Absurd policy on ER service must be fixed

The StarPhoenix April 22, 2009

We were told three years ago that the Saskatoon Health Region had written a policy on what to do with patients who show up at the emergency room even just minutes before City Hospital’s part-time ER opens.

Apparently that bizarre little policy — to call an ambulance — applies even when the ER is open.

This week The StarPhoenix reported that when Saskatoon contractor Ken Olson informed City Hospital ER staff that a man in a hospital gown had collapsed just outside the door, rather than take steps to help the unfortunate soul or even see what was wrong, their first response was to phone 911.

That, according to Patti Simonar, director of emergency and critical care services for the health region, is standard procedure. Emergency Room personnel at City Hospital apparently aren’t equipped to deal with an emergency.

There was no attempt on their part to assess the patient’s condition, to get a gurney or back-brace to the scene, or even to rush out and triage the patient. That is an assessment apparently better handled by paramedics in an ambulance that’s four to six minutes away, rather than by emergency doctors and nurses on hand whom most Saskatoon residents believed until now are trained to deal with medical emergencies.

This isn’t the first time people at City Hospital’s emergency department opted to call for help rather than offer their own expertise. In March 2006, Ron Bitz, in the midst of suffering a significant heart attack, showed up at the hospital’s ER department 10 minutes before it was officially to open for the day.

He was made to cool his heels outside, with an ambulance crew working on him until the doors were unlocked. Ever since City Hospital stopped offering 24-hour emergency service, explained Dr. Paul Hayes, then medical director of emergency services for the health region, a policy had been put in place that would leave the off-hour triaging of such patients to a switchboard operator and security guards.

“We know that before 9 o’clock, you may not have all of the staff and support services you need to treat a life-threatening emergency at City Hospital,” Deb Gudmundson, general manager of emergency services for the health region, told The SP at the time. While such a highly bureaucratic response might be reasonable in the middle of the night, when it’s hours before someone qualified to deal with an emergency shows up to work at City Hospital and it’s much quicker to rush a patient to one of Saskatoon’s other two hospitals, Mr. Bitz showed up 10 minutes before the doors were opened.

But apparently flexibility and common sense haven’t been incorporated into the health region’s policies. Better to have someone suffer serious injury or death than to take responsibility for opening 10 minutes early.

As silly as that rationale was, the argument being put forward now is even weaker. We are told that emergency room personnel dare not pop their heads out their front doors to see what’s happening with one of their patients for fear that it could result in some danger to staff or the patient. It’s absurd enough that someone in that emergency department opted to dial 911 than do the logical thing. Sometimes, in the heat of the moment a bad decision can be made. And in this instance, the security officials who saw to the man’s welfare were able to offer assistance.

According to Health Minister Don McMorris, the case also ended well in that the patient didn’t suffer any serious health problems because of the decision.

What is more distressing, however, is Ms. Simonar’s response that this irrational response is not only the policy in Saskatoon but reflects what’s in place across Canada. To his credit, Mr. McMorris no sooner learned of the incident in City Hospital’s ER than he contacted each of Saskatchewan’s 12 health regions and asked that common sense be incorporated into their policies to ensure such a thing shouldn’t happen again.

But whether the ministry will have any luck is still anyone’s guess. After all, after Mr. Bitz’s case came to light, then Health minister Len Taylor of the NDP government promised to review procedures to inject some humanity and common sense into the process of emergency evaluations.

This happened only after the Saskatchewan Party then in Opposition hammered the government daily over such shortcomings in the provincial health system. On Tuesday, it was NDP critic Judy Junor taking Mr. McMorris to task.

The government has established a commission to conduct a patients-first review of Saskatchewan’s health-care system, with the view to address issues from the consumer’s perspective.

Before that can be effective, however, there has to be a complete overhaul of the health region’s communication strategy that ignores all logic in striving to justify the unjustifiable.