INTENSIVE CARE BED SHORTAGE A CRISIS

By Mary-Jane Egan -- Free Press Health Reporter -- September 20, 1997
  London's hospitals have no empty intensive-care unit beds -- a state some are calling the worst bed crisis in 30 years in the city.
 As of Friday night, there had not been an ICU bed available the whole week, forcing the abrupt cancellation of surgeries and hurried transfers of patients to Woodstock, Hamilton and Toronto.
 Veterans of London's medical system are laying the blame in the lap of Premier Mike Harris and his government's cuts to hospital budgets.
 "I must say, this is the worst I've seen it," said Dr. Brian Taylor, chief of surgery at St. Joseph's Health Centre, where four major operations had to be cancelled this week -- all on the same day they were scheduled -- because the patients would require post-surgery care in an ICU.
 "It's not that we've turned away every seriously ill patient in the city for lack of beds. It's just that the census is staying full, so if we had a major car accident and we had several patients needing to be put on respirators, we'd have a real problem."
 RESOURCES TIGHT
 Sandra Letton, vice-president of St. Joseph's Health Centre, said she wouldn't comment on individual cases but admitted "resources are tight and that's no surprise to anyone."
 Of the cancelled surgeries, she said one has already been performed and two are scheduled for next week. She said the hospital took steps last month to increase staffing levels in ICU to accommodate 11 patients, up from six.
 "Right now, there are no available ICU beds in the city, but that will change. We try our best to match our resources and staffing patterns to patient care requirements. There are patterns in health care that are unpredictable so the reality today is we have to be flexible."
 ICU beds are for the most critically ill, from surgical patients to those suffering trauma.
 Janet Robertson, a 30-year operating room nurse at St. Joseph's, said one patient whose 12-hour cancer surgery was abruptly postponed this week was a 79-year-old woman "in tears."
 "Here's a lady who's been geared up for this major surgery and is finally ready to have it and her whole family's there. I mean, this is tragic."
 Robertson said the case was so upsetting she was compelled to speak out. "I just said, `I'm sick and tired of this. I don't care if I lose my job. I'm going to tell people what's going on.' Patients are suffering and I just can't tolerate it any more."
 While the term "bed shortage" is frequently used, Robertson called it a misnomer.
 "We've got plenty of beds. We just don't have the nurses to staff them. They've cut too close to the bone now and this may sound self-serving but it's not. I have two passions in my life -- animals and sick people. And I'm seeing very sick people suffering because of these funding cutbacks."
 Taylor agreed there are plenty of wards containing empty beds.
 "At St. Joe's, we've made a lot of changes to suit the fiscal times but I will not let the quality of patient care change to the point where people aren't being looked after properly. Now, I think our hands are being tied because we can't turn away emergency situations and that's where the crunch is hitting."
 Taylor said the ripple effect of emergencies hits all hospital areas. When a surgical patient can't be assured an ICU bed won't be taken by an emergency patient, the surgery is cancelled , bumping all other surgical patients on a waiting list back a week.
 PATIENTS FRUSTRATED
 He said patients are frustrated, angry and anxious when an operation is cancelled "and the nurses, surgeons and anesthetists feel the same way."
 Cancellations are a drain on the system because "now you've got nurses and others standing around being paid on taxpayers' money with no surgery to perform. You can't just drag another patient in at the last moment because you've suddenly got an operating room open that had been booked for a six-hour procedure."
 Unless funds are made available for the staffing of additional ICU beds, Taylor fears the whole system is nearing the breaking point. "This isn't just a London problem. Everyone is facing this and it gets tougher to find available beds."
 Taylor said it's not unusual to transfer patients between London facilities or outside the city if a bed isn't available.
 But he said this week marked the most prolonged period in which London's complement of 67 ICU beds -- the bulk of them at the London Health Sciences Centre -- remained full.
 Dr. Martin Goldbach, senior cardiac surgeon at the London Health Sciences Centre, called the lack of ICU beds "difficult for our patients and staff."
 He knows of at least two open-heart surgery cases that had to be cancelled last week because of a lack of ICU beds -- cases that involve lengthy waiting lists.
 "Everyone is concerned because the number of critical cases, not just surgery but medicine and other disciplines, is increasing yet the number of beds in ICU isn't."
 Health sciences centre president Tony Dagnone was unavailable for comment but issued a statement saying the centre's 56 ICU beds have adequate staffing levels and "we do our very best to live up to our responsibilities as a health-care provider."
 Taylor, who was on call at St. Joseph's last weekend, said all beds -- both ICU and regular in-patient beds-- were occupied and extra nurses had to be called in to handle an overflow in the emergency department.
 "One patient's son was dumbfounded the hospital was actually full. He said `What do you mean you don't have room for my mother?' All I could say was, `Don't you read the paper?' We're telling people to contact their MPPs."
 He said another patient couldn't be admitted to the coronary care unit because it was full and was sent to Woodstock -- a move he called "very unusual." Taylor said the patient was stable "and I don't think he was put at any particular risk. It's just bloody inconvenient."

1:34 PM 21-Sep-97, http://www.canoe.com/LondonNews/01_n2.html