I am thankful every day for the love and care we were able to provide our mother. Knowing that along with the Palliative Home Care team, we were able to extend my mother’s life, preserve her dignity and grant her a peaceful death surrounded by those who loved her, is priceless.
    While I have lost others in my life, I did not know the incredible importance of Palliative Home Care, until my mother needed it. Like many things, we don’t know the value of something until we need it. But no one is immune to such situations. For someday it may be you. Someday you too, may be thankful for and find peace in caring for a loved one at home. Someday you too, may need Palliative Home Care support. I hope it is there when you need it.

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    1. As a retired RN in Alberta, volunteer in the Chinook Regional Hospital and as a senior, almost certainly to be a patient at some point needing the assistance of our Health care system, I have seen the results of drastic cuts to health care during the Klein years – taking years to recover as doctors and nurses left the Province for greener pastures. I have seen the acuity
      rise over the years so that front line staff are at their bursting point as RNS being replaced with less qualified staff whose skills, although admirable, do not match the critical thinking of RNS .
      When I first came to Lethbridge 14yrs ago, we had great difficulty finding a GP as there was a shortage and at that time the ER was being filled with people who should have been treated in a primary care setting.
      We are now in a position where most people in the city are able to access a GP. This will change if the proposed changes occur as young doctors leave our province once again for greener pastures.
      I beg you to please reconsider this very short sighted way of thinking’- we , the public are going to suffer – believe me- I am talking from experience.

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  6. Mr. Kenny, Listen to the people who know. You obviously should listen to the people who voted you in.
    I would honestly believe if you had Your intentions of your cut backs out in the open for all residents of Alberta to see, we would never have voted you in….when peoples lives/health come second to financial concerns, we have major problems with decision makers like you. where is your compassion ? we see you have none…

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  7. In 2006 I had to go to the ER as I was in severe abdominal pain, I had to sit there freezing in a wheelchair for 5 1/2 hours until 11:30 pm when they took me back, only to be given something to knock me out, at 1:00 am my sister was told I would be staying in. I had emergency surgery which resulted in renal failure due to sepsis, one of the doctors that was in my surgery told me if I had been in the ER any longer I would have died. Due to my sepsis I was in hospital for 1 1/2 months. If the wait time was that long in 2006 and will be dramatically increased due to cutbacks like this, how many more people will die or come close to it and or will end up in renal failure. Since you were voted in Mr. Kenney you have made a lot of drastic changes and most if not all will be very devastating to this Province, just sit back and think about how this affects people not just the all mighty budget.

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