“Never in the field of human conflict was so much owed by so many to so few.”
Lying on a stretcher in the Ottawa Hospital Civic Campus EDX unit for 36 hours last week – awaiting a bed in the Ottawa Heart Institute – I was reminded of these historic words, spoken by British Prime Minister Winston Churchill during the Battle of Britain in 1940. They aptly apply today to Ottawa Hospital staff.
While hospital overcrowding has received considerable media attention since COVID entered the global lexicon last year, it’s impossible to get a real sense of the seriousness of the problem until you experience it.
The Civic is positively bursting at the seams. Patients are everywhere – in emergency reception, in hallways, in a tent out in the parking lot on Carling Avenue, in repurposed spaces, lying for days on stretchers instead of proper hospital beds.
Nursing scuttlebutt on Thursday night had it that the hospital had exceeded 200 percent capacity… again.
MOH has currently locked the Bed Census Summary website, so we don’t know.
I discuss the Ontario MOH BCS data obtained by CBC which show the Civic operating at over 100 per cent prior to COVID with triage staff. They say it is hospital policy to operate as close to capacity as possible… to maximize revenue.
Most of Ontario’s large community hospitals are effectively full, said Anthony Dale, CEO of the Ontario Hospital Association, “Hospitals are walking across a tightrope right now.”
How about the other provinces? Is this a national crisis?
Canadian think-tank The Fraser Institute published a study “Comparing Performance of Universal Health Care Countries, 2019” which revealed some disturbing statistics about our health care system. “Overall, the data examined suggest that, although Canada’s is among the most expensive universal-access health-care systems in the OECD, its performance is modest to poor.”
In comparison to other developed nations, Canada ranks poorly in terms of providing health care to its citizens.
It’s not that the taxpayers aren’t kicking in.
“Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems. After adjustment for “age”, the percentage of the population over 65, it ranks second highest for expenditure on health care as a percentage of GDP and tenth highest for health-care expenditure per capita,” according to the Fraser report.
The expenditures however, are not being translated into medical services.
“Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care. After adjustment for age, it has significantly fewer physicians, acute-care beds, and psychiatric beds per capita compared to the average of OECD countries included in the study (it ranks close to the average for nurses). While Canada has the second most Gamma cameras (per million population, age-adjusted), it has fewer other medical technologies than the average high-income OECD country with universal health care for which comparable inventory data is available,” the report states.
The Fraser report paints a grim picture of abject government failure to translate tax-dollars into health care.
“The data examined in this report suggest that there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system. Although Canada ranks among the most expensive universal-access health-care systems in the OECD, its performance for availability and access to resources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed,” it concludes.
While the public imagines hospitals overflowing with COVID patients, this is actually not the case.
In Ottawa, as of March 16, the Public Health Ottawa “Daily COVID-9 Dashboard” shows a total of only 20 hospitalized COVID patients across three campuses.
But the Ottawa Hospital has 1,224 beds in total… so why the overcrowding?
It was reported in October 2020 by the Ottawa Citizen that emergency overcrowding is in part due to, “… record numbers of patients in hospital beds who are unable to move to long-term care. LTC homes have reduced the number of beds in multi-resident rooms to improve infection control.”
During the COVID-19 pandemic, seniors admitted to hospital for any reason are likely to stay in hospital until such time as their LTC home is unlocked.
Hospital staff are severely strained by the over crowding.
How bad is it?
The cramped EDX unit where I count ceiling tiles for two nights, contains 5 patients on stretchers… and one nurse. The nurse is busy… every minute… literally. He is covered on short breaks over his twelve-hour shift by other nurses from triage. The following day he is back at 7am for another twelve-hour shift. He wears a mask all day, and adds a visor, gloves and gown to interact with patients. Somehow, he manages to be attentive, caring, courteous and professional with every patient. He lends me his phone charger.
A triage nurse enters to inquire whether a recently vacated bed space has been sanitized yet. The answer is “no”. The call was placed, but cleaning staff have not yet arrived. The triage nurse explodes in frustration. She has an elderly patient who has been sitting in the waiting area since 1am the previous night, and is distressed and in pain. “That’s ridiculous!” she exclaims, “I’m going to clean it myself!” She and my nurse then gown-up and grab the cleaning products, RN’s cleaning the floors.
Out in reception, it’s standing-room only.
I happily hear my cardiologist of several decades. He happens to be on-call. He is an institution, a Professor at the Department of Medicine at the University of Ottawa, Director of the Postgraduate EP Fellowship Program at the Heart Institute, and founder of the Arrythmia Service. He knows his stuff. I’ve told him in the past that I hope to die before he retires. We share a sense of humour.
After a COVID elbow-shake and catch-up chat, he confides that he has 32 cardiac patients to look after that evening, and I am number 33.
Our health care professionals are among the best Canadians. They always have our backs in times of crisis… but we do not have theirs.
Their selflessness is humbling.
In 1980 when the new General Hospital opened, the population of Ottawa was less than 550,000. Today, due more to immigration than reproduction, it exceeds 1.4 million. Construction of new hospital facilities has not nearly kept pace with population growth.
Ontario has the fewest per capita hospital beds of any Canadian province, and ranks third from the bottom of all OECD countries.
This unconscionable breach of public trust is an egregious failure of government.
The new Civic is scheduled to open in 2028… a compelling argument for project fast-tracking, if there ever was one.