This goes against the grain for bloggers, but today I’d like to devote this space to the comments made in the Legislature on Thursday by Raj Sherman, the Edmonton-Meadowlark MLA and doctor whose scathing email about the emergency room crisis in Alberta nearly derailed his career. I’m not entirely comfortable with Sherman doing a complete about face and blaming the health care bureaucracy for all of the woes of the health care system, shifting the blame from the government, but I thought what he had to say was worth reading on its own. He makes a lot of interesting points about fairly straightforward solutions to the health crisis — and yes, he calls it a crisis — that it’s difficult to understand why nobody listened to him.
In any event, here’s what Raj Sherman had to say before his time ran out in the emergency debate on Thursday.
Dr. Sherman: Thank you, Mr. Speaker. It’s truly an honour for me to join you and speak on this very important issue. I’d like to start off with a quote from Martin Luther King. “Our life begins to end the day we become silent about things that matter.” I’ve spoken up – I think the whole world knows it now – on something that’s really important and matters a lot to society. It matters a lot to me.
This issue is a nonpartisan issue. This has nothing to do with politics. Mr. Speaker, I’m in a unique position. I’m an elected representative of this government. I’m also an emergency physician. As a physician some politicians could think I’m conflicted because those can’t mix. To be honest, I think politicians and doctors and health care professionals have the same goals in mind. As a physician I took an oath, the Hippocratic oath. “I will come for the benefit of the sick.” I have a moral and ethical duty and responsibility to society as a physician and as an elected member of government to be honest to the public.
I’d just like to tell you a little story about my father. He was admitted a few weeks ago for four days to the emergency department at the U of A. He never saw an in-patient bed for four days. Definitive care was delayed because he never got to the specialists upstairs. Then he got sent home, and within 30 hours, on the day I was supposed to go to India, at 3 in the morning my mother called an ambulance. He had a heart attack. Thanks to Dr. Paul Parks and them clanging the bells, the emergency departments were decanted partially. He survived the heart attack, and he’s back home now. He’s had five near-death situations this year alone due to waits in the emergency room.
In 2007, when I was in Dr. Paul Parks’ position, I called it a crisis on February 2. We had people dying in the emergency departments. We had five deaths and about a hundred near deaths in the Calgary health region. We met with the Calgary health region, they called in the Health Quality Council, and they sucked blood from stone.
In the Capital health region on January 14, 2008, we clanged the bells through the Capital health region. We predicted an imminent death within 24 hours of this letter, and subsequently we had five to seven deaths and about 200 near deaths in the Edmonton region in one hospital alone or at least delays in care. Those are the 322 cases that were documented at the request of Sheila Weatherill and passed on to upper administration by the ER docs. They were documented at my request when I was the representative of the emergency physicians.
I won’t get into problems because I don’t have much time, so I’m only going to talk about solutions. The number one solution is simple. We must understand the problem. What I found out is that in health care, in the policy shop and the delivery shop, there are a lot of well-meaning individuals, hard-working individuals in management and front-line staff that are working hard each and every day to give it their absolute best. What I’ve also found out is that some people at the upper levels – to be honest, I don’t know much about the oil industry, and I don’t know much about agriculture, but I know a heck of a lot about my industry. Many people designing policy in health care really don’t have a health care background, many people on the board have no health care background, and that’s part of the problem. I’m just going to give you a few quick solutions immediately on this problem, not the whole system problem.
One, immediately we must convene the experts, which is Alberta Health Services and the board, the ER docs, the Alberta Medical Association leaders, the nursing leaders, and politicians from all parties. We must all put our political beliefs aside at this moment in time. Dr. Paul Parks is absolutely correct in his assertions.
Two, we must call in the Health Quality Council. Dr. John Cowell did a Health Quality Council report for the Calgary health region in 2007, and there are many good recommendations in that report that can be immediately implemented.
Three, we need to call in the SWAT team. The SWAT team would be made up of Dr. Chris Eagle, who was the Calgary health region’s COO; Dr. Ken Gardener, who now is on the College of Physicians and Surgeons; Dr. Grant Innes from Calgary; Dr. Tom Noseworthy; Dr. Chip Doig; Dr. P.J. White from the AMA; and I think Janet Davidson would be a good mix. She runs a top hospital in Canada, in Ontario, the Trillium Health Centre. I’d be happy to work along with them.
