Grace Hospital patient safety ‘severely compromised,’ doctors tell health minister
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Doctors at Grace Hospital have sent an open letter urging the province to fill a gap in overnight care which they claim has “severely compromised” after-hours patient safety.
The letter, obtained by the Free Press, alleges baseline safety concerns and critical incident reports have increased since last spring, when resident physicians were withdrawn from the St. James hospital for “multiple complex reasons.”
Resident doctors helped provide overnight coverage for about 100 patients whose conditions could deteriorate at any time, says the letter addressed to Health Minister Audrey Gordon, which was signed by 45 general internal medicine physicians.
Open letter to the province
Dear Minister Gordon,
We are deeply concerned about patient safety at Grace General Hospital. As such, it is with urgency, and a collective sense of duty, that we write to you today to request your immediate attention and action.
Throughout the COVID-19 pandemic, the Section of General Internal Medicine at the Grace Hospital stepped up to care for Manitobans on the COVID-19 wards. We now require that the system does the same in support of our patients.
As you are aware, the reorganization of the Manitoba health care system in 2017 led to the centralization of acute care in three main centers in the Winnipeg area: Health Sciences Center, St. Boniface Hospital, and the Grace Hospital. The Section of General Internal Medicine is a group of subspecialized physicians responsible for staffing the Medicine inpatient wards at each site. These centers admit complex medical patients that can deteriorate at any time of day. The acuity of these patients requires frequent and timely assessments with close clinical monitoring.
We are deeply concerned about patient safety at Grace General Hospital. As such, it is with urgency, and a collective sense of duty, that we write to you today to request your immediate attention and action.
Throughout the COVID-19 pandemic, the Section of General Internal Medicine at the Grace Hospital stepped up to care for Manitobans on the COVID-19 wards. We now require that the system does the same in support of our patients.
As you are aware, the reorganization of the Manitoba health care system in 2017 led to the centralization of acute care in three main centers in the Winnipeg area: Health Sciences Center, St. Boniface Hospital, and the Grace Hospital. The Section of General Internal Medicine is a group of subspecialized physicians responsible for staffing the Medicine inpatient wards at each site. These centers admit complex medical patients that can deteriorate at any time of day. The acuity of these patients requires frequent and timely assessments with close clinical monitoring.
Last spring, for multiple complex reasons, resident physicians were withdrawn from the site. The residents historically helped provide overnight coverage for patients. Subsequently, there has been an increase in baseline safety concerns with a rise in critical incident reports. A temporary model was implemented this winter whereby the ICU hospitalist would help provide overnight coverage. However, this model of care will end on March 31, 2023, and only served to provide rapid response to patients who had already deteriorated. There is continued concern regarding this model, as this service was not dedicated to the approximately 100 acutely ill medical patients and not set up to catch and prevent clinical deterioration prior to requiring ICU care. The situation has become so severe that some of our section members no longer feel comfortable working at Grace Hospital, recognizing the lack of patient safety which occurs after hours in that building.
In our attempts to find a solution to this crisis, we submitted briefing notes to the WRHA which we strongly believed would help augment our ability to provide safe overnight patient care. Our proposal in November 2022 requested emergent funding of an overnight HMO (hospitalist). We should stress that this is a standard of care which is already available for acute medical patients at the Health Sciences Centre and St. Boniface Hospital. Many other departments across the WRHA use HMO services to augment care of patients’ after-hours.
Our initial proposal was approved but then retracted days later, for unclear reasons. We submitted a new proposal with the same request and we were met with silence until the morning of Tuesday, March 7th. Disappointingly, WRHA leadership at this time has not provided an appropriate funding model, and we have re-iterated that as a result we are unable to recruit specialist physicians for this position.
Our members are concerned for the well-being of our patients and our continued ability to provide high quality complex care. We cannot emphasize enough that patient safety remains severely compromised at the Grace Hospital because of the current inadequate response and commitment to properly fund a position. This is below the standard of medical care that Manitobans deserve. We ask that you support the immediate competitive and fair funding of an overnight HMO for the acute medicine wards at Grace Hospital.
We remain committed to our patients, and we will continue to advocate for their safety. Your response to this request is urgently awaited.
