Understaffed and underequipped: Report shines light on struggles at Montreal ER

Dozens of unfilled positions, increasingly sick patients and a lack of space inside the emergency room have created an untenable situation at the hospital serving Montreal's West Island, a new report warns. 

The 317-page report, obtained by CBC News, was prepared by an independent mediator between the nurses' union and the local health authority after workers made complaints about conditions at the Lakeshore General Hospital.

The Lakeshore, an aging hospital in Pointe-Claire, Que., serves a growing population in Montreal's suburbs and has been the subject of negative headlines during the pandemic.

The report is based on interviews with staff, statistics and a tour of the ER by the report's author, Marie Boucher. 

It comes amid growing concern about overloaded emergency rooms in much of the province, but the report paints the situation at the Lakeshore as particularly dire.

Boucher described the ER as a "ticking time bomb," and stressed that the situation is "extremely worrying" for both patients and staff.

During her June 6 visit, Boucher said the ER was cramped and poorly lit with inadequate sight lines to ensure patient safety. 

She found a shortage of blood pressure cuffs and thermometers, and a lack of privacy for patients on stretchers.

Overall, she wrote, her visit left her concerned about a "lack of dignity for patients."

The report found the hospital relied heavily on overtime and workers from private agencies to fill the gaps in care.  

According to the report, Lakeshore had one of the highest occupancy rates in the region this past summer, regularly exceeding capacity.

During a two-week stretch in early July, for instance, the ER was at an average of 142 per cent capacity. On some days, the Lakeshore had twice the number of patients than its 31 beds.

In all, the report found, a total of 56 positions in the ER had not been filled on a full-time basis, for a total of 52 per cent of the workforce.

The report also includes testimony from staff, who expressed concern about the safety of their patients and the ability of hospital management to deal with the problems.

"Nurses leave their shift crying quite often," one staff member said. Another said orderlies were putting elderly patients in diapers to avoid helping them to the bathroom.

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What's next for Lakeshore?

The report concludes with 14 recommendations, including hiring 30 more staff in the next six months and practical changes, such as ensuring all ER patients are in a location visible to staff.

A coroner's report into the death of Candida Macarine, an 86-year-old woman found dead on the floor of the ER last year, also recommended improving the surveillance of visual and auditory alerts of patient-monitoring systems at the hospital.

Kristina Hoare, vice-president of the Fédération interprofessionnelle de la santé du Québec (FIQ) in the West Island, the union advocating for workers at Lakeshore, said the report's recommendations could help alleviate the pressure on other ERs in the province.

"We're hoping that they take the situation very seriously and that they follow the recommendations that were given by the expert," she said in an interview.

"We hope that they're applied not only to our other emergency rooms, but throughout the province to try to better the care that the population receives because it's not a secret that the emergency rooms across the province are suffering."

She said the report also underlines that nurses and other staff are motivated to treat patients with dignity and give them "safe and appropriate care when they need it."

Hoare said the union is set to meet with the local health authority, the CIUSSS de l'Ouest-de-l'Île-de-Montréal, later this week to discuss the findings and next steps.

Hélène Bergeron-Gamache, a spokesperson for the CIUSSS, said in an email the health authority is analyzing the report and an "action plan" is already in place. 

"Like other health facilities in Quebec, the Lakeshore General Hospital emergency room is currently very busy, in addition to being affected by a staff shortage," she said, adding that a committee has been set up to come up with "concrete and lasting solutions to meet these challenges."

At a news conference Tuesday, Health Minister Christian Dubé announced new measures aimed at easing the strain on ERs.

Dubé didn't go into specifics when asked about Lakeshore but said some ERs are handling the patient load better than others.

"It's a matter of saying you're open to the best practices," he said. "This job will not be finished today but it's just a start."