Alberta emergency room doctors have counted what they say are six potentially preventable deaths and numerous close calls for patients who they say waited too long for care in emergency rooms across the province.
Dr. Paul Parks, a Medicine Hat ER physician and past president of the Alberta Medical Association (AMA), says he and his emergency medicine colleagues compiled the list of cases that they say occurred over a two-week period in late December and early January.
CBC News obtained the document listing the cases from multiple sources. Parks confirmed it was authentic and said he had sent it to provincial government and health officials on Jan. 11 in a bid to get more help for the stressed system. Parks did not provide the document to CBC News.
It feels “horrendous” to watch patients suffer while health-care workers lack adequate staff or hospital space to help them, Parks said in an interview on Monday.
“I've been here 25 years and never seen it this bad,” he said, adding that he believes the cases his colleagues enumerated are the "tip of the iceberg."
Parks said emergency doctors across the province began collecting examples of cases where they say they believe patients were harmed by delayed access to care after a 44-year-old man died in the emergency room at Edmonton's Grey Nuns Community Hospital last month. Prashant Sreekumar's family says he had waited nearly eight hours to see a doctor about his chest pain. The provincial government has since ordered a fatality inquiry to look into the death.
Although Sreekumar’s family has been vocal about their experience, Parks said similar scenarios are playing out in emergency departments across the province without as much public attention.
Dr. Scott MacLean, an emergency physician working at the Royal Alexandra Hospital and Northeast Community Health Centre in Edmonton, said he believes the list likely underestimates patients who are in worse shape due to ER wait times.
An Acute Care Alberta spokesperson said they won’t comment on any of the cases compiled by doctors due to patient privacy concerns.
'Still uncertain if he will survive,' doctors writeThere are no dates or locations provided for each incident in the document sent to provincial officials in order to protect patients’ privacy, Parks said.
Among the six deaths doctors recorded was a middle-aged man with chest pain who they allege spent eight hours in an emergency waiting room before a bed was available. They say the patient was agitated, his heart stopped and staff couldn’t save him.
“This case should be very alarming, as it is exactly like the very tragic and very public case of the death at [the Grey Nuns emergency department] recently,” the document says.
The doctors allege another man in his 50s died from multi-organ failure caused by a bacterial blood infection. They said he waited in an urban ER for at least seven hours without being seen, and then left. EMS brought him in a few hours later in dire condition, they say.
WATCH | Doctors sent list to ministers and health-care agencies:A list compiled by an Alberta doctor, alleges there were six deaths and dozens of so-called near misses in the province’s emergency rooms in late December. The list was included in a letter sent to ministers and health-care agencies with a plea for help to combat overcrowding.A female patient who the doctors say waited too long for emergency surgery for a bowel obstruction and perforation died of organ failure 24 hours later, the doctors allege. They also allege that people who kept showing up at the ER more critically ill delayed a doctor from getting to her.
Among the patients who the doctors say were still alive when Parks sent the document to the provincial government was a 50-year-old woman with a tear in her aorta, which is the artery delivering oxygenated blood from the heart to the rest of the body. The doctors said she had a history of similar problems. Doctors allege she waited eight-and-a-half hours to be seen and that all assessment was done in the waiting room before she was rushed to surgery.
They allege a man with a ruptured spleen waited more than four hours for attention. A man in his 20s with influenza had pneumonia and crashed after waiting seven hours, and ended up with organ failure in the intensive care unit, they allege.
“Still uncertain if he will survive ICU care,” they note.
A woman having a stroke waited — confused — for four hours in a wheelchair, they allege. And a man in his 70s had a major heart attack in the waiting room with no bed available for two hours, they allege.
“Likely will have long-term cardiac damage due to delays, could have died in the [waiting room],” the doctors note.
The list of at least 27 cases highlights patient suffering, uncontrolled pain and no privacy to give patients and families bad news. Some patients who were in medical crisis were resuscitated in hallways, the doctors allege.
The document says patients often wait days in the emergency room to be admitted to a hospital ward and that emergency doctors don’t always have the training or expertise to manage their conditions.
MacLean said he hopes telling the stories of individual patients will garner more attention than pointing to long wait times.
Doctors sometimes aren't able to see patients triaged as needing attention within 15 to 20 minutes for five or more hours, he said.
The lack of hospital space and staff are to blame, MacLean said.
"We haven't built a new hospital in Edmonton since 1988," he said. "The population has doubled. So where are those patients going? They're coming to my emergency department and they're sitting there waiting to see me. "
Patients and their families in waiting rooms are becoming more outspoken — and sometimes aggressive to staff — to get care, he said.
Minister of Hospital and Surgical Health Services Matt Jones (Government of Alberta)Kyle Warner, press secretary to Hospital and Surgical Health Services Minister Matt Jones, said in a statement on Monday that reviewing cases with unexpected negative outcomes is a routine process for the health-care system.
Although Warner wouldn’t comment on the anonymized patient reports, he said, “We take all information related to patient outcomes seriously.”
Warner said Jones plans to meet with people with the AMA and Acute Care Alberta to hear their ideas to address pressure.
"He wants to ensure a shared understanding that the system is under exceptional strain, is responding as it has in past years, and requires additional resources beyond flu season,” Warner’s statement said. “The government is working on long-term solutions to significantly expand capacity.”
Acute Care Alberta spokesperson Jennifer Vanderlaan wrote in a statement on Monday that patients come to hospitals in serious or critical condition, and “sadly, deaths are not uncommon in the health system.”
She said there are mechanisms for doctors and staff to raise concerns about care patients have received.
“It is erroneous to suggest that all deaths are rooted in system failure,” Vanderlaan's statement said.
She said Acute Care Alberta is co-ordinating a system-wide approach to the respiratory virus season across all health-care providers.
Doctors seek specific solutionsThe provincial government and Acute Care Alberta have said they have taken steps to add surge beds to the system.
The AMA is calling for one leader to command the entire health-care system, a demand that Parks echoed on Monday.
The AMA says some health-care services that accept discharged hospital patients don’t work on weekends, which contributes to a backlog. It says Alberta also needs a health workforce plan based on the province’s population projections.
The doctor accounts of patient suffering come after 300 Alberta emergency and general medicine physicians signed in support of an op-ed calling for more consistent hospital discharge, safe patient load ratios and a return to a centrally co-ordinated health system that has been restructured into several agencies by Alberta's United Conservative government.
At a news conference on Thursday, Jones acknowledged ERs are under significant strain, but resisted calls to declare a public health emergency.