Sincerely,
The Section of General Internal Medicine
Rady Faculty of Health Sciences
1. Dr. Laura Chisick
2. Dr. Nick Hajidiacos
3. Dr. Bijai Johnson
4. Dr. Anthony Battad
5. Dr. David Christiansen
6. Dr. Elise Crocker
7. Dr. Aditya Sharma
8. Dr. Rhys Sharkey
9. Dr. Graham Duff
10. Dr. Jonathon Bellas
11. Dr. Joel Nkosi
12. Dr. Terry Colbourne
13. Dr. Martha Shepertycky
14. Dr. Matthew Mittelstadt
15. Dr. Jeffrey Wheeler
16. Dr. Tyler Friesen
17. Dr. Kiraninder Lamba
18. Dr. Asad Junaid
19. Dr. Timothy Hiebert
20. Dr. Aimee Li
21. Dr. Mathieu Labossiere
22. Dr. Evan Orlikow
23. Dr. Patrick Griffin
24. Dr. Terry Wuerz
25. Dr. Annaliese Tisseverasinghe
26. Dr. Nithya Venkatesen
27. Dr. Vinit Elimban
28. Dr. Benjamin Fultz
29. Dr. Steven Grocholski
30. Dr. Brittany Perija
31. Dr. Carmen Hurd
32. Dr. Amber Janower
33. Dr. Jessica Cudmore
34. Dr. Joe Jose
33. Dr. Michael Semus
34. Dr. Rachel Fainstein
35. Dr. Jonathan Laxton
36. Dr. Andrew McKinnon
37. Dr. Abdul-Nasser Ramadan
38. Dr. Sandip Bhangoo
39. Dr. Matthias Kramer
40. Dr. Jennifer Zeigler
41. Dr. Frank Bovell
42. Dr. Stephen Goulet
43. Dr. Amiya Chakraborty
44. Dr. Michael Sochocki
45. Dr. Shadi Mahmoud
“Our members are concerned for the well-being of our patients and our continued ability to provide high-quality complex care,” the letter, dated Thursday, stated.
The doctors called for government funding to hire an overnight hospital medical officer, or hospitalist, on the acute medicine wards to improve care for patients who require frequent and timely assessments with close monitoring.
“We cannot emphasize enough that patient safety remains severely compromised at the Grace Hospital because of the current inadequate response and commitment to properly fund a position,” stated the letter.
Some of the physicians no longer feel comfortable working at the hospital because the situation has become so severe, the group says.
The doctors said they raised their concerns with the Winnipeg Regional Health Authority and last November submitted a request for emergent funding of an overnight hospitalist.
The proposal was approved, but retracted days later without explanation, the letter claims.
A new proposal was met with silence until Tuesday, the doctors allege.
“Disappointingly, WRHA leadership at this time has not provided an appropriate funding model, and we have reiterated that as a result, we are unable to recruit specialist physicians for this position,” they wrote. “We should stress that this is a standard of care which is already available for acute medical patients at the Health Sciences Centre and St. Boniface Hospital.”
After the letter was shared with the media Friday, the WRHA said it approved more resources for the Grace last week.
“Grace Hospital has been notified that (it) can hire additional physician assistants and one hospital medical officer for the overnight shift on the acute medicine ward,” a spokeswoman wrote in an email. “We see the contributions of our staff and are thankful for their tremendous dedication to their patients and to one another. We are committed to addressing the challenges they face.”
Gordon, who held an unrelated news conference Friday, said it’s now a matter of hiring for those positions.
She insisted the government is listening and taking steps to retain physicians amid other measures to address staff shortages.
“What I say to those doctors is our government is responding,” the health minister said.
As a temporary solution after resident doctors were withdrawn, Grace Hospital brought in an intensive care unit doctor over the winter to help provide overnight coverage, according to the letter.
However, the arrangement is due to end March 31, and only provides rapid response to patients whose condition has already deteriorated, the doctors wrote.
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They said the temporary model is not dedicated to the hospital’s acutely ill medical patients, and not designed to catch and prevent a patient’s condition from deteriorating before they require ICU treatment.
The 45 doctors are from the section of general internal medicine, which staffs medicine inpatient wards at Grace, HSC and St. Boniface.
The government consolidated acute care to the three sites in 2017.
Doctors Manitoba president Dr. Candace Bradshaw said the issue shouldn’t have “languished” for so long that the physicians felt compelled to write to the health minister.
“It should never have come to this,” Bradshaw said in a statement. “However, I am optimistic, as my experience with the minister is that she listens, and I hope she is listening right now and will act swiftly to ensure patients needing medical care will get it morning, noon and overnight.”
ERIK PINDERA / WINNIPEG FREE PRESS “It should never have come to this,” Bradshaw Doctors Manitoba president Dr. Candace Bradshaw said in a statement.
Bradshaw said the situation is another example of the “serious and alarming ways” patient care is being affected by Manitoba’s record shortage of doctors.
NDP health critic Uzoma Asagwara said the letter outlines “pretty scary situations.”
The Union Station MLA called on the government to address the group’s concerns and make good on its promises of incentives to help retain staff.
“We have heard over the past one year and longer, actually, from doctors and nurses who have made very clear that Grace Hospital is struggling to provide the care that Manitobans need,” said Asagwara.
The Manitoba Nurses Union stands with the physicians who are requesting more resources to better care for their patients, said president Darlene Jackson.
“MNU has been doing the same on behalf of its members for years. Not only is lack of resources unsafe, but it is ethically disturbing for front-line staff to find themselves being placed in such a situation,” she said in a statement. “Baseline staffing is a growing concern and something that needs to be addressed throughout the system. It should not take a media leak to do so.”
— with files from Katie May and Danielle Da Silva
chris.kitching@freepress.mb.ca
Twitter: @chriskitching
Chris Kitching
Reporter
As a general assignment reporter, Chris covers a little bit of everything for the Free Press.
History
Updated on Friday, March 10, 2023 3:00 PM CST: Text of letter added.
Updated on Friday, March 10, 2023 4:35 PM CST: Adds comments from WRHA and Audrey Gordon.