It is a crisis. The problem is that many of my political colleagues are not physicians. They’re not front-line health care workers. They get speaking notes from bureaucrats who have no health care background, and they really don’t know. You can’t blame them, actually. It’s not their fault. The first thing I would do is do a partial implementation of a disaster plan in that we need to redeploy resources. We have God knows how many hundred RNs on Health Link. Let’s get them off the call centres and get them in front of patients. Let’s redeploy them into primary care networks, home care, and long-term care facilities.
We need to immediately decant the seniors from acute care ASAP. We have beds. We have long-term care beds. At one point in time a decision was made, when there wasn’t much money for AHS. That problem has been solved by this minister and this Premier and this government. We have given lots of money and funding to AHS.
I dug a shovel at the Villa Caritas in my area, at the Misericordia hospital. That should be used as a long-term care facility. I believe it’s built; it should be used immediately.
Secondly, at the Royal Alex hospital, the women’s pavilion, we have 150 empty beds. Since the Lois Hole hospital is open, they can be used as a transition unit immediately, but my understanding is that there is some legislation that needs tweaking and fixing. That should be used as a transition unit for DAL, assisted living. My understanding is that under legislation you have to have the regular staff. We need to immediately look at that and fix that.
Thirdly, home care. Home care, home care, home care is the real solution. There’s a lack of good home care. There are a lot of good, hard-working people, but they’re grossly underresourced. We have one of the worst home care systems in the country. Ontario and Nova Scotia have the best because the Red Cross and the Victorian Order of Nurses are involved. We need world-class home care. This is actually the solution.
Next, there were 1,000 Filipino nurses recruited. We couldn’t afford to pay them. We have the money. Let’s bring them in and redeploy them into this home care and into the beds.
Number eight, the primary care networks. We need to call in the AMA, Alberta Health Services, Alberta Health and Wellness and redeploy the primary care networks into acute care. I’m doing a review, and to be honest, in principle it’s good, but it’s all wrong. The people that need to be rostered onto those primary care networks as a first priority are those patients who are discharged from acute care. They have no family doctor to follow up with. Therefore, we have a 16 per cent readmission rate. One out of six people end up back in hospital to begin that same darn journey again.
Two, elderly patients who don’t have a GP need to be rostered second, right after these people, because they’ll get sick, and they’re going to be admitted.
Three, chronic disease patients who require care who will probably require hospitalization need to be on there.
Lastly, the healthy families. Don’t put the healthy families in there first and the sick patients last. The biggest problem in acute care is that we’ve got too many sick people. It ain’t the runny noses and sore throats causing the problem.
Number nine, prevention. Let’s contact our school boards and workplaces and make sure everybody gets vaccinated this flu season.
The fewer people that get sick, the fewer admissions in acute care. Now, after that’s done, we need to reassess and debrief, and we need to ensure that our medical system never ever faces this issue again, Mr. Speaker. This thing has been done every year by the emergency doctors for 10 years because this crisis happens every winter, and people die. To be honest, my poor government members have no idea because they’re not doctors, and the regions have been covering this up for years.
Then we need accountability measures after this, accountability measures where those who administrate health care must be held accountable. I have the CAEP guidelines here. This needs to be the main accountability measure, the number one performance measure of this system. This happened in the U.K. They had hundreds of deaths, and the ER wait time for admitted people is the number one accountability measure for the whole health system in the U.K. Every other health service feeds into that wait time for admitted patients in the ED. It’s not an emergency problem; it’s a system problem.
One very important thing that the member here mentioned, mental health. The problem in mental health is that we have a lot of people whom we can’t discharge to the street from Alberta Hospital Edmonton. Let’s just rent a darn hotel and get them out and then build something for these poor people who are stuck in Alberta Hospital and can’t get out.
Now, I’m going to be brutally honest here, Mr. Speaker. Some people may not like this. How did we get here? We got here because of a couple of knucklehead decisions: a knucklehead decision that cancelled Christmas dinner last year, a knucklehead decision to fire God’s representative from the Royal Alex hospital, a knucklehead decision to disband the health ethics network and close Alberta Hospital.
This is where his time ran out, which is too bad. I would have liked to hear more about the knuckleheads who run our health system.