Winnipeg Free Press - PRINT EDITION

Hospitals pass the buck, broken legs neglected

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How can our health-care system spend billions and still be unable to fix a broken leg? The following incredible scenario should never have happened. But it reminded me of a conversation I had with a snotty London hotel clerk many years ago. And what would have happened if this patient had been the U.S. president?

Recently I received a telephone call from a shaken friend whose wife had fallen at their cottage. She had been taken by ambulance to the local hospital. The diagnosis? Two badly fractured leg bones. But the emergency room doctor explained the hospital had no orthopedic surgeon on staff. His wife would have to be transferred to another hospital.

I told him not to worry, assuring him that, although our medical system was not perfect, acute problems like heart attacks and accidents receive prompt attention. But 12 hours later the hospital could find neither another facility willing to accept the patient nor an orthopedic surgeon. "No beds" they were told. Three days later, a desperate husband called again. His wife was still lying with a broken leg in the same hospital.

At this point I realized a broken leg was now being ignored by a broken medical system. I placed a desperate call to an empathetic orthopedic colleague who agreed to help. How long this patient would have remained without treatment we'll never know.

So what went wrong? Several things. First, the leg was broken at a remote cottage, the wrong location. It meant the ambulance was required to transport her to the nearest rural hospital for assessment. If this injury had occurred near a larger hospital there would have been speedier treatment. The second error is one that should not happen. Several large hospitals claimed no beds were available. They should have responded, "We will accept the transfer. We do not have a bed immediately available, but an orthopedic surgeon will see the patient and arrange for treatment."

This might have meant postponing elective surgery temporarily, such as a patient scheduled for hip replacement, or an arthroscopic operation to remove bony fragments from an arthritic knee. But I'm sure few would disagree that a badly fractured leg takes precedence over these chronic problems.

This situation reminded me of a time when I foolishly failed to make a reservation at a London, England, hotel. The reservation manager arrogantly informed me there were no rooms available. I replied, "Suppose the president of the U.S. arrived now and asked for a room, what would you do?" "Well sir" he responded, "We'd have to find one." I quickly retorted, "I'll take that room." The surprised clerk found one!

I recount this story because if this woman had been the prime minister of Canada, the mayor of Toronto or a hockey player, you can bet your last dollar they would not have lain for three days with a badly broken leg in a small hospital. In fact, you can bet another dollar they would have been immediately airlifted to a bed in large hospital.

I questioned several orthopedic colleagues how a problem of this kind could be resolved. One advised there should be more private clinics where non-acute joint problems could be treated more efficiently. He cited a facility where 10 laparoscopic procedures could be done daily compared to six in major hospitals. This, he said, would free up more hospital beds.

Others suggested incentive pay for orthopedic surgeons to work in smaller hospitals. I also know of a well-trained foreign orthopedic surgeon, willing to work anywhere in this country, who for five years has been waiting for the approval to do so.

So will this scenario ever happen again? It will if nothing is done to prohibit administrators from replying, "We have no beds," while passing the buck to the next hospital and the next.


Republished from the Winnipeg Free Press print edition September 24, 2010 A25

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