'Haphazard' Concordia ER, ICU closures too risky, city MD, past patient warns

A prominent Winnipeg physician who has undergone knee and hip surgeries at Concordia Hospital is concerned that the scheduled closures of the hospital’s emergency department and intensive care unit will put patients at risk.

Dr. Richard Boroditsky, who describes himself as "a past and future joint-replacement patient" at Concordia, called the decision "haphazard."

As a practising gynecologic surgeon, Boroditsky said he has operated on patients who have developed unexpected complications. Removing the ER and ICU will, potentially, leave some people at greater risk.

"They’ve had problems, they've had issues with complications and fortunately they've been able to handle them because they've had these support services around," he told the Free Press this week.

"Now I don’t know what’s going to happen."

'As a patient, I would not go to that hospital, and as a surgeon I would never operate at such a hospital that doesn’t have 24-hour care.' — Dr. Richard Boroditsky

The most recent plans outlined for the hospital indicate the ER will be converted to a walk-in clinic in June. The ICU is expected to close at some point in 2019.

"As a patient, I would not go to that hospital, and as a surgeon I would never operate at such a hospital that doesn’t have 24-hour care," he said.

If the closures proceed as planned, Boroditsky believes other resources should be considered, including a 24-7 team trained in advanced cardiac life support to treat cardiac arrest and respiratory problems, an around-the-clock House Medical Officer and laboratory services, EKG tests and diagnostic imaging.

"Unfortunately, most of the complications that occur during or after joint-replacement surgery aren't expected... but we’ll put it this way: even one or two complications a year that a patient dies or is put at risk is too many," he said.

Boroditsky said the Winnipeg Regional Health Authority could, as a consequence of its decision, be faced with threats from orthopedic surgeons to stop performing joint replacements without the necessary supports.

"I think the WRHA and government have to realize that they have to put some money into maintaining proper emergency coverage," he said.

As its medical director, Boroditsky fought a losing battle against the closure of the Mature Women’s Centre at Victoria General Hospital in 2017. The WRHA closed the centre, which had more than 5,000 patient visits in 2016, to save $160,000 a year.

Manitoba Nurses Union president Darlene Jackson said nurses have been concerned about cuts throughout the health-care system, including the changes at Concordia.

"They service a very large catchment area from outside the east side of the city and that’s a big concern when we already know how much overtime has been worked at the Grace, at St. Boniface and at HSC, and how busy their emergency departments are," she said.

Although post-operative complications are not common, they do happen and those patients need access to an intensive care unit, she said.

"Our understanding is that there is going to be a small unit for patients who do experience some post-operative complications and it's apparently going to be somewhere in the recovery-room area," she said.

"Unfortunately, we are not sure if that’s going to be a 24-7 unit, we don’t know what type of post-operative issues they are going to handle and those are questions that I don’t have answers to."

'I think the WRHA and government have to realize that they have to put some money into maintaining proper emergency coverage.' — Dr. Richard Boroditsky

WRHA spokesman Paul Turenne said discussions about support services are underway, but the details have yet to be confirmed.

"We will have a four-bed assessment unit on site with additional expertise and the capability to monitor and stabilize patients. There will also be a skilled clinical team in place and we will have laboratory and diagnostic imaging support," he said.

"The need to maintain access to a 24-7 code blue team has been identified by all parties. Concordia Hospital, the WRHA surgery program, physicians and other stakeholders are currently in discussions about how to ensure this access."

Turenne said a review involving professionals in anesthesia, surgery and other medical disciplines is underway to solidify the criteria that will determine a patient's risk level and eligibility to undergo surgery at Concordia.

"Patients will be assessed prior to surgery, and the highest-risk patients and those with complex medical conditions will most likely have their surgeries scheduled at a facility that has an ICU on site," he said.

From October 2017 to October 2018, more than 1,900 hip and knee surgeries were performed at Concordia.

Turenne said the pending changes to the ICU and ER at Concordia Hospital are not expected to change the number of surgeries performed.

nadya.pankiw@freepress.mb.ca