By Pamela Fayerman, Vancouver Sun
Fraser Health will fire all 28 anesthesiologists working at Surrey Memorial Hospital if they don’t agree to provide round-the-clock obstetric service within a year because some women are being forced to give birth without an epidural.
Dr. Roy Morton, vice-president of medicine at Fraser Health and a retired anesthesiologist, said patient safety and quality of care concerns spurred the warning letters sent to anesthesiologists. The letters stated that the doctors’ privileges to practice at Surrey Memorial will be revoked March 1, 2017 if the parties don’t come to terms.
The anesthesiologists are like private consultants, not employees, but all doctors must have privileges to work at hospitals. The letters about privileges being revoked give one year of notice, as per hospital bylaws.
Morton said the hospital and health authority have been negotiating for the past five years with anesthesiologists for round-the-clock availability because there are a growing number of babies being born at the hospital (about 4,300 in the past year.) At times, women in labour have to endure too much pain as they either don’t get an epidural or wait too long to get one, Morton said.
C-sections, which also require an anesthesiologist, may also be delayed, he added.
The epidural rate is considered a marker of anesthesiologist availability and only one-third of women in labour at Surrey Memorial get an epidural for vaginal delivery, compared to 50 per cent of women having babies in Vancouver hospitals. The national average is 59.4 per cent, according to the most recent (2014-15) report from the Canadian Institutes of Health Information.
Morton said there have been occasions when there is only one anesthesiologist in the hospital late at night. If they are busy in an operation and get called to administer an epidural or anesthetic for a C-section, the expectant mother will have to wait or the anesthesiologist will try to divide their time and attention. He said there have been no life and death crises that he knows of, but it is far from an ideal situation.
The Surrey hospital has one full-time anesthesiologist on site 24/7 and access to doctors on-call with pagers, as needed. But sometimes on-call specialists are at home, up to 30 minutes away. That means birthing mothers have to wait in extreme discomfort. The hospital wants at least one anesthesiologist dedicated to the obstetrics department at all hours of the day, every day of the week.
“We’ve been trying to reach an agreement with this group for five years. At some point, you just have to call it a day. We need a dedicated service and no one has stepped up to the plate to say, ‘Yes, I will sign on,’” he said.
Asked why such specialists would be unwilling to provide the needed service, Morton said:
“We are unclear about what they are asking for.”
Dr. Roland Orfaly, chief executive officer of the B.C. Anesthesiologists Society, which represents about 400 specialists, said the letter sent to doctors from Michael Marchbank, CEO of Fraser Health, clearly states the threat was not about “disciplinary procedure, patient safety issues or quality of medical care” so no one should suggest those issues are at stake.
He did not address financial issues, but said the problem has to do with a shortage of anesthesiologists. The society has been working with the government on an anesthesiology human resource plan “and it is at that table that solutions for better maternity patient care are being considered for Surrey ...”
Morton said the health authority has earmarked $1.2 million per year for five anesthesiologists to be available on a rotating basis for the obstetrics service. Since they would still be able to work in other operating rooms when they aren’t in delivery suites, they would still be able to earn additional payments through fee-for-service arrangements.
Morton said he expects that between the obstetrics contracts and the fee-for-service work, anesthesiologists would earn gross compensation of about $500,000 a year. The average for B.C. anesthesiologists is $360,000 a year, he said.
Health minister Terry Lake said he supports a dedicated obstetric anesthesia service at Surrey Memorial and two reports confirm the need.
Lake said he’s disappointed with the stalemate but hopes the sides can reach an agreement before the deadline.
“Frankly, the doctors are asking for far too much money,” he said, without disclosing the amount.
Laura Heinze, spokeswoman for the minister added:
“Fraser Health has told the anesthesiology group it will be looking for another group to take on the service, and has given the current group a full year’s notice as required.
“We are confident Fraser Health can have a dedicated obstetric anesthesia service in place, with a new group of doctors, within the year.”
Anesthesiologists are no strangers to disputes in B.C. as they have threatened to withdraw services at various times in the past. After a long dispute lasting years, the Vancouver Island Health Authority finally reached an agreement in 2012 with anesthesiologists at Victoria General Hospital for a similar round-the-clock obstetric service that is “working very nicely,” according to Morton.
Firing all the anesthesiologists at Surrey Memorial would result in health system mayhem as about 25,000 adults and children are typically waiting for surgery at any point in the year throughout the Fraser region. Morton said the College of Physicians and Surgeons of B.C. has been advised, but is not yet involved in the matter.