Quebec may punish hospital docs for long ER waits

QUEBEC CITY – Under a proposed amendment to Bill 130, hospitals would no longer be allowed to keep patients in ERs for longer than 24 hours, except those who need to be isolated for public health reasons or because of a psychiatric episode.

Hospital managers who choose to keep patients in ERs for longer than 24 hours – rather than have them admitted to an inpatient ward – would risk losing their jobs.

The Montreal Gazette reported that the amendment does not allude specifically to ER doctors, but Bill 130 would give the minister and senior administrators greater powers to revoke the privileges of physicians to practice in hospitals should they run afoul of the new duties imposed on them.

“As the minister clarified today, the objective is not punitive,” Julie White, Health Minister Gaetan Barrette’s (pictured) press attaché, explained in an email.

“It’s a tool that will help reach the goal … of better coordination between the ERs and different (hospital) departments. That said, it is possible that there could be consequences – notably disciplinary ones – if this article were adopted and the law would not be respected.”

Bill 130 is Barrette’s third reform after merging health institutions and compelling family doctors to take on more patients. Quebec’s medical specialists have threatened legal action against Bill 130 should it be adopted by the National Assembly.

Patient-rights advocate Paul Brunet, of the Conseil pour la protection des malades, argued that Barrette is tackling the ER crisis the wrong way. Instead of allocating more funds for long-term care beds, the minister is seeking to punish doctors, he said.

“Does the minister honestly think that the hospital managers and doctors want to keep patients in the emergency room on purpose,” Brunet asked. “Of course they don’t want to do that. The problem is that they can’t transfer these patients from the ER to hospital beds because 25 percent of those beds are taken up with chronic-care patients.”

Brunet expressed concern that some hospital managers might transfer some long-term care patients to outlying nursing homes far away from their families so they could free up beds for emergency cases.

“Most of the time these institutions are not adapted to the conditions of the patients and they’re far from their original community,” he added. “We’ve seen the horrors that occur when pressure is put on doctors and managers.”

Barrette announced in December that the government was spending $100 million to free up hospital beds so that ER patients could be admitted to them. Under the government plan, Quebec would create nearly 1,500 spaces in long-term care centres, which would then be able to absorb elderly patients from acute-care hospitals.

Brunet, however, urged the government to open more long-term beds to account for the province’s aging population. The problem is that the government has cut health funding in the past few years.

“They will end up with very bad results,” Brunet said of the health ministry. “They think that with $1 billion less in the budget for healthcare they can do better than they did before. That won’t happen.”

ER overcrowding remains a problem in many of the city’s hospitals, including at the Royal Victoria, Jewish General, Maisonneuve-Rosemont and Notre Dame. At the Royal Vic at the Glen site on Wednesday morning, the ER capacity soared to 130 per cent. Of that number, nine patients were receiving care in the ER for more than 24 hours.

At the Jewish General, by comparison, the ER capacity was at 102 per cent, and there were no patients languishing for more than 24 hours.

In Quebec, the current average waiting time before a patient on a stretcher in the ER gets transferred to a hospital room is 13.6 hours.

“There’s a big difference,” Barrette said, noting the average time in 2016 was 15.6 hours. While Barrette said that’s the lowest waiting time he has seen in nearly a decade, there is still room for improvement.

The medical community has concluded the reasonable average waiting time shouldn’t be more than 12 hours, according to Barrette.

He said that while Quebec’s healthcare system is close to reaching that goal, that there are still too many patients spending a day or more on stretchers in the ER.

A report published last year by Quebec’s health and welfare commissioner found that the province has had unacceptable ER wait times for at least 20 years, achieving the dubious honour of having the longest average waits in the Western world – with 35 percent of patients waiting five or more hours for care. (In Ontario, by comparison, the figure is 15 percent and in Germany, it’s 5 percent.)