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Manitoba physicians don't know who will be denied care if hospitals are overwhelmed, and need clarification on the protocol for dealing with a care-home outbreak that requires rapid intervention, a confidential document shows.

Those are two concerns detailed in an internal report from Doctors Manitoba, which represents physicians in the province.

The Free Press acquired the document, which Doctors Manitoba said it had no intention of making public. The group said it wants to work constructively with the provincial government.

“There is a lack of transparency about pandemic hospital planning and a lack of engagement of physicians in the process." — Quote from an internal report by Doctors Manitoba

The 12-page report paints a picture of physicians feeling disrespected by an evasive government that focuses more on hospital equipment and supplies than it does staffing.

"There is a lack of transparency about pandemic hospital planning and a lack of engagement of physicians in the process," reads the report, which was given to doctors and the province on Tuesday.

"This has created an acute lack of trust and serious concerns about whether effective planning has been done," reads the document, which the group asked its members to keep private.

"Physicians were distressed about the dismissive response from Shared Health regarding the need for a triage protocol if Manitoba runs out of life-saving resources," it notes.

Download Doctors Manitoba confidential report urging transparency, preparedness

The "dismissive" attitude was demonstrated in a virtual town hall on Nov. 5. At that point, St. Boniface Hospital had run out of intensive-care unit beds, and a doctor asked if they would be given guidance on who to turn away if the entire province exceeded its capacity.

"I will not be answering that question; this is a what-we-can-do, not a what-we-can't-do talk," said Shared Health’s chief medical officer, Dr. Perry Gray.

Days earlier, Health Minister Cameron Friesen had accused a group of 200 doctors of intentionally "causing chaos" by going public with their concerns about the strain on the health-care system, which they said the government had repeatedly ignored. They called for a full lockdown to clamp down on COVID-19 cases.

Friesen later said he didn’t mean to hurt doctors’ feelings, but he refused to apologize.

“... This is a what-we-can-do, not a what-we-can't-do talk." — Shared Health’s chief medical officer, Dr. Perry Gray in a virtual town hall

The Tuesday document pleads for better planning, saying Manitoba has focused on finding spaces and equipment for procedures, but not staffing. The plan to replace doctors who are sick and self-isolating is "seriously underdeveloped and lacking in details," Doctors Manitoba says.

The doctors say Shared Health has told them about a "bed map" that lists capacity in Winnipeg, but won’t share detailed information about each hospital's capacity, and what would trigger the move to send patients away from the nearest hospital.

Doctors Manitoba responds

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The group provided the following comment to the Free Press about the report it sent to the province in confidence:

Doctors Manitoba submitted a report to Shared Health offering constructive advice to rapidly improve the readiness of our hospitals for a surge in COVID admissions. While it appears provincial officials have ordered equipment and supplies to open more beds, those beds can't open without more doctors and nurses.

Our focus right now is to work with Shared Health to act on the advice from physicians to ensure hospitals are ready. Shared Health has indicated they are organizing more town halls with health-care providers next week to address the concerns physicians have raised.

— Doctors Manitoba spokesman Keir Johnson

The document lists issues doctors want to be informed about, including:

• what procedures are being cancelled

• how rural health centres will scale up or use air ambulance services

• outbreak numbers and suspected sources

• to whom frontline physicians are expected to escalate their concerns

• what would trigger a military or humanitarian intervention into Manitoba’s health system

• research or evidence that guided the development of the hospital contingency plans

Instead, the report notes, "many physicians mention that they hear information first from the media."

When told the Free Press had the document, Doctors Manitoba said it had wanted to give the province more time to respond, before making its concerns public.

In a statement, Shared Health said its planning has evolved over months, during which the "broad concepts of the plan" were given to doctors.

"We recognize that there remain questions and a desire for detailed information on where and when additional capacity will be added," wrote spokeswoman Amy McGuinness, adding that staffing plans are being finalized.

"We are committed to providing more details through a series of virtual town halls with staff and physicians over the coming weeks."