'Scary' state of health-care system prompts Fredericton ER doc to compile rescue ideas

Doctors and nurses are having panic attacks on the job, and many who haven't already left because of stress are exploring ways to, according to an emergency room doctor in Fredericton.

New Brunswick's health-care system is in "crisis," and Dr. Yogi Sehgal says political and health-care leaders need to act immediately before the exodus of staff reaches a "critical mass" that leads to widespread hospital closures.

"You could see the system kind of steadily circling the drain over the last few years and in the … last year, a lot of people have been leaving on a daily basis, and they tell me the reasons for it and those reasons haven't changed at all.

"It's scary to go to work and see people having panic attacks at work and actively looking for other jobs on their breaks."

Sehgal said the problems facing the province's health-care system have become so dire that he was inspired to gather his own recommendations and those of his colleagues.

On Wednesday, he emailed copies of a 10-page report he wrote to Premier Blaine Higgs, Health Minister Bruce Fitch, Social Development Minister Dorothy Shephard, and leaders within the Horizon and Vitalité health networks.

The laundry list of recommendations covers how emergency departments could be better staffed and operated, better compensation and more protection for nurses, and boosting incentives to recruit physicians, nurse practitioners and physician assistants for improved access to primary care.

Speaking to CBC News on Thursday, Sehgal said the problems facing the province's health-care services are systemic, with problems in one area having knock-on effects in others.

However, he said one of the biggest problems is the lag in having eligible hospital patients transferred to nursing homes.

"If you just remove those patients out of hospital, you now have a whole bunch of space and potential staff that you can use in other ways, so that's a big one for me," he said.

"And of course, the nursing home patients will get better care in a nursing home than in the hospital."

Promised improvements falling flat

Last fall, the Department of Health released its plan for improving health-care, which is referred to as being in crisis.

The plan set timelines for providing primary care access to all New Brunswickers and offering more supports to help seniors remain in their own homes and out of hospital beds.

More recently, Higgs has promised improvements by way of removing the boards of directors for Horizon and Vitalite and replacing them with trustees tasked with making quick, decisive changes in light of the death of a man while waiting in the emergency department waiting of Fredericton's hospital.

Sehgal said he's aware of those commitments, but he hasn't seen any material difference.

"You can see things getting just a little bit worse all the time, and it just takes that critical mass [of staff] to be gone and then we're in real trouble," he said.

"Like you just won't be able to get the system back up, and then you'll be shutting down hospitals and you'll be, you know, you'll be making very difficult decisions of who gets care and who doesn't, which is, you know, that's unfortunately coming. That the outcome I think we're trying to avoid."

Sehgal's recommendations to officials are "bang-on," said Anthony Knight, CEO of the New Brunswick Medical Society.

"He understands from the front lines as an emergency room physician the challenges confronting our health system, the difficulties patients are facing, and the frustrations family physicians and other health care workers are experiencing on a daily basis," Knight said.

Knight said the medical society have already advocated some of the recommendations, adding that he encourages Fitch and other leaders in his department to review the document and work on implementing them.

"There are health, human resource shortages throughout New Brunswick, and this places additional strain on those who are able to or continue to work in the province, and his recommendations really capture several of the new initiatives that need to be taken action on immediately by government."

Minister 'happy' to hear from doctor

In an email statement to CBC News, Health Minister Fitch said he was pleased to receive  Sehgal's recommendations.

"I am happy that we are hearing from him and others who are offering solutions," Fitch said.

"It is important for us to hear about actions and improvements that people working in the system see as crucial to improving our health-care system and to build upon the incredible work and care being provided to New Brunswickers every day."

Fitch said he just began reviewing Sehgal's document, which he received late Wednesday night but noted that several items align with priorities in the provincial health plan, including allowing staff to work to their full scope of practice, improving access to primary health care and addiction and mental health services.

"I will be speaking to staff with the Department, the trustees from the regional health authorities (RHAs) and Extra-Mural/Ambulance NB (EMANB) about all the ideas we are receiving to see how we can take action that will lead to improvements in our health system that benefit New Brunswickers."

Health networks review recommendations 

In an email statement to CBC News, Dr. France Desrosiers, president and CEO of Vitalité Health Network, thanked Sehgal for his report and said the network plans to follow up with him.

"At Vitalité Health Network, we have been working for several months on improvements in various sectors, including emergency services," she said.

"Our efforts continue and we look forward to share some of our early results in the weeks to come," she said, adding that health-care staffing challenges aren't unique to New Brunswick.

Horizon Health Network is focusing on the patient experience and patient flow within its emergency departments, as well as "creating the best possible work environment" for staff and physicians, and recruiting new team members, said interim president and CEO Margaret Melanson.

Melanson said Horizon recently consulted leaders at the Dr. Everett Chalmers Regional Hospital in Fredericton, and is now working on creating a "patient flow centre" at the hospital.

Also, to improve access to surgery across its hospitals, Horizon recently announced a new medical co-lead and a new administrative co-lead for surgical services.

"These leaders will engage with staff to hear their ideas on how to improve this crucial aspect of the health care system.

Melanson said Horizon leadership values the input of its physicians and staff as they work together to address health-care challenges, which are being seen across the country.

"We believe engagement and consultation with our staff is an essential means of generating important discourse and new ideas, as well as a way to receive feedback from those on the frontline. We have received Dr. Sehgal's correspondence, and it will be reviewed in accordance with our processes."