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Doctors alarm at outsourcing plan

Mon, Oct 31st 2022, 08:52 AM
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CONSULTANT physicians at the Princess Margaret Hospital are upset with government's proposed plan to "outsource" care to Doctors Hospital due to ward closures and renovations.

 

In a document dated October 20, consultants from PMH’s Department of Internal Medicine criticised the plan — which details how some PMH patients would be relocated to Doctors Hospital West — saying there is no justification for it.
#The doctors alleged there has already been a death in the pilot of this process when a patient who had been moved to the other health facility became unstable and could not be revived on arrival at PMH.
#When contacted for comment on the doctors’ concerns yesterday, Health and Wellness Minister Dr Michael Darville said some “extensive renovations” at Princess Margaret Hospital are planned. He said the upgrades cannot take place with patients on the ward and they are looking to partner with Doctors Hospital West to assist the hospital.
# He added that officials are still at the table with Doctors Hospital and nothing is finalised as yet.
# “Sorry, it’s a bit more complicated than just outsourcing — we are planning extensive renovations of our wards. We are still at the table with Doctors Hospital and nothing is finalised as yet,” Dr Darville explained.
# “As you are aware we (are) planning some extensive renovations at the PMH starting with Female Medical One and the replacement of an old elevator. Secondly the basement of the Eye Ward is in bad shape and we will be awarding a contract for some structural repairs to the columns and steel components of the first floor of that wing of the hospital. Once that is done we will proceed to renovate the Eye Ward and get the eye theatre up and running again.
# “Plans are also on the way for the renovation of Male Medical 2 and the Children’s Ward to bring back in service this critical bed space while the COVID-19 disease burden in the country is low. From our aggressive agenda and the time necessary for completion of the work in just under 12 weeks, we will need to manage some of our patients elsewhere and, yes, these important decisions are on the table with Doctors Hospital.”
# He added: “The aggressive renovations cannot take place with patients on the ward and we are looking to partner with Doctors Hospital West to assist the hospital complete these essential repairs so that we can best serve our patients.”
# According to the consultants’ document, a draft action plan for “outsourcing” of inpatients to Doctors Hospital Health System is being proposed for Princess Margaret Hospital.
# “This plan outlines how patients will be selected and moved between the institution and stipulates that a ‘private’ group of physicians, who are also contracted to work at Princess Margaret Hospital, will be subcontracted to manage these patients at an additional fee for services. Patients who become unstable and with prolonged stay are to be returned to Princess Margaret Hospital,” the consultants’ memo read.
#“This action plan singularly involves only one specialty department which is the Adult Medicine/Internal Medicine inpatients in the Department of Medicine at the PMH. Internal Medicine was directed to review this plan without any previous involvement in the drafting of the plan for the Department of Medicine and its patients. Nevertheless, the draft action plan was reviewed by the Department of Medicine’s consultants in a scheduled staff meeting on September 20, 2022.”
# Concerns were raised why this exercise was being currently undertaken noting there is a relatively low census of inpatients and COVID patients at the time of the proposal and the institution is not in a crisis currently where beds are short. The doctors also feel that the current inpatients could be accommodated elsewhere in the institution while repairs are being made to the aforementioned areas, particularly “if repairs to wards were implemented in a staggered approach”.
# “Hence, at the time of the writing of this feedback, the census of the Department of Medicine, including COVID patients, is low: This is an ideal time to prioritise continued development of the institution; there is no reason to justify transfer of patients at this time; modular units can be installed while COVID-19 patients are managed in negative-pressure isolation spaces.
# “It was emphasised repeatedly that the Princess Margaret Hospital is not currently in a state where the number of admissions is greater than the number of available empty beds.”
# The document also questioned the appropriateness of this exercise considering the large expense to the public purse related to this enterprise. The practice of continuing to transfer inpatients from the public sector to Doctors Hospital West for management is “not fiscally prudent”, the doctors said.
# According to the document, this practice was started in the COVID-19 crisis to facilitate the surge in patients presenting to the health system in a public health emergency and the costs exceeded “$50 million in two years,” according to public records.
#“The health system is no longer challenged with a surge of COVID-19 patients, given the way the virus has evolved and available vaccines, therapeutics and immunity. The consultants in the Department of Medicine have concerns about why we would endeavour to continue to transfer inpatients given the exorbitant costs.
# “The more appropriate stewardship of public funds is to fix and maintain the Princess Margaret Hospital’s current infrastructure as present circumstances can allow,” the doctors wrote.
# The consultants said 121 beds are out of commission at PMH across seven wards. Some have been out of commission for several years.
# “It is appropriate to fix the existing seven wards and bring them back into commission and to invest in the public hospital system currently and going forward rather than continuing a costly care model that does not build the public hospital capacity in any way,” the doctors wrote.
# As for the process that is proposed for the transfer and management of patients, it was described as “flawed and unsafe”. The consultants said the head of department and key senior physicians and stakeholders were not included in the preparation and drafting of the proposal.
# Then there was the allegation that there has already been a death in the pilot of this process.
# “A patient had an endoscopic intervention performed and shortly thereafter became unstable. This patient was not reviewed, became unstable and was transferred in extremis and arrived at the Princess Margaret Hospital in a state where he was coding and required resuscitative measures which were unsuccessful,” the physicians said. “He was transferred directly to the ICU where resuscitation was deemed unsuccessful and he was pronounced dead within minutes of arrival back to the institution.”

