Legal defenders for Canadian doctors want rules for life-and-death decisions during Manitoba hospital crisis

The organization that insures Canadian doctors and defends them in court has called on Manitoba to develop formal rules to determine who will or won't receive medical care if the third-wave intensive-care crisis requires physicians to choose between critically ill patients.

The Canadian Medical Protective Association, a non-profit organization based in Ottawa, wrote Premier Brian Pallister, senior public servant David McLaughlin and Shared Health CEO Adam Topp, requesting the province use an emergency order to create triage protocols.

The protocols, which have been put in place in Alberta and Quebec, are intended to ensure people with disabilities and other vulnerable groups don't face discrimination if hospitals run short of ventilators, beds or nurses.

The concern is if medical professionals choose to allocate resources to patients deemed most likely to recover, vulnerable patients would be more likely to die.

"With the worsening COVID-19 situation in Manitoba, there remains a real risk that critical care resources are likely to become further overwhelmed. We know from the experiences in other jurisdictions that a surge of cases in hospital can result in devastating patient harm, especially to the most vulnerable Manitobans," Dr. Lisa Calder, CEO of the Canadian Medical Protective Association, wrote in a letter dated Friday.

"In this scenario, and without a triage protocol implemented by way of an emergency order, health-care providers will be unable to prioritize access to ICU beds. Decisions will be made on an ad hoc basis without the benefit of a triage protocol that sets out a shared collective decision-making framework, which starts from the premise there are insufficient resources to treat everyone who needs access to an ICU bed."

As of Sunday, Manitoba had 120 patients in intensive care wards, including 74 COVID-19 patients, according to Shared Health. The ICU capacity prior to the pandemic was 72 beds.

Ten stable COVID-19 patients had been sent to hospitals in Ontario as of Sunday morning.

Meanwhile, Shared Health has increased the number of patients assigned to ICU nurses from one per nurse to up to three patients per nurse, in some instances.

Last week, ICU physican Anand Kumar called the the three-to-one ratio "an invitation to triage by error," stating patients may die from insufficient care.

Dr. Calder said a triage protocol could save lives.

"Without a triage protocol, health-care providers will not be able to take the necessary steps to minimize the number of people who will die as a result of ICU overcapacity," she wrote.

"We are seriously concerned about burnout levels amongst doctors and other health-care providers. The prospect of addressing the current surge of COVID-19 cases without the reassurance of a triage protocol and supported by an [emergency order] is daunting and we believe has impacts on future resourcing of the health-care system."

In May 2020, Shared Health published a pandemic medical ethics framework that called for the creation of a triage process.

Health Minister Heather Stefanson was asked last week why that did not happen but did not say. She is now off on medical leave.

In a statement, Acting Health Minister Kelvin Goertzen said the province "is focused on ensuring that every person is able to get the medical treatment they need" by increasing ICU capacity and working with other provinces.

"As with any medical protocol, triage protocols are developed by professionals in the health-care system, not elected officials," Goertzen said.

Manitoba Shared Health declined to comment.

On May 17, Chief Nursing Officer Lanette Siragusa said the province will engage ethicists if the province ever requires triage protocols.

"Hopefully, we never have to make those decisions," she said. 

Advocates for people with disabilities and opposition politicians have asked the province to create triage protocols.