Wednesday, January 5, 2011

Overcrowded ER may have played role in death - Montreal Gazette

When Mieczyslaw Figiel died last February in the corridor of Maisonneuve-Rosemont Hospital's emergency room, right next to the triage nursing station where an ambulance had left him earlier, his family was distraught that no one had bothered to check on a dying man.

Nearly one year later, a coroner's report into Figiel's death confirms that he died in a hospital ER that was so overloaded that other patients in the waiting room on Feb. 3 were not seen or treated until late afternoon the next day.

Coroner Jean Brochu's report concluded that Figiel's chances of survival would have improved had the severity of his condition been detected earlier.

But only after Figiel stopped breathing in the hallway did medical staff come to his side with a blood-pressure device and a thermometer.

His family had been banging desperately on the window of the triage unit for attention. Figiel was having problems breathing. No one opened the door, his daughter Della recalled.

The hospital ER was operating at 180 per cent capacity that day; there was a 16-hour wait to be seen.

Figiel's death was one of several last year related to overcrowding in hospital emergency rooms.

A year later, these chaotic conditions haven't improved much, according to the Montreal Health and Social Services Agency, which yesterday recorded ERs were at 151 per cent of capacity.

Although Montreal's emergency rooms are equipped to handle 512 patients on stretchers, yesterday's tally reached 801 patients.

The overflow included 98 patients stuck on ER gurneys longer than 48 hours.

The problem seems to affect Montreal-area emergency rooms more than regional facilities, said Karine Rivard, spokesperson for Quebec Health Minister Yves Bolduc, who suggested a link to the seasonal explosion of flu and gastroenteritis cases.

But the Montreal health agency's assistant executive director, Louise Massicotte, said the cyclic jump in flu and gastro cases is not responsible for the current situation.

Most of the people calling on the emergency rooms rather than their own doctors or walk-in clinics do not need to be hospitalized for seasonal illnesses, Massicotte said.

"Clearly it's busier, but it's not increasing the number of hospitalizations," she said.

Instead, Massicotte blamed a jump in the number of ambulances in recent months -up by 30 to 40 a day -to Montreal's hospitals, a phenomenon linked to the aging of the population, she said.

"That brings an important increase in traffic," she said, which added to the traditional holiday service reduction and the usual closures of hospital beds.

Many of those coming by ambulance need several medical consultations before there's a decision to admit them to the hospital, she said.

"Indeed, we hope that there will never be a 48-hour wait," Massicotte said.

But this week, Montreal hospitals saw an average jump of 15 per cent from the same period last year in waits of 48 hours, Massicotte said.

It takes a few days into the new year to stabilize the ER situation as hospitals resume normal activities and medical clinics and doctor's offices reopen, she said.

Massicotte would not comment on the coroner's report in Figiel's case, but said that patients coming to the ERs are seen by medical staff according to priority, called triage, and that emergency

patients do get seen before more benign cases.

"Staff dif ferentiates between influenza and heart attack," she said.

Maisonneuve-Rosemont Hospital officials were not available to comment.

Figiel's family, however, says it is not any farther ahead than last year.

"As far as (the hospital) is concerned, they did everything possible ... everything that they could," Della Figiel said recalling a meeting with health officials after the coroner's report was filed.

"It's very disturbing. We're not getting the services required or the care, it's just been awful. Saying you're overloaded is not an answer."

Figiel has hired a lawyer because the hospital has refused to release her father's health records. The family is considering legal action.

http://www.montrealgazette.com/technology/Overcrowded+have+played+role+death/4061371/story.html