In a document dated October 20, consultants from PMH’s Department of Internal Medicine criticised the plan — which details how some PMH patients would be relocated to Doctors Hospital West — saying there is no justification for it.

The doctors alleged there has already been a death in the pilot of this process when a patient who had been moved to the other health facility became unstable and could not be revived on arrival at PMH.

When contacted for comment on the doctors’ concerns yesterday, Health and Wellness Minister Dr Michael Darville said some “extensive renovations” at Princess Margaret Hospital are planned. He said the upgrades cannot take place with patients on the ward and they are looking to partner with Doctors Hospital West to assist the hospital.

He added that officials are still at the table with Doctors Hospital and nothing is finalised as yet.

“Sorry, it’s a bit more complicated than just outsourcing — we are planning extensive renovations of our wards. We are still at the table with Doctors Hospital and nothing is finalised as yet,” Dr Darville explained.

“As you are aware we (are) planning some extensive renovations at the PMH starting with Female Medical One and the replacement of an old elevator. Secondly the basement of the Eye Ward is in bad shape and we will be awarding a contract for some structural repairs to the columns and steel components of the first floor of that wing of the hospital. Once that is done we will proceed to renovate the Eye Ward and get the eye theatre up and running again.

“Plans are also on the way for the renovation of Male Medical 2 and the Children’s Ward to bring back in service this critical bed space while the COVID-19 disease burden in the country is low. From our aggressive agenda and the time necessary for completion of the work in just under 12 weeks, we will need to manage some of our patients elsewhere and, yes, these important decisions are on the table with Doctors Hospital.”

He added: “The aggressive renovations cannot take place with patients on the ward and we are looking to partner with Doctors Hospital West to assist the hospital complete these essential repairs so that we can best serve our patients.”

According to the consultants’ document, a draft action plan for “outsourcing” of inpatients to Doctors Hospital Health System is being proposed for Princess Margaret Hospital.

“This plan outlines how patients will be selected and moved between the institution and stipulates that a ‘private’ group of physicians, who are also contracted to work at Princess Margaret Hospital, will be subcontracted to manage these patients at an additional fee for services. Patients who become unstable and with prolonged stay are to be returned to Princess Margaret Hospital,” the consultants’ memo read.

“This action plan singularly involves only one specialty department which is the Adult Medicine/Internal Medicine inpatients in the Department of Medicine at the PMH. Internal Medicine was directed to review this plan without any previous involvement in the drafting of the plan for the Department of Medicine and its patients. Nevertheless, the draft action plan was reviewed by the Department of Medicine’s consultants in a scheduled staff meeting on September 20, 2022.”

Concerns were raised why this exercise was being currently undertaken noting there is a relatively low census of inpatients and COVID patients at the time of the proposal and the institution is not in a crisis currently where beds are short. The doctors also feel that the current inpatients could be accommodated elsewhere in the institution while repairs are being made to the aforementioned areas, particularly “if repairs to wards were implemented in a staggered approach”.

“Hence, at the time of the writing of this feedback, the census of the Department of Medicine, including COVID patients, is low: This is an ideal time to prioritise continued development of the institution; there is no reason to justify transfer of patients at this time; modular units can be installed while COVID-19 patients are managed in negative-pressure isolation spaces.

“It was emphasised repeatedly that the Princess Margaret Hospital is not currently in a state where the number of admissions is greater than the number of available empty beds.”

The document also questioned the appropriateness of this exercise considering the large expense to the public purse related to this enterprise. The practice of continuing to transfer inpatients from the public sector to Doctors Hospital West for management is “not fiscally prudent”, the doctors said.

According to the document, this practice was started in the COVID-19 crisis to facilitate the surge in patients presenting to the health system in a public health emergency and the costs exceeded “$50 million in two years,” according to public records.

“The health system is no longer challenged with a surge of COVID-19 patients, given the way the virus has evolved and available vaccines, therapeutics and immunity. The consultants in the Department of Medicine have concerns about why we would endeavour to continue to transfer inpatients given the exorbitant costs.

“The more appropriate stewardship of public funds is to fix and maintain the Princess Margaret Hospital’s current infrastructure as present circumstances can allow,” the doctors wrote.

The consultants said 121 beds are out of commission at PMH across seven wards. Some have been out of commission for several years.

“It is appropriate to fix the existing seven wards and bring them back into commission and to invest in the public hospital system currently and going forward rather than continuing a costly care model that does not build the public hospital capacity in any way,” the doctors wrote.

As for the process that is proposed for the transfer and management of patients, it was described as “flawed and unsafe”. The consultants said the head of department and key senior physicians and stakeholders were not included in the preparation and drafting of the proposal.

Then there was the allegation that there has already been a death in the pilot of this process.

“A patient had an endoscopic intervention performed and shortly thereafter became unstable. This patient was not reviewed, became unstable and was transferred in extremis and arrived at the Princess Margaret Hospital in a state where he was coding and required resuscitative measures which were unsuccessful,” the physicians said. “He was transferred directly to the ICU where resuscitation was deemed unsuccessful and he was pronounced dead within minutes of arrival back to the institution.”

 

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