HHS closes WLMH obstetrics until Fall ’20

By Mike Williscraft

NewsNow

West Lincoln Memorial Hospital’s vaunted obstetrics ward will be closed for business for a year after Hamilton Health Sciences officials dropped that bombshell on staff last Thursday.

HHS rolled out the news to senior staff and the Community advisory Committee earlier in the week before conducting a staff meeting Thursday afternoon.
The closure is being dubbed a “transfer of services” for expecting moms who have a natural birth planned. Only scheduled C-sections will be permitted at WLMH.

According to one staff member in the Thursday meeting, those in attendance were told there is no firm timetable bringing births back online.

This is the second major service to be lost to WLMH as endoscopies were removed about 18 months ago.

“Everyone is devastated. There were a lot of tears,” said one registered nurse, who spoke confidentially due to fear of reprisal.

“We were told to ‘be positive and show support for HHS’.”

OBS (obstetrics services) had been shut down for the last two months while some short-term renovations were completed. All was supposed to get back to normal on Monday (Sept. 30). HHS officials opted to move up a timetable for additional work but, according to Community Advisory Committee Chair Andrew Smith, their plan had one major flaw.

Initially, HHS claimed to have an understanding emergency cases could be transferred to Niagara Health Systems for care. In the end, that was not the case.

“Initially this seemed to be a logical solution to the facility issues but key to this strategy is the hospital’s ability to ‘hand off’ emergencies that could develop during childbirth, if the single OR (operating room) was unavailable, to neighbouring healthcare facilities,” wrote Smith in an opinion piece for NewsNow.

“Rather than iron out the details of this hand off before moving forward with renovations, the renovations began. Now, a few days before the OB is to reopen, we have a patient care crisis on our hands.”

HHS officials see it another way.

In a memo posted to its website, HHS stated its goal is “return all services to full capacity as quickly as possible.”

“As these upgrades and renovations are being completed, WLMH has only one operating room (OR) available until fall 2020, resulting in the need for difficult decisions about how to organize the services that rely on that OR,” the memo reads.

“The emergency department, day clinics, inpatient care and diagnostics are not affected by the renovations and continue to function while construction is happening. Further, WLMH can keep scheduling elective surgery, including elective C-sections and gynecological surgeries in the one OR.”

“However, for WLMH to be able to continue offering these services, the hospital needs to temporarily move most of its low-risk labor and deliveries to other nearby hospitals. Family doctors, midwives and obstetricians who care for patients at WLMH have designed a plan to continue providing care to their patients, which involves caring for patients at WLMH, Niagara Health and McMaster University Medical Centre (MUMC). WLMH is grateful to its system partner Niagara Health and colleagues at MUMC for maintaining the continuity of care for patients in West Niagara.”

Simply, this means scheduled C-sections will continue, while vaginal births will all be transferred. With only one operating room available, an emergency C-section case must get into an OR within 30 minutes, so that time frame could be jeopardized if the room was busy.

The news was met with a combination of disgust, sadness and general disbelief especially since obstetrics was supposed to reopen Monday after a short-term renovation was completed.

“It is all ready. We were taking delivery and putting together brand new bassinets last week,” said another staff person who would only speak with anonymity.

YEAR OF TURMOIL

WLMH has been in a state of constant turmoil for just over a year when, under the guise of safety concerns, HHS chief executive officer (CEO) Rob MacIsaac announced a 27-month closure of the facility’s operating rooms – taking with it obstetrics – would be required due to concerns about air quality and the need for a sterile equipment storage area.

In Friday’s memo, Dr. Michael Stacey, HHS’s executive vice-president academic and chief medical executive, supported those concerns.

“As healthcare providers, it’s our job to put patient safety first. We must eliminate every preventable risk to our patients, even if when it means making tough choices. The critical upgrades we are making at WLMH limit our ability to provide a safe and full labour and delivery service until construction is complete,” said Stacey.

“We are grateful to all staff, physicians and midwives, and our system partners, for finding a way to meet the needs of patients in West Niagara until the renovation work is completed next year.”

Over the last year, there have been many twists and turns on the path which led to Thursday’s announcement, but many staff and members of the Citizens’ Action Committee have said repeatedly the concern was valid, but overblown.

“Of course we are all concerned with patient safety. It is a huge part of what we do. However, West Lincoln did not have a single case where a problem was cited. There were no instances of complaint even,” said one staff member, again speaking with a promise of anonymity.

“The facility is old. We all know that. We have been working with limitations for many years, but it was and is workable until the rebuild gets done. Even the engineering report that did the initial assessment recognized that.”

The report referred to is an Oct. 5, 2018 document commissioned by HHS to assess both the physical status of WLMH’s infrastructure and what would be needed to bring it up to the standards needed.

The verdict was about $8.5 million in work which necessitated a 27-month closure of both operating rooms, said MacIsaac at the time. When asked in November 2018 why a report would be served up with only one option, MacIssac said it was because they only asked for one.

“We didn’t ask the consultant to come back with a range of options. We asked the architect to come back with the architect’s recommendations, so that’s what we got.”

However, for many in West Niagara, that is where opinion on this matter split because included in the same recommendations which noted the need for upgrades, it was also noted the work about be done mainly around current schedules for the ORs with several weekend closures and a couple of extended weekend closures.

“Almost everything HHS has done since last October has been with an eye to getting some sort of long-term closure and reduction of services in place. We’ve been lied to repeatedly,” said Tony Joosse.

“We all know and have known for years that West Lincoln is an old facility but what we have seen done to staff and community by Rob MacIsaac and HHS is simply not acceptable and it flies in the face of what Minister of Health Christine Elliott guaranteed – that all services would be maintained at current service levels at West Lincoln Memorial.”

As another example, Joosse noted endoscopy services, which were transferred “temporarily” to other facilities about 18 months ago have still not returned and will not until “this OR mess” is resolved.

“That’ll make it two-and-a-half years lost for that service. That not only effects the doctors and nurses involved, but countless people in the community as well,” Joosse said.

For Dr. Gary Benson, who resigned as WLMH’s medical director immediately after the planned 27-month closure was announced last October, said the process was flawed right from the time the proposed measures were being read out.

After hearing the plan, he asked if the measures had been approved by the HHS board of directors.

“(I) was told that the plan had been presented to the Board at their last meeting for information purposes and would be voted on at the next Board meeting,” wrote Benson in his resignation letter, published in NewsNow on Oct. 25, 2018.

Dr. Benson gave an extensive background on how WLMH has been buffeted around by previous provincial governments, had funding promised then delayed or cancelled going back decades but, in the end, he believed in the care WLMH was providing and that HHS officials were wholly off-base in pushing for long-term closure for renovations.

“I honestly believe that they (HHS) fail to understand the consequences their decision will have on our communities. I have always felt that WLMH is a model community hospital providing primary centred care to our communities,” wrote Dr. Benson last fall.

“The proposed changes will destroy this model of care.”

From that point on, HHS changed tack on several occasions, more recently regarding a patient transfer agreement with Niagara Health Systems which fell through at the 11th hour and this week when OBS was to reopen Monday but will now remain closed, essentially until next November.