PATIENTS FIRST IN EMERGENCY CARE - PRESENTED BY: DR. LISA SALAMON MD, CCFP (EM) FCFP, EMERGENCY PHYSICIAN, SCARBOROUGH HEALTH NETWORK DR. NARIMAN ...
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PATIENTS FIRST IN
EMERGENCY CARE
PRESENTED BY:
DR. LISA SALAMON MD, CCFP (EM) FCFP, EMERGENCY PHYSICIAN,
SCARBOROUGH HEALTH NETWORK
DR. NARIMAN MALIK MD, FRCPC, ANESTHESIOLOGIST, SCARBOROUGH
HEALTH NETWORK
Scarborough North Most vulnerable population in CELHIN
Birchmount Emergency Department Statistics 2017/2018 – Source NACRS Total ED visits: 51864 Children and infants: 8625 (17%) Age 18-64: 28745 Age > 65: 14314 P4R (wait times, LOS): 1st in CELHIN, 8th in Ontario
Obstetrics and Gynaecology (OHIP Specialty '20') Hospital Visits by
Scarborough Health Network Sites: FY2015/16 - FY2017/18
Hospital Visits by Scarborough Health Network Sites: % Total Hospital Visits 2017/18
FY2015/16 - FY2017/18
Scarboroug
10,000 9,738 h General,
Birchmount
, 33%
30%
Centenary
9,000
Centenary,
8,124 38%
8,000
% Total Hospital Visits 2016/17
7,050 Scarboroug Birchmount
7,000 h General, , 31%
27%
6,031 6,109
6,000 5,782 Birchmount
Centenary,
42%
5,582 5,568
5,000 5,366
Scarborough General % Total Hospital Visits 2015/16
Scarboroug Birchmount
h General, , 27%
4,000 26%
. 2015/16 2016/17 2017/18
Centenary,
46%
Source: MOH datafiles, FFS and SB claims, FY2015/16 to FY2017/18. Prepared by OMA Economics, Policy & Research, February 15, 2019.
Notes:
1. A visit is defined as a physician - patient encounter per day.
2. Analysis restricted to services rendered by Obstetrics and Gynaecology specialists (OHIP Specialty "20") and does not include anaesthesia, surgical assistant or technical fee claim submissions.Recent visits to Birchmount ED requiring immediate
Pediatric and Obstetrical assistance
7 week old baby stopped breathing in mom’s car – brought by EMS to
Birchmount Emergency department
Woman delivered baby in taxi cab outside of Emergency department
15 year old child with multiple complex medical issues having seizure
for over an hour. Parents drove him from home which is nearby
Teenager delivered stillbirth – heavily bleeding which required urgent
surgical interventionInpatient Pediatrics and Obstetrics and Gynecology is the
Standard of Care in GTA
William Osler Health System - Brampton Civic Site Very High-Volume
William Osler Health System - Etobicoke General Hospital High-Volume
Trillium Health Partners - Credit Valley Site Very High-Volume
Trillium Health Partners - Mississauga Site Very High-Volume
St. Joseph’s hosptial Very High-Volume
Toronto East Health Network - Michael Garron Hospital High-Volume
Humber River Hospital - Wilson Site Very High-Volume
Mackenzie Health Very High-Volume
Markham Stouffville Hospital - Markham Site Very High-Volume
Southlake Regional Health Centre Very High-Volume
Lakeridge Health - Ajax Site High-Volume
Lakeridge Health - Oshawa Very High-Volume
Scarborough Health Network - Birchmount High-Volume
Scarborough Health Network - Centenary High-Volume
Scarborough Health Network - Scar.Gen.Site High-VolumeIn Ontario, the Public Hospitals Act requires hospitals to maintain a reasonable
standard of care in their management, staffing and provision of services
It is anticipated that courts will be reluctant to permit a reduction in the
standard of care when conscious decisions are made to withhold available
services for reasons of cost containment alone.
Decisions made by physicians to withhold potentially available services for
reasons of budgetary restraint have been found to be negligent by the courts
as was found in Law Estate v. Simice.
In Bateman v. Doiron, the court states that the hospital must be judged
according to the standards reasonable expected by the community it serves.
