Top physicians warned Winnipeg hospitals nearing 'disintegration' in March letter

top out lake winnipeg doctors warned in a secret letter of the alphabet in process that urgent care centres might have to close and another patient death was inevitable unless immediate changes were made.

They say physicians are "repeatedly forced to choose" who gets care first, knowing the condition of other patients might decline while they wait.

"We do not want to stand at the bedside of another person who deteriorated due to preventable delays and gaps in care — knowing their outcome would have been different," the letter, which was addressed to health-care leadership, said.

"We are asking for urgent action now to prevent a preventable death and to ensure Manitobans can count on timely, safe, compassionate emergency care when they need it most."

It was signed by medical directors at Winnipeg's community hospitals: Grace, Victoria, Seven Oaks and Concordia. None of them agreed to an interview.

Since the letter was issued, the provincial government has created a new financial bonus to encourage physicians to work in community hospitals and found family doctors willing to be trained to pick up shifts in emergency department and urgent care settings.

Health Minister Uzoma Asagwara said staffing levels have improved as a result.

The eight-page letter, however, said occasions when one doctor is left to run an entire emergency department while simultaneously responding to critical situations elsewhere in the hospital "now occur daily," leading to "high-risk situations more routinely."

On Feb. 16, the only physician and resuscitation-trained nurse at Seven Oaks was tied up for four hours with a patient with a significant heart condition. That person would have usually received intensive care elsewhere, but two other hospitals were over capacity, the letter said.

That doctor and nurse couldn't respond to other emergencies at Seven Oaks during those four hours.

The letter's signatories wrote that a doctor can't safely manage two patients becoming critically ill at the same time.

"If one of these patients experiences a bad outcome, we will have to answer to their families why this happened, and whether it could have been preventable."

Medical directors warned that without immediate action, temporary closures of urgent care departments will become a "realistic outcome" in the coming months.

They cite a March evening when a single doctor at Grace's emergency department oversaw more than 90 acutely ill patients. The baseline staffing for those hours is three physicians.

The letter warned 28.1 per cent of emergency physician shifts were expected to be vacant in April, with the shortage likely worsening by summer, when 45 per cent of Seven Oaks shifts were projected to go unfilled.

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If this happened, hospitals would have no doctors to respond to emergencies. The letter recommends contingency plans be created in case of forced service reductions or closures.

Any closure would have "system-wide consequences," it said.

Some hospitals would decline transfers. Seven Oaks couldn't provide safe operations for hemodialysis, a life-sustaining treatment for kidney failures, while staff at Concordia might not have the capacity for joint replacement surgeries.

Even before reaching that point, doctors are making difficult decisions because they lack support, the letter said.

"Overall, we are repeatedly forced to choose who appears sickest — accepting that others may deteriorate while waiting, may leave without care, or may return later in extremis. This generates profound moral distress on all staff and accelerates turnover," it said.

"Another critical incident and patient death are not a question of 'if' but a question of 'when,' unless conditions change."

The medical directors also say the Victoria Hospital, which is currently an urgent care, isn't prepared to revert to an emergency department in 2027. The letter said many of the hospital's doctors haven't maintained, or never acquired, the skills necessary to work in an ER.

"Rebranding without readiness will increase only risk, not patient access," it said.

Progressive Conservative health critic Kathleen Cook said the letter is a dire warning that demands the NDP government's attention.

"It's not speculation. It's from people who know what they're talking about, and it should be raising significant alarm bells within the provincial government."

Asagwara said the province has responded. It hosted town halls with emergency physicians and led a recruiting trip to the United Kingdom where finding ER doctors was a primary objective.

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The government also launched a one-year pilot program where physicians who commit to a regular schedule of shifts in one of the community hospitals, along with the Boundary Trails and Brandon hospitals, are rewarded with a financial bonus, Doctors Manitoba said.

The physician advocacy group said the program was introduced over the last few weeks, and some gaps in coverage are being addressed.

So far, more than 80 physicians have signed up for the incentive, Asagwara said. The government has budgeted around $6 million.

"This is a way for physicians to be retained. It's also a way for them to be encouraged to increase … their hours of practice in our urgent cares and emergency departments so that we've got more consistent staffing," the minister said.

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Cook said she appreciates the new incentive but it amounts to shuffling, rather than adding, resources.

"If that's what needs to happen to prevent urgent care closures, then I'm in support of that, to be clear, but it's not a panacea."

The creation of a financial incentive was one recommendation the medical directors made in their letter.

They wrote that many of their doctors split their time with other facilities because they're better compensated at Winnipeg's tertiary hospitals, Health Sciences Centre or St. Boniface, and walk-in clinics where they see "far less acuity, liability, moral distress and shift work."

Asagwara also said the province has recently found more than 45 family practitioners who want to receive additional training to pick up shifts in emergency rooms and urgent care settings.

Other recommendations in the letter include more social workers, addictions, mental health and diagnostic services at community hospitals. They say the former PC government converting three Winnipeg emergency departments into urgent care centres between 2017-19 created a "mismatch," where departments "continue to deliver ICU level care without even acute medicine supports."

The medical directors want the consultants, who are called to assess patients requiring admission or speciality care, to take more ownership over "decision-making, orders and disposition." Otherwise, some patients are left waiting too long in ERs and urgent care facilities.

The group also wants VECTRS, Manitoba's centralized source for clinical guidance and patient transport to health-care staff, to become the "sole point of contact" around patient transfers.

It can currently take more than 30 minutes and multiple phone calls between facilities to permit a transfer, the letter said.

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The doctors also asked for more social worker support at Seven Oaks General Hospital after 4 p.m., but in June, the province announced 24/7 support for that facility.

Dr. Nichelle Desilets, past-president of Doctors Manitoba, said the fact senior physicians came together to write a letter to leadership underscores the seriousness of their concerns. The issues raised are not isolated incidents, she said.

Still, Desilets said she's encouraged the province is acting.

Provincial affairs reporter

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