Global News has obtained a copy of the notes that ER doctors at Surrey Memorial Hospital were adding to patient charts amid congestion and delay, and which allegedly led to some facing investigation.
It comes as the hospital faces intense scrutiny, amid dire warnings from doctors of a congested ER and substandard conditions at the facility.
Earlier this week, Dr. Urbain Ip, a former medical director for the hospital told Global News he wouldn’t send his own family there. He said patients faced waits of 48 to 72 hours to be admitted for care amid a shortage of hospitalist physicians.
Amid those “crisis” conditions, a majority of ER physicians began including a “progress note” in patient charts for specific cases when resource issues might put a patient at risk.
“They want to record in the chart to protect themselves, and now they’re being investigated,” Ip told Global News.
The one-page note stated that the hospital and Fraser Health were operating under “substandard conditions” and “unacceptable care delays to admission” due to a shortage of admitting doctors with the ER “dangerously congested, and appropriate monitoring and staffing ratios … not being achieved.”
“Our concerns have been clearly communicated to those that are ultimately responsible or provision of adequate resources to permit safe care of our patients (hospital leadership, the Board of Directors, the Ministry of Health,” the note states.
“Despite repeated concerns, a meaningful action plan does not exist for current congestion, and we do not have a strategy to care for admitted and unattached patients.”
The note concludes by saying hospital staff will “attempt to provide the best care possible” with limited resources.
According to Surrey ER physicians, the notes were appended to charts by some doctors from April 20 to April 26, before Fraser Health leadership stepped in, calling them “inappropriate and unprofessional.”
Sources told Global News the order to stop adding the notes came from two Fraser Health vice-presidents.
And while a majority of doctors were using the notes, sources said only a handful are facing investigation for violating physician charting rules.
On April 27, the Surrey Emergency Physicians Association wrote a response letter to Fraser Health leadership, stating 96 per cent of ER doctors had agreed to the progress notes in charts.
“The use of these notes was not from a rogue number of Emergency Physicians, but from an entire group,” it stated.
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“We do not want to have to document that the care we are offering is substandard, untimely, inappropriate or inadequate … All we want is a safe environment to provide good care for our patients. If we are unable to provide a standard of care we feel our patients deserve, we need to find an agreeable way to communicate this to our patients, to our community and to the medical record.”
On Wednesday, Health Minister Adrian Dix declined to comment on the matter, calling it a “story without specific information” he could respond to. Dix maintained Thursday that doctors have the right to speak out and have legal protection to do so.
Opposition Leader Kevin Falcon suggested even if there is no “gag order” on doctors, they face intimidation from their superiors.
“Very often it is the indirect pressure they are applying through the heath authorities to physicians to not allow them to post things on social media, to make sure they’re not speaking the truth in public for sure and definitely not writing down things on patient charts,” he said.
“When it gets to the point where they’re telling experienced physicians what they’re allowed to write in their patient charts, that’s unacceptable … They should be allowed to do that, because it’s very important to protect their own liability. The reason they do that is they want to make sure the patient chart demonstrates that earlier care could have potentially saved a life.”
Falcon said Dix should intervene to ensure any investigation of doctors who added the notes to patient charts is dropped immediately.
In an interview with Global’s Focus BC on Thursday, Fraser Health CEO Victoria Lee acknowledged the hospital faces a multitude of challenges, including ER congestion, delays and ongoing hospitalist contract negotiations.
Lee went on to insist she has “not seen anyone being reprimanded or actually fired or disciplined because of speaking out about their specific concerns about care and quality.”
But when it came to the charting issue, she said the question was about standardization. Charts are legal documents shared between multiple health-care workers and patients themselves, she said, and must be handled in a particular way.
“Absolutely if a physician believe there’s important information that needs to be added to a chart, whether it’s staffing issues or delays, that needs to be factual and can be captured in the chart,” she said.
“Where it’s not actually abiding by the standards is when its general, generic information that doesn’t abide by the standards of patient charting that’s required, and this is not a Fraser Health specific issue, it’s a provincial bylaw and standards we need to maintain for individual patient charts.”
Doctors have told Global News the note was not general, generic information but detailed specific conditions that negatively affected specific cases.
The bylaw, according to the B.C. College of Physicians and Surgeons states that there must be a clear record of specifics of any treatment, recommendation, medication and follow-up plan, but says nothing about treatments being affected by staff shortages.
The dispute, however, and alleged investigation of doctors for adding the note to charts, has some Surrey ER physicians continuing to wonder if they’ll face backlash for speaking out.
“No wonder people are worried that their job might be at stake,” Ip told Global News Tuesday.
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