‘Shell-shocked’ leaders ignoring ER chaos, weary doctor says Monster wait times affecting care, scaring some ill and injured away By: Dylan Robertson Posted: 7:00 PM CDT Thursday, Apr. 21, 2022 Last Modified: 2:49 PM CDT Friday, Apr. 22, 2022 Updates

Hey there, time traveller!
This article was published 20/04/2022 (882 days ago), so information in it may no longer be current.

Despite miserable, once-unimaginably long wait times in Winnipeg’s emergency rooms, frustrated doctors are advising people to seek treatment if they believe they need it.

“We see a lot of chronically ill and a lot of elderly people in the emergency department, and it is brutal waiting in pain,” said Dr. Alecs Chochinov, who has spent decades as an ER physician.

“The waits in emergency, while not new, have been described by many of my peers, people who have been practising for decades, as the worst they’ve seen in their careers.”

Chochinov, the former head of the University of Manitoba’s department of emergency medicine, works out of the St. Boniface Hospital ER. He started a shift this week with 30 patients waiting for admission, which he said would occur only during the Christmas season during a normal year.

As of Wednesday afternoon, 47 of St. B’s 55 emergency beds were occupied, many by patients waiting for a bed elsewhere in the hospital.

Four other ER physicians told the Free Press they are starting shifts with almost no bed availability and ever-growing lists of patients waiting for admission; the number has been as high as 39 people waiting at HSC, where there are roughly 60 emergency beds.

Chochinov did not sound optimistic about a solution in the short term.

“My biggest concern about the leaders of the system is that they’re afraid to be seen, to be open about their problems and to actually listen to good advice. They’re like, shell-shocked,” he said.

“Everybody’s in a defensive posture.”

“The waits in emergency, while not new, have been described by many of my peers, people who have been practising for decades, as the worst they’ve seen in their careers.”
– Dr. Alecs Chochinov

He said that’s likely why advice offered by doctors and nurses — whether communicated privately or in the series of letters that have eventually reached the media during the past couple of years — have been met with silence, or even pushback.

“Disasters are hard to manage optimally, and I think there has been a certain resistance to hear the voices from the professions about how to do it better,” he said.

“Leaders in health might be worried that in saying (to patients) ‘please come’ that they’ll be admitting that the system is not performing from an access perspective. Well, guess what? Everybody knows that… so let’s just come out and admit it.”

Dr. Kristjan Thompson, head of Doctors Manitoba, said 55 doctors in Manitoba were isolating due to COVID-19 Wednesday, double the number a week ago.

Shared Health said Thursday that work is “underway to improve access and reduce wait times.”

“We acknowledge the significant strain currently being felt across emergency departments and urgent care centres in our province,” a Shared Health spokesperson told the Free Press in a statement.

Chochinov said it was jarring to meet an elderly man on a recent morning shift whose chart indicated his pain had started the previous afternoon. Chochinov assumed the pain had awakened the patient, who then decided to go to the hospital, but the man told him he’d been at the ER waiting to see a doctor for 12 hours.

Dr. Doug Eyolfson, a former Liberal MP who works at the Grace Hospital emergency room, said the most urgent cases are being handled without delays, but systemic issues mean others can face interminable waits.

The Free Press was told of a mental-health patient finally being admitted to St. Boniface Hospital Wednesday after a week-long wait.

“Every eight hours they’re getting a new physician. So when you’re trying to provide a safe continuity of care for these patients, while seeing the (new) patients who come in in a timely manner, it’s a very difficult juggling act,” he said.

Eyolfson argued the knock-on effect is that some people are avoiding the ER until an illness or injury leaves them with no choice.

“We’re hearing anecdotes and people in the community saying they don’t want to come in and they’re afraid of COVID, they don’t want to wait eight hours to be seen,” he said.

But ignoring some symptoms can be a dangerous gamble, he said, offering examples of sudden back pain that could indicate an aneurysm, or fainting that could be a sign of arrhythmia; both could be fatal,

The metric “left without being seen” records the percentage of patients who walk out of the ER before they’ve been examined. It normally hovers between three and seven per cent, but it rose to 15 per cent across Winnipeg last July, and was a shocking 28 per cent at HSC.

Shared Health said Wednesday it could not provide more recent data, and didn’t explain why, but noted that a triage nurse sees all patients upon entry to an ER, so that urgent cases are seen immediately.

“This lobster is boiling and we can’t even feel it, because we’ve been with it so long.”
– Dr. Alecs Chochinov

“Winnipeg emergency departments and urgent-care centres continue to experience challenges with patient flow due to a number of factors — many pandemic-related,” wrote an unnamed Shared Health spokesperson. “These can result in some patients spending more time than we’d like in one of our emergency departments before being seen.”

Chochinov co-wrote the province’s 2017 report on reducing wait times. He said Manitobans need to understand that their health-care system has gradually declined over decades to the point of not being able to perform its core functions.

He describes it as a cumulative, multifaceted process like climate change, instead of a car suddenly careening off a cliff.

“This lobster is boiling and we can’t even feel it, because we’ve been with it so long,” he said.

“People will dismiss it and say, ‘Well there was crowding 20 years ago; it’s sustainable.’ Well, it’s actually worse.”

As the wait-times report pointed out five years ago, health-care delivery operates in silos where systems aren’t connected to each other, creating disjointed care and diffuse responsibility.

The PC government’s health reforms were meant to address those issues, but many in the system argue the pace and approach taken has been counterproductive and focused on limiting short-term costs. Unions argue it led to staff taking early retirement on the eve of global pandemic that has created unprecedented challenges on top of the existing problems.

Chochinov said the chaos is having an impact on the way the health-care system is treating Manitobans. But he said people who need care will get it.

“Everybody’s under a lot of duress, and under those circumstances people tend to not play together optimally,” he said.

“We go into medicine and nursing to serve people, and it would be horrifying for us to feel that people were staying away because they don’t want to bother us.”

— With files from Chris Kitching

dylan.robertson@freepress.mb.ca