Doctors, advocates repeat calls for policy on life-and-death decisions as COVID-19 strains Manitoba hospitals

Amid a crush of COVID-19 patients, staffing shortages and strained resources, what should happen if Manitoba hospital staff are forced to choose which patient receives life-saving care and which doesn't?

It's a question doctors and advocates for people with disabilities have been asking for months.

They say the need for a formal framework guiding those impossible decisions is even more pressing now, amid the rapidly spreading Omicron variant, which has put a record number of Manitobans in hospital and staff in isolation.

"It's something that administrators are not really keen to look at," said one doctor, who works in the Southern Health region.

"We kind of hope and pray that things will just work out and it will all be fine — and I do, too. But it's just if we reach that critical situation, I would prefer to have a clear plan."

The physician, who CBC News is not naming due to concerns that speaking out could impact their job, echoed past calls for a triage protocol in the event there isn't enough capacity to manage all critically ill patients.

Out-of-province transfers unlikely

With many Canadian hospitals struggling amid record COVID-19 patient volumes, it's less likely Manitoba would be able to rely on out-of-province patient transfers again if hospitals here are overwhelmed.

That's what the province did when actual intensive care unit admissions exceeded worst-case scenario projections in the third wave. There were also calls at that time for a triage protocol. 

In May 2021, Shared Health said it didn't need those guidelines, even though its own ethical framework for making decisions during the pandemic called for such a plan.

A Shared Health spokesperson says patients with the most urgent needs continue to be prioritized, and clinical criteria have been used throughout the pandemic to identify and pull back on elective or less-urgent services when necessary. 

"The threat of exceeding ICU capacity remains directly related to the number of unvaccinated individuals, who are statistically far more likely to require critical care due to COVID than individuals with two or three doses," the spokesperson said in an email.

'There is no plan'

The Southern Health doctor says there is still no protocol, and if one is being developed, Shared Health isn't telling hospital physicians.

The doctor works at a rural hospital that hasn't yet been hit with the massive uptick in hospitalizations or staff shortages that Winnipeg has seen.

The hospital has limited capacity to care for intubated patients, who are often transferred to hospitals in Winnipeg or Brandon.

But in one recent case, the doctor was tasked with caring for a patient on a ventilator and three others on high-flow oxygen, with two more waiting for oxygen. Winnipeg hospitals were unable to receive the ventilated patient.

"That got us all worked up, because what do I do if someone is crashing? Who do I take off [oxygen], who do I put on? There is no plan for that," the doctor said. "Alberta has a plan, Saskatchewan has a plan, Ontario has a plan."

The Manitoba Human Rights Commission has raised concerns about the lack of a transparent plan, as has David Kron, spokesperson for the Human Rights Triage Protocol Coalition.

The highly transmissible nature of Omicron makes the lack of such a protocol even more problematic, said Kron, whose coalition put together its own list of recommendations.

"We don't want the decision of life or death and who gets treatment … to happen at the bedside by an exhausted doctor and medical team that have been working for 40 hours," said Kron, who is also executive director of the Cerebral Palsy Association of Manitoba. 

"We all have built-in bias that we're not aware of.… We want to make sure that there is no ableism, there is no ageism when making those decisions."

'What do you do?'

Manitoba now leads the country in COVID-19 patient hospitalizations per 100,000 people. There were a record 631 COVID-19 patients in hospital Wednesday, and intensive care unit capacity is nearing its limit.

Another physician in Southern Health worries what could happen if staff at Boundary Trails Health Centre, between Morden and Winkler, were faced with a worst-case scenario and had to make life-or-death decisions on the fly.

Dr. Dan Hunt isn't sure how the rural hospital, which has a single respiratory therapist on staff, would manage if it was faced with a sudden rise in sick staff during an Omicron-driven surge in hospitalizations.

"You could envision a scenario where we simply can't provide care to [some] people," said Hunt. 

"What do you do? Do you take one person off [oxygen] because you say, well, they're doing poorly or they're too old or have too many comorbidities to survive, and put another person on? Or do you tell the other person, well, you're out of luck because of the order that you came in?"

The hospital hasn't been overwhelmed by staff sicknesses or the patient surge seen in Winnipeg, but that's not to say it couldn't happen.

Omicron took a foothold in the Southern Health region weeks after it did in Winnipeg, where vaccination rates are the highest in the province.

Meanwhile, the health districts of Winkler (44.9 per cent) and Stanley (24.3 per cent) that surround Boundary Trails have the lowest vaccination rates.

"With these numbers looking the way they do, it seems like … we could finally be into that scenario that we've been talking about throughout the pandemic, where we actually just run out of resources," said Hunt.