St. Mary's Hospital administration defends decision to revoke surgeon's privileges

The regional health agency in charge of St. Mary's Hospital in Montreal is defending an administrative decision to revoke the right of the hospital's only vascular surgeon to perform potentially life-saving surgery – a move which has outraged the surgeon's colleagues, especially since the decision wasn't shared with them.

Around 130 hospital staff members have signed a letter to the administration, condemning the actions that they say may have contributed to a patient's death.

ER staff caught off guard

Last November, a man arrived at the hospital's emergency room in distress, with severe abdominal pain. After an initial examination, ER staff determined he had a ruptured aortic aneurysm and needed to undergo surgery immediately.

According to a doctor familiar with the incident who spoke to CBC News, the hospital's only vascular surgeon, Dr. Carl Emond, was alerted to perform the time-sensitive surgery, however, Emond told ER staff that a few months earlier, he had been advised by a senior hospital administrator that his privilege to perform that particular operation was being taken away.

Patient died before surgery

The doctor who spoke to CBC said that news came as a complete shock to the surgeon's colleagues, who had not been told of the change to the vascular surgeon's privileges by hospital administration.

The ER unit scrambled to have the patient transferred to the MUHC Glen site, however, the man died before the surgery could be performed there.

Ruptured aortic aneurysms are usually fatal.

In a news release signed by Claire Roy, the head of public relations for the Montreal West Island Integrated University Health and Social Services Centre (known by its French acronym, CIUSSS), the administration said the medical literature shows the death rate from such a rupture is 80 to 90 per cent, even if surgery is performed.

However, the doctor familiar with the incident said transferring this patient to the Glen site rather than doing the surgery on the spot might have cost the man his life.

"The chance of survival with this condition is poor, but every minute counts. If he had any chance of surviving, transfer was not the answer," the doctor told CBC.

"It's easy to say, 'Oh well, he was going to die anyway,'" the doctor said, after learning of the CIUSSS's response. "That is not a good explanation."

Emond lauded for his work

In its statement, the CIUSSS said the decision to stop offering emergency surgery for a ruptured aortic aneurysm at St. Mary's and to refer cases to a "tertiary level hospital is a decision for quality and safety of care." 

"The situation at St. Mary's Hospital posed a risk of a break in service, as only one surgeon practised vascular surgery in the case of an aortic aneurysm," it said.

However, the doctor CBC spoke to said even though Dr. Emond is the only vascular surgeon on staff, when he was not available, he was replaced by someone else in the McGill University teaching network.  

"A rupture in service was never an issue," he said.

Unilateral changes 

He said medical staff at St. Mary's as well as at the MUHC Glen site are concerned that when the decision to revoke Emond's privileges to perform that particular operation was made last summer, that information was never shared with colleagues who needed to know it nor with Urgences-Santé.

The surgeon had been working for 30 years without incident, performing hundreds of operations and passing on his knowledge and skill to medical students at the teaching hospital, so it wasn't a matter of his competence.

According to the doctor familiar with the situation, this decision is just one of many recent changes imposed by the new administration of St. Mary's Hospital without consulting staff.

The doctor who spoke to CBC said after the patient's death, the director of professional services at St. Mary's apologized to the staff.

However, that has not quelled concern among doctors at the hospital. The letter condemning what happened, signed by close to 130 staff members and addressed to the administration, was also sent by registered mail to Health Minister Gaétan Barrette on Nov. 26.

However, a spokewoman for Barrette said Monday that in fact, the minister's office was only made aware of the St. Mary's Hospital staff's concerns a whole month later, on Dec. 26, and that Barrette has been away on holidays since that time.

The doctor who spoke to CBC said a similar letter is circulating at the MUHC Glen site from staff there also upset about the November incident.