A Retired Niagara Doctor Offers His Take On Diminishing Hospital Services In The Region

(From an address Dr. William Hogg presented to public hearings hosted this March 9 by the Ontario Health Coalition in Welland Ontario, as part of a series tof public hearings he not-for-profit, province-wide coalition is holding in regions across Ontario on concerns over service cuts to our hospitals.)

By William Hogg, MD

Hello everyone.

Dr. William Hogg, a retired Fort Erie physician, speaks on concerns over cuts to Niagara's hospital services at public hearings in Welland, Ontario.

I’m a retired doctor who has done acute emergency work – and taught it on both sides of the border.

Today I’ll try to translate a tiny part of the grievous loss of Ms Reilly Anzovino into a plea and rationale for local Medicare repair. In June of last year, concerned about the Niagara Health System’s depredations, I sent a series of short notes to NHS – warning of deaths to come. SURELY to come – should the small town Emergency Departments in our region’s southern tier be shut down?

NHS did not acknowledge my early warnings. It did not care enough to act humanely for any of the critically injured or sick people in our area. | NHS just ploughed ahead unwisely. Both emergency rooms WERE closed. And deaths HAVE happened – unwarranted and wrongful deaths! Now – the kinds of deaths I predicted and warned of happen during so-called ‘TIME-critical’ emergencies.

They can come on in a split second. They can happen anywhere. At home. On a country road. In ambulances. If a ‘far away’ hospital IS reached, disability or death may still occur – even there.

Why? Lacking prompt stabilization at a smaller nearby hospital, the injured or ill person loses critical treatment time – and life. | You may wonder – what actually IS a time-critical emergency? Well, there are ordinary everyday emergencies and there are time-critical emergencies. Specifically, any person with a stroke or suspected heart attack, or with severe trauma to head, limbs, abdomen or chest, hemorrhaging, or in shock, or bluish and gasping for breath, who has not yet been properly stabilized, is a prime candidate to die en route to a far away place. |

I ask you: What good is a ‘centre of excellence’ to a person DOA? | Or, to a multiparous woman in premature labour, pushing hard against a strangulating prolapsed cord – in transit. That is a double-death in the making, preemie and mother both. The tiny baby, held back, strangles unborn in the birth canal. And, as the placenta rips away from inside of her uterus, all of the mother’s blood gushes, flushes, out in a flood.

How dare NHS even plan to hijack ALL of Niagara’s birthing to their over-priced monster-hospital now a-building way out in the far boondocks! It might as well be a big morgue. | Anyway, those are examples of time-critical emergencies. There are many more. | In such emergencies minutes wasted are crucial.

What actually happens is this: Instead of immediately being jumped to the front of the ER lineup in a small outlying hospital, the patient is shunted to an anonymous, almost endless lineup out on the highway. That is, all the ambulances that contain critical emergencies, real people, neighbours, friends, family, in dire distress, are TOLD to bypass the nearby small hospital.

THAT cruel rule renders the patient ‘invisible’ and sets it all off. | It’s a paramedic’s nightmare: “Break the rule and deliver a live patient, or, obey the rule, bypass that small outlying hospital and maybe she dies.” What a deadly dilemma for our fine paramedics to decide! They should be solving problems, not deciding dilemmas!

Now, paramedics in ambulances are skilled, wonderful lifesavers. They can give oxygen and know CPR! But they are not trained or equipped to stabilize these particular time-critical kinds of emergencies – let alone handle them from start to finish. They never will be so qualified unless they go off to medical school to learn doctoring. | So? Consider these few facts: | Paramedics in ambulances are UNABLE give clot-busters to arrest coronaries or strokes. Paramedics are NOT ALLOWED to start a blood transfusion – which is an awful shame. They CAN help a straightforward delivery in a pinch. But frightfully complicated ones? Heaven forbid! A good doctor can save these lives. At ANY outlying hospital – if it is open and used.

Any ER can do it, even a ‘UCC’ (whatever THAT is?!). In short, there are still things that only a well-practiced MD, nurses alongside, can and must do. Dealing quickly with a time-critical emergency, before transport to a ‘more excellent’ place far afield, is one. Think on it. On this: Ambulances carrying NON-emergency patients ARE allowed to stop at outlying small hospitals. But ambulances with critical patients aboard are not. They’re NOW DIVERTED PAST THEM. Past an able and ready doctor. What a deadly paradox. It’s insane! Really serious emergencies are put in a position of dying in transit. Or soon after. In a fleeting instant. Do think on it again – and again…

That’s NHS policy and practice! Frankly, the time-critical emergencies plaguing us now, are a nasty artifact ‘created’ by NHS bureaucrats. Created by non-medical interlopers. Quick! What happens when lay-administrators stick their dogmatic but unknowing noses into front-line nursing and medical matters? | DEATHS. And more deaths. NHS = DOA !!! I’m serious and sad about all of this, and angry at NHS – but I do not know it all. |

Only a properly done coroner’s inquest can determine the true facts of Reilly’s untimely death. But there is no doubt in my mind that hers was a bona fide time-critical tragedy that should have gone straight to her home town hospital – first. The time lost in transit was a contributing factor. The closure of Fort Erie’s ER was another.

Finally, in crass economic lingo: In health care it’s not the ‘bottom line’ that counts most. It is clinical service. Most country doctors have saved more than a few people’s lives. NHS cannot even save a single dollar. The remedy? Our outlying ERs must return – or NHS must go. End Addendum – if time: NHS’s dismantling of outlying ERs, and time-critical deaths, is only part of the story. The removal and centralization of core medical services from medium-sized hospitals in Welland and Niagara Falls, as well as from the southern tier rural ones at Port Colborne and Fort Erie, is another.

Simple pediatrics and internal medicine, obstetrics, geriatrics, psychiatry, brief intensive care, minor day surgery, etc., really should be kept close by the patient’s family. It’s humane to do so. And frequent family visits, essential for sick children, facilitate faster recovery of all patients. Isn’t that economically sound too? GP-family physicians, with specialist backup, are perfectly capable of doing this core, generic work and do it cheaper. The proof is in the pudding. Small town hospitals such as DMH were the only ones in the black before NHS came into the picture.

While the idea of a large ‘centre of excellence’ is a good one, such must BE central, not somewhere way off in nowhere, inaccessible. And it should not pretend to be the sort of highfalutin place best associated with a medical school. That is not sound. It’s grandiose. I am informed by a reliable nursing source that NHS plans to get into advanced cardiac care as follows: “…the cardiac investigation lab they are wasting money on.

If … they are planning to do cardiac caths, they don’t mention that there is no cardiac surgical team in the peninsula if something goes wrong. To me that indicates very poor planning – as usual.”

(William Hogg is a retired physician living in Fort Erie and a former teacher at McMaster University’s medical school.)

(Click on http://www.niagaraatlarge.com for Niagara At Large and more news and commentary on matters of concern to residents in our binational Niagara region.)