MCMASTER UNIVERSITY MEDICAL CENTRE WILL HAVE A DEDICATED PEDIATRIC EMERGENCY CENTRE RESERVED SOLELY FOR CHILDREN

We feel that this is already in place, in the form of Kid’s Care. This service was supposed to streamline assessment and management of pediatric patients coming to the MUMC ER. This service has been in place for at least 10 years, but has not been fully implemented in that they do not have either the Emergency Room Staff or Pediatricians to staff it 24 hours a day.

All critically ill or injured children are currently brought to the MUMC site to be seen by an expert multi-disciplinary pediatric team. The quality of care provided is exemplary and no child or infant from the Hamilton area has had to be shipped elsewhere unless for very specific reasons (e.g. congenital heart disease requiring open heart surgery).

At the moment there are approximately 15,000 pediatric visits to McMaster’s Emergency Room per year which equates to approximately 40 visits per day, which is comparable to one Pediatrician or Family Doctor’s schedule of patients per day. The majority of children seen in the Emergency Room are managed on an out-patient basis (95%).

Given such a small volume, it will be extremely difficult to recruit a dedicated Pediatric Emergentologist or Pediatrician to manage this unit 24 hours a day. This is the reason why the plan has not moved forward in that in order to be both efficient and resourceful in terms of manpower, McMaster has continued to have a combined adult and pediatric Emergency Room.

There is no reason why the Pediatric Emergency Room/Centre cannot proceed, but we do not understand why this should be done to the detriment of adult services. By having both a Pediatric Emergency Room and a separate Adult Emergency Room in the same building, a benefit would be cross-utilization of staff, especially nurses, when one ER was not busy and the other was.

One of our big concerns is that high-risk Obstetrics is asked to remain at the McMaster site with no further access to Adult Specialty Services or Critical Care Medicine. One of the reasons that high-risk Obstetrics was consolidated and transferred to the McMaster site was because of accessible and timely Adult Services and Critical Care Medicine.

The vast majority of problems in high-risk Obstetrics are with the mother, not the infant. This may be the model in Vancouver or Halifax, but this is clearly a step backwards from the standard of care and service that MUMC has built and residents have come to expect. We have grave concerns that the future model will result in a significant increase in maternal morbidity and mortality in the future model.

In addition, the demographics are clear in the City of Hamilton. The vast majority of people seen in the Emergency Room and admitted subsequent to that are adults. This plan does not take into consideration any potential for future growth. This is extremely important given that the plan is to be implemented approximately 4 years from now. It is estimated that if the current trends continue, 1 in 3 people in the City of Hamilton will be a Senior!

What we are talking about is that an excess of 25,000 to 30,000 adult visits are to be transposed to the other Emergency Rooms across the city. It is also our understanding that those Emergency Rooms will not be turning away children.

There has been no concrete plan or funding that has been put into place in order to expand the other Emergency Rooms and in-hospital beds/resources at the other sites. Where will these displaced adult patients be sent?

We know that from the demographics of who comes into McMaster’s Emergency Room that the vast majority of adult visits at MUMC would probably go to St. Joseph’s Hospital. It is clear that HHS is just relocating a pressing problem to another hospital, for their fiscal budgets and administration to deal with.

A New Urgent Care Centre

While those that have signed this petition feel that a new Urgent Care Centre would be necessary if the closure of McMaster to adult patients occurred, they question how well thought out the idea is. There has been little consistency to the location for this Centre. When HHS met with residents on the West Mountain, HHS staff proposed the site should be located on the South Mountain. When HHS met with the Lower City, they proposed it should be located in Lower West Hamilton. Residents across the effected Wards are concerned, as no clear solution has been offered.

Better Organized Services for Adults

HHS suggests that by having each hospital specialize in one area, patients will receive better care. However, this suggestion does not take into consideration that in the near future, 1 in 3 people in Hamilton will be a senior. Rarely do seniors suffer from only one affliction; instead, many times they suffer from both cancer and heart disease or other combinations. Hamilton already has regionalization of centres of excellence. Ambulances have already been instructed to bypass Emergency Rooms for certain medical problems (e.g. trauma, myocardial infarction, and pediatrics, just to name a few).

The ambulance services are exemplary and should remain in place. However, the majority of patients that are in dire need of emergency care usually either drive themselves in or are brought in by one of their loved ones. Nevertheless, without any bias they are seen in a timely fashion and if they do require specialized services, they are transferred and transported safely and efficiently to the centre best equipped to deal with the problem. Alternatively, if the patient is critically ill, they have to be stabilized at the nearest site and dealt with accordingly. This plan is already in play. Currently, the patient is brought to the nearest Emergency Room; he or she is assessed properly and efficiently and, if need be, is transferred to another centre if deemed appropriate, in a safe manner. For example, patients who present with chest pain and are deemed to have a myocardial infarction are transferred in a timely fashion to Hamilton General Hospital for rapid assessment and cardiac catheterization. There currently is no waiting time. Once the patient has been stabilized, they are usually transferred back to their home hospital for convalescent/cardiologic care and appropriate follow-up. The system works extremely well and the hospitals are already providing access to best care as it stands.

As an example of the new system, a resident asked HHS staff at a Public Meeting “If my mother were to have a heart attack in front of McMaster Hospital after it is converted to a Children’s Only Emergency, will she be admitted?” The shocking response was a simple “No.”

Expanded, Modern Ambulatory Care Facilities

What they are hoping for is that if you increase out-patient traffic that you will be able to reduce Emergency Room assessment. However, access to health care for the most part begins with the Family Physician.

Up to 50% of patients within Hamilton do not have a Family Physician. They are completely reliant upon the Emergency Room for their health care. Expanding or increasing ambulatory care has to be housed and managed by both Family Physicians and Specialists. In this city, access to Specialist care is not particularly difficult except for one or two examples (Orthopedics, Neurosurgery). From a specialist’s perspective, we have already moved any and all business wherever possible to an out-patient practice. The real issue is the Family Doctor crisis that we are seeing today in Hamilton. At present there is not an absolute deficiency of out-patient care facilities, it is one of Family Physicians and some specialist groups.

Ultimately, Adult Services and Critical Care Medicine will be divided amongst the other hospitals, reducing or restricting access to best care for them and that is especially true of the taxpaying public in West Hamilton, Ancaster, Dundas, Flamborough and beyond. This is clearly a win-lose proposition. We are clearly putting the needs of a few at the cost of many.

HHS has assured the Public that before the proposal is adopted there will be several opportunities for Public input. It is the opinion of those that have signed this petition that the Public’s opinion is being disregarded. The meetings have left us with a feeling that we are being told what is going to happen and that our opinions are coming after the plan has been created, and will not be integrated into the proposal.

Further to this, many doctors have come forward stating that right from the outset there has been no input from front-line physicians and medical staff before the announcement. The general consensus is that the stakeholders have not been heard or acknowledged.