Jessica Nichol, with her 12-year-old daughter at home in Edmonton, on Jan. 23, experienced a terrifying delay due to staff shortages on the day she planned to donate a kidney to her daughter.Amber Bracken /The Globe and Mail
Edmonton’s pediatric hospital was so overwhelmed with patients and short on staff last month that it cancelled and delayed surgeries for sick and injured children, according to a letter senior physicians sent to Alberta Premier Danielle Smith and provincial Health Minister Adriana LaGrange.
The three-page letter, dated Dec. 25 and recently obtained by The Globe and Mail, describes the chaos that enveloped the Stollery Children’s Hospital in the days before Christmas. It says the Stollery, located at the University of Alberta Hospital, was beset by viral and bacterial infections and was in the midst of an extreme shortage of beds.
“We as physicians are being put into the impossible position every single morning to decide which child will receive surgery for their brain tumour, heart disease, bowel obstruction, or chemotherapy,” wrote Natalie Anton, the hospital’s divisional director of pediatric critical care, and Peter Metcalfe, its divisional director for pediatric surgery. “Several children each week are having their treatment or surgery cancelled with no guarantee of urgent re-scheduling,” they added.
“After the events of last week, we can tell you that we are failing, daily, and children are suffering and may die as a result.”
The letter provides insight into the troubles plaguing Alberta’s health care system, which like those in other provinces is buckling under outbreaks of COVID-19, influenza and respiratory syncytial virus, as well as a chronic shortage of physicians, nurses and other professionals. Earlier this month, Alberta informed patients that it was temporarily pulling its northern residents out of Canada’s kidney donor matching program because the province lacks operating-room capacity and has a backlog of transplant surgeries.
Alberta Health Services spokesperson Kerry Williamson said in a statement that the Stollery had rescheduled “approximately 11″ pediatric surgeries in December because it was under significant pressure. In preparation for the season’s wave of respiratory illnesses, the hospital had added 11 surge unit beds, expanded its short-stay surgical unit’s hours to include weekends and added and rescheduled staff, he said.
“Every effort was made to reschedule those impacted patients as quickly as possible – they were triaged the same day, and rebooked – and all emergency surgeries were completed in an appropriate timeframe,” Mr. Williamson said. “While the hospital remains very busy, patient demand has decreased slightly.” Surgeries have not been affected by capacity problems in January, he added.
In response to questions about the letter and the pressures facing the hospital, Ms. LaGrange said in a statement that last year’s provincial budget earmarked $1-million a year for three years to advance planning for a stand-alone pediatric hospital in Edmonton.
Dr. Metcalfe said in an e-mail on Tuesday that the December letter was intended for Ms. Smith and Ms. LaGrange, rather than media, and that the physicians would not comment further.
The letter details the surgical havoc inside the hospital on Dec. 20. The Stollery had about 15 emergency surgeries that needed to be performed that day, including several that had been rolled over from the previous day because staff did not have the necessary resources for them, the letter says.
The rollover list included a girl with a broken elbow who had been waiting for surgery for nearly four days. Her operation, which the letter says ideally would have taken place within 24 hours, had been cancelled three times, all while she was fasting and in pain. Another girl was waiting to receive an intravenous access device so she could start chemotherapy treatments, the letter adds.
Two patients were having surgeries that day that required the pediatric intensive care unit, or PICU: a young girl with a brain tumour that was an immediate threat to her life, and a 12-year-old transplant patient scheduled to receive a kidney from her mother. To ease the crush on operating rooms, the hospital sent home two teenagers who had surgeries planned. It is unclear whether other operations were affected.
Jessica Nichol, the mother who was scheduled to donate a kidney to her daughter, is not identified in the letter, but she spoke to The Globe. Hospital staff anaesthetized her that morning. Shortly after, the hospital realized the PICU did not have enough staff or beds to care for the child after the transplant. Officials cancelled Ms. Nichol’s operation five minutes before a surgeon was about to make the first incision, according to the letter.
“I could do nothing but cry,” Ms. Nichol said. Her daughter has cerebral palsy, was suffering from end-stage renal failure and was not a suitable candidate for dialysis. The surgery had already been delayed in October, when she and Ms. Nichol tested positive for COVID-19. “Our biggest fear was she wouldn’t make it,” Ms. Nichol said.
Ms. Nichol said hospital staff shared her agony and cried with her. Then, after what she described as “several desperate phone calls,” the Stollery physicians said they had found the employees and resources necessary to resume the transplant operation. Ms. Nichol was, once again, put under. The transplant was a success.
“We got what we needed. But we know there are still people still waiting and we know what it is like to be desperate,” Ms. Nichol said.