A city policy of fining hospitals for keeping ambulances waiting to off-load patients is creating "angst" for emergency room nurses who feel pressured to give them priority over needier patients waiting inside the ER.
Sandi Mowat, president of the Manitoba Nurses Union, raised the concern Thursday at the provincial inquest into the death of Brian Sinclair.
Mowat said Winnipeg ER nurses have told her how difficult their job has become since hospitals started being charged by the city when ambulances are forced to wait more than one hour to off-load a patient.
"There's been a lot of angst, a lot of hard feelings created by these off-loading policies," she testified at the inquest.
MNU lawyer Garth Smorang asked Mowat whether nurses felt pressured to provide a bed more quickly for patients brought in by ambulance than those waiting in an emergency room who aren't costing the hospital extra money.
"Not only has there been a feeling of pressure, there have been some facilities where the managers have come from their office and directed the triage nurse to find a place for the patient that is now costing them money," the nurses union president replied.
Later, under questioning by Winnipeg Regional Health Authority lawyer Bill Olson, Mowat stood by her statement.
"That's a very serious allegation," said Olson, who told Mowat WRHA officials were "not aware of any such incidents."
He implored Mowat to provide details to health authorities so they can investigate the matter.
Afterwards, Mowat declined to identify the hospitals involved, although she noted there were more than one.
Patients waiting inside the ER and those waiting to be off-loaded are triaged and assigned a priority number based on how serious their condition is.
Olson said the WRHA's policy is if a patient waiting in the ER and an ambulance patient are in equally serious condition, the one who is waiting to be off-loaded from an ambulance will get a bed first. That's so the ambulance can return to the streets. But the policy does not permit more seriously ill patients in the ER to be passed over, he said.
Mowat was the final witness to be called this week before provincial court Judge Tim Preston. The inquest resumes June 9.
Brian Sinclair, 45, died Sept. 21, 2008, after spending 34 hours in Health Sciences Centre's emergency waiting room without being triaged. He had been referred there by an outside clinic because of a blocked urinary catheter.
The inquest has been told Sinclair may have died up to seven hours before he was discovered by hospital staff.
In her testimony Thursday, Mowat, a former ER nurse, said as of last year there were 700 nursing vacancies in Winnipeg and likely another 500 outside the city.
Chronic staff shortages have meant nurses are joining the ER with less experience than in the past, she said.
Hospital-bed shortages continue to give ER staff fits, Mowat said, with admitted patients remaining in the emergency department for up to 150 hours.
Some patients admitted to hospital spend their entire time in the emergency department, she said.
"Nurses are torn between taking care of those patients -- some of them quite ill -- and having to also manage with what's coming through the door," Mowat said.