A Nova Scotia hospital review is calling for shorter response times for patients sent to emergency, in response to the disturbing story of how a 68-year-old man who was dying from pancreatic cancer languished for six hours in a chilly ER hallway.
The widow of Jack Webb recently provided The Canadian Press with a copy of six internal recommendations completed by the Nova Scotia Health Authority after the saga of his treatment emerged in late April.
The review includes the goal of having internal medicine specialists meet their patients within two hours when sent to ER, a standard the hospital fell far short of in Webb’s case.
“I’m putting my trust in them that they’re going to do the right thing and implement these items that they recommended. I can’t guarantee they are, but I’d like to have a follow up meeting in three months to ensure they put things in place,” said Kim D’Arcy, Webb’s widow, in an interview.
The Death of Jack Webb
D’Arcy has said that problems in her husband’s care began weeks before his Feb. 1 death, when the couple wasn’t informed he had just weeks to live and end-of-life treatments weren’t arranged.
By mid January he was struggling to breath, prompting Webb to visit the Cobequid ER on the outskirts of Halifax and leading to his transfer to the Halifax Infirmary ER.
D’Arcy said at that point a key problem occurred, as a specialist in internal medicine who was supposed to meet him wasn’t at the Infirmary ER when he arrived, sending the severely ill man into the hallway lineup.
After his wait, Webb spent time with a broken IV in his arm, was later bumped from his private room by another dying patient into a medical teaching unit, and, on his last day, he heard staff yell, “If he stops breathing, don’t resuscitate,” she added.
All of this unfolded as the hospital was in the midst of daily special alerts known as “code census” where the ER declares it’s overcrowded and sends patients into regular wards that may already be struggling to cope.
After The Canadian Press published the account just days before the May election campaign, the former health minister promised the matter would be looked into, while opposition parties said the case was part of a wider health care crisis in the province.
The resulting “quality review” says future patients who are directly transferred to internal medicine from other ERs in the city should be seen “within two hours of arrival, irrespective of patient location (e.g. hallway).”
It also recommends the hospital system create a more standard process for treating pancreatic cancer, and “explore options” for quicker followup by emergency departments when patients have a spreading of “metastatic” disease like pancreatic cancer.
In addition, it calls for staff in the hospital’s teaching unit to start filling out forms that document the goals in the care of patients. D’Arcy says this finding may have been related to a questionable invasive test that Webb went through in his final day.
Another recommendation calls for the hospital system to “provide education for physicians, residents and learners on having end-of-life care conversations.”
There is also a call for those involved in the review to “provide written feedback … to the project group assembled to address emergency department overcrowding.”
D’Arcy said she finds some of the recommendations to be too general, and wonders how she or the public will know if they come to pass.
“How they implement that and the nuts and bolts of that, I’m never going to get that from them,” she said.
Dr. Alan Drummond, chair of public affairs for the Canadian Association of Emergency Physicians in Ottawa, said in a telephone interview the quality review isn’t likely to bring significant change.
“It’s milquetoast. Let’s be honest,” he said.
“It looks like very bureaucratic blah, blah, blah. Does it really mean anything? No it doesn’t. … It’s more of the same, without anything specific that really going to change anything.”
Dr. Mark Taylor, a medical director at the health authority, said in a telephone interview that the recommendations are designed to allow flexibility in response.
“In some cases the recommendations are quite deliberately vague because they allow some leeway on whoever is going to do its implementation to do various options in its implementation,” he said.
Taylor said that he cannot comment on the specific recommendations or provide answers to the media about when and how they’re implemented.
He said a timeline will be established and adhered to, and he says that he will continue to “be more than happy” to provide D’Arcy with updates if requested.
D’Arcy, who has worked in quality assurance in the private sector, said she intends to hold the hospital to that pledge, and plans to request her follow up meeting with Taylor.
“I don’t feel I have any certainty it will be followed because there are no guarantees it will be implemented and audited,” she said.