There is a risk to both the hospital and the physicians in removing these
services. In Yepremian v. Scarborough General Hospital, it was noted that
“the recognition of a direct duty of hospitals to provide non-negligent medical
treatment reflects the reality of the relationship between hospitals and the
public in contemporary society.Board resolutions from the Central East LHIN
Board of Directors – March 27, 2013
Be it resolved that the Central East LHIN Board of Directors does not approve
any service changes proposed by The Scarborough Hospital in its Strategic
Plan related to the consolidation of maternal newborn changes or changes in
surgical services
Be it resolved that the Central East LHIN Board of Directors requires that The
Scarborough Hospital must submit to the Central East LHIN, any planned
divestment or transfer of services to another health service provider as an
integration, as defined by the Local Health Services Integration Act, 2006.
Any integration must be submitted for the Central East LHIN’s consideration
before implementation and must demonstrate engagement with affected
stakeholderscSafety concerns:
Implementation already began with goal to close
Pediatrics/ Obstetrics unit within next 4 to 6 months
Front-line physicians and nurses concerned about patient
safety and quality of careClosing PEDS/OBS at Birchmount Unplugs Lifeline for 200,000 Residents
Medical staff petition against the proposal to close
Pediatrics and Obstetrics–Jan 2019
We, the undersigned members of the Medical Staff of The Scarborough
Health Network and the Scarborough Medical Community, are writing to
express our opposition to any plan for closing Obstetrics and Inpatient
Pediatrics at the Birchmount site.
We firmly believe that it is against the best interest of our Hospital to
abandon the Maternal and Child Program in North Scarborough; an area
including many highly vulnerable and lower socioeconomic families.
We believe that a community hospital the size and location of the
Birchmount site, which has almost 52000 Emergency department visits per
year including almost 9000 pediatric visits per year, requires 24/7 on-site
Pediatric & Obstetrics/Gynecology coverage as a standard of care.
Anything less than that is felt by us to be substandard and a betrayal of
trust for the North Scarborough Community.
Signed by 161 physicians and midwives: 52 ER physicians, 12 Obstetricians
and pediatricians, 11 midwives and 86 physicians from other specialtiesBirchmount Hospital in the Media As of Feb 26 2019 https://www.toronto.com/opinion-story/9177604-birchmount-hospital-closures-an-attack-on-north-scarborough-community https://www.toronto.com/news-story/9167170--save-the-grace-meeting-called-to-oppose-scarborough-hospital-cuts/ https://www.toronto.com/opinion-story/9151007-scarborough-hospital-s-latest-birchmount-gambit-a-cruel-manoeuvre-/ https://www.toronto.com/news-story/9149809-scarborough-health-care-divide-deepens-after-birchmount-cuts-approved/ https://www.cbc.ca/news/canada/toronto/keep-your-hands-off-doctors-caution-against-moving-wards-from-scarborough-hospital-1.4984851 https://www.toronto.com/news-story/9132543-scarborough-health-network-proposes-service-cuts-at-birchmount-campus/ https://www.toronto.com/news-story/9140794-scarborough-health-network-board-to-hear-plan-for-cuts-at-birchmount/ https://toronto.ctvnews.ca/video?clipId=1590258 https://www.thediscourse.ca/scarborough/grace-scarborough-birchmount-hospital-consolidation https://toronto.citynews.ca/video/2019/02/25/concerns-raised-over-cuts-at-scarborough-grace-hospital/ https://www.huffingtonpost.ca/michelle-cohen/ontario-hospital-mergers_a_23654121/ http://www.epochtimes.com/gb/19/1/30/n11013649.htm http://www.singtao.ca/toronto/3975660/2019-02-11/post- %E6%85%88%E6%81%A9%E9%86%AB%E9%99%A2%E9%97%9C%E7%94%A2%E7%A7%91%E5%8F%8A%E5%85%92%E7%A7%91- %E5%A3%AB%E5%98%89%E5%A0%A1%E7%A4%BE%E5%8D%80%E6%8E%A1%E8%A1%8C%E5%8B%95%E6%8A%97%E7%88%AD/?variant=zh-hk
CONCLUSION
Urgent need to ensure safe, equitable and timely
access to high quality emergency services for growing
population in CELHIN Scarborough North Subregion
CELHIN to halt implementation of plan to close
Paediatrics/ Obstectrics at Birchmount site of
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